Biopsy findings change over time. Initially there is inflammation around the follicle. Over time, the degree of inflammation may lessen, and there is more scar formation. Thus, a biopsy of a late lesion may not yield a specific diagnosis, and sometimes a repeat biopsy of a more active area is required. If the alopecia is “burned out”, or inactive, even multiple biopsies may not help. In such cases, an evaluation by a clinician specializing in hair loss and review of the slides by a dermatopathologist specializing in alopecia may help to correlate the clinical and histologic findings and arrive at a diagnosis. Despite this advanced level of care, sometimes a specific diagnosis cannot be achieved.
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Eczema is a chronic condition that is not curable. However, with a well integrated, medically monitored plan of care, symptoms can be effectively controlled, and people with eczema can lead active, comfortable lives. A good treatment plan is individualized to a person's medical history, specific type and severity of eczema, the specific cause, and other factors. A combination of treatments that include lifestyle changes with medications and other treatments as appropriate is the most effective way to best control eczema. Treatment of eczema includes prevention of flare-ups by avoiding exposure to irritants and allergens and minimizing skin dryness. Typical skin irritants and allergens include soaps, chemicals, cleaning products, weeds, and some metals, such as nickel. Skin dryness can be avoided or treated by using a perfume-free moisturizer, avoiding scratchy clothes, and using a home humidifier. Other important steps include avoiding alcohol and caffeine, using mild soaps, not over washing or scrubbing skin, and avoiding hot tubs, steam baths, saunas and chlorinated swimming pools. Ice bags or cool wet compresses may be helpful to help relieve itching. Therapy can also include taking an oatmeal bath and using oatmeal soap, such as Aveeno. More severe cases of itching and eczema may be treated with a corticosteroid cream, which reduces inflammation and an antihistamine, which reduces itching. These medications can have side effects, so they should only be taken under the direction of a health care clinician. Antibiotics may be prescribed to treat secondary bacterial infections. Another type of treatment that may be effective for some people with eczema is phototherapy.