eczema that comes and goes

Overview

Eczema (also called atopic dermatitis) is a skin condition that makes your skin dry, itchy, and red. When eczema comes and goes, it means you have times when your skin is calm and other times when it flares up. A flare can last a few days or a few weeks, then settle down again.

Yes. Eczema is very common. Around 1 in 5 children and up to 1 in 10 adults in the UK have eczema at some point in their lives.

Eczema usually starts in early childhood, but it can appear for the first time at any age. It affects people of all skin colours. Many children outgrow it, although some continue to have flare-ups as teenagers and adults. Adults can also develop eczema later in life, often on their hands.

Symptoms

Common symptoms

• Dry, sensitive skin
• Intense itching, often worse at night
• Red to brownish-grey patches (on darker skin, these can look darker brown, purple, or grey)
• Rough, thick, or scaly skin
• Small raised bumps that may leak fluid when scratched
• Cracked or broken skin

Symptoms in children

• Patches often appear on the face, scalp, inside the elbows, and behind the knees.
• Children may scratch so much that their skin bleeds or becomes infected.
• Sleep problems are common because itching can be worse at night.

Symptoms in older adults

• Adults often get eczema on the hands, eyelids, and around the neck.
• Skin becomes drier and thinner with age, so eczema can make it feel more fragile.
• Long-term scratching can cause the skin to thicken and look leathery.

Causes

Main causes

• A problem with the skin barrier, which lets moisture escape and allows irritants or allergens to get in.
• An overactive immune system that reacts to triggers as if they were harmful.
• A mix of genes and environment — eczema often runs in families, along with asthma and hay fever.

Risk factors

• Family history of eczema, asthma, or allergies.
• A personal history of asthma or hay fever.
• Contact with skin irritants such as soaps, detergents, and rough wool.
• Dry, cold weather or sudden changes in temperature.
• Stress and emotional ups and downs.
• In some people, certain foods may trigger a flare, although this is not common.

When to see a doctor

See a doctor urgently if:

• Your skin becomes infected — for example, if you see oozing yellow crusts, painful swollen areas, or red streaks.
• The itching or pain is severe and your usual treatments are not helping.
• You have a high temperature along with a skin flare-up.

Book a routine appointment if:

• You have eczema that keeps coming back and affects your daily life.
• Your current skin care routine is not controlling your symptoms.
• You want to build a personalised treatment plan with your healthcare provider.

Diagnosis

A doctor or nurse can usually diagnose eczema by looking at your skin and asking about your symptoms, your personal history, and your family history. They will ask about your flare-ups and the things that seem to trigger them.

Tests that may be done

• No test is needed for most cases of eczema.
• Patch testing may be used to check for skin allergies if your eczema is not improving.
• If an allergy is suspected, your doctor may suggest allergy testing.

What to expect at your appointment

Your doctor will look at your skin and ask questions about your daily routine, sleep, and any possible triggers. They may give you a treatment plan and show you how to apply moisturisers and other treatments correctly. You may need to come back for reviews, especially if your eczema is severe or not improving.

Treatment

Treatment for eczema aims to calm the skin, reduce itching, and prevent flare-ups. Most people need a regular moisturising routine, plus other treatments applied to the skin when a flare happens. Your healthcare provider can help you choose what works best for you.

Self-care at home

• Moisturise your skin at least twice a day, even when it looks calm.
• Use gentle, fragrance-free cleansers instead of regular soap.
• Take short, warm (not hot) baths or showers, then pat your skin dry and apply moisturiser within a few minutes.
• Wear soft, breathable clothes, like cotton, and avoid wool or rough fabrics.
• Keep your nails short and consider wearing cotton gloves at night to reduce scratching damage.
• Ask your pharmacist about emollients (medical moisturisers) — these are often the first step in managing eczema.

Medical treatments

Medical treatment usually starts with emollients (moisturisers). If these are not enough, a healthcare professional may recommend anti-inflammatory creams or ointments to put on the affected skin, such as topical corticosteroids in different strengths. Other options might include topical calcineurin inhibitors, which are also applied to the skin, or phototherapy (treatment with specific light waves) for more stubborn eczema. In severe cases, an expert doctor may suggest medicines that work on the whole body to reduce inflammation. Always talk to your doctor before starting or changing any treatment.

When is surgery considered?

Surgery is not used to treat eczema itself. In very rare cases, if a skin infection becomes severe and needs drainage, this will be managed in hospital by a medical team.

Living with this condition

Living with eczema that comes and goes means learning to look after your skin every day, even when it looks fine. A simple routine can help you feel more in control and reduce flare-ups.

Lifestyle tips

• Create a daily skin care routine and stick to it.
• Identify and avoid your personal triggers, such as certain fabrics, soaps, or stress.
• Keep your home comfortably cool and use a humidifier if the air is very dry.
• Manage stress with activities you enjoy, like walking, reading, or relaxation exercises.
• Tell friends, family, or teachers about your condition so they can support you.

Diet and exercise

There is no special diet that cures eczema. For some people, certain foods may trigger a flare, but this is not common. If you suspect a food link, keep a diary and talk to your doctor or a dietitian. Exercise is good for your health and can help reduce stress. After exercise, rinse off with warm water if you have been sweating, and reapply moisturiser.

Mental health and emotional wellbeing

Living with itchy, visible skin can be stressful and can affect your confidence and sleep. It is normal to feel frustrated or low sometimes. If you are struggling, talk to your doctor or a mental health professional. If you have thoughts of harming yourself, reach out for help right away.

Prevention

You cannot always prevent eczema from starting, but you can help reduce flare-ups. The best approach is to keep your skin moisturised and avoid known triggers. Starting treatment early at the first sign of a flare can stop it from getting worse.

Vaccines

There is no vaccine for eczema itself. However, keeping up to date with routine vaccinations is important. If you use strong medicines that affect your immune system, talk to your doctor before having live vaccines.

Screening programmes

There is no routine screening test for eczema. You may need regular check-ups if you use ongoing treatments, especially medicines that affect your whole body.

Complications

If left untreated

• Skin infections, including bacterial and viral infections, can develop from scratching.
• Sleep problems and tiredness from itching.
• Thickened, discoloured skin from long-term scratching, known as lichenification.
• Emotional distress and lower quality of life.

Long-term outlook

Eczema can be unpredictable, but the outlook is generally good. Most children outgrow it or see it improve with age. Many adults find that their eczema becomes easier to control once they understand their triggers and follow a regular skin care routine. With the right support from healthcare professionals, most people live very full, active lives.

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