Eczema is one of the most common clinical disorders in dermatology. As a chronic recurrent disease that can last for months, years or even decades, eczema’s most prominent symptom is itching, which often makes it difficult for patients to sleep and eat and seriously affects their studies, lives and work. Studies have shown that the impact of eczema on patients’ quality of life is greater than that of medical conditions such as hypertension and diabetes. However, there is often a lot of confusion in the treatment of eczema, so I will answer some of the common questions below. What are the causes and mechanisms of eczema development? Many patients ask their doctors what the cause of eczema is when they see them. I always hope to get a positive answer. However, in reality, the etiology and pathogenesis of eczema are not yet clear. It is thought to be the result of a combination of internal and external factors. Endogenous factors include abnormal immune function and immune system disorders as well as hereditary or acquired skin barrier dysfunction. External factors such as environmental or food allergens, irritants, microorganisms, changes in ambient temperature or humidity, and sun exposure can trigger or aggravate eczema. Psychosocial factors such as stress and anxiety can also trigger or aggravate eczema. It is also because the causes of eczema are diverse and difficult to find, and the clinical manifestations are varied, making diagnosis and treatment difficult. How to evaluate allergen testing? Many eczema patients have been tested for allergens, but do not have a good understanding of the significance of allergen testing. There are a variety of allergen testing methods available in China, some of which are internationally compatible and some of which are unique to China, and there are a variety of methods, such as prick tests, scratch tests, intradermal tests and in vitro tests. The results of these different methods are not always the same. Therefore, the results of the tests must be interpreted with caution. In fact, the results of any allergen test are not as good as the patient’s feelings. It is important to make a judgment by combining the results of allergen testing with the actual experience of the patient. Why is basic eczema treatment necessary? When it comes to the treatment of eczema, many people may immediately think of what medications to use to treat it. However, the most important thing for eczema patients is to have a basic treatment. Basic treatment includes health education for patients to understand the nature of eczema, its possible regression, its effects on health, whether it is infectious, the clinical efficacy of various treatments, and possible adverse effects. It is also important to look for and avoid common allergens and irritants in the environment, and to avoid scratching and excessive washing. Basic treatment also includes protection of the skin barrier function. It is very important to protect the barrier function of the skin in patients with eczema because it is prone to irritant dermatitis, infections and allergies that aggravate the skin lesions. To protect the skin barrier, treatments that are not irritating to the patient’s skin should be used, secondary infections should be prevented and managed when appropriate, and moisturizers should be added for subacute and chronic eczema with dry skin. It is also important to avoid all possible triggers or aggravating factors. When do eczema patients go to follow-up appointments? Many eczema patients go to the hospital when they have an attack, and when they get better, they think they are better and stop taking their own medication and do not go for follow-ups. The result is a recurring condition. You must know that eczema is prone to recurrence and patients should follow up regularly at the hospital. It is best for patients with acute eczema to follow up 1 week after treatment, 1 to 2 weeks after treatment for subacute eczema, and 2 to 4 weeks after treatment for chronic eczema. If the condition is recurrent and persistent, work with your doctor to analyze the cause. Common causes include: ① irritation; ② exposure to allergens; ③ cross-allergy; ④ secondary allergy, such as allergy to topical medications in treatment; ⑤ secondary infection; ⑥ unfavorable environmental factors; ⑦ systemic factors. How can eczema patients take the initiative to communicate with their doctors? Many times, because they are too busy, doctors give a diagnosis and prescribe medication to patients, but they do not have time to communicate with them and tell them seriously how to use the medication correctly. The result, of course, is that the condition does not achieve the desired outcome. In fact, for the diagnosis and treatment of eczema, the role of patient education even exceeds the role of medication. Therefore, as a patient, you can take the initiative to communicate with your doctor as much as possible, you can apply and other ways to consult with your doctor. Ask your doctor about the precautions you should take in terms of clothing, food, housing and transportation. It is also important to know how to use the medication correctly and how to observe the condition. In many cases, it is not the doctor’s prescription that is not effective, but the failure to tell the patient how to use the medication. What is the best way to “avoid” eating? Many doctors often tell eczema patients to “avoid” eating this or that. These “contraindications” are often based on experience or even subjective assumptions. The results of several studies recently completed in the United States on the re-evaluation of food allergies are alarming. Therefore, “avoidance” must be based on relative and phased avoidance, so that the patient’s quality of life is not affected by the doctor’s words. The “food diary” method can also be used. Many patients use this method, after trying food, and found that many of the foods that they were afraid to eat for a long time in the past actually have little to do with the recurrence and aggravation of eczema. This simple method often frees patients from unnecessary “taboos”. Are the side effects of topical hormones significant? There is a general “hormone fear” or “hormone worry” among our patients, which is often caused by inappropriate propaganda. It should be clear that topical glucocorticoids are the first choice for eczema-like diseases, and that proper application can both treat the disease and avoid adverse reactions. The key is to understand how to choose hormones, how to select the dosage form, and how to use them safely. The absorption of topical hormones is around 1%, and the systemic absorption is minimal. As long as the medication is administered according to the doctor, it is generally safe. Sometimes some patients and families fear or even refuse to apply hormone drugs, and doctors often accommodate patients and dare not use drugs with exact efficacy, resulting in poor efficacy, or premature relapse and aggravation.