Atopic Eczema
Chronic itchy, inflamed skin commonly affecting flexures, often relapsing and remitting.
Overview
Atopic eczema is driven by skin-barrier dysfunction and immune activation. Daily emollient use and topical corticosteroids during flares are the foundation of care. Severe or extensive disease may need specialist treatment.
Symptoms
- • Itchy, dry skin
- • Red or weeping patches
- • Thickened skin from scratching
- • Flexural distribution (elbows, knees)
- • Sleep disturbance from itch
Risk factors
- • Family history of atopy
- • Asthma or hay fever
- • Filaggrin gene mutation
- • Soap and detergent exposure
Causes
- • Skin barrier dysfunction
- • Immune dysregulation
- • Environmental triggers (irritants, allergens, stress)
🚨 Red flags — seek urgent care
- • Widespread weeping rash with fever (eczema herpeticum) — urgent
- • Yellow crusting suggesting bacterial infection
- • Rapid spread
When to seek care
- • Flare not responding to usual treatment
- • Suspected infection
- • Sleep or quality of life affected
Diagnosis
- • Clinical: itchy skin condition plus ≥3 of — flexural involvement, history of asthma/hay fever, generally dry skin, onset before age 2, visible flexural dermatitis
- • Severity assessment (POEM, EASI) to guide treatment
- • Patch testing if suspected contact dermatitis; allergy testing rarely changes management
Treatment
- • Emollients liberally and frequently (≥250 g/week adult), even when skin clear
- • Topical corticosteroid potency matched to severity and body site (mild on face, moderate–potent on body)
- • Topical calcineurin inhibitors (tacrolimus, pimecrolimus) — steroid-sparing for face/skin folds
- • Identify and avoid triggers (soaps, fragrances, wool, allergens)
- • Refractory: phototherapy, oral immunosuppressants (ciclosporin, methotrexate), biologics (dupilumab), JAK inhibitors
Prevention
- • Daily emollients to maintain skin barrier
- • Avoid soaps; use emollient washes
- • Cotton clothing and lukewarm baths
- • Treat infections promptly (eczema herpeticum is urgent)
Complications
- • Secondary bacterial infection (Staph aureus)
- • Eczema herpeticum (medical emergency)
- • Sleep disturbance, low mood, school/work impact
- • Steroid skin atrophy with prolonged potent use
Education & self-care
This guidance is reviewed by Dr. Handel Emery, MD, FRCP (UK) and last updated 2026-06-08. It is educational and not a substitute for professional medical advice.
Frequently asked questions
Are steroid creams safe?
When used appropriately for short flares, topical steroids are safe and effective. Long-term continuous use should be specialist-supervised.
Are steroid creams safe?
Yes when used as directed. Mild-to-moderate topical steroids used in short bursts during flares are safe even on the face. The 'finger-tip unit' guide helps you apply the right amount.
What triggers eczema?
Common triggers include soap and detergents, wool, heat and sweat, stress, certain foods (in a minority), house-dust mite and infections. Identifying personal triggers helps reduce flares.
Will my child grow out of it?
About two-thirds of children with eczema have it clear or substantially improve by their teens. Consistent emollient use is the cornerstone of long-term control.