What eczema is
In atopic dermatitis the skin barrier does not hold moisture well and the immune system reacts more readily to irritants and allergens. The result is dry skin, itch and patches of red or darkened, rough, sometimes weeping skin. In infants it often affects the face and outer limbs; in older children and adults it favours the folds of the elbows and knees, the neck, hands and eyelids. Many people with atopic dermatitis also have asthma, hay fever or food allergy.
Other forms include hand eczema, discoid eczema, seborrhoeic dermatitis, and contact dermatitis caused by irritants or allergens. See contact dermatitis and patch testing.
Common triggers
- Dry air, especially in winter with indoor heating
- Soaps, detergents, fragranced products and frequent hand washing
- Wool and rough fabrics, overheating and sweat
- House dust mite, pet dander and pollen in some people
- Skin infection, which both triggers and results from flares
- Stress and lack of sleep
Assessment at DermCare
Your dermatologist takes a history of when the condition started, what makes it worse, what has been tried and how it affects sleep, school or work, then examines the whole skin. The diagnosis is usually clinical. Tests such as skin swabs, a biopsy or patch testing are used only when the picture is unclear or another condition is suspected. Children are seen with a parent or guardian, and the plan is written so that it can be followed at home and at school.
Treatment options
Skin care and emollients
Regular, generous use of a plain moisturiser is the foundation of treatment at every level of severity. It repairs the barrier, reduces itch and lowers the need for medicated creams. We advise on bathing, soap substitutes and how much and how often to apply.
Topical anti-inflammatory therapy
Topical corticosteroids of a strength matched to the site and severity settle flares quickly and are safe when used as directed. Topical calcineurin inhibitors are steroid free alternatives suited to the face, eyelids and skin folds and to longer term maintenance. Newer non steroid topical agents are considered where appropriate. Wet wrap therapy can be taught for severe flares in children.
Phototherapy
Narrowband UVB is delivered on site by our nursing team under physician order and is effective for widespread eczema that is not controlled with topical therapy, in adults and in children who are old enough to stand in the cabinet safely. A course usually runs two to three times a week for several weeks. Read about how phototherapy works.
Systemic and biologic therapy
For moderate to severe disease that has not responded to the above, options include short courses of oral immunosuppressive medicines, injectable biologic therapies that target the specific immune pathways driving atopic dermatitis, and oral small molecule inhibitors. Several of these are approved for adolescents as well as adults. Baseline tests and monitoring vary by medicine. Details on systemic and biologic therapy.
Signs of infection
Eczema that suddenly worsens, weeps, develops yellow crusts or pus filled spots may be infected with bacteria and usually needs antibiotic treatment. Clusters of small, punched out sores or blisters with fever or feeling unwell may indicate a herpes virus infection called eczema herpeticum, which needs same day medical attention.
For referring physicians
Please include age, distribution and extent, effect on sleep, topical agents used with strength and duration, any systemic therapy, and any history of asthma, allergy or recurrent skin infection. Patients not controlled on appropriate strength topical corticosteroids, or with more than limited body surface area involved, are appropriate for referral and may be candidates for phototherapy or systemic therapy. How to refer.