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Atopic eczema

Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
Next review due May 2023

Atopic eczema is a condition that makes your skin dry, red and itchy. It’s the most common form of eczema and is often linked to other allergic conditions such as asthma and hay fever.

Photo of atopic eczema on the arm of a baby

About atopic eczema

Atopic eczema affects people in different ways. Some people have only a few small patches of very dry skin, but others have very bad eczema all over their body.

You may have regular flare-ups. This means your skin is itchy, very red and dry for a while but it then settles down. Certain things called ‘trigger factors’ can cause a flare-up. These include harsh soaps and detergents, stress and very hot or cold temperatures.

Atopic eczema affects up to one in 10 adults and two in 10 children in the UK. It often affects babies before they’re six months old, and most people with eczema first get it as a child. Atopic eczema usually gets better over time and may clear up completely once children reach their teens. But adults can get eczema for the first time too.

Atopic eczema tends to run in families. If one or both of your parents have it, you're more likely to have it too. The term ‘atopic’ means the condition is related to allergies. Your family may have other atopic conditions, such as asthma and hay fever. People with atopic eczema are also more likely to have food allergies.

Other types of eczema

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

  • Contact dermatitis – certain substances, such as nickel in jewellery or cleaning products, can make your skin red, dry and itchy, especially on your hands. This may due to an allergy or irritation.
  • Discoid eczema (nummular eczema) – this causes very itchy coin-shaped areas of red skin, usually on your arms or legs. It usually affects middle-aged or older people.
  • Seborrhoeic dermatitis – this tends to affect areas of your skin that are hairy and more greasy or oily – such as your eyebrows, scalp and chest.
  • Varicose eczema (stasis dermatitis) – this affects the skin on your lower legs and is often linked to varicose veins.

Symptoms of atopic eczema

If you have atopic eczema, some areas of your skin will feel very itchy. They may be so itchy that you can’t sleep properly.

Your skin may also get:

  • red or inflamed
  • dry
  • cracked, crusty or scaly
  • thicker than normal, if you keep scratching it

During a flare-up, your skin may also blister and weep fluid.

Eczema can affect different parts of your body. Where you’re affected usually depends on how old you are and how long you’ve had the condition.

  • Babies are most likely to have eczema on their face, scalp and the outsides of their arms and legs.
  • Children and adults who’ve had the condition for a long time often have eczema on the inside of their joints, such as in the bends of their elbows or backs of their knees.
  • Adults with eczema often have generally dry, itchy skin, especially on their hands.

If your skin isn’t itchy, it’s likely that you don’t have atopic eczema. If you’re worried about any of the above symptoms, ask your GP for advice.

Diagnosis of atopic eczema

Atopic eczema is usually easy for your GP or other healthcare professionals to recognise. If your baby has symptoms of eczema, it may be spotted by your health visitor or practice nurse.

Your GP will usually check your skin and asking you some questions about your symptoms. They’ll also want to check if you or a close family member have ever had asthma or hay fever. It’s common for people to have atopic eczema, asthma and hay fever at the same time.

Your GP will see how bad your eczema is. They'll also ask about how it affects your daily life, including how well you’re sleeping.

Your GP will usually be able to treat your eczema. But if they’re not completely sure what’s causing your symptoms, they may refer you to a dermatologist (a specialist skin doctor). Your GP may also refer you if your eczema doesn't respond to standard treatments or if your skin keeps getting infected.

Self-help for atopic eczema

Your GP will give you some advice on how to keep your (or your child’s) eczema under control. They'll also talk to you about how you can recognise and manage flare-ups.

Trigger factors

Your GP can help you find out what could be triggering your eczema. Avoiding these triggers may help to ease your symptoms. Here are some common triggers.

  • Irritants in soaps and detergents. Use soap substitutes instead, and wash clothes with a non-biological detergent.
  • Synthetic fibres and wool. Try to wear loose, cotton clothing as much as possible.
  • Extremes of temperature. Most people find their eczema gets better in the summer and worse in the winter. Sweating can make eczema worse too.
  • Skin infections. Avoid close contact with anyone who has an active cold sore.
  • Female hormones. Some women find their eczema gets worse before their periods or during pregnancy.
  • Dust, pets and pollen. Don't keep pets if you know you’re allergic to them.
  • Teething in babies.
  • Stress, a lack of sleep and being ill – for example, having a cold.

Dealing with flare-ups

If your eczema gets itchy, try not to scratch it. Scratching can make your eczema worse and may make your skin get thicker.

If you feel itchy, try smoothing a moisturiser onto your skin instead. If you need to relieve the itch, rub your skin gently with your fingertips rather than your nails. Keep your nails short – use anti-scratch mittens for babies.

Treatment of atopic eczema

Atopic eczema can’t be cured. But you can use lots of different treatments to help control your symptoms and prevent flare-ups. Always ask your pharmacist or GP for advice, and read the patient information leaflet that comes with your products.

Emollients

Emollients are the main treatments for eczema. These special moisturisers work by hydrating and soothing your skin and helping to repair any damage. They can ease pain and itching and stop your skin getting infected.

Your doctor can prescribe emollients, but you can also buy some products from pharmacies. Use your emollients all the time, even when you don’t have any symptoms.

Types of emollient

Emollients are available as:

  • creams
  • ointments
  • gels
  • lotions
  • sprays
  • washes
  • bath and shower products

You may need to try several different emollients before you find the best one for you. You may need to use one product during flare-ups and a different one when you don't have symptoms. You may need to use several products, such as emollient bath or shower products with a moisturising cream or lotion.

Occasionally your doctor may suggest you use a special emollient with an extra ingredient.

  • Lauromacrogols may help to ease itchy skin.
  • Antiseptics may help to prevent bacterial infections.

How to use emollients

Your doctor will tell you how to use your emollients. But here are some key tips.

  • Make sure you're applying a generous amount – most people don't use enough emollient. As a guide, you should be using around 250g to 500g of emollient each week.
  • Apply your emollients as often as you can – ideally three or four times a day. It's a good idea to keep some emollient at work or at your child's school or nursery.
  • Use emollients during and after washing. Apply them after gently drying your skin, while your skin is still damp.
  • Smooth emollients onto your skin rather than rubbing them in. Always apply them in the direction of hair growth.
  • Don't share your emollient with anyone else. If it comes in a pot, use a clean spoon or spatula to get it out each time. This will stop the emollient inside the pot getting contaminated with bacteria.

Safety advice

When you’re using emollients, it’s important to keep away from fire, flames and cigarettes. Clothes, bedding and other fabrics that have been in contact with emollients (even if they don’t contain paraffin) could catch fire. Washing fabrics at high temperatures may reduce the build-up of emollients but won’t remove them completely. You should also be careful if you’re using emollients on large areas of your skin.

Steroid creams, ointments and gels

If emollients aren’t controlling your eczema on their own, your doctor may prescribe a corticosteroid cream, ointment or gel to use for a short time. These medicines are called ‘topical steroids’. They ease inflammation (redness) and itching.

Steroid creams, ointments and gels are available in several different strengths. Your doctor will tell you which one to use and how long for. They may suggest you try a mild steroid first, and then move on to a stronger one if you need to. Sometimes, your doctor may ask you to use a topical steroid more regularly to prevent flare-ups.

It’s important to apply only a small amount of steroid cream, ointment or gel to the affected areas of your skin. Your doctor will show you how much to use. Keep using your emollients as well. Ideally, apply your emollient first, then wait around 15 to 30 minutes before applying the steroid.

Side-effects

Steroid creams, ointments and gels are safe to use if you stick to the instructions. But sometimes they can cause side-effects, especially if you use them too much, for too long or in the wrong area. These side-effects may include:

  • worsening of any untreated infections on your skin
  • thinning of your skin – this may get better after you stop treatment
  • permanent stretch marks
  • acne or rosacea, or worsening of any existing acne
  • changes in skin colour
  • too much hair growth

If you’re worried about using steroids on your skin or think you’re getting side-effects, speak to your doctor or pharmacist.

Bandages and wet wraps

If your eczema is very bad, your doctor may recommend specially medicated bandages or wet wraps. You use these with emollients, steroid creams and other medicines to stop the creams rubbing off. They also act as a barrier to stop scratching.

Other treatments for eczema

Sometimes your doctor may prescribe extra treatments to use with emollients and steroid creams. These include:

  • antibiotic tablets or creams if your eczema is infected
  • antihistamine tablets if you’re finding it hard to sleep at night

If your eczema is very bad and emollients or steroid creams aren’t working, your GP or dermatologist may suggest some other treatments too.

  • Topical immunosuppressants, such as tacrolimus or pimecrolimus. These creams and ointments help to reduce inflammation.
  • Oral immunosuppressant medicines, such as methotrexate, ciclosporin or azathioprine. These tablets reduce the activity of your immune system.
  • Light therapy (phototherapy) – this uses ultraviolet light (UV).This is usually given in hospital by a dermatologist.
  • Oral corticosteroids such as prednisolone tablets. You may be prescribed a short course if you have a very bad flare-up and are waiting to see a dermatologist.
  • Biologics such as dupilumab (Dupixent). You have injections under your skin, normally every other week.

Complementary therapies

Some people try complementary treatments, such as herbal creams and homeopathy, to ease their eczema. But these therapies haven't been assessed properly in clinical trials. If you do decide to try them, tell your doctor and keep using your usual emollients too.

Products that claim to be ‘natural’ aren’t necessarily safe to use. Herbal remedies contain active ingredients and may interact with other medicines or cause side-effects.

Causes of atopic eczema

Doctors don’t yet know exactly why some people have eczema and others don’t. This condition is caused by changes in your skin, which mean it doesn’t hold water as well as it should. This may be partly due to your genes – people with eczema tend to be more likely to have the condition if their parents do too.

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

Certain ‘trigger factors’ can make your eczema flare up. See our section on self-help for atopic eczema.

Complications of atopic eczema

People with atopic eczema can be prone to bacterial skin infections. If you have an infection, your skin may be very red, ooze and crust over. At the same time, your usual treatments won’t make it better. Your doctor can prescribe a short course of antibiotic tablets. They may also suggest you use emollients containing antibacterial ingredients until the infection clears up.

Eczema herpeticum is caused by a virus called the herpes simplex virus. It is also known as the cold sore virus. This condition can make you feel very unwell. It makes your eczema very sore and you may have clusters of blisters on your skin. It can cause a high temperature too. You may have less energy than usual. Contact a doctor straightaway if you have these symptoms because they’ll get worse if they’re not treated. You may need to go into hospital and have an anti-viral medicine.

Living with atopic eczema

It can be tough living with a long-term skin condition such as eczema. Having eczema can affect your self-confidence, and the itching can feel unbearable, affecting your sleep and mood. But you should be able to control your symptoms if you’re using the right treatments for your skin and following other management advice.

You can still live a normal life if you have eczema, including taking part in sports, swimming and travel. See our FAQ: Can I go swimming with eczema? You may just need to change your daily routine so that you can moisturise your skin regularly. Eczema tends to get better in children as they get older.

If your or your child’s eczema makes you feel down or anxious, speak to your doctor. They may be able to refer you for some counselling. There’s lots of support available for people with eczema. Charities, such as the National Eczema Society, can offer advice on how to cope.

Frequently asked questions

  • Lots of people find their eczema gets better when they’ve been out in the sun. This is because the sun’s ultraviolet rays may reduce inflammation in the skin. But while your eczema symptoms may clear up for a while, this isn’t a cure.

    Don’t spend too long in the sun, and remember to protect your skin with sunscreen. Too much UV radiation can damage your skin and increase your risk of skin cancer. To use sunscreen, apply your emollient first, then wait at least 30 minutes before applying your sunscreen. Mixing the two types of creams or lotions may stop them working properly.

    If other treatments aren’t helping your eczema, your doctor may suggest you have a special type of ultraviolet light therapy called phototherapy. You’ll have controlled doses of UV radiation on your skin over several weeks. The dose of UV radiation is increased slowly so your skin doesn’t burn. This treatment is given in hospital, usually by a dermatologist.

  • You can go swimming if you have eczema. If you want to swim in a swimming pool, you may need to take some precautions because the chlorine in the water may irritate your skin. It may help if you:

    • apply a thick layer of emollient before you swim
    • shower with fresh (not chlorinated) water straight after swimming to rinse off chlorine
    • apply more emollient after gently drying your skin

    You may need to use extra emollient or a steroid cream if swimming makes your eczema worse.

    You may want to avoid swimming if your skin:

    • flares up (is very red or itchy)
    • is infected
  • Food allergies don’t cause eczema but they can sometimes cause flare-ups in young children. Common food triggers include:

    • milk
    • eggs
    • soy
    • wheat
    • peanuts

    If you think certain foods are triggering your child's eczema, keep a food diary for a few weeks. Note down what your child eats and drinks every day and what their eczema symptoms are like.

    If you suspect your child has a food allergy, talk to your doctor. You shouldn’t cut out foods from your child’s diet without advice from your doctor or a dietitian.



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Related information

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    • Therapy-related issues: skin. Oxford Handbook of Clinical Pharmacy. 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published online April 2017
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    • Rheumatology, dermatology and bone health. Atopic eczema. Oxford Handbook of Nutrition and Dietetics. 3rd ed. Oxford Medicine Online. oxfordmedicine.com, published online April 2020
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  • Reviewed by Victoria Goldman, Freelance Health Editor, and Marcella McEvoy, Bupa Health Content Team, May 2020
    Expert reviewer, Dr Anton Alexandroff, Consultant Dermatologist
    Next review due May 2023

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