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
See a doctor if eczema is not controlled by emollients, if there is infection (weeping, crusted, painful areas), or if symptoms are seriously affecting sleep and quality of life. Children with severe eczema should be reviewed by a paediatric dermatologist.
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
Emollients
Generous and frequent application of moisturisers (emollients) throughout the day is the foundation of eczema management. They reduce water loss and decrease flare frequency.
Topical corticosteroids
Applied to inflamed areas during flares. Strength is chosen based on body site and severity. Used as directed to avoid skin thinning.
Newer targeted treatments
Dupilumab (a biologic injection) and topical JAK inhibitors (ruxolitinib, delgocitinib) are highly effective for moderate to severe eczema not controlled by standard 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
Prevention
Regular emollient use from birth in high-risk infants may reduce eczema development. Identifying and avoiding personal triggers reduces flare frequency.