Eczema (atopic dermatitis)

Overview

Atopic eczema (also called atopic dermatitis) is a chronic inflammatory skin condition causing dry, itchy, inflamed skin. It follows a relapsing-remitting pattern with flares and periods of clearer skin. It is closely linked to asthma and hay fever (the atopic triad) and is not contagious.

How common is it?

Eczema affects about 1 in 5 children and 1 in 10 adults in the UK. It most often begins in childhood, with many children improving significantly by their teens.

Causes and risk factors

Eczema results from a defective skin barrier that allows moisture to escape and irritants and allergens to enter. An over-reactive immune system then causes inflammation and itch.

Common risk factors

• Family history of eczema, asthma, or hay fever
• Gene variant affecting filaggrin (skin barrier protein)
• Urban environment and reduced early microbial exposure
• Food allergies (trigger in some cases, particularly in young children)
• Triggers: soaps, detergents, pet dander, pollen, house dust mite, certain fabrics
• Stress and hormonal changes

Symptoms

• Intense itching, often worse at night
• Dry, sensitive skin
• Red or brownish-grey patches on the skin
• Small raised bumps which may weep when scratched
• Thickened, cracked, or scaly skin
• Raw, swollen skin from scratching
• Commonly affects face, neck, elbows, and knees in children

When to see a doctor

Seek urgent medical advice if eczema becomes painful, warm, swollen, suddenly worse, blistered or pus-filled, particularly with fever or feeling unwell. These can be signs of infection, including eczema herpeticum. Arrange a routine review when treatment is not controlling symptoms or eczema is disrupting sleep and daily life.

Diagnosis

Diagnosis is clinical based on characteristic appearance and history. Patch testing identifies contact allergens in adults. Food allergy testing in children with severe eczema that is not responding to standard treatment.

Treatments

Self-care and lifestyle

• Apply emollient at least twice daily and after every wash
• Use fragrance-free, soap-free wash products
• Wear cotton or natural fibre clothing, avoid wool directly against skin
• Keep nails short to minimise damage from scratching
• Do not remove foods from your or your child's diet without clinical advice. Keep emollient-contaminated clothing and bedding away from cigarettes and naked flames because fabric can ignite more easily.

Prevention

Moisturisers are an important treatment for established eczema. This is different from applying them to healthy newborn skin in an attempt to prevent eczema: the large BEEP trial did not show a preventive benefit from the regimen it tested. Ask for advice about infant skin problems instead of assuming that routine emollient use from birth prevents eczema.