Eczema
Eczema (also called atopic eczema or atopic dermatitis) is a very common dry skin
condition.
It affects about 1in 5 babies and children in the UK.
Eczema often appears in the
first few months of life. Eczema usually improves in most children as they get older, but
some children with more severe eczema may continue to have eczema into adult life.
Eczema can cause the skin to become itchy, dry, cracked and sore. Sometimes, children
with eczema make may have periods where the eczema becomes more severe (flare ups).
Many things, called “trigger factors” can make the eczema worse. These include:
- Irritants such as soap, clothing (wool, polyester), cigarette smoke, chlorine in swimming pools
- Changes in the climate such as drier air or temperature (too cold or too hot)
- Environmental allergens such as house dust mite and moulds
- Viral illnesses
- Hormone changes
- Stress and anxiety
- Rarely foods :
- Immediate reactions (less than 1 hour) after eating.
- Delayed reactions (4 to 6 hours) after eating with a flare of eczema.
Use this link to learn about household triggers and how to manage them :
https://eczema.org/information-and-advice/triggers-for-eczema/household-irritants-and-eczema/
There is currently no cure for eczema, however avoiding trigger factors and using of
moisturisers 3 to 4 times a day can help keep it under control. Your local community
pharmacist or GP can advice you if other treatment for eczema is needed.
The exact cause of eczema is unknown. It is not down to one thing. Atopic eczema often
occurs in people who get allergies. “Atopic” means sensitivity to allergens. This type of
eczema can run in families, and often develops with other conditions like asthma and hay
fever
If you are worried that the eczema rash looks different to normal please see our page
on rashes for advice on where to seek help
Eczema in babies often appears at between 3-6 months of age although it can develop just after birth or anytime in childhood
The main features of eczema are
- Intense itch
- Dry skin
- Rash
- Redness
- Inflammation
In infants and babies, eczema affects the face, scalp and body with the nappy area usually spared. As your child grows older and becomes more mobile, the pattern of eczema changes to involve the elbow and the knee creases and sometimes affects the whole body
In children of Asian, black Caribbean, black African ethnic groups, eczema may present differently with eczema affecting the front surface of the knee or wrist, the skin may look bumpy and slightly darker rather than red
It is important to be aware of and look for signs of worsening eczema
Recognise a flare: A ‘flare’ is a worsening of the eczema. Skin may become red, sore, (more)itchy, crack or bleed
Recognise infected eczema: If skin suddenly worsens, weeps or crusts it could be infected and your child may need antibiotics – seek urgent advice if child unwell or the infection is widespread
Blisters or cold sores need urgent antiviral treatment – see your GP or seek medical advice the same day
Food allergy: this is rare - consider food allergy if eczema started as a baby. It is not usually the cause of eczema in older children
Eczema in babies often appears at between 3-6 months of age although it can develop just after birth or anytime in childhood
The main features of eczema are
- Intense itch
- Dry skin
- Rash
- Redness
- Inflammation
In infants and babies, eczema affects the face, scalp and body with the nappy area usually spared. As your child grows older and becomes more mobile, the pattern of eczema changes to involve the elbow and the knee creases and sometimes affects the whole body
In children of Asian, black Caribbean, black African ethnic groups, eczema may present differently with eczema affecting the front surface of the knee or wrist, the skin may look bumpy and slightly darker rather than red
It is important to be aware of and look for signs of worsening eczema
Recognise a flare: A ‘flare’ is a worsening of the eczema. Skin may become red, sore, (more)itchy, crack or bleed
Recognise infected eczema: If skin suddenly worsens, weeps or crusts it could be infected and your child may need antibiotics – seek urgent advice if child unwell or the infection is widespread
Blisters or cold sores need urgent antiviral treatment – see your GP or seek medical advice the same day
Food allergy: this is rare - consider food allergy if eczema started as a baby. It is not usually the cause of eczema in older children
Treatment of eczema can help relieve symptoms and many cases improve over time. But there is currently no cure and severe eczema often can have significant impact on daily life. There is also an increased risk of skin infections due to the eczema itself and scratching
Top Tips
-
Moisturise every day, even when the skin is clear
-
Apply moisturiser using downward strokes – do not rub in
-
Do an extra rinse when washing clothes
-
Wear soft, comfortable, loose clothing
-
Keep fingernails short to prevent damage to skin
Emollients
- Emollients are moisturisers that soften the skin - it is okay to try different emollients – talk to your GP/nurse if you do not like one you have been given
- Expect to use large amounts – up to a large pump/tub (250-500 g) per week
- Use everyday, all over-you may need to change emollient type if one does not work
- Emollients form a protective barrier to outside irritants. These are best used few minutes after a warm bath, while the skin is still slightly damp
- Emollients are safe so they can be used as many times as required
- Use plenty when skin looks dry and is flared, at least twice a day when skin clear but increase to 4-6 times a day during flare ups
- Do not put hands in TUBS of ointment as these can introduce “bugs” easily which is a common reason for recurrent infected eczema. Use a clean spoon or spatula to get ointment out of tub
- For school and for older children/ young people creams in pumps may be better
- Apply in direction of hair growth, not against, as this can cause infection of hair follicle
- Fire hazard – most eczema treatments contain paraffin and are flammable
Bathing & Showering
- Avoid Bubble baths and perfumed products (some of the eczema bath products can provide bubbles if put in running water)
- Use your moisturiser (emollient) or a soap free wash to cleanse skin - soap or soap based products can dry the skin.
- Bath water should be tepid/lukewarm as heat is a common trigger
- Skin should be patted dry after bath
Topical (On Skin) Steroids
- Steroid- creams and ointments are treatments for flares of eczema and help heal the skin. Steroids come in different strength from mild to strong steroids.
- Steroids are safe when used in short courses as advised by your doctor. When applying it is important to apply sparingly to the skin so that skin glistens.
- Use topical steroids once a day to eczema that is red and itchy – stop when not red and itchy and re- start if eczema comes back
- It is advisable to leave a gap of around 20 mins between applying your emollient and steroid. This is so that the topical steroid is not diluted or made less effective by the emollient.
See your doctor if:
Eczema is infected – pustules, blisters, painful, weeping – antibiotics may be needed
Eczema is not going away with regular daily use of topical steroids for more than 2 weeks
Eczema is causing waking at night, missing school or mood problems
Treatment of eczema can help relieve symptoms and many cases improve over time. But there is currently no cure and severe eczema often can have significant impact on daily life. There is also an increased risk of skin infections due to the eczema itself and scratching
Top Tips
-
Moisturise every day, even when the skin is clear
-
Apply moisturiser using downward strokes – do not rub in
-
Do an extra rinse when washing clothes
-
Wear soft, comfortable, loose clothing
-
Keep fingernails short to prevent damage to skin
Emollients
- Emollients are moisturisers that soften the skin - it is okay to try different emollients – talk to your GP/nurse if you do not like one you have been given
- Expect to use large amounts – up to a large pump/tub (250-500 g) per week
- Use everyday, all over-you may need to change emollient type if one does not work
- Emollients form a protective barrier to outside irritants. These are best used few minutes after a warm bath, while the skin is still slightly damp
- Emollients are safe so they can be used as many times as required
- Use plenty when skin looks dry and is flared, at least twice a day when skin clear but increase to 4-6 times a day during flare ups
- Do not put hands in TUBS of ointment as these can introduce “bugs” easily which is a common reason for recurrent infected eczema. Use a clean spoon or spatula to get ointment out of tub
- For school and for older children/ young people creams in pumps may be better
- Apply in direction of hair growth, not against, as this can cause infection of hair follicle
- Fire hazard – most eczema treatments contain paraffin and are flammable
Bathing & Showering
- Avoid Bubble baths and perfumed products (some of the eczema bath products can provide bubbles if put in running water)
- Use your moisturiser (emollient) or a soap free wash to cleanse skin - soap or soap based products can dry the skin.
- Bath water should be tepid/lukewarm as heat is a common trigger
- Skin should be patted dry after bath
Topical (On Skin) Steroids
- Steroid- creams and ointments are treatments for flares of eczema and help heal the skin. Steroids come in different strength from mild to strong steroids.
- Steroids are safe when used in short courses as advised by your doctor. When applying it is important to apply sparingly to the skin so that skin glistens.
- Use topical steroids once a day to eczema that is red and itchy – stop when not red and itchy and re- start if eczema comes back
- It is advisable to leave a gap of around 20 mins between applying your emollient and steroid. This is so that the topical steroid is not diluted or made less effective by the emollient.
See your doctor if:
Eczema is infected – pustules, blisters, painful, weeping – antibiotics may be needed
Eczema is not going away with regular daily use of topical steroids for more than 2 weeks
Eczema is causing waking at night, missing school or mood problems