I get bad flare-ups of eczema with inflamed, watery, and broken skin. Please help.

Hello,

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Eczema is a condition that tends to recur again and again. In patients with recurring eczema there is defective skin barrier which makes these patients prone to eczema. Also, your IgE (immunoglobulin E) levels are quite high so you have atopic tendency also that is why you are so prone to eczema. Also, any kind of stress like any illness or surgery or mental stress trigger eczema. Now antibiotics in eczema is given when secondary bacterial infection develops eczematous skin, so after stopping antibiotics your eczema will not flare up as antibiotics do not play a role is controlling the eczema. Now Prednisolone is the best treatment option to control eczema so you complete the course of it. Then you can switch to topical steroid cream. Now most important thing is how to prevent the recurrence of eczema. Always use mild soap to take bath and use moisturizer to your skin. This is the most important step to control eczema. After taking bath apply moisturizer on slightly wet skin and apply it at least two to three times daily. Buy a good ceramide based moisturizer. Avoid deodorants and perfumes when possible. Do not apply directly on skin, apply on clothes. Take Primosa (high strength Primrose oil) capsules once daily in the evening, this will help in maintaining hydration of skin and will reduce chances of eczema. When you finish your oral Prednisolone course, start applying Fluticasone cream for two weeks. Take one part of Fluticasone cream and nine parts of moisturizer, mix and apply daily at night for two weeks.

Hello,

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Prednisolone is given to control flare of eczema. So continue that to control this flare. Steroids do not have major side effects when given for short term so do not worry. There are common household irritants that may trigger eczema flares like wool, synthetic fibers, soaps, detergents, cleaning supplies, dust and sand, cigarette smoke, etc. Some food allergen like milk, eggs, peanuts, wheat, soy, seafood, etc., also can trigger eczema in some patients so you keep observing that if these foods are causing flare. Any internal organ disease is unlikely to exacerbate your eczema and high eosinophils count in blood is because of this atopic eczema. But since you are on so many medication, get you routine investigation done once. Do Complete blood count, liver function test, thyroid profile done as underlying thyroid disorder can also contribute to the flare of disease. See atopic eczema is a chronic condition with high tendency of recurrence. There is no cure to this but all preventive measures are important to keep it under control and prevent flare. When such patients present to me, I advise them about all preventive measures first but even after following this measure if the patient continues to get flare, then I start them on Azathioprine low dose for a long term. So first you complete this Prednisolone course to control this flare and then follow all preventive measures, if you still get frequent flare ups then we will plan for Azathioprine but not now. As I advised about all preventive measures before, also include these precautions. Do not take hot showers as that causes damage to oil barrier of skin and causes dehydration. Always apply sunscreen whenever you go out. Avoid stress. Now about IBS and gut microbiome test, you will have to talk to some good gastroenterologist for this. Also, share the photo so I can see how much improvement is there and suggest you further treatment accordingly.