Calm Irritated Skin, Control Chronic Conditions

Understanding Skin Allergies, Eczema & Psoriasis in India

Eczema (atopic dermatitis) affects 10-20% of Indian children and often persists into adulthood, causing itchy, inflamed patches that disrupt sleep and quality of life. Psoriasis, a chronic autoimmune condition, affects 2-3% of Indians, presenting as thick, scaly plaques on elbows, knees, and scalp.

Both conditions flare unpredictably due to triggers like weather changes (Hyderabad's dry winters), stress, infections, and allergens. Post-inflammatory hyperpigmentation in darker skin types makes early, effective control critical to prevent lasting discoloration.

At Ajuda Hospitals Dermatology, we offer IADVL-aligned protocols combining:

• Barrier repair with medical-grade emollients
• Topical steroids and calcineurin inhibitors for flare control
• Narrowband UVB phototherapy for steroid-sparing maintenance
• Systemic and biologic therapy coordination for severe disease

Our multilingual team (Telugu, Hindi, Urdu, English) delivers personalized care rooted in evidence and empathy.

When to Consult Our Skin Allergy & Eczema Specialists

Schedule a consultation for persistent rashes lasting over 2 weeks, chronic scalp scaling, or if you need guidance on long-term steroid-sparing options.

Our Diagnostic Approach

Clinical Examination & Pattern Recognition

Eczema typically affects flexural areas (inner elbows, behind knees, neck folds) with dry, lichenified (thickened) skin. Psoriasis favors extensor surfaces (elbows, knees, scalp) with well-demarcated red plaques and silvery scales. Contact dermatitis shows geometric patterns matching allergen exposure (jewelry, shoe elastic).

We perform dermatoscopy to assess morphology and rule out fungal infections or malignancies.

Patch Testing (Contact Dermatitis Suspected)

48-72 hour allergen panels test for:

• Nickel (jewelry, belt buckles)
• Fragrances and preservatives (cosmetics, detergents)
• Rubber accelerators (shoes, gloves)
• Paraphenylenediamine (hair dyes)

Positive reactions guide strict avoidance strategies.

Skin Biopsy (Uncertain or Severe Cases)

Punch biopsy with histopathology differentiates:

• Psoriasis vs eczema (epidermal patterns differ)
• Fungal infections (KOH prep, PAS stain)
• Cutaneous T-cell lymphoma (mycosis fungoides mimics eczema)

Trigger Mapping & Allergy Testing

• Dietary elimination trials (dairy, gluten, nuts) for suspected food triggers
• IgE testing for environmental allergens (dust mites, pet dander, pollen)
• Medication review (beta-blockers, lithium, antimalarials worsen psoriasis)
• Stress assessment and sleep hygiene (flares correlate with cortisol surges)

Treatment Pathways

Our management follows IADVL guidelines and international best practices:

Foundation: Barrier Repair & Emollients

All patients receive:

• Thick ceramide-based moisturisers (CeraVe, Cetaphil, Aveeno) applied liberally 2-3x daily
• Gentle cleansers (Cetaphil, Physiogel) instead of soap
• Lukewarm showers (hot water strips oils); pat dry, apply moisturiser within 3 minutes
• Humidifiers in dry seasons (Hyderabad winters)

Effectiveness: Reduces transepidermal water loss; prevents 30-40% of flares.

Step 1: Topical Corticosteroids (Acute Flares)

Potency-matched steroids:

• Mild (1% hydrocortisone): Face, eyelids, groin, infants
• Moderate (mometasone, fluticasone): Body eczema, scalp psoriasis
• Potent (clobetasol): Thick psoriasis plaques, palms/soles

Pulse therapy: Apply once daily for 2 weeks, then alternate days or weekends only to minimise thinning and rebound flares.

Step 2: Topical Calcineurin Inhibitors (Steroid-Sparing)

Tacrolimus 0.1% or pimecrolimus 1%:

• Safe for face, eyelids, and sensitive areas (no thinning risk)
• Long-term maintenance to prevent flares without steroid side effects
• Mild burning first week (resolves with continued use)
• Safe for children >2 years

Step 3: Narrowband UVB Phototherapy (Chronic/Widespread Disease)

311 nm UVB light therapy 3 times weekly for 8-12 weeks:

• Psoriasis: Slows keratinocyte turnover; induces apoptosis of T-cells
• Eczema: Modulates immune response; reduces itch and inflammation
• Vitiligo (repigmentation; see dedicated service page)

Protocol:

• Baseline minimal erythema dose (MED) testing
• Gradual dose escalation tracked via EMR
• Eye protection and genital shielding
• Maintenance sessions monthly after remission

Effectiveness: 70-80% PASI improvement in psoriasis; 60-70% eczema control.

Step 4: Systemic Therapy (Severe/Resistant Disease)

For PASI >10 (extensive psoriasis) or severe eczema unresponsive to topicals and phototherapy:

Methotrexate:

• 7.5-25 mg weekly with folic acid supplementation
• Monitors: CBC, liver function (every 8-12 weeks)
• Contraindicated in pregnancy (teratogenic)

Cyclosporine:

• Fast-acting immunosuppressant for rapid control
• Short-term use (3-6 months) due to kidney/BP side effects
• Monitors: Creatinine, blood pressure

Apremilast (Otezla):

• Oral PDE4 inhibitor for psoriasis and psoriatic arthritis
• Fewer lab monitoring requirements vs methotrexate
• GI side effects (diarrhea, nausea) common first month

Step 5: Biologic Therapy Coordination (Severe Psoriasis)

For PASI >10 with failed systemic therapy or joint involvement (psoriatic arthritis):

Anti-IL-17 Biologics (secukinumab, ixekizumab):

• Subcutaneous injections every 2-4 weeks
• 90% skin clearance (PASI 90) in 40-50% of patients
• Low infection risk; monitor for candida (mucosal)

Anti-IL-23 Biologics (guselkumab, risankizumab):

• Injections every 8-12 weeks (better adherence)
• Sustained remissions; favorable safety profile

Pre-Authorization Support: Our team coordinates insurance approvals (Ayushman Bharat, TPAs) and connects you with biologic-experienced dermatologists.

Special Considerations: Contact Dermatitis

• Allergen avoidance based on patch test results
• Barrier creams for occupational exposures (healthcare workers, beauticians)
• Hypoallergenic substitutes for cosmetics, detergents, jewelry

What to Expect: Your Care Journey

First Visit (60 min)

• Detailed history: onset, triggers, previous treatments, family history
• Full-body skin exam with dermatoscopy
• Patch testing scheduled if contact dermatitis suspected
• Baseline photography for psoriasis (PASI scoring)
• Personalised treatment plan with emollient samples and prescriptions

2-Week Follow-Up

• Assess flare control; adjust steroid potency or frequency
• Reinforce moisturisation technique and trigger avoidance
• Initiate phototherapy if appropriate (after consent and MED testing)

Week Review

• Transition to calcineurin inhibitors for maintenance
• Track phototherapy response with photos (PASI, EASI scores)
• Address side effects (steroid thinning, burning with tacrolimus)

3-Month Milestone

• Evaluate need for systemic therapy (persistent PASI >10)
• Baseline labs (CBC, liver, kidney) before methotrexate/cyclosporine
• Biologic referral discussion if quality of life severely impacted

Long-Term Maintenance

• Monthly phototherapy sessions to sustain remission
• Quarterly reviews with lab monitoring on systemic agents
• Telemedicine check-ins for stable patients
• Annual patch test updates if new allergies develop

Technology & Innovation

Narrowband UVB Phototherapy with Dosimetry Tracking

Our NABH-compliant NB-UVB cabinets deliver precise 311 nm wavelengths. EMR dosimetry tracking records cumulative UV exposure, preventing overtreatment and optimising efficacy. Patients receive personalised dose schedules based on skin type and response.

Benefits:

• Steroid-sparing long-term control
• Outpatient convenience (15-min sessions)
• Safe for pregnancy (localized treatment)

Telemedicine Flare Management

• Photo uploads via secure portal for remote assessment
• Prescription adjustments without clinic visits for stable patients
• WhatsApp trigger diaries to identify pattern-related flares
• Emergency slots for severe exacerbations

Preventing Complications

Untreated eczema and psoriasis cause:

• Secondary infections: Bacterial (staph, strep) or viral (eczema herpeticum)
• Chronic sleep deprivation: From nighttime itching
• Psychological distress: Anxiety, depression, social isolation
• Psoriatic arthritis: Joint damage in 30% of psoriasis patients if untreated
• Post-inflammatory pigmentation: Dark patches in Indian skin (months to fade)

Our Prevention Strategy:

• Early, aggressive flare control to prevent infection and scarring
• Biannual joint exams in psoriasis patients (early arthritis detection)
• Mental health referrals for severe quality-of-life impairment
• Sun protection to prevent pigmentation (but allow controlled UVB therapy)

Why Ajuda for Eczema & Psoriasis Care?

Take the First Step

Chronic itch, sleepless nights, and visible plaques diminish quality of life. Evidence-based treatment restores comfort and confidence. Book a comprehensive evaluation today for personalised eczema, psoriasis, or allergy care.

Call 9010550550 or WhatsApp for same-day consultations. Our dermatology specialists are available Monday-Saturday, 9 AM-7 PM, with phototherapy slots Monday-Saturday mornings.

Healthy, calm skin is achievable—let Ajuda Hospitals guide your journey to lasting control.