Atopic eczema
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Atopic (meaning sensitivity to allergens) eczema is the most common form of eczema. It causes patches of dry, cracked skin to appear when triggered by things like dust or certain foods.
It’s a chronic (lifelong) condition, often with recurring flare-ups. That’s why we offer flexible subscription options tailored to your needs when you order atopic eczema treatment online with us.
Atopic eczema is the most common type of eczema affecting 10-20% of children and 1-3% of adults. The word ‘atopic’ means sensitivity to allergens, and eczema is a condition where patches of your skin become inflamed, dry or blistered. So, 'atopic eczema is when your skin becomes inflamed because of a reaction to an allergen, like pollen. Sometimes the condition can be inherited from a parent.
Atopic eczema typically begins during childhood, with 85% of cases starting before the age of five. But most eczema patients will go into clinical remission, which means they will have no symptoms, before adulthood. For those who don’t, treatment might be necessary to prevent the symptoms from worsening.
Anyone can get eczema including adults, children and people of different ethnicities. It’s more common in children, with most eczema patients getting it before the age of five. It’s also more common in urban populations and developed countries. Eczema is a complex condition that can affect anyone and since there are so many factors that can cause it, it’s hard to predict who will get it.
There are seven main types of eczema and the most common one is atopic eczema. Each eczema type is characterised by different symptoms. For example, dyshidrotic eczema causes itchy blisters on your feet, palms and hands.
Atopic eczema can appear anywhere on your body – it’s not specific to some areas, unlike ‘neurodermatitis’. It will appear red (or purple on darker skin) and will be itchy and dry. It sometimes can blister, but it’s less common than with dyshidrotic eczema. Additionally, it won’t have defined patches, such as circular patches in nummular eczema, or bordered patches in psoriasis.
You should get your eczema diagnosed by a clinician or doctor before starting treatment. This is because each type of eczema has different symptoms that will require different medications to treat them.
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When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
Atopic eczema is a chronic, complex skin condition that can be caused by genetic, environmental or immunological factors.
Genetic factors
Mutations to genes that are important to your skin are common in eczema patients. A common mutation that's found in 30% of eczema patients is in the FLG gene, which makes the protein filaggrin. Filaggrin is found in the outermost layer of your skin called the stratum corneum. It plays many roles in your skin, such as retaining water to help moisturise your skin, repairing damaged skin and maintaining the integrity of your skin barrier. When a mutation occurs in this gene, the production of filaggrin is reduced resulting in filaggrin-deficient skin. This makes your skin dry and more prone to infections.
Eczema can also be passed down from your parents. Research suggests that if one parent has eczema, there’s a 50% chance their offspring will have it too, and if both parents have eczema, the chance increases to 80%.
Environmental factors
Environmental changes can affect your eczema, for example, increased pollen levels can trigger your immune system to overreact and cause inflammation. Additionally, different weather conditions can cause flare-ups. For some, cold, dry conditions might draw the moisture from your skin, making it dry and itchy. Whereas, a humid climate might improve your symptoms. Some foods might also make your eczema worse. For example, eggs, cow's milk and peanuts are common hypersensitive agents in eczema patients. So even if you’re not allergic, it might be best to avoid them if you’re getting symptoms. Everyone’s eczema triggers are different, so it's good to track when your eczema flares, so you know what your triggers are.
Immunological factors
If you have eczema you’ll tend to have an overactive immune system. When your skin comes into contact with a substance, like pollen or a fragrance, your immune system deems it harmful and triggers an immune response. As a result, your body produces cells that cause inflammation to get rid of the ‘harmful’ substance. Although it doesn’t ‘qualify’ as an autoimmune disease, your immune system does play an important role in eczema.
Symptoms of atopic eczema are different depending on how severe it is. Generally, the common symptoms include dry, itchy and sore skin. If it worsens, these can be red (or purple/grey on darker skin), inflamed and painful to touch. The patches might also spread to other parts of your body where you don't usually have eczema.
In some cases, the symptoms of eczema can be confused with psoriasis symptoms. Both have similar symptoms, like redness and itching, but unlike eczema, psoriasis patches are more defined, with skin that’s crusty and scaly.
Atopic eczema can lead to other problems if not managed properly. The most common infection, which 90% of eczema patients get, is caused by the bacteria Staphylococcus aureus (also known as a ‘staph infection’). It occurs when your skin becomes cracked and opens, which makes it easy for germs to enter. This causes your skin to be blistered and filled with pus and if not treated with antibiotics it can become worse. To avoid getting infections, try not to scratch your skin. Instead, apply something cool on top or apply an anti-itch cream.
Another infection is Eczema herpeticum (EH), which is a viral infection caused by the herpes simplex virus. Although it’s less common than Staphylococcus aureus infections, it’s more dangerous and can be life-threatening. When infected, small, red, blisters appear on your skin that are painful to touch. You might also get a fever. If you think you're infected with EH, it’s important you see a doctor as soon as possible.
Asthma and food allergies are also more common among eczema patients. About 50% of children with eczema will develop asthma and 33% will have a food allergy. This is known as the allergic march or atopic march. It’s caused by many factors, including genetic and environmental. There are ways you can lower these risks, such as by breastfeeding for early protection and using emollients frequently.
Mental health issues are common in eczema patients, especially in severe cases. Having to deal with a chronic condition is never easy and repeated flare-ups can affect your daily life. Stress might also make your eczema worse, which can further take a toll on your mental health. If you’re struggling with your mental health, seeing a doctor or talking to a loved one can help.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
The way you treat eczema depends on the severity of it. If you have mild-to-moderate eczema, emollients might be enough to manage it. Emollients are medicated creams that help restore your skin barrier. They contain moisturising ingredients, like paraffin and urea, to help repair damage caused by your eczema. This also creates a physical layer that prevents germs and allergens from entering your skin. Emollients should be applied every day, preferably once in the morning and once in the evening. Even after your eczema is under control, you should continue using them.
If you have severe eczema, then you’ll likely need treatment with steroids or topical calcineurin inhibitors (TCI). Steroids are anti-inflammatory drugs that also help reduce itching and redness. They work by inhibiting the production of inflammatory molecules, which prevents swelling. They are usually applied for one to two weeks, as they can cause side effects if used long-term. You can get them in different strengths and formulas. TCIs are also anti-inflammatory drugs but they work in different ways. They inhibit calcineurin, a chemical that triggers flare-ups.
The three main categories of treating eczema are emollients, steroids and topical calcineurin inhibitors.
1. Emollient
There are many different types of emollients available. They tend to be fragrance-free and contain no harsh chemicals. The difference between them depends on the ingredients they contain. Common ones include Epaderm, Doublebase and Fifty:50. When applied, they prevent water loss from the surface of your skin, keeping your skin moisturised. It also stops the entry of germs that could cause infections.
2. Steroid
Steroids come in many different strengths and formulas. The strength of a steroid refers to how powerful or effective it is in achieving its intended effects, in this case, at reducing inflammation, redness and itching. Some common steroids include Hydrocortisone, Betnovate, Elocon and Dermovate.
You can also get them in different formulations, like as a cream, ointment and scalp solution. There isn't much difference between the cream and ointment. The main difference is that the cream is thinner, so it won't penetrate as far into the skin as the ointment.
If you have scalp eczema, you can get products made for easy and safer application on the scalp. Common steroids, like Dermovate, come in a scalp solution, but you can also get specially formulated products like Bettamousse, which are made for skin disorders of the scalp.
3. Topical calcineurin inhibitors
Topical calcineurin inhibitors work by inhibiting the activity of calcineurin, which prevents the production of inflammatory molecules, to help reduce swelling and inflammation. Some examples of TCIs include Tacrolimus, Protopic and Elidel.
Currently, there’s no cure for eczema, so treatments usually focus on managing the symptoms and keeping your eczema under control. How long it takes for the treatments to work depends on the medicine you're using and how severe your condition is. Even then, it differs from person to person, as everyone will react differently to the same drug. So there’s no one, simple answer to this question. If you want to get an idea of how long your treatment will take, your clinician might be able to give you an indication after you’ve started treatment.
How we source info.
When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.
Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.
Atopic dermatitis. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2).
Skin Barrier Repair in Eczema: A Review of Current Understanding of Pathophysiology and Treatment. Curr Derm Rep 1, 115–122
Atopic Dermatitis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
The infectious complications of atopic dermatitis. Annals of Allergy, Asthma & Immunology, 126(1), 3-12.
New Directions in Understanding Atopic March Starting from Atopic Dermatitis. Children, 9(4).
Halting the March: Primary Prevention of Atopic Dermatitis and Food Allergies. The Journal of Allergy and Clinical Immunology. In Practice, 8(3), 860.
Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Eczema: Steroids and other topical medications. 2017 Feb 23.
Widely used corticosteroid for irritated skin. Available as a cream or an ointment.
Effective steroid mousse for scalp eczema. Use it twice a day for a week before reducing your dose.
Potent steroid tablet that's effective at reducing severe flare-ups. Use a high dose for one week, followed by a lower one.
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