Eczema
(Atopic Dermatitis)

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What is eczema?

Eczema, which is also called atopic dermatitis, is a common skin disease that causes dry, itchy, and red skin to develop in different parts of the body. It is a long-term (chronic) skin condition that can sometimes get better or worse depending on different factors such as your genes and the environment.

Eczema can develop in both children and adults, but the most common type of eczema (atopic dermatitis) most commonly develops in children. 

There are different types of eczema that exist, and the symptoms and severity of this skin condition can vary from person to person.

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What are the different types of eczema?

The term “eczema” is actually the name given to a group of different skin conditions that can cause dry, irritated skin.

The different types of eczema that exist include:

Atopic eczema (also known as atopic dermatitis) is a chronic skin condition that causes the skin to become inflamed. This type of eczema usually begins in childhood, and the symptoms can often flare up (become worse) from time to time.

While the exact cause of atopic eczema is unknown, we do know that symptoms develop when the immune system overreacts to a certain allergen or irritant.

Usually, people with atopic dermatitis develop:

  • Skin that is dry and itchy
  • A rash on the cheeks, arms or legs 
  • Redness of the skin (erythema) 
  • Other symptoms that are discussed below

Red eczema on the arm.

 

Children who develop eczema usually have atopic eczema. This type of eczema often runs in families, and is linked to allergies and other allergic conditions such as asthma and hay fever.

Discoid eczema, which is also known as nummular dermatitis or discoid dermatitis, is a type of eczema that causes itchy, dry patches of skin to develop in a round or oval shape. 

Discoid eczema can look very different to other types of eczema.

Discoid eczema, also called nummular dermatitis, on the hand of a woman, showing very dry, red skin.

 

 

Although the exact cause of discoid eczema is not known, it is thought that it may be caused by the following:

  • Insect bites
  • Skin burns
  • A skin infection
  • Dry skin
  • Other types of eczema (such as contact dermatitis or varicose eczema)
  • Certain medications
  • Other skin conditions

The symptoms of discoid eczema include:

  • Round spots that are shaped like coins
  • Itchy skin
  • Dry or scaly patches of skin
  • Swollen skin 
  • Spots or blisters that are oozing fluid and are “wet”

Discoid eczema can usually be treated with:

  • Emollients (e.g. gels, creams, lotions and moisturizers) – these help keep the skin moisturised and prevent it from becoming dry.

     

  • Topical corticosteroids – a type of cream or ointment that has some medication inside to help reduce inflammation of the skin.

     

  • Antihistamines – a type of medication that also helps reduce inflammation and also reduces itching. It can usually be given as a cream or a pill. 

Contact dermatitis, which is also known as contact eczema, is a type of eczema that occurs when the body comes into contact with a particularly irritating substance. 

There are several types of contact dermatitis, but the two most common types are:

  • Irritant contact dermatitis – this develops when an irritating substance such as water, chemicals, acids or solvents damage the surface of the skin.

     

  • Allergic contact dermatitis – this is also known as allergic eczema and it develops when the skin comes into contact with a specific substance that causes an allergic reaction to develop, for example latex, certain metals, fragrances or dyes.

Contact dermatitis (contact eczema) picture, showing an allergic reaction on a man's hand.


Symptoms of contact dermatitis will usually appear on the hands or other parts of the body that have touched the irritant. The symptoms of contact dermatitis include:

  •  Redness
  •  Rash
  •  A burning sensation on the skin
  •  Swelling
  •  Blisters that may ooze fluid and become crusty

If you manage to identify what is causing your contact dermatitis to develop, then avoiding that particular irritant or allergen can usually improve your symptoms, or make them go away completely.

Identifying what triggers your contact dermatitis can however, be quite difficult sometimes. In this case, there are certain medications that can help treat your symptoms:

  • Emollients (e.g. gels, creams, lotions and moisturisers) – these help keep the skin moisturised and prevent it from becoming dry

     

  • Topical corticosteroids – a type of cream or ointment that has some medication inside to help reduce inflammation of the skin

Varicose eczema, which is also known as venous eczemagravitational eczema or stasis eczema, is a chronic skin condition that usually develops on the lower legs. It is quite commonly found in people with varicose veins on their legs, and usually affects people who are middle-aged or elderly. 

Varicose eczema can cause the following skin symptoms develop:

  • Itchiness
  • Swelling
  • Dryness
  • Flakiness 
  • Scaling
  • Crusting
  • On people with lighter skin, the patches of eczema can look red or brown
  • On people with darker skin, the patches tend to look dark brown, purple, or grey, and can be more difficult to see

There are some other symptoms that can develop, such as:

  • The skin becoming discoloured
  • Skin that is tight and tender, and can later become hard to the touch (this is called lipodermatosclerosis)
  • Small, white scars on the skin (this is called atrophie blanche)
  • Skin that feels painful 
  • Eczema that affects different parts of the body too

These symptoms of varicose eczema may improve during certain periods of time, but during other periods they may also become worse. 

Varicose eczema treatments and techniques that can help improve these symptoms include:

  • Avoiding injuries to the skin
  • Keeping your legs raised when you are resting
  • Staying physically active
  • Wearing compression stockings
  • Using emollients on the affected skin (e.g. gels, creams, lotions and moisturisers)
  • Using topical corticosteroids (a cream or ointment that has medication inside to help reduce skin inflammation)

If you leave your varicose eczema untreated, it can cause certain complications such as leg ulcers to develop. Ulcers are open wounds that develop in areas where the skin has been damaged.

Seborrhoeic eczema, which is also called seborrhoeic dermatitis, is a type of eczema that tends to develop in areas of the body that contain a lot of oil-producing glands, which are also called ‘sebaceous glands’. Areas that contain a lot of these glands include the:

  • Sides of the nose
  • Eyebrows
  • Upper back
  • Ears
  • Scalp
  • Upper chest
  • Back 

Seborrhoeic eczema (also called seborrhoeic dermatitis) on the eyebrows, forehead and scalp of a man.


Seborrhoeic dermatitis usually causes red, scaly patches of skin to develop in these areas. It can affect people of any age, and when babies develop this type of eczema, it is sometimes called ‘cradle cap’.

Unlike other types of eczema, this type of dermatitis is not caused by allergies. The exact reason why it develops is not known yet; however, it is thought that hormones and genetics may play a role. People who have diseases that affect their immune system or nervous system are considered to have a higher risk of developing seborrhoeic dermatitis. 

Symptoms of seborrhoeic dermatitis can include:

  •  A rash 
  • Dry flakes of skin (dandruff)
  • Skin redness
  • Yellow, greasy scales on the skin

Treatment of seborrhoeic dermatitis can include:

  • Antifungal creams, medications or shampoos
  • Topical corticosteroids
  • Creams or ointments containing a medication called a calcineurin inhibitor

This is also known as pompholyx or vesicular eczema, and it is a type of eczema that causes small blisters to develop on the fingers, hands, and feet. It is more common in women than in men, and tends to develop in adults under the age of 40. 

Although it is still not known exactly what causes dyshidrotic eczema, it is currently thought that it may be caused by a number of different factors such as:

  • Genetics
  • Fungal skin infections
  • Stress
  • Sweating
  • Allergies  
  • Contact with certain substances that can irritate your skin, such as metals (especially nickel), cobalt, chemicals, soaps, shampoo and perfumes 

The symptoms of dyshidrotic eczema include:

  • Small blisters (called vesicles) on the fingers, hands, and feet
  • Itchy skin
  • Redness
  • Flaking or scaly skin
  • Cracked skin  

The treatment for dyshidrotic eczema can include the following:

  • Soaking your hands in a watered down solution of potassium permanganate

     

  • Antihistamines – a type of medication that also helps reduce inflammation and also reduces itching. It can usually be given as a cream or a pill.

     

  • Emollients (e.g. gels, creams, lotions and moisturisers) – these help keep the skin moisturised and prevent it from becoming dry

     

  • Topical corticosteroids – a type of cream or ointment that has some medication inside to help reduce inflammation of the ski

This type of eczema causes a rash to develop on the skin that is made up of small itchy bumps called ‘papules’. These small, raised bumps look like pimples, and they can appear on the torso, arms and legs. Doctors can usually distinguish papular eczema from other types of eczema as papular eczema is the only type that causes these raised bumps to develop on the skin. 

Unfortunately, there is currently no cure for this type of eczema, but there are some treatments that can help people manage its symptoms.

Hyperkeratotic eczema affects the hands and/or feet. It is a chronic (long-term) condition that is usually very difficult to treat and can be resistant to treatment. It usually causes dry, thick, grey patches of skin to develop on the palms of the hands, and soles of the feet. The skin may also crack, or split open, and this can be very painful. 

Follicular eczema, which is also known as follicular dermatitis, is a type of eczema that affects the hair follicles instead of the skin. 

Although it is not known what exactly causes follicular dermatitis, it is thought that people with asthma and hay fever have a higher risk of developing it.

The symptoms of follicular dermatitis include:

  • Small raised bumps of skin that look like goose-bumps
  • Skin that is red and inflamed 
  • Swelling
  • Itching
  • Skin that feels warm

Erythroderma, also known as generalised exfoliative dermatitis, is a type of dermatitis that leads to an intense and widespread reddening of the skin that is caused by an existing skin disease. It is often associated with exfoliation (skin peeling off in scales or layers), in which case it may also be known as exfoliative dermatitis.

Eczema herpeticum is a rare skin condition that is caused by one of the herpes viruses. It causes a painful, blister-like rash to develop. It usually develops as a complication of atopic eczema, and is a serious skin condition that needs to be treated immediately with antiviral medication.

This condition is also known as dry eczema, or asteatotic eczema. It causes the skin to become red, itchy and dry. Usually, the symptoms develop in the shins, but they can also develop in other parts of the body too.

It usually develops as a result of very dry skin, and because of this, it is more commonly seen in the wintertime or in very dry weather conditions.

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Who usually gets eczema?

While adults can get eczema, it is a condition that most often develops in children. Many children develop atopic eczema before they reach the age of five.

It is a long-term (chronic) condition that often improves significantly when children enter into adulthood, and sometimes as they grow older, their symptoms can go away completely.

Atopic eczema can also commonly develop in infants and babies, causing dry and scaly patches of skin to appear in different parts of the body. These patches are often intensely itchy, and can be very irritating to the baby.

 

Atopic eczema (also called atopic dermatitis) on the cheek of a newborn baby.

Eczema can also develop in pregnancy and it oftens occurs because of hormonal changes. Symptoms can develop for short periods of time, or they can last for the whole duration of the pregnancy.

 

Pregnant lady holding her belly.

Who is at risk of getting eczema?

Anyone can develop eczema at any age. It is however, more commonly seen in babies and children, and in people who have predisposing factors that increase their risk of getting the condition. 

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What causes eczema?

Although the exact cause of eczema is unknown, we do know that it is not caused by one single thing. It is currently believed that eczema is caused by a number of factors that include:

  • Genetics
  • Problems with the immune system
  • The environment
  • Allergies

Atopic eczema often occurs in people who have allergies, and the word “atopic” itself literally means “sensitivity to allergens”. Food allergies can often play a part in the development of eczema, especially in young children.

Eczema can run in families, and often develops alongside other conditions, such as asthma or hay fever. This means that you may be born with a higher risk of developing atopic eczema because of the genes that you inherit from your parents.

Eczema triggers

There are several different things that can trigger eczema symptoms to start or to get worse. These include:

Skin infections

Sweating

Stress

Diet (e.g. dairy products)

Food allergies (e.g. cow's milk, eggs, peanuts, soya, wheat)

Certain materials & clothing (e.g. wool or synthetic fabrics)

Environmental factors (e.g. cold or very dry weather, dust mites, pollen, fur from pets, cigarette smoke)

Irritants (e.g. soaps, chemicals, bubble baths, shower gel, shampoos, washing detergents)

Hormonal changes (e.g. before or during a menstrual period or during a pregnancy)

What triggers eczema to develop or get worse can vary from person to person, but being aware of what triggers your eczema and making an effort to avoid it can often help you improve your symptoms.

What are the symptoms of eczema?

Atopic eczema can cause a number of different symptoms to develop in the skin such as:

  • Itchiness
  • Dryness
  • Cracked skin
  • Pain, tenderness or soreness
  • Rashes
  • Redness
  • Skin discolouration from inflamed skin (e.g. skin can become red in people with lighter skin, and darker brown, or purple or grey in people with darker skin)
Red eczema on the arm.

The symptoms of eczema can be mild, moderate, or severe. The severity of the symptoms can vary from time to time, and from person to person. For example, people with eczema can usually have periods of time when their symptoms are mild or unnoticeable, followed by periods of time when their symptoms become more severe (these are called flare-ups).

Yes, eczema can cause self-esteem issues, and it can also disrupt sleep leading to poor sleeping patterns (this can be due itching or pain, or because of the heat of bed linen that develops at night).

The skin condition eczema cannot directly kill you. It can however, lead to skin infections developing, and if these infections are not treated properly they can become serious and dangerous.

Yes, they can spread to other areas of the body and if the symptoms are severe enough, they can even scar the skin. These scars usually fade with time, but some extensive scars may be more permanent.

Although having eczema should not prevent you from being able to get a tattoo, it is not usually recommended to get a new tattoo during a flare-up. If you’re ever unsure if you can get one or not, you should speak to your doctor first. 

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Where can you get eczema?

Eczema can develop anywhere on the body, but it most commonly develops on the:

  • Hands (especially fingers)
  • The insides of the elbows
  • The backs of the knees
  • The face and scalp
  • Sweaty areas like the armpits, groin, back of the neck, and the area where glasses sit on the face
Common areas for eczema to develop in children and in adults.

Is eczema contagious?

No, eczema is not a contagious skin condition, which means you cannot pass it on to other people, and you cannot catch it from other people. 

Which other conditions have similar symptoms to eczema?

Other conditions with similar symptoms to eczema include: 

This is a skin condition that causes red, itchy, and scaly patches of skin to develop. Psoriasis symptoms are usually found around the elbows, chest, back, stomach, scalp, and knees.

If your doctor thinks that you have psoriasis and that your joints are being affected because of psoriatic arthritis, they will likely refer you to see a specialist joint doctor called a rheumatologist.

Acne is a common skin condition that can cause red spots, pimples, and painful pus-filled lumps to develop on the skin.

Hives, (also known as urticaria) can be similar to eczema as it causes very itchy and swollen small red lumps to develop on the skin.

Fungal infections can cause a red, itchy rash to develop that can look similar to an eczema rash. 

This is a contagious skin disease that is caused by tiny mites living in the skin. It can cause symptoms to develop that are similar to eczema such as intense itching, a rash, and blisters.

This is a type of fungal infection that causes round patches of skin to develop that are itchy, red, and scaly.

Disclaimer

The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.

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How do you treat eczema?

Things you can do at home

Before you start thinking about taking medications, there are certain things that you can try doing at home that may be able to ease your symptoms:

  • Don’t scratch – try not to scratch your skin, as this can damage the skin and make your symptoms worse. It can also increase the risk of developing skin infections, and can cause the skin to thicken and become “leathery” if you scratch it for a long time.

     

  • Gently rub instead of scratching – to prevent damaging the skin, try to gently rub your skin with your fingers instead of scratching it with your nails.

     

  • Give babies anti-scratch mittens – if a baby has atopic eczema, you can put anti-scratch mittens on their hands to help stop them from scratching their skin.

     

  • Keep your nails short and clean – this can help minimise damage to the skin if you do end up scratching it.

     

  • Identify and avoid your eczema triggers – if you know what triggers your flare-ups, try to avoid that trigger if possible. Common triggers are certain fabric detergents, heat, and certain foods such as eggs and cows’ milk. You should however, always speak to a doctor before making significant changes to your diet as it may not be healthy to stop eating certain foods, especially for young children and for women who are breastfeeding their baby.

     

  • Use emollients – these are gels, creams or other types of moisturisers that can be used every day to stop the skin from becoming dry and irritated.

Emollients are moisturising creams / gels / ointments that can be applied directly to the skin. They help treat the symptoms of eczema by:

  • Keeping the skin hydrated
  • Stopping the skin from drying out 
  • Forming a “protective layer” on top of the surface of the skin

If you have mild eczema, a pharmacist can give you some advice on emollients. If you have moderate or severe eczema, you should speak to your doctor about which emollient is best for you to use.

Emollients can usually be bought over-the-counter at a pharmacy, and can include brands such as:

  • Aveeno
  • E45
  • Aloe Vera
  • Dermalex
  • Vaseline
  • Eucerin 

How to use an emollient

You should always follow the specific instructions that your pharmacist or doctor gives you on how to use your particular emollient as each one can have different instructions. 

In general however, the following techniques can be used:

  • When applying an emollient, try to use a large amount and try not to rub it into the skin. Instead, you should try to gently smooth it over the skin.

     

  • After you have a bath or shower, pat your skin dry and apply the emollient on your skin while it is still moist (this will help lock in moisture and prevent the skin from becoming dry).

     

  • During a flare-up, use generous amounts of your emollient, more frequently. If you find that your emollient isn’t enough to control your flare up symptoms, speak to your doctor about trying another treatment.

     

  • Don’t put your fingers into an emollient pot, use a spoon instead. This helps keep the process clean, and reduces the risk of developing an infection.

  • Never share your emollient with other people as this can also help reduce the chance of infections developing.

What is the difference between a cream, a lotion and an ointment?

The difference between these moisturisers is the amount of oil that is present in them.

  • Lotions contain a small amount of oil
  • Creams contain a moderate amount of oil
  • Ointments contain larger amounts of oil

Medications

Sometimes, trying to treat your symptoms at home isn’t enough. That’s when your doctor may recommend that you try some medications.

Some medications that can be used to treat eczema include:

If your skin is sore and inflamed, your doctor may prescribe a topical corticosteroid. This is a specific type of medication that you can apply directly to your skin.  

Topical corticosteroids can help reduce the inflammation that’s causing some of your skin symptoms. They can be prescribed in different strengths (mild, moderate, or strong), depending on how bad your symptoms are. 

Examples of different topical corticosteroids include:

 Mild corticosteroids:

  •  Hydrocortisone

Moderate corticosteroids:

  • Betamethasone valerate 
  • Clobetasone butyrate

Strong corticosteroids: 

  • A higher dose of betamethasone valerate 
  • Betamethasone diproprionate

Very strong (potent) corticosteroids:

  • Clobetasol proprionate 
  • Diflucortolone valerate

You must speak to a doctor first before trying any of these topical corticosteroids as they can be harmful if they are used incorrectly.

Side effects

Topical corticosteroids may cause a mild stinging sensation when you first apply them to your skin. 

 They can cause some other side effects that are more rare, and these include:

  • Thinning of the skin – this usually happens if you are using a very strong (potent) corticosteroid for a long time on sensitive parts of the skin, such as the face 
  • Changes in skin colour – sometimes very strong steroids can cause the skin to become lighter after many months of use. Usually however, skin lightening after eczema can be caused by old patches of inflamed skin, and not because of treatments. 
  • Acne (spots) 
  • Increased hair growth

Most of these side effects will usually improve once you stop using the corticosteroid. 

The stronger the corticosteroid you are using and the longer you use it for, the higher your risk of developing these side effects.

Antihistamines are medications that stop a substance called histamine from causing certain symptoms to develop in your body such as inflammation and itching. 

It is important to be aware that some antihistamines can be “sedating” and can therefore can make you feel drowsy after you take them. These “sedating” antihistamines should be taken with caution, especially if you are driving, operating heavy machinery, or conducting another potentially dangerous task that requires a lot of concentration.

Your doctor may prescribe medicated bandages, clothing, or wet wraps to wear over areas of skin affected by eczema. These bandages and wraps can be used on top of emollients or topical corticosteroids to help:

  • Prevent you from scratching your skin
  • Allow the affected skin underneath the bandages to heal properly
  • Stop the skin from drying out

Seeing a specialist skin doctor (dermatologist)

Sometimes, these medications and treatments are not enough to help some people with their eczema. If these eczema treatments don’t work for you, or if your symptoms are severe, your doctor may ask you to see a specialist skin doctor (called a dermatologist). Your dermatologist can often prescribe stronger medications or treatments to help with more severe forms of eczema.

You may be referred if:

  • Your doctor is not sure which type of eczema you have
  • Your normal treatment is not controlling your symptoms 
  • Your eczema is affecting your daily life
  • It is not clear what is causing your eczema

A dermatologist will usually carry out a full assessment, do some allergy tests, and review the treatment you are already taking. In some cases, a dermatologist may recommend some of the following medications.

  • Topical calcineurin inhibitors (e.g. pimecrolimus and tacrolimus)  – these are creams and ointments that suppress your immune system and can therefore help reduce some symptoms.

  • Very strong topical corticosteroids

  • Immunosuppressant tablets (e.g. azathioprine, ciclosporin and methotrexate) – these are strong medications that work by suppressing your immune system and preventing certain symptoms from developing.

  • Alitretinoin – this is a specific medication that is used to treat adults with severe eczema that mainly affects their hands. 

  • Phototherapy (also known as light therapy) – this treatment uses ultraviolet (UV) light to help reduce inflammation and improve symptoms.

WARNING: Some of the medications are very strong and should not be used without the supervision of a specialist doctor.

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Seeing other specialist doctors

If your doctor thinks it is necessary, they may refer you to other specialists such as a:

  • Dietitian (a specialist in diet and nutrition)
  • Immunologist (a specialist in diseases that affect the immune system)
  • Paediatrician (a specialist in diseases that affect children)

Complementary therapies

Some people find complementary therapies such as herbal remedies useful for treating their symptoms. However if you are thinking about using complementary therapies, please speak to your doctor first to check that the therapy is safe for you to use.

Can you prevent yourself from getting eczema?

Although you cannot prevent some types of eczema from developing completely, you can work on identifying and avoiding certain triggers that make your eczema worse.

Other things you can do to keep your symptoms under control include:

  • Create a regular bathing and moisturising routine that works for you 
  • Follow the specific instructions that your pharmacist or doctor gives you on how to use your treatments and medications
  • Keep an eye on any signs of infection which can include (but are not limited to): pus-filled spots, pain, redness and skin that is warm to the touch

Is there a cure for eczema?

Although there is currently no cure for eczema, the above mentioned treatments and staying away from triggers can help ease symptoms.

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  3. Rożalski M, Rudnicka L, Samochocki Z. Atopic and Non-atopic Eczema. Acta Dermatovenerol Croat, 2016 Jun;24(2):110-5. May 5, 2020. (Access here)
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This article contains public sector information licensed under the Open Government Licence v3.0.

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