Self-care

As well as medication, there are things you can do yourself at home to help ease symptoms. 

Scratching

Eczema is often itchy and scratching it can aggravate the skin, eventually causing it to thicken. Scratching your skin also increases the risk of your eczema becoming infected with bacteria. 

Read more about complications of atopic eczema.

There may be times when you or your child cannot help scratching. Keeping nails short will minimise damage to the skin. 

If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Tapping or pinching the skin until the itch has gone may also offer relief.

Avoiding triggers

Your GP will work with you to establish what might trigger the eczema flare-ups, although it may get better or worse for no obvious reason.

Once you know what triggers a flare-up, you can try to avoid them. For example:

• if certain fabrics irritate your skin, avoid wearing these and stick to natural materials such as cotton
• if heat aggravates your eczema, keep the rooms in your home cool
• avoid using soaps or detergents that may affect your skin

Although many people with eczema are allergic to house dust mites, it is not recommended that you try to get rid of them from your home. The process is time consuming and difficult to carry out effectively, and there is no clear evidence that it helps.

Similarly, although living in an area that has hard water is associated with slightly higher levels of eczema in younger children, installing a water softener does not seem to make any difference.

Diet

You should not make any significant dietary changes without first speaking to your GP. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. 

However, it may not be healthy to cut these from your diet without medical advice, especially in young children who need plenty of the calcium, calories and protein that are provided by these foods.

If your GP suspects you have a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition).

If you are breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet.

Emollients

Emollients are substances that help soften your skin to keep it moist. They reduce water loss from the skin by covering it with a protective film. They are the most important treatment for dry skin associated with atopic eczema.

It is important to keep skin moisturised to prevent it becoming dry and cracked.

Choosing an emollient

There are several different emollients available, some of which you can buy over-the-counter without a prescription. Your GP or pharmacist can recommend a suitable one for you, although you may need to try a few before you find one that suits you.

You may also be prescribed different emollients for different uses, such as:

• an ointment for very dry skin 
• a cream or lotion for less dry skin
• an emollient to use on your face and hands 
• a different emollient to use on your body  
• an emollient to use instead of soap 
• an emollient to add to bath water or use in the shower

The difference between lotions, creams and ointments is the amount of oil and water they contain. Ointments contain the most oil so can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least oil so are not greasy, but can be less effective. Creams are in the middle.

If you have been using a particular emollient for some time, it may eventually become less effective or may start to irritate your skin. If this happens, speak to your GP as another product can be prescribed instead.

If the skin is inflamed, emollients should be used along with an anti-inflammatory treatment, such as topical corticosteroids.

How to use emollients

Use your emollient all the time, especially between flare-ups, even when you do not have symptoms. Keeping separate supplies of emollients at work or at school can be a good idea.

To apply the emollient:

• use a large amount
• smooth the emollient into the skin in the same direction that the hair grows
• do not rub the emollient in
• for very dry skin, apply emollient every two to three hours
• after a bath or shower, gently dry the skin and apply the emollient while the skin is still moist
• do not share emollients with other people
• do not put your fingers into an emollient pot – instead, use a spoon or pump dispenser as this reduces the risk of spreading infection

It is very important to keep using your emollients during a flare-up because this is when the skin needs the most moisture. During a flare-up, apply generous amounts frequently.

Other medications

Other medicines used to ease the symptoms of eczema include:   

• antihistamines for severe itching 
• oral corticosteroids for severe symptoms
• antibiotics for infected eczema  
• topical immunosuppresants, which reduce or suppress your body's immune system, such as pimecrolimus cream and tacrolimus ointment

Your GP will prescribe additional medication as and when it is needed.

Treating atopic eczema

Although there is no cure for atopic eczema, treatments can ease the symptoms.

Children with atopic eczema normally find their symptoms naturally improve over time.

Medications used to treat atopic eczema most commonly include:

• emollients – used all the time for dry skin
• topical corticosteroids – used to reduce swelling and redness during flare-ups

Your GP will prescribe emollients for dry skin and the weakest effective topical corticosteroid. Different strengths are needed for different parts of the body.

As long as the eczema is not infected, certain dressings or bandages – known as dry wraps, wet wraps and occlusive dressings – may also be applied by a healthcare professional.

They work by reducing itchiness, preventing scratching and helping to stop the skin from drying out.

Establishing triggers

Your GP should work with you to establish what triggers make your eczema worse. You may be asked about your diet and lifestyle to see if something obvious may be contributing to your symptoms. For example, you may have noticed that some soaps or shampoos make the eczema worse.
Read more about potential triggers and causes of atopic eczema.

You may also be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse.

A food diary involves writing down everything you eat and making a record of any eczema flare-ups you have. Your GP can then use the diary to see if there is a pattern between your symptoms and what you eat.

Checklist for diagnosing atopic eczema

Typically, to be diagnosed with atopic eczema you must have had an itchy skin condition in the last 12 months, as well as three or more of the signs and symptoms described below:

• You have itchiness and irritation in the creases of your skin, such as the inside of your elbows, behind your knees, your ankles, around your neck or around your eyes.
• Your skin has been generally dry in the last 12 months.
• You have or have had asthma or hay fever. For children under the age of four, they must have an immediate relative, such as a parent, brother or sister, who has asthma or hay fever.
• There is eczema in the creases of your skin, or on the forehead, cheeks, arms or legs in children under the age of four.
• In children over four and adults, the condition started at the age of two or before.

 

Diagnosing atopic eczema

Your GP will usually be able to diagnose atopic eczema by assessing the skin and asking questions about your symptoms.

These questions may include:

• whether the rash is itchy and where it appears
• when the symptoms first began
• whether you have flare-ups of severe symptoms  
• whether there is a history of atopic eczema in your family
• whether you have any other conditions, such as allergies or asthma

Tell your GP if your condition is affecting your quality of life, for example if you have difficulty sleeping because of itching or it is limiting your daily activities.

Breastfeeding

It is thought that breastfeeding may reduce the risk of your child developing atopic eczema.

Find out more about the benefits of breastfeeding.

Triggers

Triggers can make atopic eczema worse, although they do not necessarily cause the condition.

Hormonal changes in women

Hormones are powerful chemicals that are produced by the body and have a wide range of effects. Changes in the levels of certain hormones can affect the symptoms of atopic eczema in some women.

Many women's eczema is worse at certain times during their menstrual cycle. Some women have a flare-up of their eczema in the days before their period.

The hormonal changes during pregnancy can also affect atopic eczema:

• more than half of all pregnant women find their symptoms get worse
• one-quarter of pregnant women find their symptoms improve

Stress

While stress is known to be associated with atopic eczema, it is not fully understood how it affects the condition. Some people with eczema have worse symptoms when they are stressed. For other people, their symptoms cause them to feel stressed.

Read more about ways to manage stress.

Exercise

After vigorous exercise, sweating may make your eczema symptoms worse. Try to keep cool when you are exercising by drinking plenty of fluids and taking regular breaks.

Irritants

Irritants can make your symptoms worse. What irritates you may be different to what irritates someone else with the condition, but could include:

• soaps and detergents, such as shampoo, washing-up liquid or bubble bath
• some types of clothing, especially wool and nylon 
• overheating 
• very cold, dry weather
• dust
• unfamiliar pets

Other triggers

Other possible triggers include:

• substances that touch your skin, such as perfume-based products or latex (a type of naturally occurring rubber)
• environmental factors, such as tobacco smoke, living near a busy road or having water that contains lots of minerals (hard water)
• the changing seasons – most people with atopic eczema find that their symptoms improve during the summer and get worse in the winter

The environment

If your genes make you more likely to develop atopic eczema, the condition will develop after you are exposed to certain environmental factors, such as allergens.

Allergens are substances that can cause the body to react abnormally. This is known as an allergic reaction. Some of the most common allergens that can cause atopic eczema include:

• house dust mites
• pet fur
• pollen

Atopic eczema can sometimes be caused by food allergens, especially before the age of one. Foods that typically cause allergic reactions include:

• cows' milk
• eggs
• nuts
• soya
• wheat

Some studies of children and young people with atopic eczema found that one-third to nearly two-thirds also had a food allergy. Having a food allergy increases the likelihood of your atopic eczema being severe.

Read more about food allergies.

Allergies do not always play a role. There are many other things likely to bring out eczema, including:  

• cold weather
• dampness
• harsh soaps
• washing too much
• rough clothing

Genetics

Research suggests that atopic eczema is largely an inherited condition. This means that the cause lies in the genes that you inherit from your parents.

If a child's parents have atopic eczema, it is highly likely that the child will also develop the condition. Studies have shown that 60% of children who have a parent with atopic eczema will also have eczema. If both parents have atopic eczema, there is an 80% chance that a child will also have the condition.

It is not yet known exactly which genes are responsible for eczema.

Causes of atopic eczema

There is no single cause of eczema. It probably has a mixture of inherited and environmental causes that act together at different times.

You may be born with an increased likelihood of developing eczema, which you inherit from your parents. 

When you are exposed to environmental factors, such as dust or pollen, this causes eczema to appear. There are several triggers that can make your symptoms worse.

During a flare-up

Symptoms become worse during a flare-up, and you or your child may need stronger treatment when this happens.

During a flare-up, your skin may be:

• extremely itchy, red, hot, dry and scaly
• wet, weeping and swollen
• infected with bacteria (usually Staphylococcus aureus)  

Read more about infections and other complications of atopic eczema.

Symptoms of atopic eczema

The symptoms of atopic eczema may always be present. They can become worse during a flare-up, needing additional treatment.

Symptoms include itchy, dry and red skin that may be broken or cracked.

Atopic eczema can occur in small patches all over the body and is most common:

• in infants – on the face and scalp, and on the arms and legs
• in adults and children – on the hands or around joints on the arms and legs, such as the inside of the elbows or the backs of the knees

The symptoms of atopic eczema vary according to how severely you or your child are affected by the condition.

People with mild atopic eczema normally have only small areas of dry skin that are occasionally itchy. In more severe cases, atopic eczema can cause widespread dry skin, constant itching and oozing fluid.

Scratching can disrupt your sleep and make your skin bleed. It can also make itching worse, and a cycle of itching and regular scratching may develop. In children, this can lead to sleepless nights and difficulty concentrating at school.

Other types of eczema

Other types of eczema include:

• circular or oval patches of eczema that usually affect adults (discoid eczema) 
• eczema that occurs when the body comes into contact with a particular substance (contact dermatitis)
• eczema that occurs on the legs, usually around swollen and enlarged veins (varicose eczema) 
• red, scaly patches that can occur on the sides of the nose, eyebrows, ears and scalp (seborrhoeic eczema)
• eczema that causes tiny blisters to erupt across the palms of the hands (dyshidrotic eczema, also known as 'pompholyx')

Who is affected?

About one in five children in the UK has eczema. In 8 out of 10 cases, atopic eczema occurs before a child reaches five years of age. Many children develop it before their first birthday.

The number of people diagnosed with atopic eczema has increased in recent years. This could be because of changes in lifestyle or environmental factors that cause eczema, or because healthcare professionals are now more aware of the symptoms.

Males and females are affected equally.

Treating atopic eczema

Atopic eczema clears up or significantly improves in many children as they get older. In about 53% of cases, atopic eczema clears up by the time a child reaches 11 years of age, and in 65% of cases it clears up by 16 years of age.

However, severe eczema often has a significant impact on daily life and may be difficult to cope with physically and mentally. There is also an increased risk of infections. 

Read more about complications of atopic eczema.

Many different types of treatment can be used to control symptoms and manage eczema, including medication and self-help techniques. 

The main treatments are:

• emollients (moisturising treatments) – used all the time for dry skin
• topical corticosteroids – used to reduce swelling and redness during flare-ups

Read more about How atopic eczema is treated.

What causes atopic eczema?

The exact cause of atopic eczema is unknown. However, it often occurs in people who get allergies ("atopic" means sensitivity to allergens).

Atopic eczema can run in families and often occurs alongside other conditions, such as asthma and hay fever.

Read more information about the causes of atopic eczema.

Atopic eczema

Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can continue into adulthood.

Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term, or chronic, condition.

Atopic eczema commonly occurs in areas with folds of skin, such as:

• behind the knees
• the inside of the elbows
• on the side of the neck
• around the eyes and ears

Atopic eczema can vary in severity and most people are only mildly affected. Severe symptoms include cracked, sore and bleeding skin.

People with atopic eczema usually have periods when symptoms are less noticeable, as well as flare-ups when symptoms become more severe, needing additional treatment.

Read more about the symptoms of atopic eczema.

Photos

Dermatitis of the hand.

 

More severe eczema

A patch of eczema that has been scratched

Rash symptomatic of dermatitis

Complex eczema treated with a combination of antifungal and corticosteroid creams at the same time.

Tacrolimus 0.1%

Society and culture

The terms "hypoallergenic" and "doctor tested" are not regulated, and no research has been done showing that products labeled "hypoallergenic" are in fact less problematic than any others.

History

The term "atopic dermatitis" was coined in 1933 by Wise and Sulzberger. Sulfur as a topical treatment for eczema was fashionable in the Victorian and Edwardian eras.