Eczema and atopic dermatitis: treatment online in Puerto Rico

Eczema and atopic dermatitis are used almost interchangeably: MedlinePlus describes atopic dermatitis as a type of eczema, and it is the most common one. A different form is seborrheic dermatitis, with white to yellowish scales on oily areas such as the scalp (dandruff), the face or inside the ear.

Atopic dermatitis (eczema): long-lasting, comes and goes in flares, and is most common in children. It usually starts with itching, which is why it is called "the itch that rashes". It runs in families and often comes with asthma or allergies, but foods don’t cause it and it is not contagious.

Contact dermatitis: appears where the skin touched a substance. The most common kind is irritant (soaps, detergents, cleaning products, frequent hand washing). The allergic kind usually appears 24 to 48 hours after contact with something you are allergic to; common culprits are nickel in jewelry and buckles, fragrances, latex, hair dyes, some preservatives in creams, and certain plants.

Eczema is made worse by dry skin, heat and sweat, temperature changes, stress, colds, wool, and fragrances or dyes in soaps and lotions. In Puerto Rico’s climate it helps to wear soft cotton, shower after heavy sweating and moisturize straight away. Some reactions only appear when the skin also gets sun, for example after squeezing limes or trying a new sunscreen, shaving lotion or perfume.

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Eczema and dermatitis are handled in a doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the clinic can’t see you. A doctor’s note after your visit is included at no extra charge.

We do not bill insurance; the pharmacy and the lab charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

The most common symptoms are:

• Itching, sometimes intense
• Dry, red or inflamed skin
• Rough, scaly or thickened patches
• Bumps or blisters that ooze and crust
• Burning or pain in irritated skin
• Cracks in the skin of the hands

Atopic dermatitis is a long-lasting skin disease that makes the skin inflamed and irritated. Its most common symptom is itching, which can be intense; there are also dry patches, reddish to dark brown, and over time scratched skin thickens. According to the National Institutes of Health (NIAMS), it usually appears in babies and children, often fades before the teenage years, and some people get it for the first time as adults. It does not spread from person to person.

MedlinePlus explains that it can start between 2 and 6 months of age and that allergies do not cause it, although many people with atopic dermatitis also have asthma or hay fever. What it does is weaken the skin barrier, which loses water and gets irritated more easily.

Treatment works in steps. The base is moisturizer every day and avoiding what irritates you. For flares, the usual start is a mild steroid cream or ointment, such as hydrocortisone, moving to a stronger one if needed. Topical immunomodulators, steroid-free creams, can be used from age 2.

For severe cases, MedlinePlus lists short-term steroids by mouth, such as prednisone; if appropriate, the doctor prescribes them and explains how to take them. For severe atopic dermatitis there is also phototherapy (controlled ultraviolet light) and biologic medicines that act on the immune system. If your case needs them, the doctor refers you to an in-person skin specialist and gives you a summary of your visit.

Besides creams, antihistamines taken by mouth, such as prescription hydroxyzine, can help with itching. If the skin looks infected, the doctor evaluates it and decides whether other treatment is needed.

A test is rarely needed for eczema. If the doctor suspects a skin infection or another cause, we give you an order for the lab test to take to a lab near you and review the result with you.

Daily skin care cuts down flares and the need for medicine:

• Take short baths or showers in lukewarm, not hot, water and use a gentle cleanser instead of harsh soap.
• Pat dry and apply a thick, fragrance-free moisturizing cream or ointment all over while the skin is still damp, once or twice a day, even when there is no rash.
• Keep nails short to limit scratching.
• For contact dermatitis, wash the area well with water to remove the substance, and avoid it from then on.

Up to 1 in 4 children have eczema, according to the American Academy of Pediatrics (AAP). In babies it usually starts on the face and scalp; in school-age children it shows up in the elbow creases, behind the knees, on the neck and around the eyes. It is not contagious, and for some children it starts to fade by about age 4.

The AAP recommends a 5- to 10-minute lukewarm bath daily or every other day, without bubble bath; patting dry, applying any prescribed medicine to the rash first and then moisturizer all over; dressing in cotton; and using fragrance-free detergent. Talk to the doctor before cutting foods from your child’s diet.

The doctor evaluates your baby or child by video with you on camera: you help show the skin in good light. If appropriate, the doctor prescribes and we send the prescription to your pharmacy. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids and rashes in children.

These signs can mean a severe allergic reaction or a serious skin infection, such as eczema herpeticum, which NICE guidance says should be treated urgently. For your safety, go to the emergency room or call 911. See when to go to the ER.

• A rash with trouble breathing or swelling of the face, lips or tongue
• Eczema that worsens fast and is painful, with clustered blisters or round punched-out sores
• A rash with fever, lethargy or feeling very unwell
• Blisters or sores around the eyes
• Spreading redness with warmth and pain