Where
Plot No 13D/B, Wellington Rd, Vikrampuri Colony, Karkhana, Secunderabad, Telangana 500009.
- Serves Trimulgherry, West Marredpally, Bowenpally, Alwal
- Formerly BNR Skin & Vitiligo Hospital
Hyderabad
Eczema and atopic dermatitis treatment
Eczema is a barrier problem before it is an inflammation problem. Treatment that only suppresses the flare and never repairs the barrier produces exactly the pattern most families describe: better for a week, back within a month.
45 years in dermatologyDermatologist & dermatosurgeonKarkhana, SecunderabadBooking on WhatsApp
At a glance
- Curable
- No, but usually well controlled
- In children
- Most improve substantially with age
- Foundation
- Emollients, used generously and daily
- Flares
- Anti-inflammatory treatment, then step down
- Steroid phobia
- A bigger problem than steroid overuse
- Watch for
- Infection: weeping, crusting, sudden worsening
The mechanism
A leaky barrier, then inflammation.
Skin in atopic dermatitis does not hold water well and does not keep irritants out well. Water escapes, the skin dries and cracks, irritants and allergens get in, and the immune system reacts. The itch that follows leads to scratching, scratching damages the barrier further, and the cycle continues.
That is why moisturiser is not supportive care in eczema: it is the treatment. Applied generously and daily, including on skin that currently looks fine, it reduces the number of flares and the amount of steroid needed over a year.
Most families use far too little. A child with widespread eczema needs emollient measured in hundreds of grams a month, not a small tube that lasts the season.
Before you decide
Who is treating you, and what his patients said.
Dr. (Lt Col) Khagendra Varada
- 45 years in dermatology and dermatosurgery
- 25 of them in the Indian Army Medical Corps
- MBBS, Osmania Medical College
- Dip. Practical Dermatology, Cardiff · Dip. Dermatology, AAAM
Reg. No. 10461, Hyderabad State Medical Council
Full background →“A year back my father was diagnosed with cellulitis. In consultation with couple of doctors he got treated and was also operated (twice) for the issue, however the progress and recovery noticed was not as per the expectations… he right away with his knowledge and expertise discovered that along with cellulitis he had vasculopathy and eczema in conjunction with oedema… he first treated the wounds in a precise manner and once satisfactory results were seen he focused on his skin allergies and health. Within 5 weeks of visiting Lt Col Sir my father is back normal.”
“Dr Varada is very experienced and friendly, doing great work. I got myself treated for eczema. Thank you very much.”
The barrier
What the barrier is, and what sits under it.
Skin is a layered structure, and the part that holds water in and keeps irritants out is the outermost few cells of it. Everything below is what that surface is protecting.
- 1Epidermis — the barrier
- 2Dermis
- 3Hair follicle and oil gland
- 4Fat
The barrier is the top of the epidermis — a few cell layers thick. In eczema it leaks water outward and lets irritants in, which is why emollient is treatment rather than comfort.
- Epidermis — the barrier
- Dermis
- Hair follicle and oil gland
- Fat
Illustration, not a photograph.
The protocol
How eczema is managed
Emollient, generously, daily
Applied several times a day, and always after bathing on damp skin. On good days as well as bad. That is what prevents the next flare.
Treat a flare properly
An anti-inflammatory of the right potency for the site, used for long enough to actually clear it. Under-treating prolongs everything.
Step down, don’t stop dead
Reduce frequency as it settles. For frequently flaring sites, twice-weekly maintenance to the usual spots prevents the next flare.
Break the itch cycle
Nails short, cotton clothing, cool rooms at night, and treating the itch specifically. Scratching is a driver, not just a symptom.
The barrier
What a leaky barrier actually looks like.
The outermost layer works like a brick wall: flattened cells set in a continuous lipid mortar. In eczema that mortar is thin and broken, so water escapes outward and irritants and allergens get in.
- 1
- 2
- 3
- 4
- 1Continuous lipid seal
- 2Water escaping
- 3Irritants getting in
- 4Inflammation beneath
Emollient replaces the mortar. That is why it is the treatment rather than the comfort measure, and why it goes on skin that currently looks fine.
- Continuous lipid seal
- Water escaping
- Irritants getting in
- Inflammation beneath
Illustration, not a photograph.
Why it keeps going
The loop that keeps eczema going.
Eczema does not simply itch because it is inflamed. The scratching that relieves the itch damages the barrier, the damaged barrier drives more inflammation, and the inflammation makes the nerves more sensitive than they were. Each turn leaves the skin worse.
- 1
- 2
- 3
- 4
- 1Nerves fire
- 2Scratched open
- 3Water escapes
- 4Inflammation builds
This is why controlling the itch is treatment rather than comfort, and why emollient goes on skin that currently looks fine. Breaking the loop anywhere slows all of it.
- Nerves fire
- Scratched open
- Water escapes
- Inflammation builds
Illustration, not a photograph.
Steroid fear
The bigger problem is under-treatment.
Almost every family arrives worried about steroid creams, and the worry is understandable. Potent steroids used carelessly on thin skin do cause harm. But in practice far more eczema is damaged by treating it too little and too briefly than by treating it too much.
Used at the right potency for the site, for a defined period, and stepped down properly, topical steroids are safe and are the reason eczema became manageable. Where the face or eyelids are involved, steroid-free anti-inflammatory options are used instead.
If it might be an allergy insteadPotency matches the site
What is right for the shins is wrong for the eyelids. Site, not severity alone, chooses the strength.
A finger-tip unit
There is a proper measure for how much to apply. Being shown it is worth more than any leaflet.
Where to book
One clinic, in Secunderabad
Consulting rooms, phototherapy and the surgical list at one address in Secunderabad. The practice was formerly known as BNR Skin & Vitiligo Hospital.
How to book
On WhatsApp: one number, answered by the clinic team, who confirm a time and say what to bring.
- Photographs welcome before you travel
- Video consultation arranged the same way
Questions patients actually ask
Eczema questions
Will my child grow out of eczema?
Many children improve substantially through childhood, and a majority are much better by adolescence. It does not disappear in everyone, and skin often remains dry and sensitive even when the eczema itself has settled.
Are steroid creams safe for eczema?
Yes, when the potency matches the site, the course is long enough to clear the flare, and treatment is stepped down rather than stopped abruptly. Under-treating eczema causes more harm in practice than appropriate steroid use.
How much moisturiser should we be using?
Far more than most families expect, for a child with widespread eczema, hundreds of grams a month. It is applied several times daily and continued on clear skin, because that is what prevents the next flare.
Does food cause eczema?
Food allergy is a genuine trigger in a minority of children with severe eczema, and worth investigating in that group. In most people diet is not the driver, and unnecessary restriction risks nutrition without helping the skin.
Why does eczema get worse at night?
Skin temperature rises and there are fewer distractions, so the itch dominates. Cool bedding, cotton nightwear, emollient before bed and treating the itch specifically all help.
Is eczema contagious?
No. It cannot be passed to anyone. Infected eczema can spread bacteria or virus, which is a separate issue and a reason to have sudden worsening looked at.
References
The clinical statements on this page follow the guidance and evidence below. They are independent sources. None of them is connected to this clinic, and none of them sells the treatments described here.
- Atopic dermatitisUS National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH)
- Atopic dermatitisDermNet (New Zealand Dermatological Society)
- Atopic eczemaNHS (United Kingdom)
Keep reading
Related on this site
The first appointment is a diagnosis.
Not a treatment plan sold on the spot. Message the clinic and bring your history.