Atopic eczema in adults

Overview

Atopic eczema (also called atopic dermatitis) is a long-term skin condition that makes your skin dry, itchy, and inflamed. It often comes and goes, with flare-ups triggered by things like stress, weather, or certain soaps.

Yes, atopic eczema is one of the most common skin conditions. It affects around 1 in 10 adults in the UK.

Atopic eczema can start at any age, but many adults have had it since childhood. It affects men and women equally, and people with a personal or family history of allergies are more likely to have it.

Symptoms

Common symptoms

• Intense itching, especially at night
• Dry, scaly, or rough patches of skin
• Red or darker brown patches (depending on skin tone)
• Small, raised bumps that may ooze clear fluid when scratched
• Thickened, leathery skin from long-term scratching

Symptoms in children

• Eczema often appears on the face, scalp, and outer arms or legs.
• It may be weepy and crusty, and children may scratch until it bleeds.
• Sleep disruption from itching is very common.

Symptoms in older adults

• Skin can become very dry and fragile, with more visible fine lines.
• Eczema often affects the hands, lower legs, and back of the neck.
• It may take longer to heal and be harder to treat because of age-related skin changes.

Causes

Main causes

• A genetic tendency to have a weaker skin barrier, so moisture escapes and irritants get in.
• An overactive immune system that reacts to triggers with inflammation and itching.
• Triggers like harsh soaps, wool clothing, dust mites, pet dander, pollen, stress, and cold, dry weather.

Risk factors

• Having a parent or sibling with eczema, asthma, or hay fever
• Having asthma or hay fever yourself
• Living in a dry or cold climate
• Exposure to irritants at work (e.g., hairdressing, healthcare, cleaning)

When to see a doctor

See a doctor urgently if:

• If your eczema suddenly gets much worse or spreads quickly
• If you have signs of infection (red streaks, pus, fever)
• If you have a high temperature and feel generally unwell

Book a routine appointment if:

• If itching or rash is affecting your sleep, work, or daily life
• If over-the-counter moisturisers and mild steroid creams aren't helping
• If you think you might have a contact allergy (e.g., to nickel or fragrance)

Diagnosis

Your doctor or nurse will usually diagnose atopic eczema by looking at your skin and asking about your symptoms, family history, and triggers. No special test is needed in most cases.

Tests that may be done

• A patch test – small patches with common allergens are placed on your back for 2 days to see if you have a contact allergy (this is done when allergy might be causing the eczema).
• A skin prick test or blood test (like IgE) if a food or airborne allergy is suspected.
• A skin swab to check for bacterial or viral infection if the skin looks infected.

What to expect at your appointment

The doctor will gently examine your skin, ask about your daily routine and products you use, and may ask about your family's health. They'll explain your condition and suggest a treatment plan, often starting with better moisturising and a mild steroid cream.

Treatment

Treatment aims to calm the skin, reduce itching, and prevent flare-ups. It usually starts with good skin care (emollients) and avoiding triggers. If that's not enough, medicated creams or other treatments may be added.

Self-care at home

• Use a fragrance-free, thick moisturiser (emollient) every day, even when your skin looks clear.
• Apply moisturiser after bathing, when skin is still slightly damp.
• Use lukewarm water and a gentle, soap-free wash instead of soap.
• Keep nails short and wear soft cotton gloves at night to reduce scratching.
• Avoid wool, harsh detergents, and fabric softeners.

Medical treatments

If self-care isn't enough, a doctor may prescribe a topical corticosteroid cream or ointment to reduce inflammation. Other options include topical calcineurin inhibitors (non-steroid creams for sensitive areas), phototherapy (controlled UV light treatment), or oral medications that calm the immune system. These are used under medical supervision for more severe cases.

When is surgery considered?

Surgery is not a treatment for atopic eczema itself. In extremely rare cases, if severe complications like widespread infection occur, surgery might be needed for drainage – but this is very uncommon.

Living with this condition

Living with eczema means building a daily skin care routine and being aware of your triggers. Most people learn to manage flare-ups early and keep their skin comfortable between episodes.

Lifestyle tips

• Moisturise every day, even when you feel fine.
• Identify and avoid your personal triggers (e.g., certain foods, stress, harsh weather).
• Wear soft, breathable fabrics like cotton.
• Use a humidifier in dry rooms, especially in winter.
• Manage stress with relaxation techniques, exercise, or talking to someone.

Diet and exercise

For most people, diet does not cause or cure eczema. But if you notice a specific food makes your skin worse (like dairy, eggs, or nuts), you may want to discuss an elimination diet with a doctor or dietitian. Exercise is good for overall health and stress relief, but shower right after to wash off sweat, which can irritate eczema.

Mental health and emotional wellbeing

Eczema can affect your confidence, sleep, and mood. The constant itching and visible rash can make you feel self-conscious or frustrated. It's normal to feel this way. Talk to your healthcare provider if eczema is affecting your mental health – they can offer support and may refer you to a counsellor.

Prevention

Atopic eczema cannot be entirely prevented, especially if you have a genetic tendency. But you can reduce flare-ups by keeping your skin well moisturised, avoiding known triggers, and treating early signs of a flare quickly.

Vaccines

There is no vaccine for eczema. However, people with eczema should still have routine vaccinations. If you have moderate to severe eczema, talk to your doctor before getting the shingles (herpes zoster) vaccine, as the live vaccine is not recommended for people on certain immunosuppressive treatments.

Screening programmes

There is no routine screening for eczema. It is diagnosed when symptoms appear. If you have a strong family history of allergies, you may wish to discuss prevention strategies with your healthcare provider.

Complications

If left untreated

• Recurring skin infections (bacterial, viral) because of broken skin from scratching
• Thickened, darkened skin from chronic scratching (lichenification)
• Sleep problems and fatigue due to nighttime itching
• Lower quality of life, including social withdrawal and emotional distress

Long-term outlook

With the right care, most people with atopic eczema can keep their symptoms under control. The condition often improves with age, though it can still flare from time to time. Treatment advances mean there are more options than ever to help you feel comfortable and live well.

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