Atopic dermatitis (atopic eczema): symptoms, causes and treatment

The NHS says the main treatments are emollients, which are moisturising creams, lotions, ointments and gels you apply to the skin and wash with, and topical corticosteroids, which are steroid creams, lotions or gels. Depending on severity you may be able to try other treatments such as special dressings or medicines. A GP can prescribe some treatments, or you may be referred to a dermatologist.

The BAD explains the treatment ladder in more detail. Treatment depends on how severe the eczema is.

The NHS lists these things that can help. A pharmacist can advise on treatment if you have small areas of eczema that are dry and slightly itchy; if it is more severe, see a GP.

• Avoid things that make it worse, such as soap, washing detergent, some fabrics or pets.

• Apply emollients as often as possible (at least twice a day) and continue even if the eczema improves.

• Wash with an emollient instead of soap.

• Keep cool, as being hot can make eczema more itchy.

• Keep nails short, and use anti-scratch mittens on babies.

• Do not scratch; the NHS suggests gently rubbing the area with a finger instead.

• Do not use aqueous cream, which can irritate the skin and make eczema worse.

• Do not change your diet unless a doctor tells you to.

• Take care with emollients near naked flames or smoking, because they can make fabrics catch fire more easily.

The BAD says the main symptom is itching, which can be strong enough to disturb sleep. The NHS says it can make skin itchy, dry, cracked, crusty, scaly or thickened, change its colour compared with the surrounding skin, and sometimes blister or bleed.

It is common on the elbows, knees and hands, and on the face in babies and toddlers. The BAD says it most commonly appears in the creases of the joints at the elbows, knees, wrists and neck.

There are usually flare-ups, when symptoms get worse, and times when they are better. The BAD says that on brown or black skin the redness may be harder to see, but the area may become darker or lighter than the unaffected skin. Repeated scratching over time can make the skin thicker (lichenification).

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you or your child have atopic eczema and any of the following. These can be signs that the eczema is infected or that you have a more serious condition called eczema herpeticum, and you may need treatment such as antibiotics.

• It is blistered, crusty, leaking fluid or has spots filled with pus.

• It is painful, swollen or feels warm.

• It suddenly gets worse or gets bigger.

• You have a high temperature or feel generally unwell.

Atopic dermatitis and atopic eczema are the same condition. The BAD says the word "atopic" describes conditions linked to strong reactions of the immune system, including asthma, eczema and hay fever, and that eczema is a term for red, dry, itchy skin.

It can start at any age but usually starts in babies and young children and tends to get better with age. The BAD says it affects males and females equally. There are other types of eczema too, which the NHS lists as contact dermatitis, discoid eczema, pompholyx and varicose eczema.

The NHS says it is not always known what causes atopic eczema. You are more likely to have it if one or both parents have it, or if you or a close family member has asthma or hay fever. The BAD adds that genes and the environment both play a part, and that a gene called filaggrin helps keep the skin barrier strong. A weaker barrier lets bacteria, viruses and irritating substances in, making the skin inflamed and itchy.

Triggers of flare-ups listed by the NHS and BAD include:

• Irritants and allergens such as soap, washing detergent, pets, some fabrics, pollen, house-dust mites or certain foods.

• Heat or changes in temperature, and dry skin.

• Skin infections, such as a staph infection, or a cold sore virus infection.

• Stress, being unwell, teething in babies, and hormonal changes such as during pregnancy.

The BAD says atopic eczema cannot be cured, but there are many ways of controlling it. Most children will see improvements as they get older, with 4 out of 5 clear of it by their teens, though many people continue to have dry skin in adulthood. The BAD says people with eczema can lead a full life, including sport, swimming and travel.

It is not contagious, so you cannot catch it from someone else, according to both the NHS and BAD. The BAD also notes there is currently no proven way to prevent eczema developing.

The BAD says a healthcare professional can usually recognise atopic eczema just by looking at the skin, and that blood tests and skin tests are usually unnecessary. See a GP if you or your child have symptoms, or if treatments are not helping, says the NHS.

On the NHS, most atopic eczema is managed by pharmacists and GPs, with referral to a dermatology service for severe disease or when treatments are not working. Stronger medicines such as ciclosporin, JAK inhibitors or injections are usually started by a dermatologist.

Private dermatology is also available for assessment and prescribing. Whichever route you use, ask about the plan for flare-ups, how much steroid cream to use and for how long, and how and when treatment will be reviewed.