Eczema Is Associated With A Higher Risk Of Bone Breaks

Overview

Eczema (also called atopic dermatitis) is a common skin condition that makes skin dry, itchy and inflamed. 'Inflamed' means red, sore and swollen. It usually comes and goes in flare-ups — times when the skin is worse — with calmer periods in between. Recent research has found a link between having eczema and a slightly higher chance of breaking a bone. A 'link' or 'association' means the two things are seen together more often than by chance. It does not mean eczema causes broken bones, and for most people the extra risk is small.

Eczema is one of the most common skin conditions worldwide. It affects roughly 1 in 5 children and around 1 in 10 adults in many countries. Broken bones are also common. But the extra risk linked to eczema for any one person is usually small.

Eczema can affect anyone at any age. It most often starts in babies and young children, and many children improve as they grow. Adults can have it too, sometimes for the first time. People with severe or long-lasting eczema, or who need stronger treatments, may be more likely to be affected by the bone link described in research. Older adults with eczema may also be more likely to fall, which matters for bone health.

Symptoms

Common symptoms

• Dry, rough or scaly skin
• Itching, which can be intense and often worse at night
• Red, inflamed patches — 'inflamed' means red, hot and swollen
• Cracked or weeping skin that may bleed or crust over
• Skin that feels sore, stings or burns
• Patches that come and go in flare-ups
• Thickened, leathery skin in areas scratched for a long time

Symptoms in children

• In babies, eczema often appears on the cheeks, scalp and outer arms and legs
• In older children, it often appears in the skin creases — inside the elbows, behind the knees, and on the neck, wrists and ankles
• Itching can disturb sleep and make children tired and irritable
• Scratching can lead to infection — watch for yellow crusting, weeping or spreading redness

Symptoms in older adults

• Eczema may be drier and more widespread on the body
• Skin gets thinner with age, so it damages more easily and heals more slowly
• Itchy skin and poor sleep can raise the chance of falls
• Other medicines or conditions may also affect bone strength — worth reviewing with your doctor

Causes

Main causes

• Eczema happens when the skin's protective barrier does not work as well as it should, so moisture escapes and irritants get in
• It involves an over-reactive immune system — the body's defence system reacting too strongly
• Genes play a big part; eczema often runs in families along with asthma and hay fever
• Triggers include soaps, fragrances, wool, heat, sweat, stress and some infections

Risk factors

• Having more severe or long-lasting eczema
• Long courses of steroid tablets or steroid injections — steroid creams used correctly are much less of a concern
• Less physical activity or less time outdoors during flares
• Poor sleep, which is common with itchy skin
• Low vitamin D levels or a diet low in calcium
• Older age and a higher chance of falls
• Smoking, low body weight, or a family history of osteoporosis ('thin bones')
• Other conditions or medicines that affect bone strength

When to see a doctor

See a doctor urgently if:

• You have had a fall or injury and think you may have broken a bone
• Your eczema looks infected — weeping, crusting, spreading redness or fever
• The itching is so severe it is stopping you sleeping or affecting daily life

Book a routine appointment if:

• Your eczema is not controlled with moisturisers and your usual routine
• You are worried about your bone health, or about steroid treatment you have been given
• You have had more than one fracture, or a break from a minor bump
• You are an older adult with eczema and you worry about falls

Diagnosis

Eczema is usually diagnosed by a doctor or nurse simply by looking at your skin and asking about your history — no special test is needed. The bone link is something to be aware of, not something that needs testing in everyone. If you have concerns about your bones, your doctor may ask about your diet, activity, falls and any steroid treatments, and decide whether any checks are worthwhile.

Tests that may be done

• A skin examination and questions about itching, triggers and family history
• A bone density scan (called a DEXA scan) — a quick, painless X-ray-type test — may be suggested if your doctor thinks your bone strength is a concern
• Blood tests to check vitamin D, calcium and other bone-related levels, if needed
• An X-ray if a break is suspected

What to expect at your appointment

Most appointments are short and simple. Your doctor will look at your skin and talk through your symptoms. If they want to check your bones, this can usually be arranged through your local service. Ask questions — including whether your steroid treatment is at the lowest safe amount, and what you can do for your bone health.

Treatment

Treatment has two aims: keeping your skin calm and comfortable, and looking after your bones. Good eczema care reduces itch, improves sleep and lets you stay active — all of which help your bones too. Your healthcare team will tailor a plan to you.

Self-care at home

• Moisturise every day, even when skin looks clear — it helps protect the skin barrier
• Use lukewarm (not hot) baths and short showers, and a gentle, fragrance-free wash
• Apply any prescribed creams exactly as your doctor or nurse explained — the correct amount matters
• Keep fingernails short and consider cotton gloves at night to reduce scratching
• Avoid known triggers: harsh soaps, perfumed products, wool, overheating and sweat
• Stay physically active — walking, dancing and other weight-bearing activity help build strong bones
• Eat calcium-rich foods and get sensible sunlight; ask your doctor about vitamin D
• Reduce falls at home: good lighting, no loose rugs, grab rails if needed
• Do not smoke, and limit alcohol — both affect bone strength

Medical treatments

Doctors treat eczema in steps, depending on how severe it is. Most people start with daily moisturisers plus anti-inflammatory creams applied to the skin (often steroid creams) used for short courses during flares. Your clinician will explain how much to use and when to stop. For more stubborn eczema, other creams that calm the immune system, light treatment, or tablets that dampen the immune response may be considered. Steroid tablets are usually kept for short, carefully managed courses because long-term use can thin bones. If your eczema has been treated with repeated or long courses of steroid tablets, ask your doctor to review your bone health. All of these decisions are made with your healthcare team — never start or stop a treatment on your own.

When is surgery considered?

Surgery is not a treatment for eczema. It may occasionally be needed for a broken bone, or for skin problems such as large areas of thickened skin in rare cases. Your specialist team would discuss this with you.

Living with this condition

Living with eczema means building a routine: a good moisturising habit, knowing your triggers, and treating flares early. Add bone-friendly habits to that routine — movement, good food and safe surroundings. Small, steady steps work better than big bursts.

Lifestyle tips

• Keep a simple symptom diary to spot triggers and see what helps
• Choose cotton clothing and light layers to avoid overheating
• Use a humidifier in dry weather if it helps, and avoid very hot rooms
• Plan gentle exercise you enjoy and can keep up, like walking or swimming
• Check your home for trip hazards; ask about a falls review if you are older
• Keep up with routine appointments and review your medicines from time to time

Diet and exercise

There is no special 'eczema diet' that works for everyone, and cutting out foods without advice can do more harm than good — especially for children. Eat a varied, balanced diet with enough calcium (milk, yoghurt, cheese, fortified plant milks, leafy greens, tinned fish with bones) and ask your doctor or pharmacist about vitamin D. For exercise, aim for regular movement on most days: walking, dancing, stair climbing and light resistance work all strengthen bones. Swimming is often kind to eczema skin, but rinse off afterwards.

Mental health and emotional wellbeing

Eczema is more than skin deep. Constant itch, broken sleep and visible patches can cause stress, worry, low mood and embarrassment, especially for children and teenagers. That is a normal response and nothing to be ashamed of. If low mood or anxiety is affecting your daily life, please tell your doctor — support is available and it helps. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away. You deserve immediate help.

Prevention

You cannot prevent eczema completely, but you can reduce flares with good skin care and by knowing your triggers. For the bone side, there is plenty you can do: stay active, eat well, get enough vitamin D, avoid smoking, reduce fall risks, and use steroid treatments at the lowest effective amount under your doctor's guidance. If you have taken repeated courses of steroid tablets, ask for your bone health to be reviewed.

Vaccines

There is no vaccine for eczema. Keep up with routine vaccinations recommended for your age and health, and ask your doctor if you are unsure.

Screening programmes

There is no routine screening programme for bone problems in people with eczema. Your doctor may suggest a bone density scan if you have other risk factors — for example long-term steroid tablets, a previous fracture from a minor bump, or older age. Ask about it if you are concerned.

Complications

If left untreated

• Skin infections, which can become serious if not treated
• Poor sleep, tiredness and difficulty concentrating
• Thickened, leathery skin from long-term scratching
• More flares and a need for stronger treatment over time
• Broken bones, particularly hip, wrist and spine breaks in older adults
• Loss of confidence, low mood and time off school or work
• For older adults, a fracture can lead to loss of independence — which is why prevention matters

Long-term outlook

The outlook is encouraging. Most people with eczema manage it well with a simple routine, and the bone risk linked to eczema is modest. Keeping skin calm, staying active and looking after your bones puts you in the best position. If you do break a bone, modern care is very effective — and your doctor can help you reduce the chance of another. Talk to your healthcare team about anything that worries you.

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