Eczema (Atopic Dermatitis): Calming the Itch and Repairing the Skin Barrier
Eczema, also called atopic dermatitis, is a common inflammatory skin condition that causes dry, itchy, red and sometimes cracked or weeping skin. It often begins in infancy, but it can start at any age and may flare and settle for years. Although there is no cure, a consistent routine controls it well for most people.
What goes wrong in the skin
Healthy skin has a tight outer barrier that holds water in and keeps irritants and microbes out. In eczema, the barrier is weak, often because of inherited changes in proteins such as filaggrin, and the immune system overreacts. Skin loses moisture, becomes dry and sensitive, and inflammation drives intense itching. Scratching damages the skin further and sets up the itch-scratch cycle.
Eczema often runs in families with asthma and hay fever, a group known as the atopic conditions.
Where it appears
- Babies: cheeks, scalp and outer limbs
- Children: the creases of the elbows and knees, wrists, ankles and neck
- Adults: flexures, hands, face and neck, though any area can be affected
Typical features are dryness, redness (which can look purple or brown on darker skin), thickened skin from chronic scratching, and small fluid-filled bumps in acute flares.
Common triggers
- Soaps, bubble baths, detergents and hot water
- Wool and rough fabrics
- Sweating and overheating
- Dry or cold weather
- Dust mites, pet dander and pollen in some people
- Stress and poor sleep
- Skin infections
- Occasionally foods, mostly in young children with moderate to severe eczema
Triggers differ for each person, so a diary can help.
The foundation: moisturise, moisturise, moisturise
Emollients are the backbone of treatment. Use a fragrance-free moisturiser liberally and often, at least twice a day and after bathing, while the skin is still slightly damp. Thick ointments and creams work better than lotions for dry skin. Use a soap substitute or emollient wash instead of ordinary soap. Short lukewarm baths or showers are better than long hot ones.
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Treating flares
Topical corticosteroids are the safest and most effective treatment for flares when used correctly. They come in different strengths: mild for the face and skin folds, moderate or potent for the body. Apply a thin layer once or twice a day to inflamed areas until the skin is clear, then stop. Side effects such as skin thinning occur mainly with prolonged overuse of strong steroids and are uncommon when used as directed. A common mistake is under-using steroids out of fear, which prolongs the flare.
Topical calcineurin inhibitors (tacrolimus and pimecrolimus) are steroid-free options useful for the face and for maintenance.
Newer topical treatments include PDE4 inhibitors and JAK inhibitors.
Wet wraps provide intense relief for severe flares and are best taught by a nurse.
Antihistamines do not treat the itch of eczema well, though sedating types may help sleep in the short term.
When infection occurs
Weeping, crusting, painful skin, yellow crusts or a sudden worsening may signal bacterial infection, often Staphylococcus aureus. A clinician may prescribe antibiotics. Clusters of painful punched-out blisters and fever can indicate eczema herpeticum, a medical emergency needing urgent antiviral treatment.
Moderate to severe eczema
When creams are not enough, dermatologists may offer phototherapy, immunosuppressants such as methotrexate or ciclosporin, injectable biologics like dupilumab and tralokinumab, or oral JAK inhibitors. These have changed outcomes for many people with severe disease.
Practical tips
- Keep nails short and consider cotton gloves at night
- Wear soft cotton clothing and wash new clothes before use
- Use a non-biological or fragrance-free detergent and rinse well
- Keep the home cool and avoid overheating at night
- Protect the hands with gloves for wet work and cleaning
- Do not stop treatment as soon as the skin looks better; proactive twice-weekly use of a steroid or calcineurin inhibitor on previously affected sites can reduce relapses
Emotional impact
Chronic itch disturbs sleep, concentration and mood and can affect self-esteem. Do not dismiss this. Ask for support, and consider psychological approaches and habit-reversal techniques for scratching.
When to see a doctor
See your doctor if eczema is affecting sleep or daily life, is not controlled by emollients and mild steroids, or shows signs of infection. A good routine usually makes a major difference.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.