Atopic dermatitis treatment in Valencia

«Eczema» is a general term for several inflammatory skin conditions; atopic dermatitis is the most common, with a chronic, relapsing course. It combines three processes: an impaired skin barrier, losing more water than normal and allowing irritants and allergens through more readily; inflammation involving the immune system; and itching, its most characteristic symptom. Scratching briefly relieves it but further damages the barrier and restarts the itch-scratch-inflammation cycle.

Intact barrier

Healthy skin retains water and keeps irritants out.

Impaired barrier

Water is lost and irritants and allergens enter.

Inflammation and itching

Skin becomes red, dry and itchy.

Scratching cycle

Scratching briefly helps but perpetuates the flare-up.

Skin appears dry with red, scaly patches and, during flare-ups, oozing or crusting; in darker skin, redness may look brown or grey. It is not contagious, not caused by poor hygiene and does not automatically mean food allergy.

It can begin at any age and changes location with age: cheeks and scalp in infants, elbow and knee folds in children, and folds, hands, eyelids and neck in adolescents and adults. Many children improve as they grow, others continue with intermittent flare-ups, and first onset in adulthood also occurs.

An important detail: visible extent does not always reflect actual impact. A small eyelid or hand area can be very limiting, and night-time itching affects sleep and mood. We therefore assess how it affects you, as well as how much skin is involved.

Diagnosis is clinical, based on itching history, recurrent course, appearance and age-related distribution, and personal and family history. No blood test alone confirms atopic dermatitis.

Triggers or aggravating factors include soaps and detergents, frequent handwashing, dry air, heat and sweating, wool and rough fabrics, scratching, stress and skin infections.

Diet needs precise discussion: we investigate food allergy when immediate, reproducible reactions follow a food, or in infants whose dermatitis does not respond to correct treatment. We do not recommend indiscriminate test panels or exclusion diets without diagnosis, as removing tolerated foods does not cure the condition and may cause nutritional problems.

Treatment is stepwise and tailored to age, location, severity and flare-up frequency. These are not rigid steps: moisturising is usually combined with flare-up treatment and maintenance in recurrent areas to reduce relapse risk.

Daily moisturising

This is the foundation at every severity level. It reduces dryness and the need for anti-inflammatory treatment, but alone does not control an inflamed patch.

Prescription topical treatment

This is the treatment of choice for flare-ups. Different anti-inflammatory options are selected by area, age and severity, in defined regimens with reviews. Some suit delicate areas such as the face, eyelids and folds, and prolonged intermittent use. Frequently relapsing areas benefit from maintenance a couple of days each week after control, helping reduce relapse frequency.

Oozing or crusting does not always mean bacterial infection — atopic skin is often colonised — so routine antibiotics are not recommended without clear infection signs. Antihistamines do not block atopic itching or replace inflammation treatment.

Phototherapy

Narrowband ultraviolet treatment for moderate or severe cases uncontrolled by topical treatment. We do not provide it at the clinic: we assess suitability and advise where to receive it.

Systemic treatments

For moderate or severe disease persisting despite correctly used topical treatment. These require prior assessment and specific monitoring. We assess suitability and support you through the process.

What treatment can and cannot achieve

There is currently no cure. The aim is to control inflammation and itching, restore the barrier and reduce flare-up frequency and severity. Treatment cannot promise freedom from flare-ups after stopping, and skin and sleep do not always improve at the same pace. Two extremes need addressing: moisturisers alone do not control inflammatory flare-ups, while avoiding anti-inflammatory treatment through fear keeps disease active, and continuous unsupervised use has adverse effects. The key is a balanced, sustained plan designed by your dermatologist.

Much of control lies in the daily routine: apply fragrance-free emollient at least once or twice daily and whenever skin is dry, take short lukewarm baths or showers with a gentle cleanser, pat dry and apply cream within the first few minutes after bathing.

Soft, breathable clothing, avoiding wool against the skin, short nails to limit scratching damage, and controlling heat and sweating help. Atopic skin also needs sun protection with a well-tolerated product.

A written plan — daily applications, products for each area, duration and what to do at flare-up onset — makes adherence much easier, especially for children.

Seek advice:

• If itching or inflammation does not improve after a correct topical regimen.
• If flare-ups are frequent.
• If sleep or daily life suffers.
• If dermatitis is extensive or painful, or affects eyelids, hands or feet.
• If infections recur.
• If you are unsure about treatment safety or quantity.
• If it worsens after cosmetics or workplace products, suggesting additional contact dermatitis.

At the first visit, we review onset, affected areas, itching severity and sleep loss, previous treatments and response, and relevant products and exposures. We examine skin to confirm diagnosis, distinguish active inflammation from dryness or residual pigmentation and rule out other causes.

We then agree a clear plan, review application technique and decide when to assess response.

Atopic dermatitis is part of our medical dermatology care in Valencia, available in Spanish, English and Italian. You can meet the medical team before your visit.