Health condition · Clinically reviewed
Eczema, the guide that answers what to do next.
A common, itchy and manageable skin condition — with modern options for severe cases that go far beyond a steroid cream. Here’s how to look after eczema and when to escalate.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against NICE, BAD and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK guidance including biologics and JAK inhibitors for severe eczema.
Key facts
Eczema at a glance.
The essentials, in plain English — what it is, how common it is, how it’s diagnosed, and how it’s treated in the UK today.
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What it is
Atopic dermatitis — a chronic inflammatory skin condition that impairs the skin barrier and causes flares of itch and inflammation.
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How common
1 in 5 children and about 1 in 12 UK adults. Often lifelong but usually improves through childhood.
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Main features
Itch, dryness, redness (or grey/purple change on darker skin) and cracking — especially in skin folds.
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Diagnosis
Clinical — based on the pattern and history. No test is needed for typical cases.
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Everyday treatment
Emollients used liberally and often, plus topical steroids stepped up during flares.
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Severe eczema
Dupilumab and JAK inhibitors have transformed care for adults with moderate-severe disease.
Why this guide matters
Small habits, and a modern toolkit.
Eczema is common, chronic and — for most people — manageable. The three points below shape everything else on this page.
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Emollients are non-negotiable
Barrier repair is the foundation — and often the missing piece when treatment fails.
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Use enough steroid, for long enough
The most common reason topicals fail is under-treatment, not overuse.
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Severe eczema has answers
Biologics and JAK inhibitors transform care for uncontrolled disease — don’t put up with it.
How the diagnosis is made
From first itchy patch to a clear plan.
The steps a UK GP or dermatologist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Pattern, severity and triggers
Phase 2 · Confirming
Allergy and infection considerations
Phase 3 · Managing
Stepwise treatment and referral
- 01
Recognising
Pattern recognition
Itchy, dry, inflamed skin — especially in folds (elbows, knees, wrists, ankles, neck). Often personal or family atopy.
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Recognising
Assessing severity
Clinical eyeball plus tools like POEM (Patient-Oriented Eczema Measure) guide treatment intensity.
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Recognising
Identifying triggers
Soaps, heat, sweat, wool, stress and allergens — a short diary of flares often reveals a pattern.
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Confirming
When to think allergy
Persistent food-related flares or contact-pattern rashes may need allergy testing — not routinely for typical atopic eczema.
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Confirming
When infection is suspected
Weeping, honey-crusts (bacterial), or blisters spreading (eczema herpeticum) — see red flags.
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Managing
A stepwise treatment plan
Emollients every day, topical steroids stepped up during flares, non-steroidal options (tacrolimus, crisaborole) for sensitive areas.
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Managing
Specialist referral if needed
Uncontrolled moderate-severe disease — phototherapy, dupilumab, JAK inhibitors and other systemics in specialist care.
Typical timeline: a first visit to a settled plan in weeks, not months.
Symptoms
What eczema actually looks and feels like.
The classic pattern of itch, dryness and inflammation — and the features that mean it’s time to escalate.
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Itch
The hallmark — constant, often worse at night, and central to the flare-scratch-worsen cycle.
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Dry, cracked skin
A leaky skin barrier lets moisture out and irritants in. Emollients are the foundation of treatment.
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Redness or discolouration
Red on lighter skin; grey, purple or ashen on darker skin — often missed on dark skin.
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Skin-fold pattern
Insides of elbows and knees, wrists, ankles, neck — classic adult and childhood pattern.
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Thickening (lichenification)
Chronic scratching leads to thick, leathery skin — reversible with good control.
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Oozing or crusting
A sign of infection or severe flare — needs antibacterial or steroid treatment.
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Disrupted sleep
The itch wakes people — and untreated poor sleep worsens flares.
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Red-flag features
Painful blisters spreading fast (eczema herpeticum), fever, or widespread infection — urgent GP or A&E.
Treatment
How eczema is treated in the UK.
Emollients and topical steroids first, with a modern ladder that reaches biologics and JAK inhibitors when disease is severe.
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Emollients (moisturisers)
Applied liberally 2-4 times a day — the foundation of eczema care. Best applied within minutes of a shower.
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Topical corticosteroids
Stepped by potency for flare control. Used for 1-2 weeks then tapered — not indefinitely on the face.
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Non-steroid topicals
Tacrolimus and crisaborole for sensitive sites — useful for face, eyelids and skin folds.
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Wet-wrap therapy
Emollient + topical steroid under wet dressings — highly effective for severe flares.
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Antihistamines
Sedating antihistamines at night help sleep during severe flares. Non-sedating options for daytime itch.
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Phototherapy
Narrow-band UVB in specialist care for moderate-severe eczema not controlled by topicals.
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Systemic therapy
Ciclosporin, methotrexate or azathioprine — short-term or medium-term for severe disease.
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Biologics & JAK inhibitors
Dupilumab, tralokinumab and JAK inhibitors have transformed care for adults with severe atopic eczema.
What this guide is based on
The sources behind every claim on this page.
UK national guidance and specialist society standards, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.
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NICE. Atopic eczema in under 12s: diagnosis and management (CG57).
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British Association of Dermatologists (BAD). Patient information leaflets on atopic eczema.
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National Eczema Society. Patient information and support.
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Cochrane Reviews. Topical corticosteroids and emollients for eczema.
Red flags
When eczema needs urgent attention.
Most of the time, eczema is a manageable long-term condition. These are the situations where it isn’t — and you should act today.
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Painful blisters spreading fast
Suspected eczema herpeticum — urgent same-day assessment (potentially A&E). Antiviral treatment is time-critical.
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Fever with widespread rash
Suggests infection or a severe reaction — urgent GP or A&E.
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Weeping, honey-crusted lesions
Bacterial infection (usually Staph) — contact a GP for antibiotics if extensive.
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Erythroderma
Redness affecting >90% of body surface — a medical emergency, urgent hospital care.
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Eczema not improving despite treatment
Review diagnosis, technique, potency and adherence before escalating — specialist referral if truly uncontrolled.
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Severe steroid side-effects
Skin thinning, prominent vessels or striae from overuse or wrong potency — discuss with your GP.
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Eczema affecting sleep or mood
Deserves stepped-up treatment — poor sleep and low mood worsen disease.
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Contact-pattern rash
Well-defined shapes matching a jewellery, cosmetic or occupational contact — consider contact dermatitis and patch testing.
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Sudden severe swelling of face or lips
Possible allergic reaction — call 999 if breathing is affected.
Living with it
A long-term condition, but a very manageable one.
Four things that make the biggest difference day to day — barrier care, gentle washing, trigger awareness and knowing when to step up.
A quiet reminder
Consistency beats intensity, every time.
Small, steady habits — kept up for months — do more than a heroic week that doesn’t last.
- 01 Barrier
Moisturise like it’s medicine
Emollients 2-4 times a day, especially after washing, reduce flares meaningfully.
- 02 Wash
Cool and short
Cool, brief showers with soap-free wash — hot baths and harsh products worsen eczema.
- 03 Triggers
Know your own
Soaps, wool, heat, sweat, stress, cold air, house dust mites — a diary reveals yours.
- 04 Escalate
Don’t put up with it
If topical treatment isn’t enough, biologics and JAK inhibitors have changed severe eczema entirely.
Frequently asked
Everything we get asked about eczema.
Quick answers on steroids, moisturisers, food, biologics and when to worry.
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What is atopic eczema?
A chronic inflammatory skin condition with a leaky skin barrier and immune-driven itch, redness and dryness. Often lifelong but usually improves through childhood.
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Do I need any tests?
Not for typical eczema — it’s a clinical diagnosis. Testing is arranged only when infection, contact allergy or an unusual pattern is suspected.
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Are topical steroids safe?
Yes when used correctly. The main problem is under-treatment. Use the right potency for the site and severity, take flares seriously, and taper as skin improves.
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What is topical steroid withdrawal?
A rare but recognised syndrome after prolonged use of potent steroids. Discussed with your dermatologist — the risk is small, and stopping treatment altogether often causes worse flares.
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What is the fingertip unit rule?
A useful way to apply topical steroids — one fingertip unit covers about two adult palms. Simple, effective and prevents both under- and over-use.
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Which moisturiser should I use?
The one you’ll actually use, 2-4 times a day. Thicker ointments are more effective; creams and lotions are more acceptable in warm weather.
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Should I cut out food to help eczema?
Rarely. Food allergy isn’t the cause of most eczema. Restrictive diets can harm children — discuss with your GP or a paediatric dietitian first.
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What are biologics and JAK inhibitors?
Injectable antibodies (dupilumab, tralokinumab, lebrikizumab) and oral small molecules (upadacitinib, abrocitinib) that target specific parts of the immune system — transformative for severe eczema.
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Is eczema linked to hay fever and asthma?
Yes — the “atopic march”. Many people with eczema also have hay fever, food allergy or asthma.
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When should I see a GP urgently?
Painful blisters spreading fast, fever with rash, widespread infection, or eczema covering most of your body.