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Atopic eczema

Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
Next review due January 2021

Atopic eczema is a condition in which your skin becomes dry, red and itchy. The term ‘atopic’ means it's related to an increased allergic response in your body. This type of eczema is also closely linked to other allergic conditions, such as asthma and hay fever.

There are other types of eczema (also known as dermatitis), which are described in the section below. Atopic eczema is the most common type, affecting up to one in 10 adults and two in 10 children in the UK.

Photo of atopic eczema on the arm of a baby

About atopic eczema

If you have atopic eczema, you tend to have regular flare-ups when your skin becomes itchy and inflamed, followed by periods when your symptoms ease. Flare-ups can be caused by certain ‘trigger factors’, such as irritants in soaps and detergents, stress and extremes in temperatures. Atopic eczema can't be cured, but you can keep it under control by managing the symptoms and avoiding any trigger factors. It's also something that tends to get better with time.

Atopic eczema usually starts in childhood. It's common for it to appear in babies before they're six months old, and most people who have it will develop it by age five. Many children find that it clears up by the time they reach their teens, although some will have flare-ups again when they're older. It's also possible to develop atopic eczema as an adult (adult-onset atopic eczema), even if you never had it as a child.

The older you are when you develop the condition, the longer it's likely to persist. If you first develop atopic eczema as a baby, you're more likely to grow out of it within a few years than someone who develops it when they're older.

Atopic eczema tends to run in families. If one or both of your parents have it, you're more likely to develop it too. There's also likely to be a tendency to develop atopic conditions (including eczema, asthma and hay fever) in your family. 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 several other types. These include the following.

  • Contact dermatitis – this is when contact with certain substances causes your skin to become inflamed and itchy. This may either be due to an allergic reaction or to the substance irritating your skin (for instance, cleaning products). It often affects your hands.
  • Discoid eczema, also known as nummular eczema – this causes very itchy coin-shaped patches of red, inflamed skin, usually on your arms or legs. It normally affects middle-aged or elderly people.
  • Seborrhoeic dermatitis – 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, also known as stasis dermatitis – this is associated with having varicose veins in your legs – it can affect the skin around them.

Symptoms of atopic eczema

Atopic eczema causes areas of your skin to become very itchy. It can be itchy enough to disrupt your sleep.

Your skin may also become:

  • red or inflamed
  • dry
  • cracked, crusty or scaling
  • thickened, caused by repeated scratching

During a flare-up, you may also develop blisters and your skin may weep fluid.

The area of your body that's affected often depends on how old you are and how long you've had eczema.

  • Babies are most likely to have eczema on their face, scalp and the outsides of their arms and legs – particularly their wrists and elbows.
  • Children and adults who have had the condition for a long time often have eczema on the inside of their joints, such as in the bends of the elbows or backs of the knees. The neck, wrists and ankles are other areas that are commonly affected.
  • Adults with eczema often suffer from generally dry, itchy skin. Eczema on the hands is also common in adults.

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.

Diagnosis of atopic eczema

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

Your GP will usually be able to tell if you have atopic eczema, just by examining your skin and asking you some questions about your symptoms. They’ll also want to check whether you've ever had asthma or hay fever, or whether there's any history of these conditions in your immediate family. Atopic eczema, asthma and hay fever are all related to an increased allergic response in your body. That means it's common to have more than one of the conditions at the same time.

Your GP will assess how severe your eczema is. They'll also ask questions to assess what impact it's having on your quality of life. For instance, whether it's affecting your sleep, your everyday activities and your general wellbeing.

Your GP will usually be able to treat your eczema, but they may refer you to a dermatologist if there's any uncertainty about your diagnosis. A dermatologist is a doctor who specialises in identifying and treating skin conditions. Your GP may also refer you if your eczema doesn't respond to standard treatments, or if you keep getting infections.

Self-help for atopic eczema

Your GP will give you some advice on keeping your own 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 to identify any factors that may be triggering your eczema. Knowing what triggers your eczema means you can try to avoid those factors when possible, or be prepared for a flare-up when it's not possible. Here are some common trigger factors.

  • Irritants in soaps and detergents. Wash clothes with a non-biological detergent, and use a double rinse cycle on your washing machine. Avoid scented soaps, shampoos, shower gels and bubble baths, and use a soap substitute or products containing emollients instead.
  • Synthetic fibres and wool. These can irritate your skin and exacerbate your eczema. Try to wear loose, cotton clothing when possible.
  • Extremes of temperature. Most people find their eczema improves during the summer, and gets worse during winter. Try to avoid overheating though, as this can make eczema worse.
  • Skin infections can trigger a flare-up. Avoid close contact with anyone who has an active cold sore.
  • Hormonal factors – some women experience flares before their periods, or during pregnancy.
  • Dust, pets and pollen. Don't keep pets to which you know you have an allergy.
  • Teething in babies can lead to a flare-up.
  • Stress, ill health, lack of sleep can all make symptoms worse. Try to practise some relaxation techniques to help you relax and reduce your stress levels.

Dealing with flare-ups

If your eczema becomes itchy, try not to scratch it. Scratching can make your eczema worse and may cause your skin to thicken. Try smoothing a moisturiser onto itchy skin instead. Anti-scratch mittens for babies 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, and if it helps, wear gloves in bed to avoid scratching.

Treatment of atopic eczema

Although there’s no cure for eczema, there are treatments available that can 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 any products you use.

Emollients

Emollients are a special type of moisturiser, used to treat eczema and certain other skin conditions. Your doctor will prescribe these for you. They're the main type of treatment for anyone who has eczema. Emollients are different from ordinary cosmetic moisturisers. They work by restoring water and oils to your skin, soothing your skin and helping it to stay hydrated. They also help to repair any skin damage. Using emollients can ease any itching and pain you might have, and prevent your skin becoming infected.

Types of emollient

Emollients are available as creams, ointments, gels, lotions, sprays, washes and products that you can use in the bath or shower.

Different products suit different people. You may need to try several different emollients before you find the best one for you. Your doctor will recommend what to try depending on how severe your eczema is and the area of skin affected. They may also suggest trying one product for times when you're experiencing flare-ups, and a different one for when you don't have symptoms. You might be prescribed emollient soap substitutes and products to use in the bath or shower, as well as your standard moisturising cream or lotion.

Occasionally your doctor may suggest using an emollient that contains an additional active ingredient. For example, emollients that contain lauromacrogols can help to relieve itchy skin. These include Balneum Plus and E45 Itch Relief Cream. Emollients that contain an antiseptic can help to reduce the risk of bacterial infections. Examples include Dermol preparations and Emulsiderm liquid emulsion.

How to use emollients

Your doctor will advise you how to use your emollients, including how to apply them, how frequently and how much to use. Here are some key tips to remember.

  • Use your emollients all the time, even when you don’t have any symptoms. This makes them more effective in preventing flare-ups.
  • Make sure you're applying a generous amount – most people don't use enough emollients. As a guide, you should be using around 250–500g per week, depending on how severe your eczema is and the area of skin affected.
  • You should be using emollients much more than any other treatment you might be prescribed, such as steroid creams.
  • Apply your emollients as often as you can – aim for four times a day if you can. It's a good idea to keep separate packs of emollient at your work, or at your child's school or nursery.
  • It's particularly important to use emollients during and after washing. Apply them after gently drying your skin, while your skin is still moist.
  • 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, and if your emollient comes in a pot, 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, your doctor may prescribe a steroid cream to use for a short time. Steroid creams reduce inflammation and help to relieve itching.

There are different strength steroid creams. Milder ones are usually prescribed for use on your face, genitals and other areas where your skin is thinner. Stronger steroids tend to be used in areas where your skin is thicker like your hands and feet. They may also be used for shorter periods in other areas. Your doctor will tell you which one to use and how long for. They may suggest you try a mild steroid to start with, and then move on to a stronger one if you need to.

Your doctor will normally ask you to apply the cream once or twice a day to active areas of eczema (including any broken skin). Always follow your doctor's advice about how to use your steroid cream. If you use too much, use them for too long, or in the wrong area, they can cause side-effects (see our FAQ below for more information). But when applied correctly they can be very effective in dealing with a flare-up. Sometimes, if you're having frequent problems, your doctor may ask you to try using a steroid cream more regularly to prevent flare-ups.

Always continue using your emollients while you're using the steroids. You can use steroid creams before or after applying your emollient, but leave a bit of time (ideally around 15–30 minutes) between applying them.

Bandages and wet wraps

Your doctor may recommend trying specially medicated bandages or wet wraps if you have more severe areas of eczema. You use these with emollients, steroid creams and other medicines to prevent creams rubbing off, and to act as a barrier to prevent scratching.

Other treatments for eczema

If your eczema doesn't respond to emollients or steroid creams, there are other treatments your GP or dermatologist may suggest trying. 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.
  • 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.
  • Light therapy (or phototherapy) – this is treatment with ultraviolet light (UV) treatment. Your doctor may suggest trying it if other treatments haven't helped. It's usually given in hospital by a dermatologist.
  • Oral steroids, such as prednisolone tablets. These aren't used very often for eczema, and only if your eczema is very severe. You may be prescribed a short course if you have a severe flare-up and are waiting for a referral to see a consultant.
  • Biologics, such as dupilumab (Dupixent). These are a new type of treatment for moderate to severe eczema. Dupilumab is given as injections under the skin, normally every other week. Your doctor may suggest you try it if other treatments haven't helped.

Sometimes, your doctor may prescribe other treatments alongside your usual treatments for eczema. These may include antibiotic tablets or creams if your eczema has become infected, and antihistamine tablets if you’re having trouble sleeping at night.

Complementary therapies

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

Causes of atopic eczema

There’s no single known cause for eczema – it's a complex condition that results in a disruption in your body's normal immune response, affecting the normal function of your skin. Your genes play a large part in development of the diseases – people who have eczema 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. Eczema isn’t infectious, so you can’t catch it from anyone else.

There are certain ’trigger factors’ that can cause your eczema to flare up. These are described in the self-help section above.

Complications of atopic eczema

People with atopic eczema are at greater risk of developing a bacterial skin infection. If you develop an infection, 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. Contact a doctor straightaway if you have these symptoms. You may need to be admitted to hospital, where you will be treated with an anti-viral medicine.

Living with atopic eczema

It can be tough living with a long-term skin condition like eczema. Having eczema can often affect your self-confidence both as an adult or a child. The itch from eczema can feel unbearable for some people and lead to sleep loss, stress and depression.

Remember that you can live a normal life with eczema, including taking part in sports, swimming and travel. It may just mean making adjustments to incorporate your treatments into your routine. With good management and appropriate treatment, most people are able to control their atopic eczema. It's also worth bearing in mind that for children with eczema, it tends to gradually improve as they get older.

You may find it helpful to seek support from charities, such as the National Eczema Society, which can provide advice on ways to help you cope.

Frequently asked questions

  • 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.

    If your eczema isn't responding to other treatments, your doctor may suggest you have a special type of ultraviolet light therapy 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.

  • 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 with fresh water to rinse the chlorinated water off your skin. Apply more emollient after gently drying your skin. You may need to use extra emollient or a steroid cream if you find that swimming has made your eczema worse.

    Sometimes it's better not to go swimming at all. For instance, you might want to avoid it if you have:

    • a flare-up with itchy, red and oozing skin
    • a skin infection
    • an open sore

  • Allergies to certain foods – such as milk, eggs, soy, wheat, peanuts and fish – can sometimes cause flare-ups in children. Most children grow out of this as they get older.

    Food allergies don't cause eczema. But they can sometimes trigger a flare-up in children. If you think certain foods are triggering your child's eczema, it might be worth keeping a food diary for a few weeks, noting down what your child eats and drinks, and their eczema symptoms. If you suspect that your child has a food allergy, talk to your doctor about it. You shouldn’t exclude foods from your child’s diet without advice from your doctor or a dietitian.

  • If you use your steroid cream as your doctor has advised, they're unlikely to cause any serious side-effects. The longer you use a steroid cream, and the stronger (more potent) it is, the greater your risk of getting certain side-effects. These may include:

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

    You can reduce your chances of these side-effects by applying a steroid cream sparingly to the affected areas of your skin. Your doctor will advise you how much to use, and this should also be specified in the information leaflet that comes with the cream. 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.


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Related information


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  • Reviewed by Pippa Coulter, Freelance Health Editor, Bupa Health Content Team, January 2018
    Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
    Next review due January 2021



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