Eczema | Mate harehare

Atopic eczema is a very common skin condition that causes your skin to be dry, itchy and red (inflamed). It's also called atopic dermatitis.

‘Atopic’ is a term used to describe a group of conditions such as asthma, eczema and hay fever. Atopic eczema is more common if you have one of these conditions or a whānau (family) member is affected with one.

Atopic eczema occurs most frequently in pēpi (babies) and tamariki (children). But it can sometimes occur for the first time when you’re an adult. Many tamariki grow out of atopic eczema, but it can return years later.

Video: What is eczema? | Patient explainers

The exact cause of eczema is not known but health professionals believe it's caused by a combination of genes and environmental factors. Some people with atopic eczema have a lower amount of a protein called filaggrin. Filaggrin plays an important role in keeping your skin barrier healthy, so having a lower level leads to dry skin and increases the risk of developing eczema.

People with atopic eczema also tend to have an overactive immune system which can be triggered by a substance inside or outside of the body, causing inflammation.

Itch is the main symptom of eczema. People often scratch their skin because of the itch, which can be moderate to severe and often worse at night. Your skin may also be dry, inflamed and cracked.

Eczema can be mild, moderate or severe. When eczema worsens it’s called a flare-up. Mild cases only involve 1 or 2 affected areas. With severe flare-ups, many areas of your skin can be affected and it can last for several weeks.

Eczema can affect any area of the skin:

• In babies, it's often seen on the face, body, arms and legs.
• In older children, it often affects the skin in the creases behind their knees, wrists, elbows and ankles.
• In adults, it can affect any part of your body with common areas being the wrists, inside elbows, back of knees, trunk and limbs.
• Sometimes it can affect the face and genital areas.

Sometimes your skin can become infected. Signs and symptoms of infection include:

• skin that's weepy and crusted
• lots of white or yellow pimples
• a sudden flare-up of eczema all over your body
• shivering
• painful skin
• painful blisters that look like chickenpox.

Important:

If you suspect infected eczema, see a doctor or nurse as soon as possible. You may need antibiotics to treat the infection.

A trigger is something that makes your eczema worse (flare-up) and can vary from person to person.

Common triggers include:

• heat or changes in temperature
• irritants, eg, soap, bubble bath, detergent, fabric conditioner, perfumed products
• fabrics, eg, wool or synthetic materials, that can be prickly
• chemicals, eg, chlorine in a swimming pool or chemicals in a spa
• environmental allergens, eg, animal dander, pollen, or house dust mites.

Your doctor will usually diagnose eczema based on your medical history. They'll talk to you about your symptoms and see what your skin looks like. Blood tests and skin tests are not usually necessary.

Treating atopic eczema involves looking after your skin. This includes moisturising and using medicated creams if needed. See below for helpful self-care advice.

See eczema medicines and eczema in children for more information on treating atopic eczema. 

Apps reviewed by Healthify

You may find it useful to look at some Eczema apps.

Having eczema (dermatitis) can be challenging. While there’s no cure for eczema, you can control it. The key is to avoid irritants, keep your skin well moisturised, bathe regularly and use topical (rub-on) steroids when needed.

Avoid irritants (triggers)

Avoid things that make your eczema worse (flare-up). Common irritants (known as triggers) include soap, detergent, wool and heat. Once you know your triggers, you can try to avoid them. For example, wear soft cotton and keep room temperatures cool.

Keep your nails short

Scratching leads to inflammation and itching (this is called the itch-scratch cycle). Keeping your nails short will stop you scratching yourself.

Moisturise your skin

The main aim of eczema treatment is to keep your skin moisturised and hydrated.

Moisturisers (also known as emollients) are applied directly onto your skin. They soften it, relieve dryness, reduce itch and provide a protective barrier for your skin.

Moisturisers are available in creams and ointments. Ointments moisturise your skin better than creams but are also thicker and greasier. Because ointments are greasy, some people like to use a cream during the day and an ointment at night. Moisturisers can also be used as a soap substitute since soaps and bubble bath can make eczema worse.

There are many types of moisturisers so you might want to ask your pharmacist for advice. If you have moderate or severe eczema, talk to your healthcare provider

You can buy moisturisers directly from your pharmacy. Or you can get them through prescription from your healthcare provider.

Tips on applying a moisturiser:

• Apply 2 to 3 times a day or as often as needed to keep your skin moist. It’s important to use moisturisers all the time, not just when you have symptoms.
• Always wash and dry your hands thoroughly before applying.
• When you apply moisturiser, smooth it onto your skin in the direction that your hair grows.
• Don’t rub it in. Let your skin absorb the moisturiser on its own.
• Use after a bath or shower. Pat your skin dry and apply the moisturiser while your skin is damp.
• Apply to all areas of your body, not just the affected areas.

Video: How to use emollients

(Guy's and St Thomas' NHS Foundation Trust, UK, 2017)

Bathe or shower daily

Have a bath or shower every day to help moisturise your skin.

• Limit bathing time to 10 to 15 minutes and try not to have the water too hot as it can dry out and irritate your skin.
• Avoid soap (including liquid soap) as it can dry out your skin. Use soap substitutes such as Sorbolene. You can apply this to your skin before bathing then wash it off. You can buy these without a prescription.
• Avoid using bubble baths, which can be extremely drying and irritating. Instead try bath oils which can hydrate your skin, coating it with a film of oil to trap water in the skin. You can buy bath oils or dissolve a teaspoon of emulsifying ointment under the hot tap.
• If your scalp is affected, use a less irritant shampoo such as E45 Dry Scalp Shampoo. T-Gel is a gentle tar shampoo that may help treat dry scalps.
• Avoid hair conditioner as it can cause irritation.
• If you often get infected eczema, it may help to add an antiseptic to your bath such as Oilatum Plus or QV Flare Up. But don’t use this more than once a week. These products can be quite expensive. An inexpensive option is a bleach bath. Bleach comes in different strengths. This factsheet tells you how much to use. Don’t have a bleach bath more than twice a week.

Topical steroids for more severe eczema

Topical steroids come in creams and ointments and help by reducing inflammation, making your skin less red and itchy. You apply them directly to your skin.

They come in several different strengths. Usually, you use a stronger topical steroid cream (or ointment) on your body and a weaker one on your face and in skin folds. It’s important to use the right strength.

Your healthcare provider will tell you the correct strength to use and for how long.

Use the steroid cream when your skin is red and inflamed. Stop using it once the redness settles down. Continue using your moisturiser while using the cream.

How to apply topical steroids:

• Always apply as directed by your healthcare provider.
• Apply before or after your moisturiser.
• Always wash and dry your hands thoroughly before applying.
• Gently rub it into the affected areas and only those areas.
• Wash your hands thoroughly after applying.

How much steroid cream to use:

• Generally, use one fingertip unit (FTU). This is a thin line of cream from the last joint of your index finger (the finger next to your thumb) to your fingertip. This is enough to cover an area that is double the size of the palm of your hand.
• Use more cream depending on the part of the body affected. Read more about the FTU and how to use it here.
• Read more about the types of topical steroids and formulations.
• The amount also varies with age. See eczema in children for information about treating a tamaiti (child).

Video: How to use topical steroids

This video describes the different types of topical steroids and how to apply and use them safely.

(British Association of Dermatologists, UK, 2017)

Managing infection

Eczema-prone skin is more likely to get infected and this will make the eczema worse. Infected eczema will not improve with your usual treatments. It can be weepy, crusty or have pus-filled blisters. It can be a small patch or cover a large area of skin.

If you think your eczema is infected, see your general practice team as soon as possible. They may prescribe a short treatment with antibiotics, which should clear the infection.

If you often get skin infections, it may help to add an antiseptic to your bath using Oilatum Plus or QV Flare Up. They are quite expensive. An inexpensive option is to have a bleach bath.

If you have showers rather than baths, add a gel like Microshield to your soap substitute twice a week to prevent infections.

Speak to your heatlhcare provider if:

• your eczema is not improving
• you have infected eczema.

If you have severe eczema that's not responding well to treatment, your healthcare provider may refer you to a Hospital Dermatology Department. There you'll be seen as an outpatient by a doctor who specialises in skin conditions (a dermatologist).

If you prefer, you can pay to see a private dermatologist. You can find a private dermatologist on Healthpoint(external link).

Eczema not only affects your skin but can also affect your quality of life. It can have an impact on sleep, self-esteem (particularly if it's visible on your hands or face), work and personal relationships. See your healthcare provider if your eczema is affecting your mood.