POEM, the Patient Oriented Eczema Measure, was developed at the University of Nottingham and is the most widely used eczema severity tool in research and clinical practice. It captures how eczema has actually felt over the past week. Total scores range from 0 (clear) to 28 (severe). The advantage of POEM over a clinician's visual exam is that it includes itch and sleep, which are often the symptoms patients care most about and the symptoms a 5-minute exam can miss.
Eczema and the atopic march
Eczema is the entry point of the atopic march. Children with moderate to severe eczema have a meaningfully higher chance of developing food allergy, allergic rhinitis, and asthma over the next 5 to 10 years. Treating eczema well, including identifying and addressing allergic triggers when they exist, can change that trajectory.
When allergy testing helps
Not every eczema flare is allergic. But for patients whose flares cluster around specific exposures (certain foods, pet contact, dust-heavy environments), targeted testing can be a game changer. We use both skin testing and specific IgE blood testing for environmental allergens, plus food challenges (in office, supervised) when food triggers are suspected.
Modern treatment options
Beyond the standard moisturizer-and-topical-steroid approach, options have expanded substantially. Topical calcineurin inhibitors (tacrolimus, pimecrolimus) for sensitive areas. Crisaborole and ruxolitinib for non-steroidal control. Dupixent for moderate to severe eczema in patients 6 months and older. Oral JAK inhibitors for severe disease. Allergy and asthma specialists are commonly the prescribers of these biologics, given the overlap with our patient population.
Track your score over time
Take POEM monthly. The number tells you whether your treatment is working in a way that memory does not. Score going down means the plan is succeeding. Score holding steady or rising is a signal to revisit the approach.
