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Health condition · Clinically reviewed

Eczema and dermatitis, emollients first, then steroids, biologics and JAK inhibitors when itch runs your life.

Two words for the same thing - inflamed, itchy skin. This guide covers every common type, the modern UK ladder of treatment, and when to ask for dermatology.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE, BAD, the National Eczema Society and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK guidance including dupilumab, tralokinumab and oral JAK inhibitors for moderate-to-severe atopic dermatitis.

Key facts

Eczema and dermatitis at a glance.

The essentials, in plain English - what these words mean, the common types, and how modern UK dermatology treats them.

  • What it is

    A group of inflammatory skin conditions - itchy, red, scaly patches driven by barrier dysfunction and an overactive Th2 immune response.

  • Main types

    Atopic, contact (irritant and allergic), seborrhoeic, stasis, dyshidrotic, nummular, neurodermatitis, perioral and diaper dermatitis.

  • Genetics

    Filaggrin (FLG) loss-of-function mutations are found in about 20 percent of severe atopic dermatitis and drive barrier failure.

  • Foundation therapy

    Generous, daily emollients - typically 500g per week for adults - are the mainstay whatever the severity.

  • Anti-inflammatory

    Topical corticosteroids by potency, topical calcineurin inhibitors (tacrolimus, pimecrolimus) and wet-wrap bandaging where needed.

  • Biologics and JAKs

    Dupilumab and tralokinumab (biologics) plus upadacitinib, abrocitinib and baricitinib (oral JAK inhibitors) have transformed severe atopic disease.

Looking for a single-word entry point? Read our shorter guides to eczema and dermatitis.

Why this guide matters

A ladder, not a shelf of creams.

Eczema and dermatitis are treatable - and treatment has changed. Three ideas shape everything below.

  • Emollients are the foundation

    Barrier repair with generous, daily emollients does the quiet, heavy lifting - typically 500g a week for adults, whatever else you use.

  • Steroids and calcineurin inhibitors

    Used properly - right potency, right site, right length - they control most flares and, in a proactive twice-weekly pattern, keep skin quiet between them.

  • Biologics have changed severe disease

    Dupilumab, tralokinumab and the oral JAK inhibitors have transformed moderate-to-severe atopic dermatitis for people who used to run out of options.

How the diagnosis is made

From flare to a working plan.

The steps a UK GP or dermatologist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Skin exam and pattern

    The distribution tells the story - extensor surfaces in infants, flexural creases in older children and adults, and hand or foot patterns in dyshidrotic disease.

  2. 02

    Assessing

    History and triggers

    Personal and family atopy, occupation, cosmetics, cleaning products, and any relationship to stress, sweat or seasonal change.

  3. 03

    Assessing

    Severity scoring - POEM, SCORAD, EASI

    Validated tools that put a number on itch, sleep loss and skin signs - useful for tracking treatment and accessing biologics.

  4. 04

    Confirming

    Patch testing for contact eczema

    The gold standard for allergic contact dermatitis - a specialist-led panel applied to the back for 48 to 96 hours.

  5. 05

    Confirming

    Total and specific IgE

    Not diagnostic on its own but supports an atopic picture when other allergic conditions co-exist.

  6. 06

    Escalating

    Specialist dermatology referral

    For moderate-to-severe disease, treatment failure, diagnostic doubt, or where systemic therapy or a biologic is being considered.

  7. 07

    Escalating

    Allergy and MDT input

    A specialist eczema clinic can bring in dermatology nurses, allergy, psychology and links to the National Eczema Society and the British Association of Dermatologists.

Typical timeline: first visit to a working plan in a single appointment; specialist review within weeks where needed.

Symptoms

What eczema and dermatitis actually look like.

Itch, redness and scale in acute flares - lichenification and pigment change over time. Plus the features that mean it is time to escalate.

  • Itchy erythematous patches

    The hallmark - red, inflamed, intensely itchy plaques that come and go in flares.

  • Scale and dryness

    Fine or coarse scale over a rough, dehydrated surface reflecting barrier failure.

  • Oozing and crusting

    A sign of acute flare or secondary bacterial infection - often Staphylococcus aureus.

  • Lichenification

    Thickened, leathery skin with exaggerated markings after months of scratching - the chronic phase.

  • Post-inflammatory pigmentation

    Dark or pale patches after a flare settles - more visible on skin of colour, usually reversible over months.

  • Flexural distribution in adults

    Inside the elbows, behind the knees, wrists, ankles and neck - the classic atopic pattern.

  • Extensor pattern in infants

    Cheeks, scalp and outer limbs in babies - flexural involvement takes over from about age two.

  • Red flag - eczema herpeticum

    Sudden painful monomorphic vesicles or punched-out erosions on eczematous skin - urgent aciclovir and specialist review.

Treatment

How eczema and dermatitis are treated in the UK.

Emollients first. Topical steroids and calcineurin inhibitors for flares and maintenance. Phototherapy, systemics, biologics and JAK inhibitors when disease is more severe. Infections treated on their own merits.

  • Emollients - the mainstay

    Generous, frequent application (aim for 500g per week in adults) plus emollient wash substitutes. Continued during and between flares.

  • Topical corticosteroids

    By potency - mild for face and folds, moderate to potent for body and limbs, very potent short-course for stubborn plaques. Use the weakest that controls the flare.

  • Topical calcineurin inhibitors

    Tacrolimus and pimecrolimus - steroid-sparing options ideal for the face, eyelids and skin folds, and for proactive twice-weekly maintenance.

  • Wet-wrap bandaging

    Emollient, weak topical steroid and moistened tubular dressings for severe flares - often started in a specialist clinic.

  • Narrowband UVB phototherapy

    Two or three hospital-based sessions per week for eight to twelve weeks - useful when topicals are not enough and before systemic therapy.

  • Systemic immunosuppressants

    Methotrexate, azathioprine, ciclosporin and mycophenolate - dermatology-led options for moderate-to-severe disease.

  • Biologics - dupilumab, tralokinumab

    Dupilumab (anti-IL-4Rα, Dupixent) is NICE-approved for moderate-to-severe atopic dermatitis; tralokinumab (anti-IL-13, Adtralza) offers a targeted alternative; lebrikizumab is emerging.

  • Oral JAK inhibitors

    Upadacitinib, abrocitinib and baricitinib - rapid-onset oral options for moderate-to-severe atopic disease, with specialist monitoring for infection and lipids.

Bacterial infection is usually managed with flucloxacillin (or clarithromycin if penicillin-allergic). Eczema herpeticum needs urgent oral or intravenous aciclovir under specialist care. Psychological support, sleep advice and links to the National Eczema Society and the British Association of Dermatologists (BAD) sit alongside every step.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist society standards and patient charities, 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.

  • NICE. Atopic eczema in under 12s: diagnosis and management (CG57) and the atopic eczema technology appraisals for dupilumab, tralokinumab and the JAK inhibitors.

  • British Association of Dermatologists (BAD). Atopic eczema guideline and patient information leaflets.

  • National Eczema Society. Patient guidance on emollients, flare management and living with eczema.

  • European Academy of Dermatology and Venereology. Guideline on the treatment of atopic dermatitis in adults and children.

Red flags

When eczema needs urgent attention.

Most eczema is manageable in primary care. These are the situations that are not - and where a specialist opinion is needed quickly.

  • Eczema herpeticum

    Painful monomorphic vesicles or punched-out erosions with fever and unwellness - urgent same-day aciclovir and dermatology review.

  • Widespread bacterial infection

    Golden crusting, weeping, spreading redness or systemic symptoms - flucloxacillin (or clarithromycin if penicillin-allergic) and swabs.

  • Erythroderma

    More than 90 percent of the body inflamed - a dermatological emergency requiring admission and fluid, temperature and skin care.

  • Severe sleep loss and mood impact

    Chronic itch that wrecks sleep and mood is a red flag for escalation to systemic therapy or a biologic - and for psychological support.

  • Failure of optimised topical therapy

    Ongoing moderate-to-severe disease despite emollients, appropriate potency steroids and calcineurin inhibitors - refer for specialist options.

  • Suspected allergic contact dermatitis

    A hand, face or eyelid pattern linked to work or products - patch testing in a specialist clinic guides avoidance.

  • Stasis dermatitis with ulceration

    Lower-leg eczema with venous changes and ulcers - needs vascular assessment and compression as well as skin care.

  • Perioral dermatitis after topical steroids

    A rash of small papules around the mouth or eyes after steroid use - stop the steroid and use gentler alternatives.

  • Diaper dermatitis with candidal spread

    Beefy-red rash with satellite pustules in babies - needs a topical antifungal alongside barrier care.

Living with it

A long-term condition, with a clear ladder.

Four things that make the biggest difference day to day - daily emollient, trigger awareness, decisive flare treatment and knowing when to ask for a biologic.

A quiet reminder

Consistency beats heroics, every time.

Small, steady habits - kept up for months - do more than a heroic week that does not last.

  1. 01 Routine

    Emollient every day, forever

    Twice-daily generous application - not just during flares. Keep a pump at the sink, by the sofa and by the bed.

  2. 02 Triggers

    Know your flare pattern

    Soaps, fragrance, wool, heat, sweat, stress and infection are the usual suspects - keep a short list of your own.

  3. 03 Flares

    Treat early, treat hard

    A short, appropriate-potency steroid used properly for a week is safer than a weak steroid dragged out for months.

  4. 04 Escalate

    Ask about systemics and biologics

    If itch is running your life despite the basics, ask your dermatologist about dupilumab, tralokinumab or a JAK inhibitor.

Frequently asked

Everything we get asked about eczema and dermatitis.

Quick answers on emollients, steroids, calcineurin inhibitors, biologics and JAK inhibitors.

  • What is eczema and how is it different from dermatitis?

    The two words are used interchangeably in UK practice - both mean inflamed, itchy skin. Atopic dermatitis is the most common form and is what most people mean by eczema. Other named types include contact (irritant and allergic), seborrhoeic, stasis, dyshidrotic, nummular, neurodermatitis, perioral and diaper dermatitis.

  • Why do I get atopic eczema at all?

    It is a mix of a leaky skin barrier and an overactive Th2 immune response. Filaggrin (FLG) loss-of-function mutations are found in about 20 percent of severe atopic dermatitis, and cytokines IL-4, IL-13 and IL-31 drive the itch and inflammation that biologics like dupilumab and tralokinumab now target.

  • How much emollient should I actually use?

    A lot more than most people think. Adults typically need around 500g a week during a flare, spread across body, face, hands and wash substitutes. Children need around 250g. Applied in the direction of hair growth, without rubbing in hard.

  • Are topical steroids safe?

    Used at the right potency for the right site and time, yes. Face and folds need mild steroids or a calcineurin inhibitor; body and limbs can take moderate to potent. The bigger risk is undertreatment - short, decisive courses beat months of a too-weak cream.

  • When would I be offered a biologic or a JAK inhibitor?

    When moderate-to-severe atopic dermatitis is not controlled by optimised topicals, phototherapy or a systemic immunosuppressant. Dupilumab (anti-IL-4Rα) and tralokinumab (anti-IL-13) are NICE-approved biologics; upadacitinib, abrocitinib and baricitinib are oral JAK inhibitors used under specialist care with infection and lipid monitoring.

  • What should I do if my eczema suddenly turns painful with blisters?

    Treat it as eczema herpeticum until proven otherwise - a herpes simplex infection layered on eczema. You need same-day medical review and oral aciclovir. Do not just add more steroid to inflamed, painful, punched-out skin.

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