Atopic Eczema

Overview

Atopic eczema is a common, long-term skin condition that makes your skin dry, itchy, and easily irritated. It often comes and goes in flare-ups, where the skin becomes red, cracked, and sore. Although it can be uncomfortable, it is not contagious and can usually be managed well with the right care.

Yes, atopic eczema is very common. It affects around 1 in 5 children and up to 1 in 10 adults at some point in their lives.

It most often starts in early childhood, usually before age 5, but it can appear at any age. It tends to run in families and is more likely if you or your close relatives have asthma, hay fever, or food allergies.

Symptoms

Common symptoms

• Intense itching, especially at night
• Dry, sensitive skin
• Red or brownish patches on the skin (on darker skin tones, these may look darker or greyish)
• Small raised bumps that may weep or crust when scratched
• Cracked, scaly, or thickened skin

Symptoms in children

• Rashes often appear on the face, scalp, elbows, and knees
• Babies may have weepy, crusted patches on the cheeks and scalp
• Children often scratch at night, disturbing sleep
• The urge to rub against furniture or bedding to relieve itching

Symptoms in older adults

• Rashes often affect the hands, eyelids, and around the neck
• The skin may become very dry, thick, and leathery from long-term scratching
• Flare-ups can be triggered more by stress, weather changes, or certain soaps and fabrics
• Older adults may have eczema only on specific small patches that are slow to heal

Causes

Main causes

• The exact cause is not fully known, but it involves a combination of your genes and your environment.
• People with eczema often have a slightly faulty skin barrier — it loses moisture more easily and lets irritants in.
• The immune system overreacts to triggers, causing inflammation and itching.

Risk factors

• A family history of eczema, asthma, hay fever, or allergies
• Living in a climate with very cold or very dry air
• Being exposed to certain irritants like soaps, detergents, or rough fabrics
• Stress and anxiety can make symptoms worse
• In some people, certain foods may trigger a flare, but this is individual and not the main cause for most

When to see a doctor

See a doctor urgently if:

• If you see signs of a skin infection (increased redness, heat, swelling, pus, or yellow crusting), contact your doctor or call your local medical advice line the same day
• If a severe flare does not improve with your usual moisturisers and treatments after a few days

Book a routine appointment if:

• If eczema affects your sleep, work, or daily life
• If you or your child have frequent flares that are difficult to control
• If you are unsure about which treatments to use or how to apply them
• If the rash changes in appearance, spreads, or bleeds without a clear reason

Diagnosis

A doctor can usually diagnose atopic eczema by listening to your symptoms and examining your skin. They will look at where the rash appears and ask about your personal and family history of eczema, asthma, and allergies.

Tests that may be done

• No specific lab test is needed to confirm atopic eczema.
• Sometimes a patch test or skin prick test may be offered to check for allergies if a trigger is suspected.
• If there are signs of infection, a swab may be taken from the skin to identify the germ.

What to expect at your appointment

During your appointment, the doctor will gently look at the affected areas. They may ask about your daily skincare routine, what triggers you have noticed, and how the eczema affects your sleep and wellbeing. You can show them your current moisturisers and ask for advice on how to use them effectively.

Treatment

Treatment for atopic eczema focuses on three things: restoring the skin barrier, reducing inflammation, and avoiding triggers. This usually involves a daily skincare routine with moisturisers, and using prescribed treatments during flare-ups. The plan is tailored to you and may change over time.

Self-care at home

• Apply an emollient (medical moisturiser) every day, even when your skin feels clear — this is the most important step.
• Use lukewarm water for bathing, not hot water, and keep baths short (5–10 minutes).
• Pat your skin dry with a soft towel instead of rubbing.
• Use fragrance-free, gentle cleansers or emollient wash rather than regular soap.
• Wear soft, breathable fabrics like cotton and avoid wool or synthetic materials directly against your skin.
• Keep your fingernails short and consider cotton gloves at night to reduce scratching damage.

Medical treatments

For flare-ups, doctors often recommend topical treatments applied directly to the skin, such as steroid creams or ointments (as a group of medications) to reduce inflammation, or non-steroid prescription creams. If eczema is severe, a doctor may suggest light therapy (phototherapy) or oral medicines that quiet the immune system. You may also be referred to a dermatologist for specialist treatment. Always follow exactly how your doctor or pharmacist tells you to apply these treatments.

When is surgery considered?

Surgery is not used to treat atopic eczema. In rare cases, if the skin becomes severely infected or thickened, a doctor may consider other procedures, but this is not a routine part of eczema care.

Living with this condition

Living with eczema is about building a simple, consistent routine. Apply your moisturiser at the same times each day (for example, after bathing and before bed). Carry a small amount of moisturiser with you for handwashing at work or school. Learn to notice early signs of a flare — such as itching or redness — and act quickly by using your prescribed treatments as directed.

Lifestyle tips

• Find ways to manage stress, such as breathing exercises, gentle yoga, or talking to a friend.
• Keep your bedroom cool at night to reduce itching.
• Choose non-biological washing powders and avoid fabric softeners if they irritate your skin.
• During winter, protect your skin from cold winds and use a humidifier in dry rooms.

Diet and exercise

For most people, food is not a direct cause of eczema. It is important to eat a balanced diet and drink plenty of water to keep your skin healthy from the inside. If you suspect a specific food makes your eczema worse, keep a diary and discuss it with your doctor — never cut out major food groups without professional advice. Regular exercise can improve wellbeing, but shower soon after and moisturise to avoid sweat irritating your skin.

Mental health and emotional wellbeing

Eczema can take an emotional toll. The itching and visible rash may affect your confidence, sleep, and mood. It is completely normal to feel frustrated or upset. If you notice persistent anxiety, low mood, or difficulty sleeping, speak to your doctor. You deserve support for your mental health as much as your skin. If you are having thoughts of harming yourself, reach out to a crisis helpline in your area immediately.

Prevention

You cannot always prevent atopic eczema from developing, especially if it runs in your family. However, you can reduce how often and how severely it flares by keeping your skin well moisturised, avoiding known irritants, and treating the skin at the first sign of a problem.

Complications

If left untreated

• Repeated scratching can break the skin, allowing bacteria to enter and cause infection — this often requires antibiotic treatment.
• Chronic scratching can lead to thickened, dark, or scarred skin (lichenification).
• Poor sleep due to itching can lead to tiredness, irritability, and difficulty concentrating at work or school.
• Eczema that affects visible areas can cause embarrassment and low self-esteem.

Long-term outlook

The outlook for atopic eczema is positive. With consistent care, most people are able to control their symptoms well and live full, active lives. Many children see significant improvement as they grow older. Even if your eczema continues into adulthood, treatment options have improved greatly, and you can work with your healthcare team to find a plan that suits you.

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