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Eczema

Key points

  • Eczema is a skin condition in which your skin is inflamed and itchy.
  • As well as itching, your skin may be very dry and cracked.
  • Treatments include emollients (moisturisers) and steroid creams.
  • You can help prevent eczema flare-ups by avoiding things that you know trigger your symptoms.

Eczema, also known as dermatitis, describes a group of skin conditions in which your skin is inflamed and itchy.

About eczema

Eczema can develop anywhere on your body. There are various types of eczema, all with slightly different causes and symptoms. This factsheet will focus on atopic eczema but other types are also described.

Atopic eczema is the most common type of eczema. It’s an itchy skin condition that commonly affects parts of your body where your skin creases, such as the backs of your knees and the inside of your elbows, as well as your chest, face and neck. The term ‘atopic’ refers to having family tendency to develop a variety of allergic conditions, including asthma, hay fever as well as eczema.

In the UK, up to two in 10 children and up to one in 10 adults have atopic eczema. It affects men and women equally.

Other types of eczema

Allergic contact eczema

If substances come into contact with your skin and cause an allergic reaction, you may develop allergic contact eczema. Nickel, perfume and hair dye are common substances that may cause allergic contact eczema.

Discoid eczema

It’s unknown what causes discoid eczema but it’s often harder to treat than other types of eczema. Disc-shaped patches of inflammation appear on your skin and it can occur at any age, but most commonly in middle age.

Irritant contact eczema

If you’re in frequent contact with substances that damage the surface of your skin, this can cause irritant contact eczema. Substances such as detergents or cleaning products are common irritants.

Seborrhoeic eczema

This is thought to be caused if your immune system reacts to a yeast called Malassezia. Seborrhoeic eczema causes inflammation on areas of your skin that are often hairy and more greasy or oily – such as your eyebrows, scalp and chest. You can get seborrhoeic eczema at any age and it’s often so mild that you don’t notice it.

Varicose eczema

If you have varicose veins in your lower leg, this type of eczema affects the skin over and around them. It’s usually worse around your ankle, often affecting both legs and is common in older people, especially women.

Symptoms of atopic eczema

Symptoms of atopic eczema are often described by how your atopic eczema looks. If you have atopic eczema, your skin may be:

  • red or inflamed
  • dry
  • cracked or broken
  • itchy
  • thickened

It’s common to get an itchy rash in the skin creases of your knees or elbows. If your eczema becomes itchy, try not to scratch it. Scratching can damage and break your skin, which can lead to an infection.

These symptoms may be caused by problems other than atopic eczema. If you have any of them, see your GP for advice.

Causes of atopic eczema

Eczema isn’t infectious, so you can’t catch it from anyone else.

You can inherit a tendency to develop atopic conditions such as eczema, asthma and hay fever.

Although eczema can flare up for no obvious reason, you may notice certain triggers that make your atopic eczema worse.

Common triggers may include:

  • infections caused by bacteria such as Staphylococcus aureus
  • allergens, such as pollen, house dust mites, mould or pet dander (fur or hair)
  • irritants, such as detergents, soaps or shampoo
  • rough clothing fabrics, such as wool
  • sweat
  • stress
  • if you’re a woman, changes in hormone levels, for example at different times in your menstrual cycle or if you’re pregnant

It’s rare but certain food or drink, such as milk, eggs, soya, nuts or wheat, may cause your eczema to flare up. For more information, see our FAQs.

You may find the severity of your eczema varies throughout the year. Your eczema may improve over the summer months because of increased exposure to sunlight and get worse during winter when the air is drier or vice versa.

Diagnosis of eczema

Your doctor will ask you about your symptoms and examine your skin. If your GP suspects your eczema may be infected, he or she may rub a sterile swab (cotton bud) over the affected area on your skin. This will be sent to a laboratory to find out what is causing the infection.

You will usually be treated by your GP, but he or she may refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions) if your eczema is severe or infected.

Treatment of atopic eczema

If you had atopic eczema as a child, you may find it improves as you get older, although certain triggers may still cause it to flare up.

Self-help

Keeping a diary about your eczema symptoms may help you spot any triggers that may make your eczema worse.

Scratching can make your eczema worse and make your skin feel more itchy. Anti-scratch mittens for babies and young children can be helpful. If you need to relieve an itch, rub the skin with your fingertips instead of using your nails. You may want to put something cold onto the area, such as ice cubes or frozen peas wrapped in a towel, to relieve itching. Don’t apply ice directly to your skin as it can damage your skin.

If your eczema isn’t getting better, it’s especially important to avoid skin irritants such as soaps, shower gels and bubble baths.

Medicines

Although there isn’t a cure for eczema, there are a range of medicines available from your GP or pharmacist to help control your symptoms. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Emollients

Emollients are moisturisers that prevent water loss from your skin and can also help repair your skin. They reduce the dryness of your skin and ease itching. Emollients also help to prevent your skin becoming infected. Emollients are most effective at preventing eczema when they are used frequently, even when you don’t have eczema symptoms.

You can apply emollients directly to your skin as creams, lotions, oils or washes as often and as much as you need. There are many different types of emollient that can be used on the whole of your body. Examples are shown in the table below.

Non-branded products Branded creams Branded ointments Branded gels, lotions, and sprays Branded washes and bath and shower additives

Aqueous cream, BP

Emulsifying ointment, BP

Hydrous ointment, BP

Liquid and White soft paraffin ointment, NPF

Aveeno

E45

Hydromol Cream

Vaseline Dermacare

Epaderm

Hydromol Ointment

Kamillosan

Dermamist spray application

Doublebase gel

QV lotion

Aveeno colloidal bath additive

Cetraben emollient bath additive

Imuderm bath oil

Oilatum emollient bath additive

Generally, most emollients will help improve the appearance of your eczema. However, if your eczema is severe, you may need to try a greasier emollient, such as an ointment. You may have to try several different emollients before you find the best one for you. For emollient that comes in pots, use a clean spoon or spatula to remove it when you’re applying it to your skin.

Steroid creams

These creams contain steroids, such as hydrocortisone, which reduce inflammation and help to relieve itching. There are different strength steroid creams, from mild and moderate, to potent and very potent. Mild steroid creams (such as hydrocortisone) are available over the counter. Your pharmacist can offer advice about how much you can use and how often you can apply it. Use the mildest cream that works for you.

If your GP prescribes a steroid cream, always follow his or her advice about how much to use. You can apply them directly to your skin, but only on areas that have symptoms. They’re usually applied only once a day. However, if this doesn’t help to relieve your symptoms, your GP or dermatologist may recommend using them twice a day.

You can use steroid creams before or after applying your emollient, but you need to leave at least half an hour between applying the two creams. This prevents the active ingredients in your steroid cream from being diluted by your emollient.

Potent or very potent steroid creams, such as betamethasone valerate, are available on prescription. Using stronger steroid creams too often, or on delicate skin (such as on your face), can thin your skin. This can make your skin bruise more easily. Always follow your GP or dermatologist’s advice about using any type of steroid cream. For more information, see our FAQs.

Other prescription medicines

If emollients or steroid creams don’t help your eczema, there is a range of other medicines your GP or dermatologist may prescribe you.

  • Topical immunosuppressants, such as tacrolimus or pimecrolimus are creams or ointments that you apply to your skin to reduce inflammation. These new treatments don’t contain steroids so won’t cause thinning of your skin. You may notice a burning sensation or redness on your skin when you first start to use the cream. This side-effect usually clears up after about a week of using the cream.
  • Antibiotics, such as flucloxacillin or erythromycin, are used if your eczema has become infected. For large areas of infected eczema, you’re likely to be prescribed antibiotic tablets. For smaller areas, an antibiotic cream may be prescribed.
  • Oral immunosuppressant medicines, such as ciclosporin or azathioprine, are tablets that can be highly effective and are prescribed only by dermatologists specialised in the treatment of severe eczema.
  • Oral steroids, such as prednisolone tablets can be a very effective treatment for severe eczema, but are not recommended for most people. You will be prescribed these for as short a time as possible, but they should only be used as a last resort.
  • Antihistamine tablets are not often recommended, but if your eczema is stopping you from sleeping, they may be useful to reduce irritation and itching.
      

Other therapy

If you have severe eczema, you may need medicated paste bandages to soothe and protect your skin. They contain emollients and other substances, such as ichthammol, to help relieve itching. They’re usually applied to your arms or legs and act as a barrier to prevent scratching. Usually bandaging is only used for up to two weeks to control a flare-up of your eczema.

Another option is using wet wraps, which are cooling bandages that can help to soothe severe eczema. These are wet bandages applied over emollient creams. Dry bandages are placed over the top. These wet wraps help to prevent you from scratching and allow your skin to absorb as much of the creams as possible. These are often useful when treating young children with severe eczema, particularly at night. It’s important to remember not to use bandages or wet wraps if your eczema is infected because this can lead to the infection spreading.

You may find ultraviolet light treatment, known as phototherapy, helpful for relieving your symptoms. This is usually given in hospital by a dermatologist.

Complementary therapies

Some people find that complementary treatments, such as herbal creams and homeopathy, are helpful. However, there is currently little evidence to suggest they are useful in treating eczema. It’s important to remember that natural doesn’t mean harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Always speak to your GP or dermatologist before trying complementary therapies. If you do decide to try a complementary therapy, check that your therapist belongs to a recognised professional body.

Living with eczema

If you think that certain food or drink causes your eczema to get worse, see your GP before you make any changes to your diet. Excluding certain foods from your diet may not improve your eczema and can lead to deficiencies of essential nutrients. Dietary changes should only be considered for children under the supervision of your GP or a dietitian.

The itch from eczema can feel unbearable for some people and lead to sleep loss, stress and depression. You may find it helpful to seek support from charities, such as the National Eczema Society (see further information), who can provide advice on ways to help you cope.

With good management and appropriate treatment, most people are able to control their atopic eczema.

 

Reviewed by Louise Abbott, Bupa Health Information Team, May 2013.

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For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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