Eczema

How Eczema Affects the Skin

Eczema is a long-term condition that affects the skin’s ability to protect itself properly. It most commonly starts in early childhood, often before the age of five, although it can develop or persist into adulthood.

People with eczema tend to produce less of the natural oils that keep the skin hydrated and protected. This leaves the skin dry, fragile, and more prone to irritation, inflammation, and infection. As a result, the skin may become itchy, red, scaly, or sore, with symptoms that can flare up and settle over time.

Eczema develops due to a combination of genetic, immune, and environmental factors, which together disrupt the skin barrier and affect how the immune system responds.

The most common form, atopic eczema, is part of a group of conditions known as atopic diseases, which also include asthma, hay fever, and food allergies. These conditions are linked by an increased sensitivity of the immune system.

How Eczema is Assessed

An eczema diagnosis is usually based on your symptoms and how your skin looks. A pharmacist or healthcare professional might ask about:

• When your symptoms first started
• Which areas of skin are affected
• How severe and frequent flare-ups are
• Any triggers you’ve noticed, such as soaps, detergents or stress
• Relevant lifestyle factors and personal or family history of allergies

This information helps build a clearer picture of what may be aggravating your eczema and supports appropriate treatment or self-care recommendations. In some cases, referral to a GP or specialist may be advised.

Types of Eczema

There are several different types of eczema. Some people experience more than one type at the same time.

Atopic Eczema

Atopic eczema is the most common form. It often affects the creases and folds of the body, such as the elbows, knees, neck and face, but can also appear on the hands, wrists and eyelids.

It is a chronic condition, meaning symptoms may come and go over many years. During flare-ups, the skin can become red, inflamed and very itchy. Repeated scratching over time can cause the skin to thicken and harden, a process known as lichenification.

Seborrhoeic Eczema

Seborrhoeic eczema is a long-term, relapsing condition that commonly affects areas with oil-producing glands, such as the scalp, face, chest and groin.

It causes flaky, scaly patches of skin that may appear red, pink, brown, purple or lighter than the surrounding skin, depending on skin tone. The affected areas can look greasy and feel irritated.

In infants, this condition is known as cradle cap, which appears as greasy, scaly patches on the scalp and usually clears on its own.

Contact Dermatitis

Contact dermatitis occurs when the skin reacts after coming into contact with a substance that irritates it or triggers an allergic reaction.

Irritant contact dermatitis is caused by substances such as soaps, detergents and cleaning products damaging the skin

Allergic contact dermatitis occurs when the immune system reacts to a specific allergen

Symptoms typically include red, itchy, sore or scaly skin and may affect any area that has been exposed. In some cases, contact dermatitis is occupational, affecting people who regularly handle irritants at work, such as healthcare workers, mechanics or hairdressers.

Stasis (varicose) Eczema

Stasis eczema, also known as venous eczema, usually affects the lower legs and is more common in middle-aged and older adults.

It develops when poor blood circulation in the legs increases pressure in the veins, causing fluid to leak into surrounding tissues. This can lead to red or brown patches, swelling, and itchy, fragile skin.

Without appropriate management, stasis eczema can increase the risk of skin breakdown and leg ulcers, so early assessment is important.

Discoid (nummular) Eczema

Discoid eczema is more common in adults with very dry skin. It causes distinctive coin-shaped patches that can be itchy, inflamed and sometimes weepy.

These patches often appear on the trunk, forearms, and lower legs and may persist for weeks or months.

Dyshidrotic Eczema

Dyshidrotic eczema (or pompholyx) causes small, intensely itchy blisters on the palms of the hands, fingers, and soles of the feet. The skin can become sore, inflamed, and cracked as the blisters heal.

Flare-ups may be triggered by stress, sweating or contact with irritants.

Asteatotic Eczema

Asteatotic eczema, also known as eczema craquelé, occurs when the skin becomes extremely dry due to a lack of natural oils.

It is more common in people over 60 and is often linked to over-washing, low humidity, and cold weather. The skin may appear cracked, sore, and inflamed, particularly on the legs, thighs, and back.

Reducing the risk of eczema flare-ups

While eczema can’t be cured, flare-ups can often be reduced with consistent skincare and trigger management. NHS-recommended measures include:

• Using emollients regularly to keep the skin moisturised
• Avoiding soaps, detergents, and products that irritate the skin
• Keeping baths and showers short and lukewarm, rather than very hot
• Using a humidifier in cold, dry weather, if the indoor air is dry
• Identifying and avoiding individual triggers, such as allergens or irritants

Take a look at some of the available treatments for eczema.

Main Treatments for Eczema

Eczema treatment focuses on soothing inflamed skin, restoring the skin barrier, and reducing flare-ups. For most people, management involves two main types of treatment: emollients and, where needed, topical steroid creams.

1. Emollients (moisturisers)

Emollients are the foundation of eczema treatment and are suitable for mild to moderate eczema, as well as ongoing daily skin care for more severe forms.

They work by replacing lost moisture, softening the skin, and helping to repair the damaged skin barrier. Used regularly, emollients can reduce dryness, itching, and the frequency of flare-ups.

People with eczema are usually advised to apply emollients liberally and frequently, typically at least 3-4 times a day, even when the skin looks clear.

Emollients come in different formulations, including creams, ointments, and lotions. Thicker products tend to be more effective for very dry skin. For best results, emollients should be applied after bathing or showering, while the skin is still slightly damp, to help lock in moisture.

Some emollients can also be used as soap substitutes or bath additives, helping to avoid further irritation from standard soaps and cleansers.

2. Topical Steroid Creams

Topical corticosteroids are used when eczema becomes inflamed, red, and itchy, and emollients alone are not enough to control symptoms. They help reduce inflammation and calm flare-ups so the skin can heal.

Steroid creams are usually applied in thin layers to affected areas, typically once or twice daily, for a short period. Using the correct strength for the right area of the body is important to ensure effective treatment while minimising side effects.

Topical steroids are grouped by strength:

Mild Steroids

Mild steroids are generally used for mild eczema and for sensitive areas, such as the face, neck, or skin folds.

• Hydrocortisone

Moderate Steroids

Moderate-strength steroids are used when eczema is more inflamed and has not responded adequately to mild treatments.

• Clobetasone butyrate (e.g., Eumovate)

Potent Steroids

Potent steroids are usually reserved for thicker skin areas, such as the palms, soles, or knuckles, and for more persistent flare-ups.

• Beclometasone dipropionate
• Betamethasone (e.g. Betnovate)
• Fluticasone
• Mometasone furoate (e.g. Elocon)

Very Potent Steroids

Very potent steroids, such as clobetasol propionate (e.g., Dermovate), are used for severe eczema and are typically prescribed for short-term use only, under medical supervision.

Topical steroids should always be used as directed, alongside regular emollient use, which helps maintain skin hydration and reduce the need for repeated steroid treatment.

Using eczema treatments safely

• Continue using emollients daily, even when symptoms improve
• Apply emollients before or after steroid creams, leaving a short gap between applications
• Use the lowest effective steroid strength for the shortest time needed
• Seek medical advice if symptoms worsen, do not improve, or signs of infection develop

Check If You May Have Eczema

Eczema can affect the skin in different ways, and symptoms may vary from person to person. Flare-ups often come and go, with periods where the skin improves in between.

Common signs and symptoms of eczema include:

Itching

Persistent itching is one of the most common symptoms and can range from mild to severe. Scratching can worsen inflammation and damage the skin, increasing the risk of infection.

Dry, sensitive skin

Skin affected by eczema often becomes very dry, rough or tight due to a weakened skin barrier. Dryness can persist even when other symptoms improve.

Redness and inflammation

Inflamed areas may appear red, pink, darker brown, purple or grey, depending on skin tone. During flare-ups, the skin may feel warm, sore or swollen.

Thickened or leathery skin

Repeated scratching over time can cause the skin to thicken and harden, a process known as lichenification. This is commonly seen in areas such as behind the knees, inside the elbows and around the neck.

Blisters and oozing

In more active flare-ups, small blisters may develop and leak fluid. As this fluid dries, it can form crusts or scabs on the surface of the skin.

Skin cracking and splitting

Very dry or inflamed skin can crack or split, particularly in skin folds or areas that bend. These cracks can be painful and may bleed.

Changes in skin colour

Eczema can cause temporary changes in skin colour during or after flare-ups. In some cases, discolouration may also be a sign of infection and should be assessed by a healthcare professional.

When to seek medical advice

You should seek advice from a pharmacist, GP, or other healthcare professional if:

• Symptoms are severe or worsening
• The skin becomes painful, swollen or oozes yellow fluid
• Eczema is interfering with sleep or daily activities
• Treatments are not improving symptoms

Early assessment helps ensure the most appropriate treatment and reduces the risk of complications such as skin infections.