What are the signs of eczema?

In mild cases of eczema, the skin is dry, red or darker than a person’s normal skin colour, depending on skin tone, and itchy. In more severe cases there may also be weeping, crusting and bleeding.

Is eczema contagious?

No, eczema is not contagious. Children with eczema should be allowed to play normally with their friends.

What are emollients?

Emollients are medical moisturisers used to treat eczema and other dry skin conditions. Unlike cosmetic moisturisers, they are unperfumed and do not have ‘anti-ageing’ additives. Emollients have been used for over 5,000 years and form an essential part of the therapy for all dry skin conditions. Emollients are safe and effective – a good skin care routine using emollients can soothe, moisturise and protect the skin, helping to reduce the number of eczema flares.

There are over 120 emollient products that are approved for use by the NHS (listed on what is known as the ‘NHS Drug Tariff’). However, healthcare professionals are usually only allowed to prescribe a few different brands, and the range available will depend on where you live. These emollients can also be purchased in pharmacies and some shops, although they may need to be ordered specially.

Please see our Emollients factsheet for further information on emollients and the different kinds available.

What is the best emollient to use?

The best emollients are the ones that work well for you and that you like using, because you will use them more often. Healthcare professionals may sometimes provide samples of emollients for people to try.

Always test new products on a small area of unaffected skin for 48 hours in case you have a reaction. You may need to use different types of emollient on different parts of the body to obtain the best hydration and to restore the skin’s barrier function.

You may prefer to use a cream or gel during the day and during the spring and summer months, and a greasier emollient just before bed and during the autumn and winter. Remember to also use your leave-on emollient as a soap substitute for washing (unless it’s 50:50 Ointment).

Should I be wary of topical steroids?

Topical steroids (topical corticosteroids) are recommended by the NHS for treating eczema flare-ups and have been used for over 70 years. To work effectively, they need to be used alongside emollients, which soothe, protect and moisturise the skin. For some people with eczema, daily use of emollients for moisturising and washing is all that is needed to keep their condition under control. However, for most people with eczema, topical steroids will need to be used for short treatment bursts, at the correct strength for the person’s age, eczema severity and affected body area, to bring a flare-up under control.

In the UK, topical steroid preparations are divided into four categories according to how strong or potent they are. These categories are ‘mild’, ‘moderate’, ‘potent’ and ‘very potent’. The potency of the steroid you are given will be based on several factors, including age, eczema severity, body site, size of the affected area and other treatments being used.

Topical steroids are effective treatments for eczema, but like many medicines, they can have side effects including thinning of the skin. When used for short treatment bursts as directed by a healthcare professional, and applied to areas of affected skin only, the risk of side effects is small.

Please see our Topical steroids factsheet and Topical steroid withdrawal page for further information.

Which should I apply first, emollient or topical steroid?

In January 2023, a clinical study was published looking at whether the application order affects how much topical steroid is delivered to the skin.

The study looked at the order of application (emollient or topical steroids) and the time between applications. The results showed that applying emollient first reduced the amount of topical steroid that reached the skin.

The study proved that it’s more effective to apply topical steroids before emollients. It also found that if topical steroids are applied before emollients, then a 30-minute gap between the two applications is long enough. On the other hand, if emollients are applied first, the gap should be longer than 30 minutes.

How much emollient should I apply?

Use your emollient of choice frequently. Aim to apply it at least twice a day, and every few hours if the skin is very dry. It is recommended that an adult uses at least 500g per week (at least 250g for a child) when the eczema is affecting a large area of the body. Apply emollient gently in the direction of hair growth. Never rub up and down, as this could trigger itching, block hair follicles and lead to infection in the hair follicles.

How much topical steroid should I apply?

There are guidelines on the amount of topical steroid required to cover different body areas affected by eczema. These are based on the Finger Tip Unit (FTU), which is the amount of cream or ointment that covers the end of an adult finger from the tip to the crease of the first joint when squeezed from an ordinary tube nozzle. One FTU is enough to cover an area of skin the size of one adult hand.

Different parts of the body require different amounts of topical steroid. For example, in an adult, one arm will need 3 FTU while a 4-year-old child will require 2 FTU for an arm and hand. Adjustments will be required if only a small part of the larger area is affected by eczema. Further information is often provided in the leaflet supplied with your treatment. We also have more detailed information in our Topical steroids factsheet.

Any unused steroid cream or ointment should be discarded after the course of treatment is completed. Wash your hands after applying steroids unless you are using them to treat hand eczema.

I have a regular emollient routine and have tried topical steroids but my eczema is still really bad! What other treatments are there?

For a ‘crisis’ flare of eczema, a GP may prescribe a ‘rescue’ course of oral steroids. If your eczema cannot be control by topical treatments (treatments that are applied to the skin) ask your GP for a referral to dermatology. Dermatologists can initiate advanced or ‘second-line’ therapies, which include phototherapy, immunosuppressant drugs, JAK-inhibitors and biological therapies. These are usually prescribed in a step-wise approach. Monitoring, either shared with the GP or done by dermatology, will be needed.

How can I tell if my eczema is infected?

If you think your skin is infected, you should see your GP as soon as possible so that it can be assessed. Skin can be infected with bacteria, fungi or a virus.

Staphylococcus aureus (Staph. aureus) is the bacterium that is most commonly responsible for secondary infection of eczema. Look out for one or more of the following signs of a bacterial infection:

  • Eczema becomes suddenly worse, with redness or skin becoming darker, depending on skin tone, itching and soreness.
  • The skin is weepy with clear or yellow fluid.
  • The skin has blisters, or red/yellow pus spots appear.
  • You have a raised temperature, flu-like symptoms or swollen glands in the armpit, neck and groin.

Small infected patches can be controlled with antiseptics or topical antibiotics, but larger areas may require oral antibiotic treatment.

We have more detailed information on our Skin infections and eczema page.

Can people with eczema swim in a pool or in the sea?

As a form of exercise, swimming doesn’t involve getting too hot and sweaty (and therefore itchy); however, chlorine is a chemical irritant. Some people with eczema may experience irritation or drying of their skin; others experience no negative effects (especially if they wash well with emollients and apply moisturisers before and after swimming).

If swimming indoors, apply your usual emollient 30 minutes before entering the pool, perhaps before you leave home to travel to the pool. It’s a good idea to put on more cream than you usually would, so that it acts as a good barrier to the water. As soon as possible after swimming, shower off using your usual emollient wash/oil/gel. Then apply more leave-on cream than usual.

If swimming outdoors, be aware that emollients will increase your risk of sunburn. When you get out of the pool, after showering, apply emollient first and then sunscreen once the emollient has soaked in. This will prevent the sunscreen becoming diluted by the emollient and ensure that the sunscreen keeps its reflective properties and protects your skin.

Can certain foods cause eczema?

We do not yet properly understand the role of diet in eczema. There is no clinical evidence that there is any connection between diet and eczema getting better or worse in adults. Many carers believe that their child’s eczema is caused by something in their diet, but only a small number of children with eczema are helped by changes to their diet (generally those under the age of three).

Even those for whom changes to their diet have helped will still need to employ a good skincare routine to protect against other triggers. It is rarely diet alone that triggers eczema.

Keeping an accurate diary of what your child eats and the condition of the eczema can be useful when discussing concerns with your GP. If you are planning to make changes to a major nutritional source such as milk in young children, you must consult your GP so that the best supplement is identified. The most common food triggers are eggs, nuts, cows’ milk and sesame, but many other foods including soya, wheat, fish and nuts are common. Allergy testing is a specific area of medicine that requires expert interpretation of the results.

Can you recommend a natural cream?

People often incorrectly conflate the terms ‘natural’ and ‘safe’. The internet and local shops are bursting with creams marketed for eczema, and it is difficult to know which are safe and the standards to which they have been manufactured. African and Chinese herbal creams have often been found to contain potent topical steroids and even life-threatening ingredients (e.g. arsenic). We therefore advise you to stick with medically licensed products, as this gives you more protection. Ingredients are required to be listed in full and manufacturing standards are checked with medically licensed products.   

Am I entitled to a referral to a specialist?

You will need to see your GP to ask for a referral to an NHS dermatologist. Some private dermatologists will see you without a referral if you are self-funding, but if you are claiming on a medical insurance policy, a GP referral is usually required. Your GP can decide whether a specialist referral is necessary and, if so, recommend appropriate hospitals or clinics.

Access to NHS specialist services is based on need and your GP will assess your need. Your GP may also have local guidelines or criteria to consider when referring. If your GP does not feel you need a referral, find out why. It may be that your eczema is limited or mild in presentation, and therefore should be controlled by topical treatments that a GP can prescribe.

When referring, GPs need to demonstrate that it is clinically appropriate to do so; for example, in cases of an uncertain diagnosis, recurrent bacterial infections, severe uncontrolled eczema or a significant impact on quality of life or psychological wellbeing. Information on referral for children can be found in the NICE guidelines for Atopic eczema in under 12s: diagnosis and management.

What’s the best washing powder?

Generally speaking, many people with eczema find that non-biological detergents suit their skin better than biological detergents. It is also advisable to buy products that do not contain perfume or fragrance. Before changing your detergent, you could try out the following tips, to see if they help:

  • Add an extra rinse cycle to your wash to make sure all the detergent is washed off your clothes
  • Reduce the amount of detergent to one third of the recommended amount
  • Avoid using fabric softeners or conditioners, as they bind to the fibres of clothing to make them soft. They are often fragranced and can be irritants

It’s also worth considering whether it’s the material of your clothes that is bothering you rather than the detergent. People with eczema often find that wearing 100% cotton clothing makes a positive difference.

What’s the best shampoo?

As with all products, different shampoos will work best for different people with eczema. If you have dry, itchy skin and scalp eczema, normal shampoos containing detergents and fragrance are likely to irritate your scalp. Non-fragranced, gentle baby shampoos may work well for you.

Alternatively, there are shampoos specifically aimed at people with dry skin or skin conditions, examples of which include: E45 Dry Scalp Shampoo and Eucerin DermoCapillaire Calming Urea Shampoo. Or you could simply use water with the optional addition of bicarbonate of soda mixed into a thin paste, or an emollient lotion.

Conditioners can also irritate the scalp, so are often best avoided. There are several medicated shampoos available for treating scalp problems, which may help in managing scalp eczema. However, these need to be selected carefully, and washed off thoroughly to avoid irritation. The following are examples: Dermax Shampoo contains a mild antiseptic, benzalkonium chloride, and helps to reduce scale; T-Gel is a gentle tar shampoo; and Capasal contains salicylic acid, coconut oil and tar, which may help a very scaly scalp.

Seborrhoeic dermatitis should be managed with shampoos especially designed to reduce the yeast element and flaking in seborrhoeic dermatitis of the scalp (for example, Ketaconazole shampoo and shampoos containing selenium sulphide or zinc pyrithione). It is neither necessary nor advisable to use anti-yeast shampoos for other types of eczema.

My partner and son both have eczema. I am now pregnant – what can I do to prevent my baby from getting eczema?

Unfortunately, there is no known way of preventing your baby from developing eczema. There is nothing you can do to alter your child’s genetic risk, but you may choose to pay closer attention to caring for your baby’s skin and minimise exposure to potential triggers.

If you’re starting to decorate your baby’s room, you might consider using laminate flooring and blinds rather than carpets and curtains, to reduce the baby’s exposure to house dust mites. However, the evidence showing a benefit in doing this is limited.

If your child does show signs of developing eczema despite your best efforts, you should not feel guilty. We would suggest seeking professional advice. If well-controlled, eczema is unlikely to have any long-term effects on your child’s health and wellbeing.

What are the guidelines for allergy referral?

The criteria for allergy testing is based on the patient’s best interests. There are three types of allergy testing for foods: IgE blood tests, prick tests and challenge tests. No one test is 100% reliable and usually a combination of tests is undertaken. The interpretation of these tests requires an expert in allergies or dermatology to review the results, as it is often not a clear-cut process.   

Allergy testing referral on the NHS is considered appropriate for people with symptoms of an immediate allergy, that is, an allergy occurring within a few seconds of eating a food and up to two hours after eating the food. Symptoms include vomiting, lip swelling, tongue and throat swelling, hives and difficulty breathing. Allergy testing is also appropriate for people with moderate to severe eczema which cannot be controlled on topical treatments. If your eczema is moderate to severe, it is likely that you will be under the care of a dermatologist, with whom you can discuss the merits of allergy testing further.

Although environmental allergens, such as pollen and grasses, can be tested for, testing is not routinely carried out, as the knowledge that you are allergic to them does not change the outcome. The expectation is that all patients with eczema should take steps to minimise environmental allergens where they can, for example, by closing windows when pollen counts are high. With time, patients will come to know what makes their eczema worse, and can avoid the relevant allergens without needing the allergy confirmed with a test result.

Private allergy testing can be arranged directly if you are self-funding. If you are arranging the testing through a private medical insurance provider, a doctor’s referral is still required.

For further information on the referral criteria, please read the NICE guidance on allergies.

Will allergy-testing pinpoint what is causing my or my child’s eczema, and help me to clear it?

Several different things are usually to blame for eczema – genetic factors play a part and the triggers for eczema can be described as ‘multifactorial’. Triggers include airborne allergens such as pollen, grasses or pollution, which are hard to escape from even if you do identify them as triggers. Other factors include stress, pets, chemicals in household products, perfumes, foods and the climate. This being the case, it is unlikely that adult or child eczema will clear completely after removing or reducing a possible allergen. However, if you know what triggers your or your child’s eczema, it may make some difference to try to minimise exposure to the relevant allergen/s where possible.

I’d like to try a complementary treatment. What do you advise?

Although complementary therapies are not a cure for eczema, some people find them helpful, especially when used in combination with conventional medicine. You should always let your GP know if you are thinking of trying any kind of complementary therapy and discuss if you can continue your treatments while undertaking the complementary treatment.

If you decide to try a complementary therapy, make sure you go to a properly trained and registered practitioner (you can find these through a therapy’s governing body). Ask in advance how much the treatment is going to cost and how many visits the practitioner anticipates; complementary medicine can be expensive. Check also that the practitioner has professional indemnity insurance. Please see our factsheet on Complementary therapies for further information.