Atopic eczema


Atopic eczema




Atopic eczema can affect any part of the body, but the most common areas to be affected are:

backs or fronts of the knees

outside or inside of the elbows

around the neck





What causes atopic eczema?

The exact cause of atopic eczema is unknown, but it's clear it's not down to one single thing. It often occurs in people who get allergies – "atopic" means sensitivity to allergens.



The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes  can play a part, especially in young children with severe eczema.


Treating atopic eczema 

There is currently no cure for atopic eczema, but treatment can help relieve the symptoms and many cases improve over time.



self care techniques, such as reducing scratching and avoiding triggers



Who is affected?

About one in five children in the UK has atopic eczema. In 8 out of 10 cases, the condition develops before a child reaches the age of five. Many children develop it before their first birthday.

Atopic eczema can improve significantly, or even clear completely, in some children as they get older. About half of all cases improve a lot by the time a child reaches 11 years, and around two-thirds improve by the age of 16.

However, the condition can continue into adulthood and can sometimes develop for the first time in adults.

Other types of eczema







Symptoms of atopic eczema 



Atopic eczema can occur all over the body, but is most common on the hands (especially fingers), the insides of the elbows or backs of the knees, and the face and scalp in children. The face is more commonly involved in adults.




Signs of an infection


your eczema getting a lot worse

fluid oozing from the skin


the skin becoming swollen and sore

a high temperature (fever) and generally feeling unwell

See your doctor as soon as possible if you think your or your child's skin may have become infected.


Causes of atopic eczema 







Eczema triggers


Common triggers include:

irritants – such as soaps and detergents, including shampoo, washing-up liquid and bubble bath





skin infections




Diagnosing atopic eczema 

Your GP will usually be able to diagnose atopic eczema by looking at your skin and asking questions about your symptoms.

These questions may include asking:

whether the rash is itchy and where it appears

when the symptoms first began

whether it comes and goes over time

whether there is a history of atopic eczema in your family

whether you have any other conditions, such as allergiesor asthma

You should tell your GP if your condition is affecting your quality of life – for example, if you have difficulty sleeping because of itching, or your eczema limits your everyday activities.

Checklist for diagnosing atopic eczema


visibly irritated red skin in the creases of your skin, such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional

a history of skin irritation occurring in the same areas mentioned above

generally dry skin in the last 12 months



Establishing triggers

Your GP should work with you to establish if any triggers make your eczema worse. 

You may be asked about your diet and lifestyle to see if something obvious may be contributing to your symptoms. For example, you may have noticed some soaps or shampoos make the eczema worse.



Allergy tests are not usually needed to identify triggers, although they are sometimes helpful in identifying food allergies that may be triggering symptoms in young children or in those where a food allergy is suspected.


Treating atopic eczema 


The main treatments for atopic eczema are:



Other treatments include topical pimecrolimus or tacrolimus for eczema in sensitive sites not responding to simpler treatment, antihistaminesfor severe itching, bandages or special body suits to allow the body to heal underneath, or more powerful treatments offered by a dermatologist (skin specialist).

Read on to learn about the different treatments you may be offered. You can also read a summary of the pros and cons of these, allowing you to compare your treatment options.

Self care


Try to reduce the damage from scratching





Avoid triggers







Dietary changes

Some foods, such as eggs and cows' milk, can trigger eczema symptoms. However, you should not make significant changes to your diet without first speaking to your GP.


If your GP suspects you have a food allergy, you may be referred to a dietitian (a specialist in diet and nutrition), who can help work out a way to avoid the food you're allergic to while ensuring you still get all the nutrition you need.




Emollients are moisturising treatments applied directly to the skin to reduce water loss and cover it with a protective film. They are often used to help manage dry or scaly skin conditions such as atopic eczema.


Choosing an emollient


an ointment for very dry skin

a cream or lotion for less dry skin

an emollient to use instead of soap

an emollient to add to bath water or use in the shower






How to use emollients

Use your emollient all the time, even if you are not experiencing symptoms. Many people find it helpful to keep separate supplies of emollients at work or school, or a tub in the bathroom and one in a living area.

To apply the emollient:

use a large amount






Topical corticosteroids



They can be very mild (such as hydrocortisone), moderate (such as clobetasone butyrate), or even stronger (such as mometasone).


How to use topical corticosteroids


Most people will only have to apply it once a day as there is no evidence there is any benefit to applying it more often.

When using a topical corticosteroid:


apply the recommended amount of the topical corticosteroid to the affected area




Side effects


In rare cases, they may also cause:




increased hair growth

Most of these side effects will improve once treatment stops.

Generally, using a strong topical corticosteroid for many months, using them in sensitive areas such as the face, armpits or groin, or using a large amount will increase your risk of side effects. For this reason, you should be prescribed the weakest effective treatment to control your symptoms.





Bandages and wet wraps



Corticosteroid tablets




Seeing a specialist


You may be referred if your GP is not sure what type of eczema you have, normal treatment is not controlling your eczema, your eczema is affecting your daily life, or it's not clear what is causing it.

A dermatologist may be able to offer the following:


topical calcineurin inhibitors – creams and ointments that suppress your immune system, such as pimecrolimus andtacrolimus

very strong topical corticosteroids

bandages or wet wraps

phototherapy – ultraviolet (UV) light that reduces inflammation




Complementary therapies




Complications of atopic eczema 


Bacterial skin infections

As atopic eczema can cause your skin to become cracked and broken, there is a risk of the skin becoming infected with bacteria. The risk is higher if you scratch your eczema or do not use your treatments correctly.

Signs of a bacterial infection can include:

fluid oozing from the skin

a yellow crust on the skin surface

small yellowish-white spots appearing in the eczema

the skin becoming swollen and sore

a high temperature (fever) and generally feeling unwell


You should see your doctor as soon as possible if you think your or your child's skin may have become infected.

They will usually prescribe antibiotic tablets, capsules or cream to treat the infection, as well as making sure the skin inflammation that led to the infection is well controlled.

Speak to your GP if these don't help or your symptoms get worse.


Viral skin infections


Symptoms of eczema herpeticum include:

areas of painful eczema that quickly get worse


a high temperature and generally feeling unwell, in some cases 

Contact your doctor immediately if you think you or your child may have eczema herpeticum. If you cannot contact your GP, call 111 or go to your nearest hospital.


Psychological effects






Problems sleeping

Sleep-related problems are common among people with eczema.


If your child has problems sleeping because of their eczema, they may fall behind with their schoolwork. It might help to let their teacher know about their condition so it can be taken into consideration.














Atopic eczema