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DEFINITIVE GUIDE

Eczema causes and treatment

Eczema is the name for a group of inflammatory skin conditions that cause the skin to become itchy, red, swollen and cracked. It is often a chronic (long lasting) condition, though it can improve significantly and usually clears completely over time.

Eczema more commonly affects young children, often developing before the age of one, but can also affect teenagers and adults. It is estimated that 1 in 5 children in the UK is affected by eczema at some stage.

As there are also other types of eczema, identifying your eczema is key to getting the right treatment.

Written by Dr Saira Goheer and Dr Anthony Bewley. Reviewed by Dr Jackir Hussain. Last reviewed on 01/06/2020. Next review date 01/06/2023.

Fast facts

What is eczema?

Eczema is the name for a group of medical conditions which causes the skin to become red, inflamed, itchy, cracked and rough. It can sometimes cause blisters which may cause the skin to weep, crust, scale and thicken. Eczema can affect any part of the body but most often appears on the hands, elbows, knees, face and scalp. People with eczema often find their condition varies between periods where it is less noticeable and more severe flare-ups.

How do I get rid of eczema?

Although there is no cure for eczema, some sufferers find that their symptoms improve without treatment, and doctors, nurses and other colleagues can help get the eczema better. Most patients learn how to control or clear their skin of eczema. Depending on the type of eczema, symptoms may improve within as little as two to three weeks.

There is a range of topical treatments (usually creams, but sometimes other treatments such as tablets), natural remedies and self-care options to help ease the symptoms of eczema. However, as eczema is a chronic condition, symptoms may return. Most children with eczema will ‘grow out of it’ and although many have the genetic likelihood to get eczema, most will eventually not show any eczema on their skin at all.

CHAPTER ONE

Types of eczema

The most common and chronic type of eczema is atopic dermatitis, also known as atopic eczema. When people commonly refer to eczema, they most often mean atopic dermatitis. Atopic eczema often appears with a red rash and causes the skin to become dry and itchy.

However, there are many different types of eczema. Knowing which eczema you suffer from is key to identifying the right treatment. If you are unsure what sort of eczema you have, we can help with:

  • What are the types of eczema?
  • And what does eczema look like?

Atopic eczema

Atopic dermatitis, also known as atopic eczema, is the most common form of eczema. It is identifiable by dry and itchy skin, often appearing with a red rash. Atopic eczema usually starts in childhood and gets milder or clears completely by adulthood.

The term ‘atopic’ is used to describe a group of conditions including eczema, hay-fever, asthma and allergic conjunctivitis. Atopic conditions are characterised by increased activity of the allergy side of the body’s immune system.

Contact dermatitis

If your skin has developed eczema following close physical contact with a substance, you may have contact dermatitis. Contact dermatitis is caused by contact with irritants or allergens, leading to burning, itching and redness on the skin. Thankfully, the inflammation passes when the irritant or allergen is removed.

There are two types of contact dermatitis. Allergic contact dermatitis is caused by an immune system reaction to an allergen such as hair dye or nickel (for example earlobe dermatitis from costume jewelry). Irritant contact dermatitis occurs when a chemical or other substance (often soap or detergents) irritates your skin.

Tip

Successfully treating contact dermatitis depends on identifying and avoiding the cause of the condition. If you can avoid the irritant or substance that caused the reaction, the rash should clear within two to four weeks.

Discoid eczema

Discoid eczema, also referred to as nummular eczema and nummular dermatitis, is a common type of eczema. It can occur at any age but is more common in middle aged adults..

People with discoid eczema develop round, coin-shaped spots on their skin which can be very uncomfortable and itchy. Treatment is usually with anti-inflammatory creams (often steroid creams) mixed with anti-bacterials.

Dyshidrotic eczema (pompholyx)

Dyshidrotic eczema, also known as pompholyx, is a type of eczema that causes small blisters to form on your fingers, hands and feet. Allergies, stress, moist hands and feet, or exposure to irritants such as detergents may trigger dyshidrotic eczema.

Dyshidrotic eczema can affect people at any age, but most often occurs in adults under the age of 40. It is also twice as common to affect women than men.

Varicose eczema

Also known as venous, gravitational or stasis eczema, varicose eczema is a long-term skin condition that affects the lower legs. Varicose eczema is most common in people with varicose veins, occurring when fluid leaks out of weakened veins into your skin, and thereby setting up an inflammatory reaction. This is why wherever possible varicose eczema is best treated and prevented by using compression stockings (as well as anti-inflammatory steroid creams at the start or during flares).

Varicose eczema can cause the lower part of the legs to swell up, varicose veins, open sores, swelling, redness, itching and pain.

Seborrhoeic eczema

Seborrheic eczema, also known as seborrheic dermatitis, is a chronic form of eczema appearing on the body where there are a lot of oil-producing glands. Seborrheic eczema causes itchy, red, scaly rashes to form on the scalp, eyelids, eyebrows, sides of the nose and behind the ears.

Seborrheic dermatitis can develop at any age including infants (referred to as “cradle cap”). It is slightly more common in men than in women. People with conditions that affect the immune system or nervous system are also believed to be at increased risk, such as HIV or AIDS or Parkinson’s disease.

CHAPTER TWO

Eczema signs and symptoms

Eczema is different for everyone. Depending on the type and severity of your condition, your symptoms may look different from another person with eczema. These symptoms may even appear in different places on your body at different times.

Although most common in children, eczema can also affect teenagers and adults. Eczema usually causes dry, itchy skin but more severe cases may have further complications. If you think you might have eczema, we can help with:

  • What are the first signs of eczema?
  • And what does an eczema rash look like?

What does eczema look like?

The symptoms of eczema may vary depending on the type and severity of your condition. However, common symptoms include:

  • Dry, sensitive skin
  • Red and inflamed skin
  • Frequent itching
  • Swelling, oozing or crusting
  • Rough, leathery or scaly patches of skin

Where does eczema affect?

Although most commonly appearing on the face, back of the knees, wrists, hands or feet, eczema can affect other areas as well. Depending on what type of eczema you have, it is possible for symptoms to affect your eyelids, scalp, ears, nipples, lips, breasts, penis or neck.

How severe is my eczema?

Mild eczema is characterised by areas of dry skin and/or infrequent itching. It may also include small areas of redness, but not always.

Moderate eczema is characterised by areas of dry skin, frequent itching and redness. There may also be localised areas of skin thickening.

Severe eczema is characterised by widespread areas of dry skin, constant itching and large amounts of redness. There may also be skin thickening, bleeding, oozing, cracking and alteration of pigment.

When to seek medical advice for eczema

You should seek medical advice for eczema if the itching and redness don’t fade over time, or if your condition starts to interfere with your day-to-day life. Most often your doctor will be able to identify if you have eczema by looking at your skin and asking a few simple questions.

CHAPTER THREE

What causes eczema?

Atopic eczema is a complex skin condition caused by a combination of different risk factors. People with eczema typically have weakened skin barriers and overly reactive inflammatory and allergic responses.

Other environmental factors can increase the risk of eczema, including contact with irritants and exposure to allergens. Susceptibility to atopic conditions may also run in your genes. If you are uncertain what causes eczema, we can help with:

  • Who is most affected by eczema?
  • And is eczema caused by stress?

What are the causes of eczema?

The cause of eczema is not fully known, but it is believed to be an overactive response by the body’s immune system in a genetically predisposed individual. Quite often there may be an external reason why the eczema has appeared or made it worse, such as hair dye, detergents or contact with furry animals. It is also commonly found in families with a history of other atopic conditions, as well as people with defects in the skin barrier which may allow moisture out and germs in.

What are the risk factors of eczema?

There are several risk factors that can increase your chances of developing eczema. Children who suffer from other atopic conditions, such as asthma or hay fever, or adults who develop these conditions before the age of 30, are more likely to have eczema.

Sometimes there is an external component to the eczema, such as an allergen (nickel is the most common) or irritant (often detergents).

Is eczema hereditary?

Atopic eczema is often hereditary. If one or both of your parents have eczema, then it is more likely that you will develop it too. In addition, roughly one third of children with atopic eczema will develop other atopic conditions such as asthma or hay fever.

Is eczema contagious?

Eczema is not contagious, meaning you cannot catch it from another person. While the exact cause of eczema is not currently known, it is believed to be a combination of genes and environmental triggers.

What makes eczema flare-up?

There are a number of environmental and biological factors which can increase the risk of atopic eczema flaring up. These include:

  • Environmental factors such as heat and dust
  • Contact with irritants (wool clothing, pets, soaps, detergents)
  • Other illness, such as a common cold
  • Dry skin
  • Stress
  • Bacterial or viral infections
  • Food allergies may rarely cause a flare-up
Important

While each of the following factors can cause eczema to flare up, often no specific cause is identified.

Can eczema be cured?

There is currently no cure for atopic eczema, but there are methods to control it. Most children who suffer from atopic eczema will see it improve by their teens, with 60% of cases clearing completely. However, these people may continue to suffer from dry skin and so should avoid irritants such as soaps and detergents.

CHAPTER FOUR

Eczema treatment

Depending on the type and severity of your eczema, different treatments are available. The most common type of eczema (atopic eczema) is usually treated with moisturisers and awareness of irritants. Other forms of eczema may require further guidance from your GP.

There is also a range of natural remedies, high street products and self-care techniques to help treat eczema. If you are unsure which treatment is best for you, we can help with:

  • What is the best eczema cream?
  • And are there any natural remedies for eczema?

How is eczema diagnosed?

A medical professional will usually recognise eczema simply by looking at your skin. It is rare for blood tests or skin tests to be necessary. Occasionally, the skin may need to be swabbed to check for viral or bacterial infections and sometimes allergy tests may be taken.

How is eczema treated?

Most eczema treatments are topical, however, in more severe cases people may need to take oral medication as well. The most common eczema treatments are emollients (moisturisers), which should be applied regularly.

Applying emollients throughout the day helps the outer layer of your skin better shield against your environment. If your skin is particularly dry, you may have to apply moisturiser more frequently. Using soap substitute creams reduces the disruption to the skin barrier from soapy detergents.

Topical treatments for eczema

There is a range of over-the-counter products which can help prevent and reduce the symptoms of eczema. As eczema makes the skin dry and itchy, lotions and creams help to keep the skin moist. Furthermore, cold compresses may also be used to help relieve itching.

Creams and ointments containing corticosteroids are often prescribed to help lessen any inflammation from eczema. These treatments reduce swelling, redness and itching during flare-ups.

If you are uncertain which emollient is best suited for you, consult your GP. The best moisturiser is the one you are most comfortable using on a daily basis.

Self-care advice for eczema

There are a number of self-care steps you can take to help prevent or ease the symptoms of eczema. These include:

  • Try to avoid scratching where possible. Eczema is very itchy, and it can be tempting to scratch the skin. However, this often damages the skin and makes the condition worse.
  • Avoid triggers. Your GP will work with you to identify what might trigger your eczema, such as certain fabrics, heat or detergents. Take steps to avoid these triggers where possible.
  • Adjust your diet. Certain foods, such as eggs and milk, can trigger eczema. However, you should only make significant adjustments to your diet after consulting your GP first.

How can eczema flare-ups be prevented?

Following these tips can help you avoid or manage eczema outbreaks:

  • Moisturise often
  • Avoid overheating or sweating
  • Avoid sudden temperature or humidity changes
  • Destress
  • Avoid any foods that may cause an outbreak
  • Avoid scratchy materials, such as wool
  • Avoid harsh detergents, soaps and solvents
  • Use a humidifier in the room where you sleep
CHAPTER FIVE

Natural remedies for eczema

Finding the right solution to eczema can be a long process. When living with eczema, some treatments can leave your skin feeling drier and more irritated than before. Thankfully, there are a range of natural remedies which you can try at home.

If you’re looking for natural remedies for eczema to try at home, we can help with:

  • How can I get rid of eczema naturally?
  • And what gets rid of eczema fast?

Coconut oil

Studies suggest that applying coconut oil to the skin can help reduce the number of staph bacteria and decrease the risk of infection. Coconut oil is one of the most regularly recommended natural remedies for eczema.

Apply coconut oil one or two times a day to damp skin. Make sure to use only virgin or cold-pressed oils, as these methods of oil extraction are chemical-free.

Sunflower oil

Sunflower oil can help to boost the skin barrier and help it retain moisture. It is also known to have anti-inflammatory properties. Apply sunflower oil twice a day to the skin. One of these times should be shortly after bathing, while the skin is still wet.

Important

Avoid using sunflower oil if you have a known allergy to sunflower seeds.

Aloe vera gel

Aloe vera gel has antibacterial and antimicrobial properties. These can help to prevent skin infections which can be caused by eczema’s dry, cracked skin. The wound-healing effects of aloe vera may also help to soothe the broken skin.

Try to choose aloe gel products with few ingredients as preservatives, alcohol, fragrances and colours can all irritate sensitive skin. Start by applying a small amount to check for skin sensitivity. If it does not cause any burning or stinging, continue to apply daily.

Cardiospermum

Cardiospermum is a flowering tropical vine native to India and Africa. When extracted and put into a topical ointment, Cardiospermum may reduce inflammation, itchiness and help fight bacteria on the skin.

Tea tree oil

Tea tree oil is often used to help with a number of skin conditions including psoriasis and acne. Studies have identified antibacterial, anti-inflammatory and wound-healing properties in tea tree oil. These properties may relieve skin dryness, itching and help fight infections.

Make sure to dilute tea tree oil before applying to the skin. Try mixing tea tree oil with a carrier oil, such as almond or olive oil, before using the treatment.

CHAPTER SIX

For parents: eczema and babies

You may have recently noticed a rash on your child’s arms, legs, hands or face. This can be very worrying, however, baby eczema is actually a very common condition that affects 1 in 5 adolescents.

While eczema can be painful, with the itching often interrupting sleep, the symptoms often improve over time and are easily treatable. If you think your child may have eczema, we can help with:

  • Is eczema different for babies than for older children?
  • And what creams are best for baby eczema?

How to tell if your baby has eczema

If your child has recently developed a red rash on their arms, legs, hands or face this might be eczema. Eczema, also known as atopic dermatitis, is a non-contagious skin condition characterised by redness, itching and rashes.

These symptoms can be painful, sometimes causing changes in skin colour and blisters. The itching may also interrupt sleep, with scratched skin at risk of infection. However, they can be easily alleviated by identifying potential irritants and using topical treatments.

What causes eczema in babies?

While the exact cause of eczema is unknown, it is believed to be a mixture of genetic and environmental triggers. For instance, if you have a family history of atopic dermatitis, asthma or hay fever, it is more likely your child will develop eczema.

What can trigger eczema in babies?

Common eczema triggers include:

  • Dry skin
  • Irritants such as soap, detergents or wool clothing
  • Heat and sweating
  • Infection
  • Allergens such as pollen or dust
Tip

Understanding your child’s symptoms and triggers will help you to manage their eczema and keep the condition under control.

Is eczema different for young children than older children?

Eczema affects infants and toddlers differently to older children. The location and appearance of eczema often alter, so it is important to know what to look for during each stage of development:

  • Infants (first 6 months). For infants, eczema usually appears on the face, cheeks, chin, forehead and scalp. It may spread to other areas, but usually not to the nappy area. The affected areas tend to look redder and “weepy”.
  • Babies (6-12 months). For babies, eczema most often affects the face, elbows and knees as these places are easily scratched and rubbed as they’re crawling. If the eczema rash becomes infected, it may form a yellow crust or very small bumps of pus on the skin.
  • Toddlers (2-5 years). Above the age of two, your toddler’s eczema will most likely affect the creases of their elbows and knees, or their wrists, ankles and hands. Sometimes, it may also affect your toddler’s mouth and eyelids. The skin may look dry and scaly at this stage.
  • Children (5+ years). Above the age of five, eczema usually affects the folds of the elbows and/or knees. Sometimes, it may only affect your child’s hands. Other affected areas may include behind your child’s ears, their feet or their scalp.

Tips on how to treat your child’s eczema

There are a number of simple steps you can take and treatments you can use to help soothe your child’s eczema. These include:

  • Apply an unperfumed moisturiser to the affected areas several times a day. This helps to keep their skin moist and protected. Gently smooth the moisturiser into the skin, don’t rub it in.
  • Avoid aqueous creams as these can cause stinging, itching, burning and redness. Also, try to avoid soap, baby bath and bubble bath as these may further dry and irritate the skin.
  • Where possible, keep your child’s bedroom cool. Hot and moist temperatures can make their eczema worse.
  • As long as suggested by your GP or pharmacist, steroid creams can help prevent eczema from getting worse.
  • Try to identify and avoid any irritants that might be making your child’s eczema worse. These may include soap, animals, chemicals or fabrics.
CHAPTER SEVEN

Eczema pictures

The following images show the different types of eczema. It is recommended that you see a GP who will be able to accurately diagnose your eczema instead of attempting to diagnose yourself. We can help with:

  • What does eczema look like?
  • And what does an eczema rash look like?

Atopic eczema

Note the redness and the scratch marks from tearing at the skin. There is some erosion of the skin and skin thickening over the wrist. Image source.

Discoid eczema

Dyshidrotic eczema (pompholyx)

Seborrhoeic eczema

Varicose eczema

CHAPTER EIGHT

Get same-day treatment with Medicspot

Our private doctors can diagnose your eczema and provide expert treatment and advice. Find out how severe your eczema is and get the right treatment today. We can help with:

  • When can I book an appointment?
  • And how can Medicspot help?

How it works

Book an appointment to see a doctor in minutes.

CHAPTER NINE

About the authors

Written by Dr Saira Goheer and Dr Anthony Bewley. Reviewed by Dr Jackir Hussain. Last reviewed on 01/06/2020. Next review date 01/06/2023.

Dr Saira Goheer

Dr Goheer grew up in Glasgow and attended Hutchesons' Grammar. She qualified from Aberdeen University Medical School in 2010. She returned to Glasgow for her GP training. Saira is now based in Edinburgh working as a qualified GP. She started working for Medicspot in 2019 and has a real passion for travel and fitness.

Dr Anthony Bewley

Dr Anthony Bewley is a Consultant Dermatologist at Barts Health (The Royal London Hospital and Whipps Cross University Hospitals NHS Trust). He qualified from Bristol University Medical School in 1987 and has trained in general dermatology in London, becoming a consultant in 1996. Dr Bewley has developed an interest in how the skin interacts with the brain and the mind. He has a specialist clinic with a multidisciplinary team at least every week at the Royal London Hospital, which was awarded 'BMJ Dermatology Team of the Year' in 2017.

Dr Bewley has written many peer reviewed papers, chapters and textbooks on a variety of skin disease, and continues in active dermatology research. He is the co-author of Practical Psychodermatology (Wiley 2014) and a range of other texts. Dr Bewley is the secretary of the European Society for Dermatology and Psychiatry and co-chair of Psychoderematology UK. He also writes Twitter updates on current psychodermatology training events using #psychodermatologyuk.

Dr Jackir Hussain

Dr Hussain is a GP based in Edinburgh. He qualified as a doctor from the University of Manchester in 2010. He did his foundation training in Glasgow and then went on to do GP training in Lanarkshire. He now works across practices in Edinburgh and is also a member of the urgent care service in Fife. Jackir joined Medicspot in 2019 and is passionate about how technology can improve primary care.

Disclaimer

This article is for general information only and should not be used for the diagnosis or treatment of medical conditions. Medic Spot Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. In the event of an emergency, please call 999 for immediate assistance.