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Eczema is a condition that causes the skin to become itchy, red, dry and cracked. It is a long-term, or chronic, condition.
Atopic eczema, also known as atopic dermatitis, is the most common form of eczema. It mainly affects children, but can continue into adulthood.
Atopic eczema commonly occurs in areas with folds of skin such as:
See Atopic eczema - symptoms for more information.
What causes atopic eczema?
The exact cause of atopic eczema is unknown. However, it often occurs in people who get allergies ("atopic" means sensitivity to allergens).
See Atopic eczema - causes for more information.
How common is atopic eczema?
About one in five children in the UK has eczema. In 8 out of 10 cases, atopic eczema occurs before a child reaches five years of age. Many children develop it before their first birthday.
The number of people diagnosed with atopic eczema has increased in recent years. This could be due to changes in lifestyle or environmental factors that cause eczema, or because healthcare professionals are now more aware of the symptoms.
Males and females are affected equally. There is some evidence that eczema may be slightly more common in people from African-Caribbean backgrounds.
Atopic eczema can vary in severity. Most people are only mildly affected and have small areas of dry or red skin, which are occasionally itchy.
Other people have more severe symptoms, such as cracked, sore and bleeding skin.
A person with atopic eczema usually has periods when symptoms are less noticeable, and flare-ups when symptoms become more severe and require additional treatment.
Atopic eczema clears up or significantly improves in many children as they get older. In about 53% of cases, atopic eczema clears up by the time a child reaches 11 years of age, and in 65% of cases it clears up by 16 years of age.
Severe eczema often has a significant impact on daily life and may be difficult to cope with physically and mentally. However, many different treatments can be used to control symptoms and manage the eczema.
See Atopic eczema - treatment for more information
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The symptoms of atopic eczema may always be present. Symptoms become worse during a flare-up, and you or your child may need stronger treatment when this happens.
Atopic eczema can cause your skin to become:
During a flare-up, your skin may be:
The symptoms of atopic eczema vary according to how severely you or your child are affected by the condition.
People with mild atopic eczema normally have only small areas of dry skin, which are occasionally itchy. In more severe cases, atopic eczema can cause widespread dry skin, constant itching and oozing fluid.
Scratching can disrupt your sleep and make your skin bleed. It can also make itching worse, and a cycle of itching and regular scratching may develop. In children, this can lead to sleepless nights and difficulty concentrating at school.
Where atopic eczema occurs
Atopic eczema can occur in small patches all over the body. It is most common:
There is no single cause of eczema. It probably has a mixture of inherited and environmental causes that act together at different times.
You may be born with an increased likelihood of developing eczema, which you inherit from your parents. When you are exposed to environmental factors, such as dust or pollen, this causes eczema to appear.
There are also several triggers, which can make your symptoms worse.
Research suggests that atopic eczema is largely an inherited condition. This means that the cause lies in the genes that you inherit from your parents.
If a child's parents have atopic eczema, it is highly likely that the child will also develop the condition. Studies have shown that 60% of children who have a parent with atopic eczema also have the condition. If both parents have atopic eczema, there is an 80% chance that a child will also have the condition.
It is not yet known exactly which genes are responsible for eczema, although a protein called filaggrin is involved. Filaggrin attaches to a tough substance called keratin in cells and, along with other structures, forms a barrier at the skin's surface. If there is a problem with your filaggrin, the skin barrier can no longer provide effective protection from the environment.
There may be a problem with your filaggrin if you have inherited a defect in the gene responsible for making filaggrin. In this case, you have a higher risk of developing atopic eczema. The filaggrin gene may account for up to one in five cases of eczema. Other genes responsible for skin inflammation may also be responsible.
If your genes make you more likely to develop atopic eczema, the condition will develop after you are exposed to certain environmental factors, such as allergens.
Allergens are substances that can cause the body to react abnormally. This is known as an allergic reaction. Some of the most common allergens that can cause atopic eczema include:
Atopic eczema can sometimes be caused by food allergens, especially in the first year of life. Foods that typically cause allergic reactions include:
Some studies of children and young people with atopic eczema, which were not carried out in the UK, found that one-third to nearly two-thirds also had a food allergy. Having a food allergy increases the likelihood of your atopic eczema being severe.
See the encyclopaedia topic about Food allergies for more information.
Allergies do not appear to play a role in many people with eczema. Other non-allergic factors may be just as important in bringing out eczema in someone who is likely to get it. These factor could include:
Triggers can make atopic eczema worse, although they may not cause the condition.
Hormonal changes in women
Hormones are powerful chemicals that are produced by the body and have a wide range of effects. Changes in the levels of certain hormones can affect the symptoms of atopic eczema in some women.
Many women's eczema is worse at certain times during their menstrual cycle. Some women have a flare-up of their eczema in the days before their period.
Pregnancy, which causes hormonal changes, can also affect atopic eczema:
While stress is known to be associated with atopic eczema, it is not fully understood how it affects the condition. Some people with eczema have worse symptoms when they are stressed. For other people, their symptoms cause them to feel stressed.
See the encyclopaedia topic about Stress for more information and ways to manage stress.
After vigorous exercise, sweating may make your eczema symptoms worse. Try to keep cool when you are exercising by drinking plenty of fluids and taking regular breaks.
Irritants can make your symptoms worse. What irritates you may be different to what irritates someone else with the condition, but could include:
Other possible triggers include:
Your GP will usually be able to diagnose atopic eczema by assessing your or your child's skin and asking some questions about the condition, such as:
Your GP will also assess the severity of your eczema, such as how much the itching is bothering you and how widespread the areas of dry skin are. Tell your GP if your condition is affecting your quality of life, for example if you have difficulty sleeping or if it is limiting your daily activities.
Checklist for diagnosing atopic eczema
To confirm a diagnosis of atopic eczema, your GP may assess the appearance of your skin against a checklist of symptoms.
Typically, to be diagnosed with atopic eczema, you must have had an itchy skin condition in the last 12 months, as well as three or more of the following signs and symptoms:
If your symptoms do not meet these criteria, you may still have atopic eczema, although other types of skin problems may be more likely.
Your GP will work with you to establish what triggers make your eczema worse (see Atopic eczema - causes). They may ask you about your diet and lifestyle to see if any obvious factors may be contributing to your symptoms. For example, you may have noticed that some soaps or shampoos make the eczema worse.
Your GP may use other methods to try to determine what is triggering your eczema. For example, they may ask you to keep a food diary for four to six weeks to find out whether a specific food makes your symptoms worse.
A food diary involves writing down everything you eat and making a record of any eczema flare-ups that you have. Your GP can see if there are any patterns between your symptoms and what you eat.
Diagnosing a food allergy
Some types of food can make your eczema symptoms worse within 24-48 hours, and you may be allergic to some types of food. A food allergy can cause:
These symptoms usually develop within a few minutes to an hour after exposure to the food. See the Health A-Z topic about Food allergy - symptoms for more information.
If you or your child develop these symptoms immediately after coming into contact with a particular food, you may have a food allergy.
Although there is no simple cure for atopic eczema, a variety of treatments can ease the symptoms of an eczema flare-up. Children with atopic eczema normally find that their symptoms naturally improve over time.
Medication used to treat atopic eczema includes:
These two medicines provide effective treatment for most cases of eczema, even severe eczema.
Your GP will prescribe emollients for dry skin, and the weakest effective topical corticosteroid. Different strengths are needed for different parts of the body.
Other medicines that may be used include:
Your GP will prescribe additional medication as and when it is needed.
As well as medication, the following self-care advice should also help.
You can use several self-care treatments at home to manage your or your child's eczema symptoms.
Eczema is often itchy. Scratching it will aggravate the skin more and will eventually cause it to thicken, like a piece of leather. If you scratch your skin, it increases the risk of your eczema becoming infected with bacteria. See Atopic eczema - complications for more information.
There may be times when you or your child cannot help scratching. Keeping nails short will minimise any damage to the skin. If your baby has atopic eczema, anti-scratch mittens may stop them scratching their skin. Other techniques for avoiding skin damage from scratching include tapping or pinching the skin until the itch has gone.
Your GP will work with you to establish what triggers your or your child's eczema flare-ups, although eczema may get better or worse for no obvious reason. See Atopic eczema - diagnosis for more information.
If you establish what triggers a flare-up, you can try to avoid contact with the triggers. For example:
Although house dust mites have been shown to trigger eczema flares, you are not recommended to try to get rid of dust mites from your home. The process is very time consuming and difficult to carry out effectively, and there is no clear evidence that it helps.
Similarly, although living in an area that has hard water is associated with slightly higher levels of eczema in younger children, installing a water softener does not seem to make any difference.
If you or your child have atopic eczema, do not make any significant dietary changes without first speaking to your GP. Some foods, such as milk, eggs and nuts, have been shown to trigger eczema symptoms. However, it may not be healthy to cut these from your diet without medical advice, especially in young children who need plenty of calcium, calories and protein provided by these foods.
If your GP suspects that you have a food allergy, you may be referred to a dietitian. This is a healthcare professional who specialises in diet and nutrition.
If you are breastfeeding a baby who has atopic eczema, get medical advice before making any changes to your regular diet.
Emollients are substances that help soften and smooth your skin to keep it supple and moist. They are the most important treatment for dry skin associated with atopic eczema. See the encyclopaedia topic about Emollients for more information.
As atopic eczema can cause your skin to become dry and cracked, it is important to keep it moisturised to prevent it from becoming more irritated. Emollients stop water being lost from the outer layer of the skin, and add water to the skin. They act as a protective barrier to keep the moisture in and the irritants out.
Choice of emollient
Several different emollients are available, some of which you can buy over-the-counter without a prescription. Your GP can recommend a suitable product.
You may need to try a few different emollients to find one that suits you. You may also be prescribed different emollients for different uses, such as:
The difference between lotions, creams and ointments is the amount of oil and water they contain. Ointments contain the most oil so can be quite greasy, but they are the most effective at keeping moisture in the skin. Lotions contain the least oil so are not greasy but can be less effective. Creams are in the middle.
If you have been using a particular emollient for some time, it may eventually become less effective or it may start to irritate your skin. If this is the case, speak to your GP as another product can be prescribed instead. The most common reason for emollients not working is that they are used for inflamed skin without the help of an anti-inflammatory treatment, such as topical corticosteroids.
How to use emollients
Use your emollient all the time, especially between flare-ups, even when you do not have symptoms. Keeping separate supplies of emollients at work or at school can be a good idea.
To apply the emollient:
Creams and lotions tend to be more suitable for red, inflamed areas of skin. Ointments are more suitable for areas of dry skin that are not inflamed.
It is very important to keep using your emollients during a flare-up because this is when the skin needs the most moisture. During a flare-up, apply emollients frequently and in generous amounts.
An adult with moderate eczema over quite a lot of their body should use around 500-600g (1.1-1.3lb) of emollient a week. A child should use about half this amount. Check the amount of your emollient on the packaging to work out roughly how long the pot or tube should last.
The most common side effect of using emollients is stinging, which is often due to eczema not being sufficiently treated. Emollients alone rarely control eczema unless the eczema is very mild.
It is also possible for the emollient to block your pores, which is why you should apply it in the same direction that the hair grows.
If you have atopic eczema, your skin is very sensitive and can sometimes react to certain ingredients within an emollient. If your or your child's skin reacts to the emollient, speak to your GP. They will check to see if you are using enough topical corticosteroids or can prescribe an alternative product.
Some emollients contain paraffin and can be a fire hazard. As some emollient products are highly flammable, they should not be used near a naked flame.
Emollients that are added to your bath can make your bath very slippery, so take care getting in and out of the bath.
As long as you are aware of these hazards, you should be able to use emollients safely.
When your or your child's skin is red and inflamed from an atopic eczema flare-up, your GP will probably prescribe a topical corticosteroid. Topical means something that is applied directly to your skin. Corticosteroids work by quickly reducing inflammation.
Corticosteroids are any type of medication that contains steroids, a type of natural hormone. Hormones are powerful chemicals that have a wide range of effects on the body. See the encyclopaedia topic about Topical corticosteroids for more information.
You may be concerned about using medication that contains steroids. However, corticosteroids are not the same as anabolic steroids, which are sometimes used illegally by bodybuilders and athletes. When used correctly, corticosteroids are a safe and effective treatment for eczema.
Choice of topical corticosteroid
Topical corticosteroids can be prescribed in different strengths, depending on the severity of your atopic eczema. They can be very mild, such as hydrocortisone, moderate, such as clobetasone butyrate, strong or very strong. Severe cases of atopic eczema will require a stronger corticosteroid than milder cases. You may be prescribed:
If your atopic eczema is moderate to severe, you may need to apply topical corticosteroids between flare-ups, such as at weekends, as well as during them.
If you need to use corticosteroids frequently, see your GP regularly so they can check that the treatment is working effectively and that you are using the right amount.
How to use topical corticosteroids
Apply the treatment sparingly to the affected areas. Always follow the directions on the patient information leaflet that comes with the corticosteroid. This will provide details about how much you should apply, such as the number of fingertip units (see box, above left).
During an atopic eczema flare-up, do not apply the corticosteroid more than twice a day. Most people only have to apply it once a day. To apply the topical corticosteroid:
If you or your child are using corticosteroids for a long time, you may be able to apply them less frequently. Your GP will advise you about how often you should apply them.
Speak to your GP if you have been using a topical corticosteroid and your symptoms have not improved.
Topical corticosteroids may cause a mild burning or stinging feeling as you apply them.
If strong topical corticosteroids are used for too long, they may also cause:
Generally, using a stronger topical corticosteroid or using a large amount of topical corticosteroid may increase your risk of side effects. For this reason, use the weakest preparation that controls your symptoms well.
Antihistamines are a type of medicine that stops the effects of a substance in the blood called histamine. Your body often releases histamine when it comes into contact with an allergen.
Antihistamines may be prescribed during flare-ups to help you cope with the itching that atopic eczema causes. Antihistamines can be sedating, which cause drowsiness, or non-sedating. See the encyclopaedia topic about Antihistamines for more information.
You may be prescribed a non-sedating antihistamine to take once a day for a month if you have severe itching or associated hay fever. If this helps, you may continue taking the non-sedating antihistamine in the long term. You should be reviewed every three months to see if you still need the medication.
These antihistamines may still cause some drowsiness. For example, loratadine can cause drowsiness in 1 in 100 people.
If your itching affects your sleep, you may be prescribed a sedating antihistamine to reduce the itching at night and improve your sleep. Sedating antihistamines are prescribed on a short-term basis, usually for a maximum of two weeks at a time, as they seem to lose their effect quickly.
You or your child may still feel drowsy the following day, so make sure you let your child's school know that they may not be as alert as normal. If you are taking sedating antihistamines, avoid driving the next day if you still feel drowsy. The sedative effect is likely to be stronger if you drink alcohol.
In rare cases, if you have a severe flare-up, your GP may prescribe oral corticosteroids. These are also used for flare-ups of asthma. They contain steroids, as topical corticosteroids do, but are swallowed. See the Health A-Z topic about Corticosteroids for more information.
You may be prescribed prednisolone to take once a day, usually in the morning, for one to two weeks.
If oral corticosteroids are taken often or for a long time, they can cause side effects, such as:
For this reason, your GP is unlikely to prescribe oral corticosteroids more than once a year without referring you to a specialist (see referral, below).
Infected eczema is often sore, very red and oozing with occasional yellow pus spots in it. If your or your child's eczema has become infected, you will usually be prescribed an antibiotic.
If you have an extensive area of infected eczema, your GP may use a swab to take a sample of the skin. A swab is a small piece of absorbent material, such as gauze or cotton, attached to the end of a stick or wire. The sample can then be tested to see what is causing the infection and which antibiotic it will respond to.
You will usually be prescribed an antibiotic to take by mouth. The antibiotic most commonly prescribed is flucloxacillin, which is usually taken four times a day for seven days. If you are allergic to penicillin, you may be prescribed:
If your infection is severe or does not improve after one week, you may be given antibiotics to take for another week.
If you have a small amount of infected eczema, you will normally be prescribed a topical antibiotic. This medicine, which is an ointment or cream, is applied directly to the affected area of skin.
Topical antibiotics should not be used for longer than two weeks because the bacteria may become resistant to the medication.
If you use topical antibiotics for longer than two weeks, your skin may also become sensitive to the product and become irritated. If your symptoms get worse, stop using the topical antibiotic and return to your GP.
Once your infection has cleared, your GP will prescribe new supplies of any topical medication or treatments that you use, such as emollients or topical corticosteroids. This is in case your old ones are infected. Once you have received the new supplies, dispose of your old treatments safely.
The most important way to control infection is to control the underlying inflammation with topical corticosteroids. The inflammation causes the bacteria to live in this area of skin and needs to be treated.
If areas of your eczema are prone to infection, you may be prescribed a topical antiseptic. This type of treatment is also applied directly to your affected skin and works by helping to kill bacteria. Commonly prescribed topical antiseptics include chlorhexidine and triclosan.
In some cases of atopic eczema, your GP may refer you for assessment and treatment by a dermatologist, a specialist in treating skin conditions. Your GP may refer you if:
Some of the treatments a dermatologist may offer you are explained below. These types of treatments are not suitable for everyone, and can only be carried out by experienced skin-care specialists.
Possible treatments include:
Alitretinoin, sold under the brand name Toctino, is a medication for severe, long-term hand eczema that has not responded to other treatments, such as topical corticosteroids. Treatment with alitretinoin must be supervised by a dermatologist and can only be used by people who are 18 years of age or over.
Alitretinoin is a type of medication called a retinoid. Retinoids reduce the levels of irritation and itchiness associated with eczema.
Alitretinoin comes as a capsule that most people are recommended to take once a day for 12-24 weeks.
Alitretinoin should never be taken during pregnancy because it can cause severe birth defects. Also, avoid taking alitretinoin when breastfeeding because the medication can enter your breast milk and harm your baby.
Due to the risk of birth defects, the use of alitretinoin is not recommended for women of child-bearing age. If you are a woman of child-bearing age, you will only be prescribed alitretinoin if you agree to the following strict rules:
Some common side effects of alitretinoin include:
Uncommon side effects of alitretinoin include nose bleeds and sight problems, such as blurred vision. If you have vision problems, stop treatment immediately and contact your dermatologist.
There have also been reports of people suddenly having thoughts of hurting or killing themselves while taking retinoids, which are related to alitretinoin. However, this has never been reported with alitretinoin.
It may be helpful to tell a close friend or relative that you are taking alitretinoin and ask them to tell you if they notice changes in your behaviour or are worried about the way you are acting. If you have any concerns, let you dermatologist know.
For a full list of side effects, see the patient information leaflet that comes with your medicine or the alitretinoin medicines information above.
Some people choose to use complementary therapies to treat atopic eczema, such as food supplements or herbal remedies. Although some people find these therapies helpful, there is a lack of evidence to show that they are effective in treating atopic eczema.
If you are thinking about using a complementary therapy, speak to your GP first to ensure that the therapy is safe for you to use. For example, some herbal treatments can cause serious side effects of the liver and may require blood tests for monitoring. Continue to use any other treatments your GP has prescribed.
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Atopic eczema can cause several complications, which can be physical or psychological. Possible complications are explained below.
As atopic eczema can cause your skin to become dry and cracked, the risk of getting a skin infection is increased. The risk is higher if you scratch your eczema and if you do not use treatments as advised.
Bacterial infections can cause more severe symptoms. The most common type of bacteria that infects atopic eczema is Staphylococcus aureus. If your skin becomes infected with Staphylococcus aureus, it can make your eczema worse, causing:
Your skin will be unable to heal naturally from this type of infection and you will need to take antibiotics (see Atopic eczema - treatment).
It is possible to have an infection caused by the herpes simplex virus, which normally causes cold sores. This can develop into a serious condition called eczema herpeticum. Symptoms of eczema herpeticum include:
Contact your GP immediately if you think you or your child may have eczema herpeticum. If you cannot contact your GP, call NHS Direct on 0845 4647 or go to your nearest hospital.
As well as affecting you physically, atopic eczema may also affect you psychologically.
Preschool children with atopic eczema are more likely to have behavioural problems than children who do not have the condition. They are also more likely to be more dependant on their parents compared with children who do not have the condition.
School children may experience teasing or bullying if they have atopic eczema. Any kind of bullying can be very traumatic and difficult for a child to deal with. Your child may become quiet and withdrawn. Explain the situation to your child's teacher and encourage your child to tell you about how they are feeling.
The National Eczema Society provides information about regional support groups, where you may be able to meet other people living with atopic eczema.
Research suggests that sleep-related problems are very common among young children with eczema.
A lack of sleep may affect your child's mood and behaviour. It may also make it more difficult for them to concentrate at school, which may lead to them falling behind with their work. Again, it is important to let your child's teacher know about their condition so that they can take this into consideration.
During an eczema flare-up, your child may need to take time off from school. This may also affect their ability to keep up with their studies.
Atopic eczema can affect the self-confidence of both adults and children. Children may find it particularly difficult to deal with their condition, which may result in them having a poor self-image.
If your child is severely lacking in confidence, it may affect their ability to develop their social skills. Support and encouragement will help boost your child's self-confidence and give them a more positive attitude about their appearance.
Speak to your GP if you are concerned that your child's eczema is severely affecting their confidence.
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