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Atopic eczema

Eczema is a condition in which your skin becomes inflamed and itchy. Atopic eczema is the most common type of eczema, affecting up to one in 10 adults and two in 10 children in the UK.

The term ‘atopic’ means you have inherited the tendency to develop allergic conditions, including asthma, hay fever and eczema. Atopic eczema commonly affects parts of your body where your skin creases, such as the backs of your knees and the inside of your elbows. It may also affect your chest, face and neck.

Atopic eczema usually starts in childhood, and may improve as you get older. But it may also appear for the first time in adults and older people

Atopic eczema is the most common type of eczema, but there are several other types.

  • Allergic contact eczema – this is when certain substances cause an allergic reaction when you come into contact with them.
  • Discoid eczema – this causes very itchy coin-shaped patches of red, inflamed skin, usually on your arms or legs.
  • Irritant contact eczema – you may get this if you’re in frequent contact with substances that damage the surface of your skin, such as cleaning products.
  • Seborrhoeic eczema – this causes inflammation on areas of your skin that are often hairy and more greasy or oily – such as your eyebrows, scalp and chest.
  • Varicose eczema – if you have varicose veins in your legs, this can affect the skin around them.
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  • Symptoms Symptoms of atopic eczema

    Atopic eczema causes areas of your skin to become very itchy. Your skin may also be:

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

    Eczema usually begins in children, and often develops in babies before they turn one year old. If your baby has eczema, their cheeks may become red and sore. The eczema may then start to spread. It often affects behind the knees, elbows and neck folds. Eczema clears up in around three-quarters of children by the age of 15 years.

    If your skin isn’t itchy, something else is likely to be causing your symptoms other than atopic eczema. If you have any of the symptoms described here or notice them in your child, see your GP for advice.

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  • Diagnosis Diagnosis of atopic eczema

    Your GP will be able to tell if you have eczema by looking at your skin and asking you some questions about your symptoms. They’ll also ask you about your medical history.

    Your GP will usually be able to treat your eczema, but they may refer you to a dermatologist (a doctor who specialises in identifying and treating skin conditions) if your eczema is severe or infected.

  • Treatment Treatment of atopic eczema

    If you had atopic eczema as a child, you may find it improves as you get older. However, certain triggers may still cause it to flare up. There are many different ways of keeping your eczema under control, depending on how severe your symptoms are.


    Keeping a diary about your eczema symptoms may help you spot any triggers that make your eczema worse. Common triggers include stress, pets and temperature changes.

    If your eczema becomes itchy, try not to scratch it. Scratching can make your eczema worse and may cause your skin to thicken. Anti-scratch mittens for babies and young children can be helpful. If you need to relieve an itch, gently rub your skin with your fingertips instead of using your nails. Keep your nails short.

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


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


    Emollients soothe and soften dry skin. They moisturise your skin by preventing water loss and adding water back into your skin. They can also help to repair any skin damage. Using emollients can ease itching and prevent your skin becoming infected.

    Emollients are most effective at preventing flare-ups of eczema if you use them all the time, even when you don’t have any eczema symptoms. Apply them as often as you need to – ideally at least every four hours or up to three to four times a day. It can also really help to use emollients during and after a bath or shower.

    Smooth emollients onto your skin rather than rubbing them in. Always apply them in the direction of hair growth. This will reduce your risk of developing an infection at the bottom of your hair follicles.

    Emollients are available as creams, lotions, oils or washes. There are many different types of emollient. 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

    Emulsifying ointment, BP

    Hydrous ointment, BP

    Liquid and White soft paraffin ointment, NPF



    Hydromol Cream

    Ultrabase Cream


    Hydromol Ointment

    Zeroderm Ointment

    Dermamist spray application

    Doublebase gel

    QV lotion

    Aveeno colloidal bath additive

    Cetraben emollient bath additive

    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 formulation, such as an ointment rather than a cream. Emollient products containing urea may be particularly helpful for severe eczema or in older people. Don’t use emollients containing antibacterial ingredients unless your skin is infected or your doctor recommends it.

    Different products suit different people. You may have to try several different emollients before you find the best one for you. For emollients that come in pots, use a clean spoon or spatula to get it out when you’re applying the emollient to your skin. This will stop the emollient inside the pot becoming contaminated with bacteria.

    Steroid creams

    Sometimes, emollients on their own aren't able to control your eczema symptoms. If this is the case, you may need to use a steroid cream for a short time. Steroid creams reduce inflammation and help to relieve itching. There are different strength steroid creams, from mild to 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 their advice about how much to use. You can apply a steroid cream directly to your skin, but only use it on areas with visible eczema. You will usually only need to apply the cream once a day. However, if this doesn’t help to relieve your symptoms, your GP or dermatologist may recommend using the cream twice a day.

    Always continue using your emollients while you are using the steroids. You can use steroid creams before or after applying your emollient, but you need to leave around half an hour between applying the two different 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, your GP or dermatologist may prescribe some other medicines. These include the following.

    • Topical immunosuppressants, such as tacrolimus or pimecrolimus. These are creams and ointments that help to reduce inflammation. Topical means you apply it to your skin. Your doctor may prescribe them if you have severe eczema and topical corticosteroids aren’t helping. They’re suitable for adults and children over the age of two years.
    • Antibiotics, such as flucloxacillin or erythromycin. Your doctor may prescribe these if your eczema has become infected. You may be prescribed antibiotic tablets or creams, depending on how severe the infection is.
    • Oral immunosuppressant medicines, such as methotrexate, ciclosporin or azathioprine. These reduce the activity of your immune system to treat inflammation. They’re taken as tablets and can only be prescribed by dermatologists specialising in the treatment of severe eczema.
    • Oral steroids, such as prednisolone tablets. These can be very effective for severe eczema, but aren’t recommended for most people. Your doctor may suggest trying them if other treatments haven’t helped – and you’ll be prescribed them for as short a time as possible. 
    • Antihistamine tablets. These can sometimes be useful to reduce irritation and itching, especially if you’re having trouble sleeping at night. You shouldn’t keep taking them for a long time, though.

    Other therapy

    If you have severe eczema, you may need to use medicated paste bandages to soothe and protect your skin. These contain emollients and other medicines, such as ichthammol, to help relieve itching and reduce thickening of your skin. You usually apply them to your arms or legs, and they act as a barrier to prevent scratching.

    Your doctor may also recommend using wet wraps, which are cooling bandages that can help to soothe severe eczema. Once you have smoothed an emollient onto your skin, you cover the emollient with wet bandages and then a layer of dry bandages. These wet wraps help to prevent you from scratching and allow your skin to absorb as much of the emollient as possible. These are often useful when treating young children with severe eczema, particularly at night. Don’t use bandages or wet wraps if your eczema is infected because this can cause the infection to spread.

    Your doctor may suggest trying ultraviolet light (UV) treatment (phototherapy), to relieve your symptoms. This is usually given in hospital by a dermatologist.

    Complementary therapies

    Some people consider trying complementary treatments, such as herbal creams and homeopathy. But there isn’t any good evidence that these therapies are effective in treating eczema. If you do try them, remember that even products marketed as ‘natural’ aren’t necessarily harmless. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects. Always speak to your pharmacist or GP before trying complementary therapies. If you do decide to try a complementary therapy, check that your therapist belongs to a recognised professional body.

  • Causes Causes of atopic eczema

    There’s no single known cause for eczema, but people who have it tend to inherit a tendency to develop it from their parents. If you have eczema, you may also have a tendency to develop asthma and hay fever as well. Eczema isn’t infectious, so you can’t catch it from anyone else.

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

    Common triggers may include:

    • stress
    • allergens, such as pollen, house dust mites, mould or pet dander (fur or hair)
    • food allergies – especially cow’s milk and egg in babies
    • irritants, such as cosmetics, detergents, soaps or shampoo
    • rough clothing fabrics, such as wool
    • sweat
    • changes in temperature
    • 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 for food allergies to cause eczema in adults. However, certain food or drink, such as milk, eggs, soya, nuts, wheat or fish, 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.

  • Complications of atopic eczema Complications of atopic eczema

    If you have atopic eczema, you may occasionally develop a bacterial skin infection. This occurs when Staphylococcus aureus bacteria, which normally live on your skin, enter through cracks in your dry skin. Your skin may be very red, ooze and crust and won’t respond to your usual eczema treatments. Your doctor can prescribe a short course of oral antibiotics to treat the infection. Your doctor may also suggest that you use emollients containing antibacterial ingredients until the infection clears up.

    Eczema herpeticum is a condition caused by a virus, in which your eczema becomes very painful and rapidly gets worse. It usually causes clusters of blisters, and you may also have a fever and not as much energy as usual. Your doctor may prescribe an anti-viral medicine called aciclovir, and refer you to a dermatologist.

  • Living with atopic eczema Living with atopic 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 for more than two weeks can lead to deficiencies of essential nutrients. Prolonged dietary changes in adults or any dietary changes in children should only be considered 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.
  • FAQ: Can I go swimming with eczema? FAQ: Can I go swimming with eczema?


    Yes, you can go swimming if you have eczema. You might need to take some precautions, though, as the water and chlorine from the swimming pool may irritate your skin and make your eczema worse.


    How swimming will affect your eczema will depend on how severe your eczema is, how much chlorine there is in the swimming pool and how long you spend in the pool. If the swimming pool contains a lot of chlorine, it’s more likely to irritate your skin.

    To reduce the harmful effects that swimming may have on your skin, apply a thick layer of emollient before you swim. Shower straight after swimming to rinse the chlorinated water off your skin. Apply more emollient after swimming once you have dried. You may need to use extra emollient or a steroid cream if you find that swimming has made your eczema worse.

    You may find that your eczema improves after swimming in an outdoor pool in the summer. This is because your skin is being exposed to the Sun without the heat. If you’re swimming outdoors, make sure you wear waterproof sunscreen.

  • FAQ: Can the sun make my eczema better? FAQ: Can the sun make my eczema better?


    Yes, many people find that their eczema improves when they’ve been out in the sun. Don’t spend too long in the sun though, and remember to protect your skin by using sunscreen.


    Ultraviolet (UV) radiation, which is given off by the sun, reduces inflammation of your skin. This may help to clear your eczema symptoms temporarily – but it isn’t a cure.

    Too much UV radiation can cause sunburn, cause your skin to age prematurely and increase your risk of skin cancer. Because of this, you need to be careful not to stay in the sun for too long and you should always wear sunscreen. When using sunscreen, apply your emollient first then wait at least 30 minutes before applying your sunscreen. Mixing the two types of creams or lotions may change how well the ingredients in either of them work.

    You can have special medical UV-light treatment for your eczema, called phototherapy. Controlled doses of UV radiation are applied to your skin over several weeks. The dose of UV radiation that you’re given is increased gradually so that your skin doesn’t burn. This treatment is given in hospital, usually by a dermatologist, if you have severe eczema. Your GP will be able to advise you on whether this would be a suitable treatment for you.

  • FAQ: Could my eczema be caused by a food allergy? FAQ: Could my eczema be caused by a food allergy?


    It’s rare for food allergies to cause eczema in adults, but certain foods may cause eczema flare-ups.


    You may find that certain foods or drinks cause your eczema to get worse. It’s rare that diet alone will trigger your eczema though, so you’re unlikely to be offered a food allergy test.

    Young children under the age of three years who have eczema are more likely to have a food allergy such as cow’s milk or eggs. But it’s unclear how this affects eczema. Children may find that their eczema gets better as they get older, whether they have food allergies or not. To help spot certain triggers, try to keep a diary, noting down what you eat and drink, and your eczema symptoms. If you suspect that your child has a food allergy, it’s essential to speak to your GP. You shouldn’t exclude foods from your child’s diet without medical advice or without advice from a dietitian.

    If you’re pregnant or breastfeeding, don’t change your diet without advice from your GP or dietitian.

  • FAQ: What side-effects may I get from using steroid creams to treat my eczema? FAQ: What side-effects may I get from using steroid creams to treat my eczema?


    Using too much of potent steroid creams can cause side-effects, such as thinning of your skin, stretch marks or acne.


    Most people who use steroid creams find them highly effective and if used correctly, never get any side-effects. If you use these creams too much though, you’re at greater risk of getting certain side-effects. These include:

    • any infections you have on your skin and aren't getting treatment for, getting worse
    • thinning of your skin – this may be reversed after stopping treatment but your skin may never recover completely
    • stretch marks and broken veins
    • acne or rosacea
    • changes in skin colour
    • excess hair growth on your skin

    You can reduce your chances of these side-effects by applying a steroid cream in a thin layer to only the affected areas of your skin. If you have any concerns about how much steroid cream to use or if you feel you’re developing side-effects, see your GP. They may recommend a different treatment, or refer you to a dermatologist to discuss alternative treatment options.

  • FAQ: Will stress make my eczema worse? FAQ: Will stress make my eczema worse?


    No-one knows for sure how stress relates to eczema symptoms. Each person with eczema is different and reacts differently to certain triggers, but you may find that your symptoms are worse when you feel stressed.


    Sometimes, things happen in your life that can make you feel stressed, such as changes in your job situation, a house move, divorce or bereavement. It’s possible that the combination of your usual triggers with added stress is causing a flare-up of your eczema. Continue with your usual treatments, including emollients, and see your GP or dermatologist if your symptoms don’t start to clear up within a few days. If your eczema is causing you to feel very itchy, it can disturb your sleep and begin to affect your quality of life.

    Getting the right treatment for you will help to ease your eczema symptoms. To avoid scratching when you feel itchy, distract yourself by moving into a different room or changing activity. Deep breathing, muscle relaxation and imagery (using your imagination to think of a relaxing scene) may help you relax and reduce your stress levels. See your GP or dermatologist for advice if you think stress may be affecting your eczema.

  • Resources Resources

    Further information


    • Atopic eczema (dermatitis). The Merck Manuals., reviewed October 2014
    • Dermatology. Oxford handbook of general practice (online). Oxford Medicine Online., published April 2014
    • Atopic dermatitis and eczema. PatientPlus., reviewed 12 February 2015
    • Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12 years. National Institute for Health and Care Excellence (NICE), December 2007.
    • Management of atopic eczema in primary care. Scottish Intercollegiate Guidelines Network (SIGN), March 2011.
    • Allergic contact dermatitis. Medscape., reviewed 19 March 2014
    • Nursing patients with dermatology and skin problems. Oxford handbook of adult nursing (online). Oxford Medicine Online., published August 2010
    • Irritant contact dermatitis. Medscape., reviewed 16 April 2014
    • Seborrheic dermatitis. Medscape., reviewed 28 April 2014.
    • Baron S, Cohen SN, Archer CB, et al. Guidance on the diagnosis and clinical management of atopic eczema. Clini Exp Dermatol. 2012; 37(S1):7–12. doi: 10.1111/j.1365-2230.2012.04336.x
    • Eczema – atopic. NICE Clinical Knowledge Summaries., reviewed March 2013
    • Joint Formulary Committee. British National Formulary (online). London: BMJ Group and Pharmaceutical Press., accessed 19 March 2015
    • Therapy-related issues: skin. Oxford handbook of clinical pharmacy (online). Oxford Medicine Online., published January 2012
    • Ernst E. Homeopathy for eczema: a systematic review of controlled clinical trials. Brit J Derm 2012; 166:1170–72
    • Zhang W, Leonard T, Bath-Hextall FJ, et al. Chinese herbal medicine for atopic eczema. Cochrane Database of Systematic Reviews 2013, Issue 9. doi:10.1002/14651858.CD002291.pub4.
    • Atopic dermatitis. Medscape., reviewed 8 December 2014
    • Drug safety update: aqueous cream: may cause skin irritation. Medicines and Healthcare Products Regulatory Agency (MHRA)., published 25 March 2013
    • Eczema and swimming factsheet. National Eczema Society., published September 2014
    • Sunburn. PatientPlus., reviewed 18 March 2011
    • Berglind A, Alderling M, Meding V. Life-style factors and hand eczema. Br J Derm 2011; 165(3):568–75
    • Childhood atopic eczema – your questions answered. National Eczema Society., published November 2014
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    Reviewed by Pippa Coulter, Bupa Health Content Team, June 2015

    Peer reviewed by Mike Arden-Jones, Associate Professor and Consultant Dermatologist.

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