Atopic dermatitis (eczema) – how to manage it

Atopic dermatitis (eczema) is a common condition that causes dry, red, itchy skin.

The word ‘atopic’ is used to describe a group of conditions caused by allergies, such as dermatitis, asthma and pollen allergies (hay fever). These conditions are linked together by having an overactive immune system.

Although atopic dermatitis is common in children, it can develop for the first time in adulthood.

The constant itching can lead to sleepless nights, and difficulty concentrating. Scratching can make your skin bleed and cause infection.

But there are many treatments that you can use to ease your symptoms, including self-care and medical treatments.

What are the symptoms?

You can have eczema anywhere on your body.You might notice it more commonly in areas such as your hands, the inside of your elbows, and the backs of your knees.

Common symptoms of atopic dermatitis (eczema) include:

• dry, itchy, inflamed, and irritated skin
• moist, crusted, weeping skin, blistering if more severe
• bleeding and cracked skin.

On darker skin tones, atopic dermatitis might be harder to see and look brown, purple or gray. If you have a lighter skin color, it usually looks more red.

You might notice more symptoms if atopic dermatitis is on parts of your body exposed to more triggers, like your hands or face.

This can lead to a flare-up, which is when your dermatitis gets worse. You’ll usually have periods when it’s better, too.

What’s the cause?

There is no single known cause for atopic dermatitis (eczema), and it's not completely understood. It's thought to be linked to a range of factors including:

• genetics – research shows that almost 50% of cases are likely to be caused by a mutation of a gene called filaggrin. Other genes are also thought to play a role, including those involved in your immune system. Research has shown about 70% of people with atopic dermatitis have family members with the condition
• the environment – contact with soaps, detergents or other chemicals can trigger dermatitis, as can allergens in our environments such as animal dander or even bugs like bacteria
• your immune system – if you have dermatitis, your immune system often has an overactive response to allergy or inflammation.

This combination means your vital skin barrier is more vulnerable and unable to retain moisture or prevent irritants, allergies, and skin bugs from entering your skin. So your skin tends to feel more dry and itchy, is more likely to get inflamed, and is more susceptible to allergens.

What causes an atopic dermatitis flare-up?

Flare-ups of atopic dermatitis (eczema) can happen as often as 2 or 3 times a month. Triggers can include:

• irritants such as soaps and detergents, and shampoo
• clothes made from materials like wool and synthetic fabrics
• allergens such as latex, house dust mites, pet dander, pollen, or – more rarely – certain foods such as cows’ milk or eggs
• the weather – especially cold and dry weather in winter
• being unwell – having a cold, for example
• skin infections with bacteria or viruses
• having dry skin
• stress – try our tips for how to relieve stress.

You may notice patterns when your dermatitis flares up, linked to your lifestyle and diet. It's important to note these down as this will help in working out triggers and avoiding them.

Getting a diagnosis is important – if you treat atopic dermatitis early before it becomes severe, it’s usually easier to manage.

When to see a doctor

If you have symptoms of atopic dermatitis (eczema), make an appointment with your doctor.

It's also important to see a doctor if your condition is getting worse or if treatments haven’t helped.

In some cases, your atopic dermatitis might be infected and you’ll need to see a doctor – do this if your skin:

• is oozing or leaking fluid
• is yellow, crusting, or spots appear
• looks more swollen, sore, red/darker than your usual skin color
• has new fluid-filled blisters that leave small open sores
• is painful and getting worse
• feeling unwell, with a fever (in some cases).

How it’s diagnosed

To diagnose atopic dermatitis (eczema), your doctor will ask about your symptoms and how they affect your life. They will also ask about other conditions you may have, like asthma and pollen allergy, and whether they run in your family.

You may be advised to keep a food diary if you’ve noticed any food triggers. In some cases, you may be referred to a specialist for further tests such as allergy testing to identify triggers.

What treatments are available?

The best management for atopic dermatitis (eczema) usually involves a combination of lifestyle changes and medications.

Moisturizers

Known as emollients, moisturizers are the most important part of treatment for atopic dermatitis and help trap moisture in the skin by providing a protective barrier. They should be applied frequently – at least 3-4 times a day – and used instead of soap in the shower.

You can buy different emollients from lotions (good for applying to hairy or damaged skin) to ointments (ideal for dry, thickened skin - and leaving on overnight).

Take care when near any open flames and avoid smoking, as emollients contain oils that can easily catch on fire.

Medication

If your atopic dermatitis (eczema) is severe your doctor may prescribe:

• steroid creams and tablets – these reduce the itching and redness when your skin is active and inflamed. Your doctor may prescribe stronger types than can be bought over the counter, to help reduce inflammation. In severe cases, you might be prescribed steroid tablets, which can be used for around 5 to 7 days to help bring flare-ups under control. Steroids can have side-effects, especially when used for long periods, so speak to your doctor for advice
• antihistamines – in some cases these can be helpful to reduce itching, particularly at night
• medicated bandages / wet wraps – to protect areas of skin damaged by dermatitis, and allow it to heal.

Specialist treatments

You may need to see a specialist if your symptoms are getting worse despite regular treatments, or keep coming back. They might recommend:

• creams and ointments that will suppress your immune system called ‘topical calcineurin inhibitors’. These are also called immunomodulators
• immunosuppressant treatment to help reduce your immune response
• ultraviolet light also called phototherapy to reduce inflammation
• medicines to treat severe dermatitis.

Self-care for atopic dermatitis

Use treatments directed by your healthcare professional alongside self-care steps, including:

• stop the scratch – keep skin covered with light clothing to limit scratching, try gentle rubbing instead of scratching if you need to, and keep nails short and clean to prevent infection
• stick to soft clothing in natural materials, such as cotton, to avoid skin irritation
• keep rooms like your bedroom cool if heat is a trigger for you
• use soap substitutes rather than soaps or detergents that may irritate your skin
• talk with a therapist or counselor if your condition is affecting your self-confidence. Look at resources at the National Eczema Society or Altogether Eczema to find help and support.