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Eczema Assessment & Treatment

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City Dermatology Clinic London
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Eczema is a common inflammatory skin condition that can cause itching, redness, dryness, and recurring flare-ups. It affects both adults and children and may involve the face, hands, or larger areas of the body. While some people manage mild eczema with basic skincare, others experience persistent or worsening symptoms that benefit from specialist assessment. At City Dermatology Clinic, eczema consultations are led by Dr Andreea Anton, a consultant dermatologist who assesses and manages adult and chronic eczema in both NHS and private practice. Appointments are available in London and Harley Street, with a focus on careful assessment and appropriate treatment planning.

Eczema can present in different ways and often overlaps with other inflammatory skin conditions. For this reason, management begins with a clinical assessment rather than assuming a single cause or treatment approach. During consultation, the skin is examined to understand the pattern of eczema, the areas affected, and the severity of symptoms, alongside a review of previous treatments and response to them.

 

Treatment options are discussed based on individual findings and may include a combination of approaches rather than a single intervention. These can include:

  • Topical treatments
    Often used as first-line management. These may be prescribed to reduce inflammation, restore the skin barrier, or manage secondary infection where appropriate.

  • Systemic treatments
    Considered in more persistent or widespread eczema, or when topical treatments alone have not been effective. Suitability depends on individual health factors and requires careful monitoring.

  • Trigger identification and avoidance
    In some cases, eczema may be influenced by irritants, allergens, or occupational exposure. Where relevant, this is explored as part of assessment to help reduce flare-ups.

  • Supportive skincare and maintenance plans
    Long-term eczema management often involves ongoing skin care alongside medical treatment. Advice is tailored to the individual rather than generic routines.

 

Eczema treatment is rarely static. Response can change over time, and follow-up may be recommended to review progress, adjust treatment, or address new concerns. The aim is to manage symptoms effectively while minimising side effects, recognising that eczema is often a long-term condition rather than one that is “cured” with a single course of treatment.

People seek specialist assessment for eczema for different reasons, often when symptoms are persistent, changing, or difficult to manage with general measures alone. While mild eczema may settle with basic skincare, other patterns benefit from a more detailed clinical review.

 

Common reasons for booking an eczema consultation include:

  • Ongoing or worsening symptoms
    Eczema that does not improve, continues to flare, or spreads to new areas despite treatment.

  • Frequent flare-ups
    Recurrent cycles of improvement and relapse, particularly when triggers are unclear or difficult to avoid.

  • Concerns about treatments
    Uncertainty about long-term use of topical treatments, side effects, or lack of response to previous prescriptions.

  • Diagnostic uncertainty
    Symptoms that resemble eczema but do not behave as expected, raising questions about whether another inflammatory skin condition may be present.

  • Impact on daily life
    Itching, discomfort, or visible eczema affecting sleep, work, concentration, or confidence.

 

A specialist consultation allows time to review the history, examine the skin carefully, and clarify whether ongoing medical management is appropriate, rather than relying on repeated short courses of treatment without review.

Eczema is an umbrella term that covers several related inflammatory skin conditions. These can look similar on the surface but differ in triggers, behaviour, and response to treatment.

 

Identifying the type or pattern of eczema present helps guide appropriate management.

  • Atopic eczema
    A long-term form of eczema often associated with dry, sensitive skin and a history of allergies, asthma, or hay fever. It may begin in childhood but can persist or reappear in adulthood.

  • Adult-onset eczema
    Eczema that develops for the first time in adulthood. This can be more persistent and may affect areas such as the hands, face, or neck. Assessment is important to exclude other inflammatory skin conditions that can appear similar.

  • Contact dermatitis
    Caused by exposure to substances that irritate the skin or trigger an allergic reaction. This may be related to work, skincare products, metals, fragrances, or household chemicals. Identifying triggers can be an important part of management.

  • Hand eczema
    A common and often stubborn form of eczema affecting the hands and fingers. It may be related to frequent washing, occupational exposure, or underlying atopic tendencies.

  • Facial or eyelid eczema
    Eczema affecting delicate areas of the face or eyelids. This often requires careful assessment, as the skin is more sensitive and treatment choices may differ from other body areas.

 

More than one type of eczema can be present at the same time, and patterns may change over time. A clinical assessment helps clarify the presentation and avoid treating eczema as a single, uniform condition.

Eczema is often a long-term condition that fluctuates over time. While treatment can help control symptoms and reduce flare-ups, response varies between individuals and management usually requires adjustment rather than a fixed approach.

 

All treatments carry potential risks and limitations, which depend on the option used and the area of skin involved. These are discussed during consultation and may include local side effects from topical treatments or broader considerations with longer-term or systemic therapies. Monitoring and review help ensure treatment remains appropriate.

 

Long-term management typically focuses on:

  • Controlling inflammation during flare-ups while avoiding unnecessary overtreatment

  • Maintaining the skin barrier between flares to reduce recurrence

  • Reviewing triggers and exposures where relevant, recognising these may change over time

  • Adjusting treatment plans based on response, side effects, and lifestyle factors

 

Improvement is usually gradual rather than immediate. Periods of good control may be followed by flares, and this does not necessarily mean treatment has failed. Follow-up appointments allow progress to be reviewed and management refined, with the aim of achieving stable, manageable control while minimising treatment-related risks.

 

Expectations are discussed openly during consultation so that management decisions are realistic, proportionate, and tailored to the individual rather than based on fixed timelines or outcomes.

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Dr. Andreea Anton

Consultant Dermatologist in London & Harley Street

MBBS, MD, MRCP (Derm)
GMC reference no: 7531865

 

Dr Andreea Anton is a Consultant Dermatologist on the GMC Specialist Register. She works in both private practice and the NHS and currently holds a Consultant Dermatologist position at London North West Healthcare NHS Trust.

 

She graduated in Medicine in 2009 with distinction and completed five years of specialist dermatology training in Bucharest. Following this, she undertook further higher specialist training in dermatology at Imperial College London, where she has worked as a Locum Consultant Dermatologist since 2016.

 

Dr Anton is a member of several professional organisations, including the British Association of Dermatologists, the Royal College of Physicians, the European Academy of Dermatology and Venereology, and the International Society of Dermoscopy.

 

Her clinical interests include acne, rosacea, mole assessment, skin cancer, mole removal, skin surgery, and hair loss conditions such as alopecia areata, female pattern hair loss, and telogen effluvium. She regularly runs NHS skin cancer clinics as part of her consultant role.

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Questions Patients Commonly Ask About Eczema Care

How do I know whether what I have is eczema or something else?

Several inflammatory skin conditions can look similar to eczema, particularly when symptoms are long-standing or treatment has already been used. A dermatologist assesses the appearance, distribution, and behaviour of the rash over time, rather than relying on a single symptom or flare. In some cases, what appears to be eczema may turn out to be another condition requiring a different approach.

Why does my eczema improve for a while and then flare again?

Eczema tends to fluctuate. Even when treatment is working, flare-ups can occur due to factors such as irritation, infection, environmental changes, stress, or treatment being reduced too quickly. A flare does not necessarily mean treatment has failed, but it may indicate that management needs to be adjusted.

Is it normal for eczema to change location or appearance over time?

Yes. Eczema patterns can change, particularly in adults. Areas affected may shift, and symptoms can become more localised or more widespread depending on triggers and skin sensitivity. This is one reason periodic reassessment is often helpful.

Can long-term use of creams make eczema worse?

Used appropriately, prescribed treatments are intended to control inflammation and protect the skin. Problems tend to arise when treatments are used inconsistently, stopped abruptly, or applied without review for prolonged periods. A dermatologist helps balance effective control with minimising unnecessary exposure.

What if I am worried about using steroid creams?

Concerns about topical steroids are common. These treatments can be effective when used correctly, but they are not suitable in the same way for every body area or long-term scenario. During consultation, risks, alternatives, and appropriate use are discussed so decisions are informed rather than based on fear or avoidance.

Why does my eczema itch even when the skin looks better?

Itching can persist after visible inflammation has improved because the skin barrier and nerve sensitivity take longer to settle. Ongoing itch does not always mean active eczema is still present, and management may focus on restoring the skin rather than escalating treatment.

Can eczema be triggered by work or daily activities?

Yes. Repeated exposure to water, cleaning products, gloves, chemicals, or friction can worsen eczema, particularly on the hands. Occupational factors are often overlooked and can be an important part of assessment.

Is eczema linked to allergies?

Some people with eczema also have allergic conditions, but eczema itself is not always driven by allergy. Allergy testing is not routinely required and is only considered when the history suggests it may be relevant.

What happens if treatments stop working over time?

Eczema management is reviewed periodically because the skin’s response can change. If a treatment becomes less effective or causes side effects, alternatives may be considered. Adjusting treatment is a normal part of managing a long-term condition.

Will stress make my eczema worse?

Stress does not cause eczema, but it can contribute to flare-ups or make symptoms feel more intense. This is discussed in context rather than treated as the sole explanation for symptoms.

Is eczema something I will always have?

For some people, eczema settles over time; for others, it remains a long-term condition that needs intermittent management. The focus is usually on control and quality of life rather than assuming a fixed outcome.

When should I consider specialist review rather than continuing with repeat prescriptions?

Specialist assessment is often helpful when eczema is persistent, frequently flaring, affecting sensitive areas, or when there is uncertainty about diagnosis or long-term treatment use. A consultation allows management to be reviewed as a whole rather than continuing the same approach indefinitely.

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