What are the signs of eczema?

In mild cases of eczema, the skin is dry, scaly, red and itchy. In more severe cases there may 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 non-cosmetic moisturisers. They help soothe the skin and provide relief from itching and dryness. Their regular use can prevent eczema from ‘flaring up’. There are many different types of emollients, and they can be classified according to how they are used and how greasy they are. Greasy ointment emollients are best for very dry skin. Cream emollients are the best to use on sore and weeping skin. You may need to try several emollients to find the one that works best for you, as different emollients suit different people.

What is the best emollient to use?

There is no ‘best emollient’, as such. The type (or types) to use depends on the dryness of the skin, the area of skin involved, and what is comfortable and acceptable to you. More than one emollient may be required for use at different times of the day, or for when the condition is more active. You may need to try several emollients to find the one that suits you best.

Should I be wary of topical steroids?

Topical steroids, used appropriately and under medical supervision, are a safe and effective treatment for eczema. The likelihood of side effects occurring is directly related to the potency of the preparation, where it is being used, the condition of the skin on which it is used and the age of the user. All these factors will be taken into consideration when a prescription is given to treat eczema.

Pregnant women should consult their GP regarding the advisability of continued use of their usual topical steroid preparation.

Side effects such as skin thinning usually only occur when potent or very potent steroids have been applied for a long period of time to more delicate areas of skin, such as the face and neck, or flexures (the parts of the body able to flex. That is, the backs of the knees and the insides of the armpits, elbows and groin).

Which should I apply first, emollient or topical steroid?

There are no standard rules on whether to apply a topical steroid before or after using an emollient. Some people are happiest using an emollient first to prepare the skin, followed by the topical steroid. Whichever order of care you choose, it is important that you leave a gap of at least 10 minutes (and if possible 20-30 minutes). This is intended to avoid diluting the strength of the topical steroid preparation, and to prevent the spread of topical steroids to areas not affected by eczema.

How much emollient should I apply?

Use your emollient of choice frequently. Ideally, this will be every few hours, but should be at least twice a day, and every few hours if the eczema is flaring. It is recommended that an adult use 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 vigorously, 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 body areas that are affected by eczema. The guideline amount varies depending on your age. The guideline is based on the Finger Tip Unit (FTU), which is the amount of cream or ointment that just 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 two adult hands with the fingers together. Adjustments will be required if the whole area is not covered by eczema. Further information is often provided in the leaflet supplied with your treatment, or can be found in our factsheet on Topical steroids.

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

In addition to topical treatments (that is, treatments that are applied to the skin), there are other treatments available for moderate to severe eczema: different bandaging techniques, light therapy, steroid tablets, systemic immunosuppressant drugs and a biologic drug. These treatment options are overseen by a dermatologist. We would suggest that you speak to your GP about these treatment options, and referral to a dermatologist.

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. Bacterial infection is the most common.

Look out for one or more of the following signs of bacterial infection:

  • Eczema becomes suddenly worse, with redness, 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. A study on Oral and Topical Antibiotics for Clinically Infected Eczema in Children (2017) showed no clinically meaningful benefit from the addition of either oral or topical antibiotics in children with milder clinically infected eczema.

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. Our factsheet on Diet and eczema in children contains further information.

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.