Eczema
Symptoms, Causes & Treatment
Understanding eczema: what triggers it, how to control flares, and the full range of prescription treatments from topical steroids to biologics.
What Is Eczema?
Eczema (atopic dermatitis) is a chronic, relapsing inflammatory skin condition characterised by dry, itchy, red, and inflamed patches of skin. It is the most common inflammatory skin condition in the UK, affecting approximately 1 in 5 children and 1 in 10 adults.
Eczema is part of the "atopic triad" -- a group of conditions that frequently occur together and share an underlying immune predisposition: eczema, asthma, and hay fever (allergic rhinitis). A person with eczema has a higher chance of developing asthma or hay fever, and vice versa.
The condition is caused by a combination of genetic factors (particularly mutations in the filaggrin gene, which impair the skin barrier), immune dysregulation (an overactive Th2 immune response), and environmental triggers. The impaired skin barrier allows moisture to escape and irritants, allergens, and microorganisms to penetrate, triggering inflammation and the characteristic itch-scratch cycle.
Eczema is not contagious. It is a chronic condition that typically follows a relapsing-remitting course -- periods of flare (active disease) alternating with periods of remission (clearer skin). Many children with eczema improve significantly by adolescence, though the condition can persist into or begin in adulthood.
What Are the Symptoms of Eczema?
Eczema symptoms vary by age and severity. During flares, symptoms can be severely debilitating.
Dry, itchy, inflamed, cracked skin · Red, scaly patches on face, hands, inside of elbows, behind knees · Thickened, leathery skin from chronic scratching · Weeping, crusted areas during flares · Dark patches on affected skin (hyperpigmentation) · Sleep disturbance from itching
Eczema herpeticum (widespread blisters from herpes virus in eczema skin — emergency) · Eczema infected with bacteria (golden crust, rapid worsening, fever) · Severe flare covering most of body surface (erythroderma) · Eczema causing severe sleep deprivation or psychological crisis
Seek urgent assessment if eczema becomes infected (golden crusting, weeping, rapidly worsening redness). Eczema herpeticum is a medical emergency — call 999 or attend A&E immediately.
What Causes Eczema?
Eczema results from a combination of genetic skin barrier defects and immune system dysregulation, triggered and worsened by environmental factors.
Atopic eczema results from a defective skin barrier (commonly due to filaggrin gene mutation), allowing allergen entry and triggering a Th2-dominant immune response with excess IgE and mast cell activation.
Contact dermatitis occurs when skin comes into contact with an irritant (irritant contact dermatitis) or a specific allergen (allergic contact dermatitis via type IV delayed hypersensitivity). Common allergens: nickel, latex, fragrances, preservatives.
Common eczema triggers include wool, synthetic fabrics, dust mites, pet dander, pollen, mould, soaps, detergents, food allergens (in children), and emotional stress. Identifying and avoiding personal triggers reduces flare frequency.
Psoriasis is an immune-mediated chronic inflammatory skin disease. T-cell activation drives rapid keratinocyte proliferation (3–5 days instead of 28–30), producing the characteristic thickened plaques.
Multiple psoriasis triggers are recognised: streptococcal throat infection (especially guttate psoriasis), medications (lithium, beta-blockers, antimalarials, NSAIDs), stress, trauma (Koebner phenomenon), alcohol, and smoking.
Around 30% of people with skin psoriasis develop psoriatic arthritis — an inflammatory arthropathy with joint erosions, enthesitis, and dactylitis. It can be severe and requires DMARD treatment to prevent joint destruction.
Key Risk Factors
How Is Eczema Diagnosed?
Eczema is diagnosed clinically based on characteristic features: itchy skin, typical distribution, onset before 2 years of age, and family or personal history of atopy. Patch testing identifies contact allergens. Skin swabs identify bacterial infection.
How Is Eczema Treated?
Treatment is stepwise, starting with emollients and moving through topical steroids, calcineurin inhibitors, phototherapy, and biologics for severe disease.
Supportive Measures
Apply emollient at least twice daily, even when skin is clear. Use emollient as a soap substitute. Wear soft, breathable cotton clothing. Avoid known triggers. Keep nails short. Use non-biological washing powder.
Managing Recurrent Eczema Flares
Proactive therapy (applying topical steroids twice weekly to previously affected areas, even when clear) reduces flare frequency. Tacrolimus or pimecrolimus can be used long-term on the face. Uncontrolled eczema despite optimal topical therapy should be referred to dermatology for phototherapy or dupilumab.
When Should You Seek Medical Advice for Eczema?
Widespread painful blistering over eczematous skin with fever — possible eczema herpeticum, a medical emergency requiring intravenous antiviral treatment.
Eczema becomes infected with golden crusting or weeping · Current treatment is not controlling your flares · Eczema is significantly affecting sleep or daily life.
How Can You Control Eczema?
Eczema cannot be prevented, but flares can be significantly reduced with consistent skin care and trigger avoidance.
Apply emollient to slightly damp skin immediately after bathing (within 3 minutes) to lock in moisture. Use at least 250–500g per week. Emollients are the most important eczema management tool — more important than any topical steroid.
Identify and avoid personal eczema triggers: dust mites, pet dander, pollen, food allergens, synthetic fabrics, perfumed products, and stress. Keep a symptom diary to identify patterns.
Wet wrapping in a flare (applying emollient-soaked bandages over affected areas) provides rapid relief and significantly reduces itch. It can be done at home after brief instruction from a nurse or dermatologist.
Psoriasis is a lifelong condition that requires long-term management. Attend regular reviews, monitor for psoriatic arthritis symptoms (joint pain, stiffness), and do not stop treatments abruptly as rebound flares can occur.
Frequent, effective milk removal is the most important mastitis prevention. Feed or express every 2–3 hours; never skip feeds. Get breastfeeding support from a midwife, health visitor, or lactation consultant early — before problems develop.
Ensure your baby latches on deeply and correctly. A poor latch causes nipple trauma (cracks), which are an entry point for bacteria. Ask for a latch assessment if breastfeeding is painful.
Speak to a Clinician About Eczema
Through The GP Service, a licensed clinician can assess your eczema, prescribe appropriate topical treatments, and refer for specialist care where needed.
Expert clinical advice, when you need it.
Eczema FAQs
Eczema (atopic dermatitis) cannot be cured, but it can be very effectively controlled. Many children improve significantly or outgrow it by adulthood. In adults, long-term management with emollients, trigger avoidance, and appropriate treatments keeps most cases well controlled.
When used correctly, topical corticosteroids are safe. Thinning of the skin (atrophy) occurs with prolonged use of high-potency steroids on the face or skin folds. Using the minimum effective potency for the shortest time, with emollients between flares, minimises this risk.
Common triggers include soaps, detergents, wool clothing, pet dander, house dust mites, heat, sweat, stress, and certain foods (particularly in children). Identifying and avoiding personal triggers is a key part of eczema management.
Emollients (moisturisers) are the cornerstone of eczema management. They should be applied multiple times daily, even when skin appears clear. Emollients restore the skin barrier and reduce the frequency and severity of flares.
Dupilumab (Dupixent) is a biologic injection approved for moderate-to-severe eczema that has not responded to standard treatments. It is highly effective and works by blocking key inflammatory pathways. It requires specialist initiation.
Wet wrapping involves applying emollient-soaked bandages over the affected skin, often over topical steroids. It is used for severe flares in children and adults and can provide rapid relief. A nurse or clinician should demonstrate the technique first.
Yes. Infected eczema (oozing, crusting, golden crusts, rapidly worsening redness) is usually caused by Staphylococcus aureus and requires antibiotic treatment — either topical or oral depending on extent.
Eczema is not contagious and cannot be passed to others through contact, regardless of how severe it appears.