Complete Guide to Eczema SOAP Note Examples for Healthcare Providers

If you've ever struggled to document eczema visits in a way that satisfies insurance requirements while actually being useful, this guide is for you.

I've talked to countless dermatologists, family physicians, and pediatricians who spend extra hours documenting atopic dermatitis cases to meet insurance standards for treatment approvals.

The reality is that eczema documentation has specific requirements that go beyond basic visit notes.

Insurance companies want to see severity assessments, documentation of treatment failures, and clear justification for prescribing newer biologics or systemic therapies.

That's exactly why I built SOAP Notes Doctor to handle the heavy lifting of documentation while you focus on patient care.

In this article, I'll show you exactly how to write eczema SOAP notes that meet insurance standards, with real examples you can use as templates.

🧾 What SOAP Notes Really Are (And Why They Matter for Eczema)

SOAP notes might feel like bureaucratic busywork, but they serve a real purpose.

They were introduced in the 1960s by Dr. Lawrence Weed as part of the Problem-Oriented Medical Record (POMR).

His goal was straightforward: create a documentation system that anyone reviewing a chart could understand quickly and completely.

For eczema specifically, SOAP notes are critical because they demonstrate:

• Clear documentation of disease severity and body surface area affected
• Appropriate treatment escalation when first-line therapies fail
• Medical necessity for expensive biologics or phototherapy
• Impact on quality of life justifying aggressive treatment

SOAP stands for:

• S — Subjective: What the patient reports about itching, sleep disruption, flare triggers, and impact on daily activities.
• O — Objective: Your clinical findings including distribution of lesions, severity scoring, body surface area involved, signs of infection, and treatment response.
• A — Assessment: Your clinical diagnosis, severity classification, identification of triggers, and evaluation of treatment efficacy.
• P — Plan: Your treatment plan including topical therapies, systemic medications, patient education on triggers and moisturization, and follow-up timeline.

This structure keeps your documentation organized, defensible, and insurance-friendly.

You're not just recording what happened—you're building a clinical narrative that justifies treatment decisions and medication approvals.

How You Can Approach Eczema SOAP Notes

There's no single correct method for writing eczema SOAP notes, but some approaches work better than others depending on your practice.

Here are two main approaches I've seen work well.

1. Traditional, Manual Documentation

This is the classic method: typing out each section after each visit. It works if you have strong clinical writing skills and consistent time built into your schedule. The challenge is it's time-consuming, and notes can become inconsistent when documenting severity scores or body surface area calculations.

2. SOAP Notes Doctor

You record your examination findings or dictate your observations, and the tool automatically structures everything into proper SOAP format. It maintains consistency, saves hours of documentation time, and ensures you never miss critical components that insurance companies look for when reviewing prior authorization requests.

How to Make Eczema SOAP Notes Faster

One of the biggest complaints I hear from providers treating eczema is how documentation eats into their already limited time.

You've just finished a full day of evaluating skin conditions, performing procedures, and counseling anxious parents about their child's flares, and instead of finishing on time, you're stuck typing detailed justifications for dupilumab or other biologics.

The pressure is real: make them too brief and you risk denials or having to rewrite prior authorizations; make them too detailed and you've just added hours to your week.

Here's what we built to solve this:

✅ Head to soapnotes.doctor
✅ Record your examination findings or dictate key observations
✅ Generate properly formatted SOAP notes instantly
✅ Get your evenings and weekends back

With soapnotes.doctor, you can record during or right after a visit, add rough notes about specific findings, or even upload audio later. The system converts everything into insurance-compliant SOAP notes automatically.

You still get the clinical accuracy and thoroughness that insurance companies require, but without manually typing every detail.

Maybe you noted specific findings?

"Erythematous plaques bilateral antecubital fossae, excoriated, weeping in some areas, BSA approximately 15%, EASI score 24, patient reports itch severity 8/10, sleep disruption nightly, failed triamcinolone and tacrolimus."

Use the tailorr feature to add them. Keep it raw and unpolished—soapnotes.doctor handles the rest.

Example 1: Pediatric Atopic Dermatitis, Moderate Severity

Patient: 7-year-old male
Chief Complaint: Worsening eczema, severe itching
Visit: Follow-up dermatology visit

S – Subjective:

Patient's mother reports worsening eczema over past 3 weeks despite compliance with current regimen. Intense itching, severity 8/10, worse at night, disrupting sleep 4-5 nights per week. Child scratching to point of bleeding. Flares primarily affect antecubital and popliteal fossae. Mother notes flare coincided with return to school and increased stress. Currently using triamcinolone 0.1% cream twice daily to affected areas and CeraVe moisturizing cream. Reports adequate application technique. Bathing daily with fragrance-free cleanser. No recent viral infections or new exposures. No dietary changes. Family history positive for atopic dermatitis (father) and asthma (mother). Child has history of seasonal allergies, currently controlled.

O – Objective:

General: Alert, active child, appears uncomfortable with frequent scratching
Skin Exam: Bilateral antecubital fossae with erythematous, scaly plaques with excoriations and areas of lichenification. Bilateral popliteal fossae similarly affected but less severe. Scattered patches on neck and behind ears. No signs of secondary infection (no warmth, purulence, or honey-colored crusting). Xerosis noted on trunk and extremities.
Body Surface Area Affected: Approximately 12%
EASI Score: 18.5 (moderate severity)
Distribution: Flexural areas primarily affected, classic pattern for atopic dermatitis

A – Assessment:

Atopic dermatitis, moderate severity, inadequately controlled on current mid-potency topical corticosteroid regimen. Sleep disruption and quality of life significantly impacted. Classic flexural distribution consistent with chronic atopic dermatitis. No evidence of secondary bacterial infection at this time. Potential trigger includes school-related stress and possible environmental allergens.

P – Plan:

Escalate Treatment: Prescribe fluocinonide 0.05% ointment (high-potency corticosteroid) to affected areas twice daily for 2 weeks, then taper to once daily for 1 week. Prescribe triamcinolone 0.1% ointment for maintenance after taper, apply 2-3 times weekly to prevent flares. Add tacrolimus 0.03% ointment for face and neck areas (steroid-sparing), apply twice daily.

Itch Management: Prescribe hydroxyzine 10mg at bedtime for itch control and sleep improvement.

Barrier Repair: Continue CeraVe moisturizing cream, apply liberally at least twice daily, immediately after bathing while skin still damp. Recommend unscented laundry detergent and avoiding fabric softeners.

Education: Reviewed proper application technique (apply medication first, then moisturizer 15 minutes later). Discussed trigger avoidance including stress management, maintaining cool environment, loose-fitting cotton clothing. Reviewed signs of infection requiring urgent evaluation.

Follow-up: Return in 4 weeks to assess treatment response. If inadequate improvement, will consider referral to pediatric dermatology for phototherapy or systemic therapy consideration. Mother to call if signs of infection develop or symptoms worsen significantly before scheduled follow-up.

Example 2: Adult Atopic Dermatitis, Severe, Prior Authorization for Biologic

Patient: 34-year-old female
Chief Complaint: Severe eczema unresponsive to multiple treatments
Visit: Dermatology consultation for biologic therapy consideration

S – Subjective:

Patient reports lifelong history of atopic dermatitis, significantly worsening over past 18 months. Current symptoms include severe pruritus rated 9/10, affecting entire body. Sleep severely disrupted, waking 6-8 times nightly due to itching. Symptoms significantly impacting work performance and quality of life. Reports anxiety and depression related to skin condition. Has tried multiple treatments including: triamcinolone 0.1% cream (minimal benefit), fluocinonide 0.05% ointment (temporary improvement only), tacrolimus 0.1% ointment (burning sensation, discontinued), crisaborole (inadequate response), oral prednisone bursts (improvement while on, rapid rebound), and phototherapy 3 times weekly for 12 weeks (minimal sustained benefit). Currently using clobetasol 0.05% ointment with modest control. Generous emollient use throughout day. Identifies triggers including stress, certain fabrics, cold weather. No recent infections. History of asthma (well-controlled) and seasonal allergies.

O – Objective:

General: Well-appearing but uncomfortable, evidence of distress when discussing symptoms
Skin Exam: Extensive erythematous, scaling, lichenified plaques involving bilateral arms, legs, trunk, and neck. Areas of excoriation with some oozing. Facial involvement with erythema and scaling around eyes and mouth. Hands show palmar hyperlinearity, fissuring, and xerosis.
Body Surface Area Affected: Approximately 45%
EASI Score: 42.8 (severe)
DLQI (Dermatology Life Quality Index): 23 (very severe impact on quality of life)
IGA (Investigator Global Assessment): 4 (severe disease)

A – Assessment:

Severe, refractory atopic dermatitis with significant impact on quality of life and sleep. Patient has failed multiple topical therapies including high-potency corticosteroids, calcineurin inhibitors, and PDE4 inhibitor. Also failed phototherapy and requires frequent oral corticosteroid bursts with rebound flaring. Extensive body surface area involvement and high severity scores. Meets criteria for systemic therapy. Patient is appropriate candidate for dupilumab (Dupixent) biologic therapy given disease severity, treatment failures, and quality of life impairment.

P – Plan:

Biologic Therapy: Initiate prior authorization for dupilumab 600mg loading dose followed by 300mg subcutaneous injection every 2 weeks. Provided detailed documentation of treatment failures, severity scores, and quality of life impact for insurance review.

Baseline Testing: Order CBC, CMP, hepatitis B and C screening prior to initiating biologic therapy per protocol.

Bridging Therapy: Continue clobetasol 0.05% ointment to affected areas twice daily until biologic therapy approved and initiated. Consider short oral prednisone taper (40mg daily for 5 days, then 20mg daily for 5 days) if symptoms become intolerable while awaiting approval.

Adjunctive Care: Continue aggressive moisturization with thick emollients (CeraVe Healing Ointment or Aquaphor) multiple times daily. Prescribe doxepin 10mg at bedtime for sleep and pruritus management.

Patient Education: Reviewed expected timeline for insurance approval (typically 1-2 weeks), dupilumab administration technique, expected efficacy timeline (improvement typically within 4-16 weeks), and potential side effects including conjunctivitis and injection site reactions.

Follow-up: Patient to follow up 2 weeks after initiating dupilumab therapy to assess tolerance and early response. Then monthly visits for first 3 months to monitor efficacy and safety. Contact office immediately if develops signs of infection, severe injection site reactions, or vision changes. Provided patient support program information for financial assistance if needed.

Example 3: Hand Eczema, Occupational Exposure

Patient: 28-year-old male, restaurant dishwasher
Chief Complaint: Persistent hand rash, cracking, pain
Visit: Initial dermatology evaluation

S – Subjective:

Patient reports 4-month history of progressive hand dermatitis. Works as dishwasher at busy restaurant, hands in water 6-8 hours daily with frequent exposure to detergents and sanitizers. Symptoms began 2 months after starting current job. Reports severe dryness, fissuring, burning pain, and mild itching. Symptoms worse at end of work shifts and improve slightly on days off. Has tried over-the-counter hydrocortisone 1% cream with minimal improvement. Currently using petroleum jelly with some relief. Denies similar rash elsewhere on body. No personal history of eczema, but mother has psoriasis. Denies recent illnesses or new medications. Non-smoker, no recreational drug use.

O – Objective:

General: Well-appearing, no acute distress
Hand Exam: Bilateral palmar and dorsal hand involvement. Erythema, scaling, and xerosis prominent. Multiple painful fissures noted on fingertips and palmar creases bilaterally. Involvement extends to wrists. No vesicles, pustules, or bullae. No nail changes. Negative Auspitz sign (ruling out psoriasis).
Remainder of Skin Exam: No lesions noted on forearms, face, trunk, or lower extremities
Body Surface Area: Less than 5% (localized to hands)

A – Assessment:

Irritant contact dermatitis of hands, likely occupational in nature given temporal relationship to dishwashing job and improvement on days off. Differential diagnosis includes allergic contact dermatitis (less likely given distribution and history), but patch testing may be considered if inadequate response to treatment. Hand eczema with painful fissuring impacting ability to perform job duties.

P – Plan:

Topical Therapy: Prescribe clobetasol 0.05% ointment to hands twice daily for 2 weeks, then taper to once daily for 1 week. Prescribe triamcinolone 0.1% ointment for maintenance, apply to affected areas 2-3 times weekly.

Barrier Protection: Prescribe thick emollient (CeraVe Healing Ointment or Vanicream) to apply frequently throughout day, especially after hand washing. Apply generous amount at bedtime and consider cotton gloves overnight for enhanced penetration.

Occupational Modifications: Provided work accommodation letter recommending use of vinyl or nitrile gloves (avoid latex) under work gloves, frequent emollient application during shifts, use of milder cleansers when possible. Advised employer consultation regarding less irritating cleaning products if feasible.

Education: Reviewed hand care regimen including gentle cleansers (Cetaphil or CeraVe), patting hands dry rather than rubbing, immediate emollient application after washing. Discussed importance of protective gloves at work and during home chores involving water or chemicals.

Follow-up: Return in 3 weeks to assess treatment response. If inadequate improvement, will consider patch testing to rule out allergic contact dermatitis component. Discussed that job modification or change may ultimately be necessary if condition proves refractory. Patient to contact office if develops signs of infection (increased warmth, purulence, fever) or if condition worsens significantly before scheduled follow-up.

Key Components Insurance Companies Look For in Eczema SOAP Notes

When reviewing your eczema documentation, insurance companies specifically want to see:

1. Severity Assessment

Use validated scoring systems like EASI, IGA, or BSA percentage. Document impact on quality of life and daily functioning using DLQI when appropriate.

2. Treatment History and Failures

For prior authorizations, document specific medications tried, duration of treatment, and reason for inadequacy. Insurance typically requires failure of topical corticosteroids and at least one other topical agent before approving biologics.

3. Body Surface Area Documentation

Clearly state percentage of body surface area affected. This is critical for justifying systemic therapies and biologics.

4. Functional Impact

Document sleep disruption, work/school impairment, psychological impact, and effect on activities of daily living.

5. Infection Screening

Note presence or absence of secondary bacterial infection, as this affects treatment decisions and may require antibiotic therapy.

6. Patient Education

Document counseling on trigger avoidance, proper application techniques, moisturization regimen, and when to seek urgent care.

Common Mistakes to Avoid

Vague Severity Documentation: Instead of "moderate eczema," document specific EASI score or BSA percentage with description of lesion characteristics.

Inadequate Treatment Failure Documentation: List specific medications, dosages, duration tried, and why they failed when justifying biologics.

Missing Quality of Life Impact: Insurance wants to see how disease affects functioning, not just clinical appearance.

Forgetting Distribution: Always document which body areas are affected and whether pattern is typical for atopic dermatitis.

No Infection Assessment: Always note presence or absence of signs of secondary infection.

Skipping Trigger Discussion: Document identified triggers and counseling provided on avoidance strategies.

Final Thoughts

Eczema SOAP notes don't need to be overwhelming.

They need to be thorough, yes, but they don't need to consume your life.

The key is having a system that captures severity assessments, treatment history, and quality of life impact without making you feel like a secretary instead of a clinician.

Whether you write them manually or use a tool like soapnotes.doctor, the goal is the same: clear documentation that serves your patient and satisfies insurance requirements, especially for those prior authorization battles.

Your time is better spent caring for patients than fighting with documentation.

That's exactly why we built this tool.

Try it out, see how much time you get back, and let me know what you think.

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