What is atopic eczema?

Atopic eczema is a common skin condition and may start at any age, but the onset is often in childhood: It is estimated that up to 1 in 5 children will be affected by eczema at some point. 

The term ‘atopic’ is used to describe a group of conditions, which include asthma, eczema and hay-fever. These conditions are all linked by an increased activity of the allergy reaction of the body’s immune system. ‘Eczema’ is a term which comes from the Greek word ‘to boil’ and is used to describe red, dry, itchy skin which sometimes weeps, blisters, crusts, scales and thickens. 

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What does it look like?

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Main body location

All over / widespread


Can it appear anywhere?


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What causes atopic eczema?

Atopic eczema is a complex condition and a number of factors appear important for its development including patient susceptibility and environmental factors. Patients typically have alterations in their skin barrier, and increased inflammatory and allergy responses. Environmental factors include contact with soaps, detergents and any other chemicals applied to the skin, exposure to allergens, and infection with certain bacteria and viruses. A tendency to atopic conditions often runs in families (see below). An alteration in a gene that is important for maintaining a healthy skin barrier has been closely linked to the development of eczema. This makes the skin of patients affected by eczema much more susceptible to infection and allows irritating substances/particles to enter the skin, causing itching and inflammation. Atopic eczema cannot be caught from somebody else – it is not infectious. 

Is atopic eczema hereditary?

Yes, AE tends to run in families. If one or both parents have eczema, it is more likely that their children will develop it too. Approximately one third of children with atopic eczema will also develop asthma and/or hay fever. Atopic eczema affects both males and females equally.  

What are the symptoms of atopic eczema?

The main symptom is itchiness. Scratching in response to an itch may cause many of the changes seen on the skin. The itch can be severe enough to interfere with sleep, causing tiredness and irritability. Typically, atopic eczema goes through phases of being severe, less severe, and then gets worse again. Sometimes a flareup can be due to the reasons outlined below, but often no cause can be identified.  

What does atopic eczema look like?

Atopic eczema can affect any part of the skin, including the face, but the areas that are most commonly affected are the creases of the joints at the elbows and knees, as well as the wrists and neck (called a flexural pattern). Other common appearances of atopic eczema include coin-sized areas of inflammation on the limbs (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern). 

Affected skin is usually red and dry, and scratch marks (accompanied by bleeding) are common. When atopic eczema is very active, it may become moist and weep during a flare-up and small water blisters may develop, especially on the hands and feet. In areas that are repeatedly scratched, the skin may thicken (a process known as lichenification) and this may cause the skin to itch more. Sometimes affected areas of the skin may become darker or lighter in colour than the surrounding, unaffected skin. 

How is atopic eczema diagnosed?

The features of atopic eczema are usually easily recognised by health visitors, practice nurses and doctors, when they assess the skin. Blood tests and skin tests are usually not necessary.  

What makes atopic eczema flare-up?

  • Many factors in a person’s environment can make atopic eczema worse; these include irritants such as soaps, detergents and other chemicals, heat, dust, woollen clothing, and pets. 
  • Being unwell, for example having a common cold can cause a flare-up. 
  • Infections with bacteria or viruses can make atopic eczema worse.  Bacterial infection (usually with a type of bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment. An infection with the cold sore virus (herpes simplex) in skin affected by eczema can cause a sudden painful widespread (and occasionally dangerous) flare-up of atopic eczema, with weeping small sores.  
  • Dryness of the skin. 
  • Teething in babies. 
  • Rarely, food allergens may cause a flare-up 
  • Stress  

Can atopic eczema be cured?

No, it cannot be cured, but there are many ways of controlling it. Most children affected by atopic eczema will see improvement as they get older, with 60% clear of it by their teens. However, many of these people continue to have dry skin and will therefore benefit from lifelong avoidance of irritants such as soaps, detergents and bubble baths.  

Atopic eczema may be troublesome for people in certain jobs that involve contact with irritant materials, such as catering, hairdressing, cleaning, or healthcare work. In later life, atopic eczema can present as hand dermatitis and as a result exposure to irritants and allergens should be avoided both in the home and at work. 

Can atopic eczema be prevented?

There is no clear proven way to prevent eczema. 

Although exclusive breast-feeding has been advocated for the prevention of eczema in susceptible infants, there is no evidence that this is effective. There is also no definite evidence that organic dairy products help to reduce the risk of eczema, or that eating fish oil during pregnancy helps to prevent eczema in childhood.  

Can someone with atopic eczema lead a normal life?

Yes, you can lead a full life including sports, swimming and travel. You may need to make minor changes such as keeping moisturiser with you at school, work or when away from home 

How can atopic eczema be treated?

‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical, although for more severe eczema some people may need to take ‘oral’ (by mouth) medication as well.   

‘Complete emollient therapy’ is the most important treatment for all patients affected by eczema. This means regular application of a moisturiser (also known as an emollient) and washing with a moisturiser instead of soap (known as a soap substitute).  

Self care (What can I do?)

  • Moisturise your skin as often as possible, ideally at least 2-3 times each day. The most greasy, non-perfumed moisturiser tolerated is the best. This is the most important part of skin care. Smooth the moisturiser on in the direction of hair growth. Do not put your fingers back and forth into the pot of moisturiser, as it may become contaminated and be a source of infection. It is best to remove an adequate amount to cover the skin with a spoon or spatula and put this on a saucer or piece of kitchen roll.  
  • Wash with a moisturiser instead of soap (known as a soap substitute), and avoid soap, bubble baths, shower gels and detergents. 
  • Treat eczema early – the more severe it becomes, the more difficult it is to control. 
  • Wear non-powdered, non-rubber gloves (e.g. vinyl gloves) to protect your hands and avoid skin contact with irritants when doing jobs such as housework. 
  • Rinse well after swimming and apply plenty of moisturiser after drying. Make sure the shower at the swimming pool contains fresh water and not chlorinated water from the swimming pool. 
  • Wear comfortable clothes made of materials such as cotton and silk and avoid wearing wool next to your skin. 
  • Try to resist the temptation to scratch. It may relieve the itch briefly, but it will make the skin itchier in the long term. Smooth a moisturiser onto itchy skin. 
  • Avoid close skin contact with anyone who has an active cold sore as patients with eczema are at risk of getting a widespread cold sore infection.  
  • Do not keep pets to which there is an obvious allergy. 
  • Keep cool. Overheating can make eczema itch more. 
  • Wash clothes with a non-biological washing powder and use a double rinse cycle to remove detergent residues from the clothing. 

Images DermNetNZ.

This information is provided by the British Association of Dermatologists.

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