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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 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 (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 affects the arms and legs. It occurs in round scaly patches and is incredibly itchy. Discoid eczema is most
common in middle-aged men.
The symptoms of eczema vary depending on the type. Atopic eczema symptoms include:
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.
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
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
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
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.
Atopic eczema cannot be cured. Treatments aim to control the symptoms.
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
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.
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.
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
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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