Comprehensive Eczema Panel: Which Tests Should Be Included?

For people living with eczema, every flare can feel like a battle—one filled with confusion, frustration, and the constant question: “What’s causing this?” The unpredictable nature of eczema and the constant struggle for lasting relief can leave patients overwhelmed with trying to identify countless potential triggers. 

Whether it's food, environmental allergens, or something more elusive, the challenge of identifying what’s behind the flare-ups can be distressing. A comprehensive eczema panel offers clarity, helping clinicians pinpoint triggers, assess severity, and provide more tailored treatment.

No two cases of eczema are exactly alike, which is why this personalized approach is so critical to managing the condition effectively.

In this article, we’ll explore the key tests that should be included in a comprehensive eczema panel. Our goal is to arm healthcare professionals with the insights they need to make informed treatment decisions while supporting their patients to find relief from this often overwhelming condition.

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What is a Comprehensive Eczema Panel?

A comprehensive eczema panel includes blood tests, allergy screenings, and other diagnostic tools to uncover the underlying causes of eczema. For many patients, especially those with severe or unexplained symptoms, one test often isn’t enough. A combination of tests helps uncover different pieces of the puzzle.

A comprehensive eczema panel helps clinicians identify triggers, assess inflammation, and rule out other conditions, leading to more personalized and effective treatment plans. For patients stuck in a cycle of flare-ups, the panel offers much-needed clarity and direction.

Key Tests to Include in a Comprehensive Eczema Panel

The following tests should be considered in a comprehensive eczema panel:

Total IgE (Immunoglobulin E) Test

This test measures the overall level of IgE, which is often elevated in people with eczema and other allergic conditions. High IgE levels suggest an overactive immune response to allergens like dust mites, pollen, or certain foods that may contribute to eczema-related inflammation.

Specific IgE (Allergen-Specific Test)

RAST (radioallergosorbent test) and ImmunoCAP tests measure specific IgE antibodies in the blood to identify allergen triggers like pollen, dust mites, and foods such as wheat, eggs, peanuts, soy, and dairy.

Allergen-specific testing can help create personalized treatment and avoidance strategies, helping patients avoid triggers that worsen their symptoms.

Complete Blood Count (CBC)

A CBC is included to detect signs of infection, anemia, or other underlying health issues. Elevated white blood cell counts, particularly neutrophils or lymphocytes, may indicate inflammation or infection, which may help to assess immune dysfunction and uncover infections that can complicate skin healing.

A CBC will also report eosinophil count, which is another type of white blood cell that participates in the pathogenesis of eczema.

Eosinophil Count

Eosinophils are a type of white blood cells that play a key role in allergic responses. Elevated eosinophil levels are common in eczema and indicate a stronger allergic response, which helps gauge eczema severity and guide treatment plans.

C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR)

These tests measure overall inflammation in the body. High CRP levels indicate acute inflammation, while elevated ESR reflects chronic inflammation, both of which are useful in assessing the severity of eczema and monitoring treatment effectiveness.

Patch Testing

Patch testing can identify allergens that may be triggering or worsening eczema through allergic contact dermatitis. It assesses delayed hypersensitivity reactions on the skin’s surface that develop over several days, pinpointing environmental triggers like metals, fragrances, or cosmetics-related substances. 

Since contact dermatitis can overlap with eczema, identifying specific allergens through patch testing can improve eczema management by guiding allergen avoidance strategies. It’s especially recommended for patients with chronic or unexplained flare-ups, or when standard treatments fail to provide relief.

Skin Biopsy

A skin biopsy is rarely used in eczema but may be necessary when the diagnosis is unclear or when symptoms are severe, persistent, or atypical. It helps rule out other conditions like psoriasis, fungal infections, or skin cancers and is particularly useful when eczema does not respond to standard treatments. 

While often showing nonspecific inflammation, a biopsy is mainly used to confirm or exclude other potential diagnoses that may complicate eczema management.

Limitations of the Comprehensive Eczema Panel

While these tests provide valuable insights, they have limitations that must be considered for accurate diagnosis and treatment.

Total IgE Test

Elevated IgE levels are common but not specific findings in eczema as they also appear in other allergic disorders, infections, and autoimmune diseases, making this test insufficient for a definitive diagnosis alone.

Specific IgE Test

This test helps identify allergen triggers but can be inaccurate up to 60% of the time. Interpretation alongside clinical history is necessary.

Complete Blood Count (CBC)

A CBC gives general information about inflammation or infection but cannot specifically identify eczema-related issues, as elevated white blood cells may signal various conditions.

Eosinophil Count

High eosinophil levels suggest an allergic response but are not exclusive to eczema. High eosinophils can also be seen in other allergic reactions including asthma, and in parasitic infections. This test should be used with others to assess eczema severity more accurately.

CRP and ESR

These tests measure inflammation but are non-specific, meaning elevated levels could result from various causes, not just eczema. They are useful for assessing inflammation but not for identifying triggers.

Additional Tests to Consider for Specific Cases

The following tests may be helpful in specific cases:

Food Sensitivity Testing

Food allergies are recognized as significant triggers in some eczema flare-ups, making IgE-specific food allergy testing reasonable. 

Food sensitivity testing is generally not given the same consideration. However, some studies show that there may be value in considering food sensitivity testing as well, especially in children with atopic diseases. 

Food allergy involves an immediate immune response (IgE) to certain foods, triggering symptoms like hives, swelling, or anaphylaxis. In contrast, food sensitivity causes a delayed, non-IgE immune response and can result in symptoms such as rashes, fatigue, or digestive issues. 

These are both different than food intolerance, which is a non-immune reaction often due to an enzyme deficiency (like lactose intolerance) which makes it difficult to digest certain foods. 

Vitamin D Levels

Vitamin D, known for its role in bone and immune health, is also vital for healthy skin.

A lack of vitamin D has been linked to more severe cases of eczema, and taking vitamin D supplements might help improve the condition.

Vitamin D regulates the immune system and supports the production of antimicrobial peptides (AMPs) in the skin. These peptides play a role in skin conditions like eczema and psoriasis by reducing inflammation and lowering the risk of infections.

Thyroid Function Tests

Thyroid dysfunction is associated with atopic dermatitis. For patients with persistent eczema and suspected thyroid conditions, thyroid function tests including TSH, Free T3, and Free T4, and thyroid antibodies can help assess thyroid health and identify connections between thyroid and skin health.

Hypothyroidism can lead to dry, itchy skin and may exacerbate, or be associated with, eczema symptoms. Autoimmune thyroiditis may also be associated with eczema. Treating thyroid disorders may help in managing skin health in eczema patients.

Interpreting the Results from a Comprehensive Eczema Panel

Understanding the results of a comprehensive eczema panel requires viewing them as part of a larger eczema management strategy. Lab results should be interpreted alongside clinical observations and patient history to form a complete picture of the individual’s condition. 

Any changes in the frequency and severity of flare-ups following adjustments to the patient’s treatment plan should be documented, and these adjustments should be incorporated into their long-term care strategy.

This combination allows healthcare providers to customize treatment plans and make informed adjustments over time, helping to manage flare-ups and optimize long-term skin health.

How the Comprehensive Eczema Panel Guides Treatment

Identifying specific allergens helps guide avoidance strategies and lifestyle changes, reducing exposure to triggers that may worsen eczema.

Adjusting Medication Regimens Based on Inflammation Markers

Inflammation markers from the panel may help fine-tune prescription medications like topical steroids or biologics, ensuring appropriate dosing to improve symptom management.

Ongoing Monitoring and Retesting

Regular monitoring and retesting allow healthcare providers to track treatment effectiveness, make necessary adjustments, and optimize long-term eczema management.

Who Should Consider a Comprehensive Eczema Panel?

A comprehensive eczema panel is recommended for patients experiencing persistent flare-ups, unclear triggers, severe eczema, or when standard treatments are not effective.

This panel can be especially helpful for those with unusual eczema symptoms or complex health issues, providing deeper insights into potential triggers and more tailored treatment options.

Working with Your Healthcare Provider

Your healthcare provider will be able to discuss the benefits of comprehensive testing for eczema for your specific situation.

Consulting a Specialist

A dermatologist or an allergist should be consulted to determine which tests are necessary for your specific case, as they can provide expert guidance based on your symptoms and medical history.

Preparing for Tests

Your healthcare provider will explain how to prepare for the tests, which may involve stopping certain medications or avoiding specific foods. The diagnostic process is usually straightforward and non-invasive, but knowing what to expect can help ease any concerns.

Follow-up Appointments

Regular follow-up appointments are essential for reviewing test results and updating your treatment plan as needed. Ongoing monitoring ensures the treatment remains effective and adjusts to any changes in your condition.

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Key Takeaways

• A comprehensive eczema panel helps identify the severity of allergic response, inflammation levels, and other triggers that may be causing or worsening eczema, enabling more personalized and effective treatment plans.

• If you're struggling to manage eczema symptoms or face persistent flare-ups, discuss testing options with your healthcare provider to uncover potential triggers and refine your treatment plan.

• Comprehensive testing provides deeper insights into eczema triggers, allowing for tailored treatments and ongoing adjustments, ultimately leading to better long-term symptom control.