Eczema in adults: hands, work, sleep and long-term control

Eczema is an umbrella term for conditions that make skin dry, red, itchy and irritated. In adults the NHS describes several types: atopic eczema, the most common and often family-linked; contact dermatitis, triggered by a particular substance; discoid eczema with circular or oval patches; and varicose eczema, affecting the lower legs because of poor blood flow in the leg veins.

Atopic eczema usually starts in childhood and most children improve, but the British Association of Dermatologists notes that many people continue to have dry skin in adulthood. The NHS says symptoms can start at any age, and contact dermatitis can appear at any age too.

The NHS says contact dermatitis most commonly affects the hands and face. It is mainly caused by irritants such as soaps and detergents, solvents or regular contact with water, and less commonly by allergy to substances in cosmetics or metals such as nickel. The BAD says anyone can develop irritant hand dermatitis from handling irritating substances or frequent handwashing, and that food handlers can develop protein contact dermatitis.

Atopic eczema may be troublesome in jobs involving irritant materials, such as catering or hairdressing, according to the BAD. If your job seems to make your skin worse and better on days off, say so to your GP, because workplace changes and protective equipment can matter as much as creams.

• Rinse the skin with warm water and an emollient as soon as you can after contact with an irritant or allergen (NHS).

• Wear gloves to protect your hands but take them off now and again, as sweating can worsen symptoms; cotton gloves under rubber gloves may help (NHS).

• Apply emollients frequently and in large amounts, and use soap substitutes rather than bar or liquid soap (NHS).

• Check ingredients in make-up and soap for irritants or allergens (NHS).

Atopic eczema is usually recognised by appearance, and blood or skin tests are normally unnecessary, as the BAD says. For contact dermatitis, the NHS suggests seeing a GP for persistent, recurrent or severe symptoms. If the substance cannot be identified or symptoms do not respond, referral to a dermatologist follows. The BAD says patch testing, carried out in a specialist dermatology department, is required to identify the exact cause of allergic contact dermatitis; small patches of suspected allergens are applied and a positive result shows as a small rash.

Contact dermatitis usually clears if the trigger is found and avoided, according to the NHS; emollients and topical corticosteroids are used meanwhile, and oral steroids are rarely needed for severe widespread episodes. For atopic eczema the stepped options include emollients as soap substitutes, topical steroids of the appropriate potency, calcineurin inhibitors such as tacrolimus ointment where steroids are unsuitable, and dressings.

When eczema is severe and does not respond, a dermatologist can prescribe stronger options: oral steroids for short periods, azathioprine, ciclosporin, methotrexate or mycophenolate mofetil, JAK inhibitors (abrocitinib, baricitinib, upadacitinib) and injections (dupilumab, tralokinumab, lebrikizumab). Ultraviolet light therapy in a specialist hospital department helps some people with chronic eczema, but the BAD says commercial sunbeds should not be used. These are prescription medicines needing specialist assessment and monitoring.

The BAD says itch can be so strong that it affects sleep, causing tiredness and irritability. Short-term sedating antihistamines at night can reduce sleep disruption during flare-ups but are not recommended long term. The NHS says that living with eczema can be difficult and that if it affects mental health you may be referred to a mental health specialist. The BAD mentions habit reversal therapy as a technique for scratching, used alongside topical treatment.

Ask for an urgent GP appointment or call NHS 111 if eczema becomes blistered, crusty or leaking, or has pus-filled spots, is painful, swollen or warm, or suddenly gets worse, or you feel unwell with a high temperature. These can signal infection or eczema herpeticum.

Most adults are treated in primary care. Dermatology referral is appropriate when the trigger is unclear, work is affected or treatments fail. Private dermatologists can arrange patch testing and light therapy; ask whether patch testing uses a recognised standard series and who will explain how to avoid the identified allergens.