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Eczema (atopic)

This fact sheet is for people, or parents of children, who have atopic eczema.

Eczema, also known as dermatitis, describes a group of skin conditions where the skin is irritated or inflamed. There are many different types of eczema - the most common is atopic eczema (also called endogenous eczema). About 1 in 6 children get atopic eczema in the UK, but most grow out of it by their teens. However for some people, it can continue into adulthood.

What is eczema?

There are various types of eczema, with slightly different causes and symptoms. This factsheet will focus on atopic eczema but the other types are described below.

Allergic contact eczema

Also called exogenous eczema, allergic contact eczema develops when substances or chemicals irritate the skin and cause an allergic reaction. The rash usually starts at the site of contact with the substance, but may then spread to other areas.

Irritant contact eczema

Irritant contact eczema is similar to allergic contact eczema and is caused by frequent contact with everyday substances such as detergents in toiletries or cleaning products.

Seborrhoeic eczema

Seborrhoeic eczema is common in babies under one, although adults can get it too. The rash is greasy and it usually starts on the scalp (this is sometimes called cradle cap in babies) and can then spread to other areas. It usually clears up in babies by the time they are one but can go on for a number of years in adults.

Varicose eczema

Varicose eczema (also known as gravitational or stasis eczema) is found in older people. It occurs on the lower legs and is associated with varicose veins and poor circulation.

Discoid eczema

Discoid eczema affects the arms and legs. It occurs in round scaly patches and is incredibly itchy. Discoid eczema is most common in middle-aged men.

Eczema symptoms

The symptoms of eczema vary depending on the type. Atopic eczema symptoms include:

• red skin

• dry skin

• itchy skin

• small water blisters on the skin, particularly on the hands and feet - or the skin can become wet and weepy if it gets infected

• scaly areas of skin in places that are scratched frequently - this is known as lichenification

Atopic eczema usually affects the backs of the knees and the front of the elbows as well as the chest, face and neck. 

Causes

You cannot catch eczema. It does not spread from one person to another.

The exact cause of atopic eczema isn't fully understood at present. People do have a genetic, or inherited, tendency to develop the condition however. Atopy means a family tendency to a variety of allergic conditions, including asthma, hay fever and eczema.

Sometimes, the symptoms "flare up" for no obvious reason. But you may notice certain triggers that set off your, or your child's, eczema including:

• chemicals, detergents, soap or shampoo

• inhaled irritants such as pollen or house dust mites

• infections with bacteria or viruses

• certain foods in people that have food allergies, although this is quite rare

• dry skin

• being "run down", if you are ill with a cold, for example

• changes in hormone levels - eczema can be worse in women before their monthly period

• stress

Diagnosis

Your GP will ask you about your symptoms and examine your, or your child's, skin. Y

our doctor may also rub a sterile cotton bud on the skin to check for infections.

Most people with atopic eczema are treated by their GP but you may be referred to a specialist.

Treatment

Atopic eczema cannot be cured. Treatments aim to control the symptoms.

Home treatment

There are a number of over-the-counter remedies available from pharmacies to treat eczema including those below. Ask your doctor or pharmacist for advice on which treatment to use.

• Emollients are moisturisers which soothe, smooth and add water to (hydrate) the skin. They are the most common treatment and should be used every day even if you do not have eczema symptoms. Examples include aqueous cream and E45 cream. You can apply emollients directly to your skin as lotions, creams or ointments. A good time to apply them is just after a bath, while your skin is still slightly moist. Oils or washes are also available, which you can use in the shower or add to a bath.

• Mild steroid creams, such as hydrocortisone (eg Dermacort or Lanacort) can calm flare-ups of eczema by suppressing your body's inflammatory response. You should ask the pharmacist's advice or see your GP before using any steroid cream. The stronger steroids are only available on prescription (see below). You should continue to use emollients at the same time as steroid creams.

Prescription drug treatments

If emollients and mild steroids don't treat your condition, there are a range of other treatment options that your doctor can prescribe.

• Stronger steroid creams, such as betamethasone (eg Betnovate) are available on prescription. You should apply them sparingly and use the mildest cream that works as steroids may have side-effects. If you use a strong steroid for too long or on a delicate area of skin such as the face and armpits, it can thin the skin. This can make the skin more fragile leading to blemishes, wrinkles or visible small blood vessels. You should see your doctor for regular check-ups to prevent this happening and follow their advice or that of a pharmacist or nurse.

• Oral steroids, such as prednisolone, are available as tablets to treat severe eczema. They are only used for short periods of time (typically a course of up to a week).

• Immunosuppressant tablets, such as azathioprine or ciclosporin, are prescribed for severe eczema. They can have severe side-effects so you should not take them for long periods - ask your doctor for more information.

• Topical immunosuppressants are creams or lotions that you apply to your skin to reduce inflammation. They may be prescribed to you if other treatments have not worked or you cannot use them due to side-effects. Examples include tacrolimus (Protopic) and pimecrolimus (Elidel). These are new treatments that do not contain steroids so they may have less side-effects but the long-term safety has not been evaluated.

• Antibiotics, such as flucloxacillin or erythromycin, will be prescribed if your, or your child's skin is infected.

• Antihistamine tablets can help people with eczema to sleep, but they are unlikely to ease itching.

Hospital treatment

• If your, or your child's, eczema is severe you may need hospital treatment. This will remove you from the environment that may be triggering your symptoms and the hospital staff will ensure that you are taking your treatments correctly.

• If your, or your child's, skin is infected with a herpes simplex infection, antiviral treatment will be given to you in hospital.

• For some people with eczema, ultra violet light treatment is helpful. This is usually given in hospital by a specialist.

Complementary treatments

Some people find that complementary treatments such as herbal creams and homeopathy are helpful, although there is no firm scientific evidence for this.

Chinese herbal medicines may also help, but the active ingredients are poorly understood. Also, information about the quality and safety of the preparations is hard to obtain and side-effects such as liver damage have been reported.

If you use additional creams on your skin, you should use reputable brands and tell your doctor about these as well as other treatments you are taking.

Eczema management

Drug treatments are only part of the treatment for eczema. Eczema also needs to be managed by dealing with the things that make it worse.

Identifying and avoiding the things that trigger your, or your child's, eczema are an essential part of your overall treatment plan. Keeping a diary to record anything that triggers eczema can help you to discover a pattern.

If your, or your child's, eczema is triggered by certain foods you should ask your doctor for advice on how to deal with this. Excluding foods may not have any effect and can lead to a deficiency of essential nutrients, calcium or protein. It should only be considered for children under the supervision of a doctor or dietitian.

With good management and appropriate treatment, most people are able to control their atopic eczema.

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