Eczema & Dermatitis

Atopic Dermatitis: The Topical Ladder and Flare Control

Atopic dermatitis looks like a rash, but it behaves like a leak. The skin's outer wall is built poorly, water escapes, irritants and microbes pour in, and an over-eager type-2 immune system answers every breach with inflammation and a maddening itch. Scratch, and the wall breaks further — the cycle feeds itself. Almost every effective treatment, from a tub of plain moisturiser to the newest topical JAK inhibitor, is really an attempt to do one of two things: patch the wall, or quiet the fire behind it. Learn to read a flare as a barrier-plus-inflammation problem and the whole topical ladder suddenly makes sense.

Systemic Eczema Therapy: Dupilumab and the Type-2 Revolution

For most people with atopic dermatitis, a good emollient and a topical steroid are enough. But for a minority the disease is relentless — skin that cracks and weeps, an itch that shreds sleep, a life quietly ruled by scratching. For decades the only systemic options were blunt instruments: ciclosporin, methotrexate, azathioprine, drugs that suppressed the whole immune system and demanded blood tests forever. Then biology caught up with the disease. Once we understood that atopic dermatitis is driven by a specific set of immune signals — the type-2 axis — we could design drugs that silence just those signals and leave the rest of the immune system standing. This chapter is that story.

Contact Dermatitis: Irritant vs Allergic, Patch Testing, and Hand Eczema

Atopic dermatitis is the eczema you inherit — written into a leaky skin barrier from birth. Contact dermatitis is the eczema you catch: the skin meets something in the outside world and reacts. Sometimes that something simply corrodes the skin by brute chemistry — no immune system required. Other times a single molecule teaches the immune system a grudge it will hold for life, so that every future contact triggers a delayed, itching flare. Telling these two apart, and above all naming the culprit, is what turns a chronic, career-threatening rash into a solvable problem.