Eczema (also called atopic dermatitis) is a chronic inflammatory skin condition that causes dry, itchy, inflamed skin. It affects around 1 in 5 children and 1 in 10 adults in the UK, making it one of the most common skin conditions. While there is no cure, effective management can keep symptoms well-controlled and allow people to live comfortably.
What Is Eczema?
Eczema is a condition where the skin barrier is weakened, making it more susceptible to irritants, allergens, and infections. The immune system reacts to these triggers with inflammation, causing the characteristic itch-scratch cycle. Eczema often runs in families and is associated with asthma and hay fever (the “atopic triad”).
Symptoms of Eczema
- Intense itching (often worse at night)
- Dry, cracked, or scaly skin
- Red to dark brown patches of skin
- Small raised bumps that may weep fluid
- Thickened, leathery skin from scratching (lichenification)
- Swollen, sensitive skin from scratching
- Raw or inflamed skin
In babies, eczema typically affects the face, scalp, and outer limbs. In older children and adults, it more commonly affects the inner elbows, backs of knees, neck, and around the eyes.
Common Eczema Triggers
- Soaps, detergents, and shampoos — strip natural oils from the skin
- Synthetic fabrics (polyester, nylon) — wool and rough textures also irritate
- House dust mites — a major allergen trigger
- Pet dander (cats, dogs)
- Pollen — seasonal flares in some people
- Food allergens — particularly in young children (milk, eggs, nuts)
- Stress and anxiety
- Sweat and heat
- Dry or cold weather
- Hormonal changes — flares often occur around menstruation
- Infections — bacterial (Staphylococcus aureus), viral (herpes)
NHS Treatment for Eczema
Step 1: Emollients (Moisturisers)
Emollients are the cornerstone of eczema management. They should be applied generously and frequently (at least 2–3 times daily) to keep the skin hydrated and strengthen the barrier. NHS-prescribable options include:
- Lotions (light, good for daytime use on large areas)
- Creams (moderate — most commonly used)
- Ointments (heavy, greasy — best for very dry skin and night-time use)
- Bath additives and soap substitutes
Step 2: Topical Corticosteroids
Applied directly to the skin during flares to reduce inflammation. They range in potency:
- Mild — hydrocortisone 1% (suitable for face and children)
- Moderate — clobetasone butyrate (Eumovate)
- Potent — betamethasone valerate (Betnovate), used for short periods on body
- Very potent — clobetasol propionate (Dermovate); specialist supervision required
Use the lowest effective strength for the shortest time. Steroid phobia is common, but when used correctly, topical steroids are safe and effective.
Step 3: Topical Calcineurin Inhibitors (TCIs)
Tacrolimus (Protopic) and pimecrolimus (Elidel) are non-steroid anti-inflammatory treatments suitable for sensitive areas (face, neck, skin folds) where prolonged steroid use is not appropriate.
Step 4: Systemic Treatments (for Moderate-Severe Eczema)
- Dupilumab (Dupixent) — a biologic injection targeting IL-4/IL-13 pathways; licensed for moderate-to-severe eczema in adults and children 6+ on the NHS
- Cyclosporin — immunosuppressant tablet used short-term for severe flares
- Azathioprine or methotrexate — longer-term immunosuppressants for severe refractory eczema
- Oral corticosteroids — short courses only for severe acute flares
- Baricitinib (Olumiant) and upadacitinib (Rinvoq) — JAK inhibitor tablets for adults with moderate-to-severe eczema
Managing Itching
- Non-sedating antihistamines (cetirizine, loratadine) during the day
- Sedating antihistamines (chlorphenamine) at night to help sleep
- Keep nails short to minimise skin damage from scratching
- Cool compresses or wet wrapping to soothe intense flares
Eczema in Children
Most children with eczema see improvement as they get older — around 60% grow out of it by their teens. Key management points for children include:
- Use fragrance-free, gentle emollients and bath products
- Dress in soft, breathable cotton clothing
- Keep bedrooms cool and use cotton bedding
- Wash soft toys regularly at 60°C to reduce dust mite exposure
- Avoid known food triggers (discuss allergy testing with GP if food allergy is suspected)
Infected Eczema (Secondary Infection)
Broken skin is vulnerable to infection. Signs of infected eczema include increased redness, warmth, weeping of yellow or clear fluid, crusting, swelling, and pain. The most common bacterial infection is Staphylococcus aureus. Treatment includes topical or oral antibiotics. Eczema herpeticum — a widespread viral infection with herpes simplex — is a medical emergency requiring urgent antiviral treatment.
Skin Care Routine for Eczema
- Bathe or shower in lukewarm (not hot) water for no more than 10 minutes
- Use emollient as a soap substitute — never soap, bubble bath, or shower gel
- Pat skin dry gently with a soft towel — do not rub
- Apply emollient immediately after bathing while skin is still slightly damp
- Apply any topical treatments as prescribed
- Reapply emollient throughout the day
NHS Resources and Support
Speak to your GP if eczema is affecting daily life or not controlled with over-the-counter treatments. A referral to a dermatologist may be needed for severe or persistent cases. The National Eczema Society (eczema.org) provides excellent patient support, helplines, and resources.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Asthma Guide — Eczema, asthma and hay fever form the “atopic triad” — understanding one condition helps manage the others through NHS atopic disease pathways.
- Rheumatoid Arthritis Guide — Both eczema and RA involve immune dysregulation; learn about NHS biologics used across both inflammatory conditions.
- Anxiety & Depression Guide — Chronic itch and visible skin changes from eczema significantly impact mental health; understand NHS psychological support for skin conditions.
- Coeliac Disease Guide — Gut and skin are linked through the immune system; some eczema patients benefit from addressing gut health issues such as coeliac disease.
- Lupus Guide — Lupus causes a characteristic butterfly rash; understand the differences between lupus skin manifestations and eczema under NHS rheumatology.
- Sleep Apnoea Guide — Eczema-related sleep disruption is common and severe; learn how poor sleep affects skin barrier function and itch cycles.