Eczema (Atopic Dermatitis)

What is eczema?

Eczema, also known as ‘atopic eczema’ or ‘atopic dermatitis’ (used interchangeably to describe the same condition), is a common chronic inflammatory skin condition. Eczema affects people of all ages but is most commonly first seen in infants and young children.

There are many different types of eczema, and atopic eczema is one of the most common.  ‘Atopic’ means it runs in families and/or affects those who already have other types of allergies. An atopic person is likely to have more than one allergic condition, such as eczema, asthma, hay fever or food allergy.

Eczema symptoms affect the skin and include:

Atopic eczema causes the skin to become itchy, dry, cracked and sore. Some people only have small patches of dry skin, but others may experience widespread inflamed skin all over the body. Inflamed skin can become red on lighter skin, and darker brown, purple or grey on darker skin. This can also be more difficult to see on darker skin.

Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.

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

• Dry skin
• Itchy skin (intense itch that cannot be relieved)
• Red and inflamed areas (eczema flares)
• Skin barrier becomes damaged (broken and cracked skin).

What does atopy/atopic mean?

There are many types of eczema and dermatitis:

• Atopic Eczema / Atopic Dermatitis
• Discoid Eczema
• Contact Dermatitis

Specifically, atopy, or being atopic, means having a genetic tendency for your immune system to make increased levels of IgE antibodies to certain allergens. An atopic individual is likely to have more than one allergic condition during their lifetime, such as eczema, asthma, hay fever or food allergy.

Can food allergies cause eczema?

Children are born with the tendency to have eczema, and many things can make their eczema worse. These are known as eczema ‘triggers’. Eczema in children can have various triggers, of which food can be one, especially in babies. However, foods are not the primary cause of eczema.

You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. Allergy tests are not usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.

Dietary changes

Some foods, such as eggs and cows’ milk, can trigger eczema symptoms, but you should not make significant changes to your diet without first speaking to a GP. It may not be healthy to cut these foods from your diet, especially in young children who need the calcium, calories and protein from these foods. If a GP suspects a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition). They can help to work out a way to avoid the food you’re allergic to while ensuring you still get all the nutrition you need. If you’re breastfeeding a baby with atopic eczema, get medical advice before making any changes to your regular diet.

Eczema / Dermatitis treatments

• Emollients. Emollient lotions and creams are prescribed for treating  atopic eczema and dry skin, and are, in their simplest form, mixtures of oil and water.
• Topical steroid creams. It is sometimes necessary to apply topical corticosteroids (e.g. hydrocortisone), as these reduce inflammation in the skin caused by eczema.
• Wet wraps. Sometimes, special pyjama-like garments (known as ‘wet wraps’) that are used for children may also help certain areas of your body that have not responded to the usual topical application of emollients and steroids.
• Calcineurin inhibitors. Calcineurin inhibitors are an alternative to steroid creams. Like steroid creams, they reduce the skin inflammation and can lessen itching.

There is more detailed information about each treatment on our downloadable eczema Factsheet

How can I manage eczema?

You can find a whole host of useful tips on our eczema Factsheet but here are 3 top tips to follow:

1. Apply your emollients regularly. The chore of a twice daily skin cream regime can become annoying, especially if your symptoms have improved. But remember that the eczema symptoms have improved because the eczema is under control. Without the cream, it may flare up again. Keep up the routine so that your efforts to keep your skin healthy and hydrated do not go to waste.
2. You could need to apply your emollients from two to four times a day. It can be useful to have extra emollients available should you need them when you are away from home. For example, keep spares at work or in the car.
3. It is important to be aware of, and look for, the signs of bacterial infections (weeping and crusting), since the skin of eczema sufferers is more prone to infection due to the cracks and constant scratching.

How to avoid causing damage to the skin from scratching

Eczema is often itchy, and it can be very tempting to scratch the affected areas of skin, but scratching usually damages the skin, which can itself cause more eczema to occur. The skin eventually thickens into leathery areas as a result of chronic scratching. Deep scratching also causes bleeding and increases the risk of your skin becoming infected or scarred.

• Try to reduce scratching whenever possible. You could try gently rubbing your skin with your fingers instead.
• If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin.
• Keep your nails short and clean to minimise damage to the skin from unintentional scratching.
• Keep your skin covered with light clothing to reduce damage from habitual scratching.

Avoiding triggers with eczema

A 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 your triggers, you can try to avoid them.

For example:

• if certain fabrics irritate your skin, avoid wearing these and stick to soft, fine-weave clothing or natural materials such as cotton
• if heat aggravates your eczema, keep the rooms in your home cool, especially the bedroom
• avoid using soaps or detergents that may affect your skin – use soap substitutes instead

Although some people with eczema are allergic to house dust mites, trying to rid your home of them is not recommended as it can be difficult and there’s no clear evidence that it helps.

World Atopic Eczema Day podcast

For World Atopic Eczema Day 2021, we recorded a podcast to raise awareness and understanding of what it is really like to live with this condition.

Holly Shaw, a Nurse Advisor at Allergy UK, discusses the challenges of life with eczema from a patient’s perspective with our guest speaker Stephen who has lived with eczema for many years. Stephen shares insights into how eczema has impacted his life psychologically, physically, and financially.

This podcast was made possible by Global Skin