Eczema

Also known as atopic dermatitis

Eczema is a common skin condition that causes redness, inflammation, dryness and itching of your skin.

This page focuses on ezcema in general. Read about eczema in children

Key points

  1. Eczema is commonly found behind your knees and on your arms, hands, neck and face.
  2. Eczema is not contagious – you cannot give eczema to someone else and you cannot get eczema from someone else.
  3. Eczema can be mild, moderate or severe and can go through phases of being mild and less severe, to periods of being worse and very severe.
  4. When eczema worsens it is called an eczema flare. Sometimes flares can be due to the factors mentioned below but often no cause can be identified. During flares the skin may become red, rough, itchy, weepy or blistered, and is more prone to becoming infected.
  5. Management of eczema involves avoiding things that make it worse, using moisturisers and correct use of corticosteroid creams. Antibiotics may be needed if your skin becomes infected.

What causes eczema?

Eczema is associated with having an impaired skin barrier (‘sensitive skin’). With the most common form of eczema, called atopic dermatitis, there is often a family history of eczema, hay fever and/or asthma.

Who does eczema affect?

Eczema is more common in babies and children than adults, as many people find eczema improves as they get older.

Eczema in babies

  • Eczema in babies (known as infantile eczema) usually starts between 4 and 6 months of age when the baby develops a red itchy rash, which may weep.
  • The rash appears on the cheeks and may spread to the forehead and the backs of arms and legs.
  • In severe cases, it may involve the whole body. Heavy scaling similar to cradle cap may occur.
  • In some cases eczema improves after the age of 1 year. However it has the potential to persist or recur in later life.

Eczema in children

  • Childhood eczema may follow the baby phase almost immediately, or it may start for the first time between the ages of 2 and 4 years.
  • In childhood eczema, the rash is found in the creases of the elbows, behind the knees, across the ankles and wrists, and may involve the face, ears and neck as well.

Read more about eczema in babies and children.

Eczema in adults

  • Adult eczema usually has large areas of very itchy, reddened, weeping skin with your elbow creases, wrists, neck, ankles and behind your knees being especially affected.
  • It may be provoked by sunlight or exposure to environmental allergens.
  • Adults who have had childhood eczema are more likely to suffer from hand dermatitis (due to contact with irritants and allergens).
  • Eczema tends to improve in middle life and is unusual in elderly people.

What makes eczema worse?

The following factors can all make eczema worse:

  • dry skin
  • hot weather, high humidity and perspiration from exercise
  • being unwell eg, having a common cold or stress
  • skin infections caused by bacteria or viruses
  • contact with things in the environment that cause an allergy (called allergens) such as dust, grass, wool or pet fur
  • chemicals that irritate skin, such as those found in detergents and other cleaning products
  • teething in babies
  • children with eczema are at increased risk of developing food allergy, but the food doesn’t cause the eczema. Instead, some foods can cause irritation or a delayed eczema flare, eg citrus or tomatoes.

How is eczema treated?

There is currently no cure for eczema, but there are many ways of controlling the symptoms. If you manage your eczema well with the appropriate treatment and self-care, it should improve over time. Do the following to help keep eczema under control:

  • Avoid the following:
    • Irritants, eg, soaps, detergents, solvents, ink, vegetable juice, gardening, flour.
    • Scratching – scratching in response to itch can make your rash even worse, leading to more inflammation and itching. This is called the itch-scratch cycle. Read more about itching.
    • Hot baths and overheating.
    • Scratchy fabrics next to your skin – instead use cotton bedding and underclothes. Soft merino wool is okay for many people.
    • Non-sedating antihistamine medications have been shown to be no better than a placebo for managing the itch of eczema.
  • Bath or shower every day to help to keep your skin moist and clean.
    • Use warm water (not hot) and a soft cloth to gently soak and lift off any crusts.
    • Use a soap-free wash such as your prescribed moisturiser or aqueous cream.
    • Don’t use soap and bubble bath as these make your skin dry.
    • Antiseptic baths two times a week can help.
    • Gently pat your skin dry – don't rub.
  • Use moisturisers (emollients) regularly.
    • Keep your skin moist by using moisturiser daily.
    • When the eczema is active, applying moisturiser more often (as often as you like) can help relieve the itch.
    • Put on moisturiser within 3–5 minutes after bathing. Moisturisers are more effective if applied immediately after a bath or shower as they ‘lock in’ moisture.
    • Apply all over your body, not just where there is eczema.
  • Apply steroid creams and ointments when required.
    • When eczema flares up, applying cream or ointment that contain steroid reduces inflammation, eases soreness and irritation, reduces itching, and relieves the need to scratch. This gives your skin a chance to heal and recover.
    • Ask your doctor or nurse to fill in an eczema action plan so you know what cream to use where and how often.
    • Apply a thin layer of steroid to all rough or red and itchy skin (active eczema) once a day. Straight after your bath or shower is best.
    • When your skin is no longer rough, red and itchy, stop using the steroid but keep moisturising your skin, as it takes 6 weeks for the skin barrier to recover.
    • If the eczema comes back, start using the steroid again.
    • Steroid creams are very safe to use. They do not cause thin skin or other side effects when used appropriately.
    • If you apply a topical steroid daily for more than 2 weeks without your eczema improving, go back to your doctor as you need a different treatment.

Emollients and moisturisers

Emollients and moisturisers help to maintain your skin’s barrier function. They keep moisture in and irritants, allergens and pathogens out. Some are very thick and oily, which is great for dry skin. Apply often and use plenty. Lotions are not usually recommended for eczema. 

Common emollients and moisturisers include:

Steroid creams and ointments

When you get an eczema flare-up, you need a steroid cream or ointment (also called topical steroids) to help settle the inflammation. If you get severe eczema, you may need to use a strong steroid cream for a few days to get it under control, changing to a moderate or low-strength steroid cream for a few more days before stopping.

Make sure you know which one to use where and how often to apply, as this varies from cream to cream. Ointments are more greasy than creams and often better for eczema. 

For your face, a mild corticosteroid cream or ointment such as hydrocortisone 0.5% or 1% is usually used. 

Managing infected eczema

Infected eczema needs to be treated with an antibiotic. See your doctor or nurse if you have the following symptoms:  

  • weeping and/or crusted areas
  • lots of yellow or white pimples
  • sudden flaring of eczema all over the body
  • shivering or fever
  • skin that is painful to touch
  • painful chicken pox-like blisters and sores.

When should I go back to my doctor or nurse about my eczema?

  • If the topical steroid does not work to make the eczema go away after 1–2 weeks.
  • If eczema means school or work is missed on a regular basis.
  • If eczema is affecting sleep.
  • If the infection is not improving after 2–3 days of treatment or keeps coming back.
  • If other people in the house have skin infections – they may also need treatment.

If you don't respond to emollients and steroids for your eczema and continue to have significant symptoms, there are other treatments that may be effective and are available by referral to a dermatologist. These include phototherapy and systemic immune modulators.

Learn more

Atopic eczema DermNet, NZ
Childhood eczema KidsHealth, NZ
Eczema and allergies Allergy New Zealand
Bleach baths for eczema Child and Youth Eczema Clinical Network, NZ, 2019
Eczema and food – fast facts Australasian Society of Clinical Immunology and Allergy, ASCIA, 2020

Credits: Health Navigator Editorial Team. Reviewed By: Dr Angela Craig, Paediatrician, Hawke's Bay DHB, Dr Diana Purvis, Dermatologist, Auckland DHB and the Child and Youth Eczema Clinical Network, NZ Last reviewed: 31 Aug 2020