Eczema

Also known as atopic dermatitis

Eczema is a common skin condition that causes redness, inflammation, dryness and itching of the skin. The exact cause of eczema is not known but with the most common form of eczema – called atopic dermatitis – there is often a family history of eczema, hay fever and/or asthma.

Quick facts about eczema
  1. Eczema is commonly found behind the knees and on 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. Very severe periods are called flare-ups or flares. Sometimes flares can be due to the factors mentioned below but often no cause can be identified. During flares the skin may become red, weepy and blistered, and is more prone to becoming infected.
  5. Management of eczema involves avoidance of irritants, use of moisturisers and correct use of corticosteroid creams. Antibiotics may be needed if skin becomes infected.

Who does eczema affect?

Eczema is more common in babies and children than adults, as most people 'grow out' of eczema 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 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.
  • Eczema usually disappears between the ages of 3 and 5 years.

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 may involve the face, ears and neck as well.
  • Most children grow out of eczema, with their skin becoming less dry or irritable as they get older. About 60% of children have almost normal skin by 6 years of age and 90% by puberty. 

Eczema in adults

  • Adult eczema usually has large areas of very itchy, reddened, weeping skin with the elbow creases, wrists, neck, ankles and behind the knees being especially affected.
  • The condition tends to improve in middle life and is unusual in the elderly.

Things that make eczema worse

  • Contact with things in the environment that cause an allergy (called allergens) such as dust, grass, wool or pet fur.
  • Food allergies – commonly  dairy products, eggs, nuts and seeds or wheat.
  • Stress or being unwell – for example having a common cold.
  • Hot weather, high humidity and perspiration from exercise.
  • Chemicals that irritate the skin such as those found in detergents and other cleaning products.
  • Dryness of the skin.
  • Teething in babies.
  • Infections of the skin caused by bacteria or viruses.

Things that help make eczema manageable

There is currently no cure for eczema, but there are many ways of controlling the symptoms. Well-managed with appropriate treatment and self care, many cases improve over time. To help keep eczema under control it is recommended that you:

  • Avoid:
    • irritants, e.g., 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
    • hot baths and overheating
    • wool and scratchy fabrics next to the skin – instead use cotton bedding and underclothes.
  • Bath or shower every day to help to keep the 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 ie, aqueous cream or emulsifying ointment.
    • Don’t use soap and bubble bath as these make the skin dry.
    • Antiseptic baths two times a week can help.
    • Gently pat the skin dry – don not rub.
  • Use moisturisers (emollients) regularly:
    • Keep the skin moist by using moisturiser two to three times per day.
    • Aim to apply moisturiser within 3 to 5 minutes after bathing. Moisturisers are more effective if applied immediately after a bath or shower as they ‘lock in’ moisture.
    • Apply all over not just where there is eczema.
  • Apply steroid creams and ointments when required:
    • When eczema flares up, applying cream or ointment that contain steroid will reduce inflammation, ease soreness and irritation, reduce itching, and relieve the need to scratch, allowing the skin to heal and recover.
    • Ask your doctor or nurse to fill in the eczema action plan so you know what cream to use where and how often.
    • Apply a thin layer of steroid to all red and itchy skin (active eczema) once a day. Immediately after the bath is best.
    • When the skin is no longer red and itchy stop using the steroid but keep moisturising as it takes 6 weeks for the skin barrier to recover.
    • If the eczema comes back start using the steroid again.

Emollients & moisturisers

Emollients and moisturisers help to maintain the skin’s barrier function – keeping 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. 

Common emollients and moisturisers include:

Steroid creams & ointments

When you get an eczema flare, you will often 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 what 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. 

On the 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 to go back to your doctor/nurse

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

Learn more

Atopic eczema DermNet (NZ), 2014
Childhood eczema Kidshealth (NZ), 2013
Childhood eczema SAFERx – Waitemata DHB (NZ), 2014
Eczema Itchykids (NZ), 2004
Eczema and Allergies AllergyNZ (NZ), 2010 
Bleach bath handout Dr Diana Purvis, Paediatric Dermatologist, ADHB

Credits: Editorial team. Last reviewed: 24 Feb 2016