Eczema

Published by Bupa's Health Information Team, May 2011.

This factsheet is for people, or parents of children, who have atopic eczema, or who would like information about it.

Eczema, also known as dermatitis, describes a group of skin conditions where the skin is inflamed and itchy. There are many types of eczema – the most common is atopic eczema.

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

The term ‘atopic’ refers to a family tendency to develop a variety of allergic conditions including asthma, hay fever and eczema. Atopic eczema is an itchy skin condition that commonly affects parts of your body where the skin creases, such as the backs of your knees and the front of your elbows, as well as your chest, face and neck. In the UK, up to one in five children and one in 12 adults get atopic eczema.

Irritant contact eczema

Irritant contact eczema is caused by frequent contact with substances that damage the surface of your skin. Substances such as detergents or cleaning products are common irritants.

Allergic contact eczema

Allergic contact eczema develops when substances come into contact with your skin and cause an allergic reaction of the skin. Nickel, perfume and hair dye are common substances that may cause allergic contact eczema.

Seborrhoeic eczema

Seborrhoeic eczema is thought to be caused by a reaction to a yeast called malassezia. Malassezia is present on the surface of everyone’s skin, but people with seborrhoeic eczema seem to have more of it. Seborrhoeic eczema causes inflammation on areas of your skin that tend to have hair growing from them and are more greasy or oily – such as your eyebrows, nose and scalp.

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 the ankle, often affecting both legs and is common in older people.

Discoid eczema

Discoid eczema is disc-shaped patches of inflammation of the skin. It can occur at any age, but most commonly in later life. The cause is unknown but it’s often harder to treat that than other types eczema.

Symptoms of eczema

Symptoms may differ depending on the type and severity of your eczema. 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 eczema

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

There are many possible causes of atopic eczema and these often affect people in different ways. 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, or your child’s, atopic eczema worse.

Common triggers may include:

• chemicals such as detergents, soaps or shampoo
• irritants such as pollen, house dust mites, mould or pet dander (fur or hair)
• rough clothing fabrics, such as wool
• sweat
• stress
• changes in hormone levels, for example at different times in your menstrual cycle or if you’re pregnant
• being run-down, for example if you have a cold
• bacteria such as Staphylococci

It’s rare but certain food or drink, such as milk, eggs, soya, nuts or wheat, may cause some people’s eczema to flare up.

You may find the severity of your eczema varies throughout the year. Some people may find their eczema improves over the summer months and gets worse during winter.

Diagnosis of eczema

Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may rub a sterile swab (cotton bud) on your skin to check for infections.

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).

Treatment of eczema

Some children who get atopic eczema find it improves as they get older, although certain triggers may still cause it to flare up.

Self-help

Try to keep a diary about your eczema symptoms to help spot any triggers that may make your eczema worse. Scratching can also make your eczema worse and make your skin feel more itchy. You may damage your skin, causing it to bleed and become infected.

Try to resist the temptation to scratch. Keep your nails short, and if you tend to scratch at night, wear gloves when sleeping. Anti-scratch mittens for babies and young children can also be helpful. If you need to relieve a scratch, rub the skin with your fingers 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.

Medicines

There are a range of medicines available from your GP or pharmacist to help control your, or your child’s, symptoms of eczema, although there is no cure. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Emollients
Emollients are moisturisers that soothe and add water to (hydrate) the skin. They reduce the dryness of your skin and ease itching. This can help to prevent flare-ups of eczema. 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 lotions, oils or washes as often as you need. There are many different types of emollient, including aqueous cream or emulsifying ointment, that can be used on the whole of your body. You may have to try different emollients before you find the best one for you.

Steroid creams
These creams contain steroids, such as hydrocortisone, which reduce inflammation and help to relieve itching. There are different strength steroid creams available. Apply steroid creams thinly over your skin and use the mildest cream that works for you. You can apply them directly to your skin, but only on the areas that have symptoms. They’re usually applied once or twice a day. Spread the cream thinly over your skin and use emollients before steroid creams. Wait at least 15 minutes between applying them. Mild steroid creams are available over the counter, but ask your pharmacist for advice.

Stronger steroid creams, such as betamethasone (eg Betnovate) 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’s advice about using steroid creams.

Prescription medicines

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

• Topical immunosuppressants, such as tacrolimus (eg Protopic) or pimecrolimus (eg Elidel) are creams or ointments that you apply to your skin to reduce inflammation. You may be prescribed these if other treatments haven’t worked or if you can’t use them because of their side-effects. These are new treatments that don’t contain steroids so they may have fewer side-effects.
• Oral steroids, such as prednisolone, are available as tablets to treat severe eczema. You will be prescribed these for as short a time as possible but they should be used as a last resort.
• Antibiotics, such as flucloxacillin or erythromycin, are used if your eczema has become infected.
• Antihistamine tablets are not often recommended, but if your eczema is stopping you from sleeping, they may be useful to reduce irritation and itching.

Hospital treatment

If you have severe eczema, you may need to see a dermatologist for treatment. This may include 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.

Wet wraps are cooling bandages that can help to soothe severe eczema. These are wet bandages soaked in emollients and steroid 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.

For some people with eczema, ultraviolet light treatment known as phototherapy is helpful. This is usually given in hospital by a dermatologist.

Oral immunosuppressant medicines, such as ciclosporin or azathioprine, are available as tablets for severe eczema.

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. Always speak to your GP before trying complementary therapies. If you do decide to try complementary therapy, check that your therapist belongs to a recognised professional body.

Living with eczema

Eczema can be managed by dealing with things that make it worse. You may find it useful to keep a diary of what triggers your, or your child’s eczema.

If 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, calcium or protein. It should only be considered for children under the supervision of your GP or a dietitian.

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

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

For sources and links to further information, see Resources.