Atopic dermatitis guidelines
Guidelines for the diagnosis and assessment of eczema
Eczema, or atopic dermatitis, is a chronic, itchy inflammatory skin disease that affects up to 25% of children and 2% to 3% of adults. Guidelines set out how it is diagnosed, how its severity is judged and which linked conditions to ask about.
Independent explainer. This is not the website of the American Academy of Dermatology or any eczema society, and it is not a guideline document.Updated 2026-10-28
What the guidelines say about diagnosis
- Diagnosis is clinical: it rests on the history, the look and spread of the rash and associated signs, according to the guideline's full text.
- Criteria sets: Hanifin and Rajka (1980) need 3 of 4 major and 3 of 23 minor criteria; the UK Working Party set uses one mandatory and five major criteria, with no lab test.
- No biomarker: none is recommended, and routine IgE monitoring is not advised.
- Assessment: ask about itch, sleep, daily life and how long it lasts; formal severity scales are not for routine practice.
- Linked conditions: food allergy, asthma, hay fever, poor sleep and depression. Part 1 explained.
From a skin exam to a photo review
The eczema guidelines rest on one practical point: atopic dermatitis is diagnosed clinically. No blood test or biomarker settles it. A clinician takes a history and examines the skin, looking at where the rash sits, how it looks and whether itch comes first. Because the verdict depends on what can be seen, clear photos of the skin carry much of what that exam needs.
That is why skin care adapts well to telehealth. MedlinePlus describes telehealth as getting health care through electronic communications, and lists photos among the files a patient can send through a secure patient portal. Acne is a good fit for it. The National Institute of Arthritis and Musculoskeletal and Skin Diseases says a provider diagnosing acne may ask how long you have had it, ask which medicines you take or recently stopped, and examine your skin to tell the type of lesion; lab work is only for ruling out another cause. Each of those steps fits an intake form plus photos, which is how online acne treatment works, as the guide from onlineacnetreatment.com below explains.
- Pimples, blackheads, whiteheads: suited to an online visit with daylight photos.
- An itchy, dry rash in skin folds: ask about eczema, where itch is the hallmark.
- Deep, painful nodules or scars: book an exam in person.
Sources: NIAMS, Acne: diagnosis and treatment; MedlinePlus, Telehealth
Below is the full guide to online acne treatment.
The full guide, from onlineacnetreatment.com
Online acne treatment
Online acne treatment works in four steps: you answer health questions, upload photos, a licensed provider checks them, and a prescription goes to your pharmacy or your door. Deep cysts and scarring still need an in-person dermatologist.
A telehealth visit: send photos, get a prescription (tretinoin, spironolactone) and a treatment plan once a dermatologist or licensed provider reviews them. Medicine is delivered or sent to your pharmacy; cost and insurance rules differ by service.
- Online Intake
- Photo Upload
- Provider Review
- Prescription & Delivery
Last reviewed · Sources: American Academy of Dermatology (AAD), MedlinePlus, FDA
How online acne treatment works
The four steps of an online acne visit:
-
Online Intake
- What you do
- Answer questions about your skin, health history and the medicines you've tried.
- Who's involved
- Just you, on the service's website or app.
- What drives the cost
- A visit or consultation fee. Some services don't bill insurance for it.
-
Photo Upload
- What you do
- Upload clear photos of your acne. Some services use text, a call or video instead.
- Who's involved
- You. Photos go to your secure account.
- What drives the cost
- Part of the visit fee.
-
Provider Review
- What you do
- Answer any follow-up questions.
- Who's involved
- A provider licensed in your state, sometimes a board-certified dermatologist. They decide if telehealth is safe for you.
- What drives the cost
- A one-time visit or a subscription.
-
Prescription & Delivery
- What you do
- Pick it up at a pharmacy, sometimes same day, or get it by mail.
- Who's involved
- A local or mail-order pharmacy.
- What drives the cost
- The medicine, priced by your insurance plan. Some services add a monthly fee.
| Route | Best for | Who looks at your skin | Prescription? | What you pay for |
|---|---|---|---|---|
| Over-the-counter products | Mild acne: blackheads, whiteheads, small pimples. Many people do well at home first, without a prescription. | You | No | The product |
| Online prescription service | Mild to moderate acne that store products haven't cleared | A licensed provider or dermatologist, from photos or chat | Yes, if it's right for you | A visit or subscription, plus medicine |
| In-person dermatologist | Severe acne, deep nodules or cysts, scarring | A board-certified dermatologist, face to face | Yes, plus office procedures | An office visit, medicine and any procedures |
What online providers can prescribe
An online acne prescription is the same medicine a clinic prescribes, written after a telehealth review. It means the provider picks from four groups. The options of online acne treatment:
- Topical Retinoids
- Tretinoin, adapalene or tazarotene to clear pores, usually applied in the evening.
- Topical Antibiotics & Cleansers
- Clindamycin, used with a benzoyl peroxide product to limit antibiotic resistance.
- Oral Medications
- Antibiotics such as doxycycline or minocycline, and for women, birth control pills or spironolactone.
- Custom Blends
- Combination creams with two or three medicines in one, such as a retinoid with benzoyl peroxide.
Itchy, same-size bumps may be fungal acne instead, so mention any itching.
What usually needs an in-person visit
An in-person visit is an exam in a dermatologist's office. It means procedures and close monitoring. The cases of in-person acne care:
- Isotretinoin: patients enroll in the FDA's iPLEDGE program and have regular follow-ups, in person or by telemedicine. Anyone who can get pregnant takes the pre-treatment pregnancy test in a medical setting. Some online services don't prescribe it.
- Nodules and cysts: a dermatologist can inject a corticosteroid into a large, painful breakout.
- Scarring: acne that leaves scars needs a dermatologist's exam.
How to compare services
A service comparison is a check of how each online clinic runs its care. It means looking past the ads at who treats you and how you pay. The questions of a fair comparison:
| Question | Why it matters |
|---|---|
| Who reviews my photos? | Some services use licensed providers, others board-certified dermatologists. Ask whether the provider is licensed in your state and whether a dermatologist oversees the care. |
| Subscription or one-time visit? | Some services offer one, some the other, some both. A subscription may ship automatic refills until you pause or cancel. |
| Does it take my insurance? | Some bill insurance for the medicine but not for the visit, and some don't accept Medicare or Medicaid. Others don't use insurance at all. |
| Delivery or pharmacy pickup? | Some mail the medicine to you; others send the prescription to a local pharmacy, sometimes for same-day pickup. |
| Can I message the provider later? | Ask whether follow-up messages and a check-in after a few weeks are included. |
| Who can't use it? | Some services treat adults only, and some don't treat people who are pregnant, breastfeeding or trying to conceive. |
Under 18? Many teens can start at home: this guide to the best acne treatment for teens matches benzoyl peroxide, salicylic acid or adapalene to each breakout type.
Is online acne treatment right for you
Online acne treatment is a good fit for mild to moderate acne. It means your acne shows clearly in photos and nothing needs an exam. The limits of online care:
- Good fit: blackheads, whiteheads and pimples that store products haven't cleared in a few months.
- In person instead: painful nodules or cysts, scarring, sudden severe acne, signs of another medical condition, or pregnancy if you want prescription treatment.
Once your skin is clear, a topical retinoid can keep it that way, and how to prevent acne covers the daily habits that help.
Reader questions
Which company is the best for acne treatment?
There isn't one best company. The right one depends on your acne, your insurance and whether you want delivery or pickup, so use the table above.
What do doctors prescribe for really bad acne?
For severe acne with deep nodules that other treatments haven't cleared, dermatologists prescribe isotretinoin. For moderate to severe pimples, an oral antibiotic such as doxycycline, paired with benzoyl peroxide, is the usual pick. One big, painful bump can get a corticosteroid shot in the office.
What pill makes acne go away?
No pill works for everyone, and they all need a prescription. The options are antibiotics (doxycycline, minocycline, sarecycline), birth control pills or spironolactone for women, and isotretinoin for severe acne. Each has side effects to discuss with your doctor.
What clears up acne the fastest?
Nothing clears acne overnight. Even with the right treatment, it takes at least 6 to 8 weeks to see fewer breakouts. So stick with one plan.
Is benzoyl peroxide face wash safe?
Usually, yes. It can dry, sting or irritate, especially sensitive skin, so start with 2.5%. It also bleaches hair and clothing. If irritation doesn't go away, stop and get medical care; serious reactions are rare.
Sources
- AAD: What can clear severe acne?
- MedlinePlus: Benzoyl peroxide topical
- AAD: Acne diagnosis and treatment
- AAD: Isotretinoin
- FDA: iPLEDGE REMS
Last reviewed . Service details vary, so check each service's own terms; this guide doesn't rank services or list prices, which change often.
This page is general information, not a diagnosis. See a dermatologist in person if you have painful nodules or cysts, scarring, sudden severe acne, signs of another medical condition, or you're pregnant or planning to be and want prescription treatment.