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.‍

‍The National Eczema Society has more information about household triggers and how to manage them.

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

How to tell it’s eczema?

Eczema in babies often appears at between 3-6 months of age. It can develop anytime after birth or 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. It does not usually affect the nappy area. As your child grows older the pattern of eczema changes. It affects the skin behind the elbow and the knee. In some children it affects the whole body.

In children of Asian, black Caribbean or black African ethnic groups, eczema can affect different places including the front surface of the knee or wrist. It can also look different with the skin being bumpy and slightly darker instead of 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 fluid or crusts it could be infected and your child may need antibiotics. Seek urgent advice if your child is 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.

How to treat eczema

Treatment of eczema can help reduce symptoms.  Most children’s eczema improves over time.  Severe eczema can have significant impact on daily life.  Eczema has an increased risk of skin infections.

Top Tips

• Moisturise every day, even when the skin is clear of eczema
• Apply moisturiser using downward strokes. Do not rub it in 
• Do an extra rinse when washing clothes
• Wear soft, comfortable, loose clothing
• Keep fingernails short to prevent scratching

Emollients

• Emollients are moisturisers that soften the skin. It is okay to try different emollients. Talk to your GP or nurse if you do not like one you have been given
• Expect to use large amounts. A large tub (250 to 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 on the skin 
• Emollients 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 a day as needed
• Use at least 2 times a day when skin clear but increase to 4 to 6 times a day during flare ups or when the skin looks dry
• Do not put hands in tubs of emollients as these can introduce “bugs” easily. This is a common reason for repeated skin infections in eczema. Use a clean spoon or spatula to get emollients out of the tub
• For school and for older children and young people emollients with pumps may be better
• Apply in direction of hair growth. This reduces the chance of infection
• Fire hazard. Most eczema treatments contain paraffin and are flammable
• Visit our Healthier Together page for more information on how to apply eczema treatments

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 or lukewarm as heat is a common eczema trigger
• Skin should be patted dry after bath

Topical (On Skin) Steroids

• Steroid creams and ointments are treatments for flare ups 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 no longer red and itchy and restart if eczema comes back
• Leave a gap of 20 mins between applying your emollient and steroid. This is so that the topical steroid is not made less effective by the emollient.
• Visit our Healthier Together page for more information on how to apply eczema treatments

See your doctor if:

Eczema is infected. It may be pustules, blisters, painful, weeping fluid. Antibiotics may be needed

Eczema is not going away with regular daily use of topical steroids for 2 weeks

Eczema is causing waking at night, missing school or mood problems

Helpful resources

Allergy Care Pathway Itchy Sneezy Wheezy Project - Eczema Videos

Eczema in Children Factsheet | Allergy UK | National Charity

A-Guide-for-Teenagers-with-Eczema-booklet-2019.pdf