Eczema

Eczema

Understanding eczema: what is eczema?

Eczema, also known as dermatitis, is an umbrella term for a group of common skin conditions that cause red, dry, and itchy skin (1). These conditions can vary in severity and appearance, but the main symptom is persistent itching, often described as "the itch that can’t be scratched." 

This sensation can lead to excessive scratching, which worsens the inflammation and irritation. Persistent scratching can cause the skin to crack and bleed, leaving it more vulnerable to infection.

In the UK, one in five children and one in ten adults have eczema. Eczema accounts for 84-90% of occupational skin diseases at work.(2) In mild cases of eczema, the skin becomes dry, scaly, red, and itchy. The skin may ooze, crust, or bleed in more severe cases.

What causes eczema?

The exact cause of eczema is unclear, though a weakened skin barrier (the outer protective layer of skin), an overactive immune system and environmental triggers all play a role.(1)

Research involving twins suggests that there is a genetic component involved too, but eczema is more complex than other genetic conditions where you either have it or you don’t. It involves multiple genes, and the interaction between those genes and environmental triggers determines how severe the symptoms become.(2)

Is eczema contagious?

No, eczema is not an infectious disease, though it often runs in families. A parent with eczema, asthma, or hay fever is more likely to have a child with eczema.

What are the different types of eczema?

Each type of eczema can look and feel different, so identifying the specific type can help with proper management. If there is uncertainty, consulting a healthcare professional is recommended.

Atopic eczema (atopic dermatitis)

This is the most common type of eczema. It usually starts in childhood and by adulthood, most children outgrow it. It’s also possible to develop it for the first time as an adult. The most common areas to be affected are the creases of the arms, behind the knees, the hands, face, neck and upper chest area.

Contact dermatitis

Contact dermatitis is a type of eczema that occurs when the skin comes into contact with something that causes irritation (irritant contact dermatitis) or an allergic reaction (allergic contact dermatitis). Examples of irritants can be chemicals, soap, or detergents, while an example of an allergen can be eggs or nuts.

Dyshidrotic eczema

Dyshidrotic eczema appears as small, itchy blisters on the hands and feet. If scratched, these blisters can be painful and may become infected. Stress, allergies, and sweaty skin are common triggers for this type of eczema.

Nummular eczema

Nummular eczema causes round, coin-shaped patches to appear on the skin. These patches are often very itchy and can become dry or cracked. Nummular eczema is more common in adults and is often triggered by skin injuries, like insect bites or cuts.

Seborrhoeic dermatitis

Seborrhoeic dermatitis affects areas of the skin that are rich in oil-producing glands, like the scalp, face, and chest. It causes red, scaly patches, and dandruff on the scalp. In babies, the dry scalp symptoms are often referred to as cradle cap.

Eczema herpeticum

Eczema herpeticum is a rare but serious infection caused by the herpes simplex virus (HSV), typically responsible for cold sores. When HSV infects eczema-affected skin it can lead to a widespread herpetic infection that may cause painful blisters, sores, fever, and swollen lymph nodes. Prompt medical attention is crucial, as untreated cases can spread rapidly and cause complications.

Under the microscope; a closer look at what causes eczema

Eczema is a condition that affects the outer layer of the skin, known as the epidermis. The cells in the epidermis are usually packed tightly together, forming a protective barrier that keeps moisture in and irritants out. In healthy skin, these cells are held together by natural oils and fats, making the barrier strong and secure.

However, in people with eczema, the cells that form the epidermis are not as tightly packed because the skin produces fewer oils and may lack certain proteins that help keep the barrier together.(2) This makes the spaces between the skin cells wider, allowing moisture to escape and irritants, allergens, bacteria, or pollutants, to enter more easily. As a result, the skin becomes dry, cracked, and is more prone to inflammation and infection.

What triggers eczema flare-ups?

Eczema flare-ups are triggered by various factors, which can differ widely from person to person. Common triggers include weather changes, irritants, allergens, and stress. Each individual with eczema responds differently to these triggers, making it important to identify personal triggers to manage symptoms better.(3)

Weather

Cold and dry air in winter can strip moisture from the skin, making it more prone to dryness, irritation, and cracking. In contrast, hot, humid weather can cause sweating, which may lead to skin irritation and worsen eczema symptoms. Rapid changes in temperature, such as moving from a cold environment to a warm one can also trigger flare-ups as the skin struggles to adapt.

Food sensitivities

Anecdotal evidence suggests that food intolerances may play a role in triggering eczema in some individuals. Foods like dairy, eggs, wheat, and soy are common culprits. However, the link between food and eczema is not straightforward, and many dermatologists believe that food intolerances play only a minor role in eczema management.

Irritants

When irritants come into contact with eczema-prone skin, they can cause redness, itching, and inflammation. By avoiding the offending irritant flare-ups can be reduced or avoided. Common irritants include:

• Soaps and detergents: These can strip the skin of its natural oils, leaving it dry and more sensitive.
• Cleaning products: Harsh chemicals found in household cleaners can irritate the skin, especially with repeated exposure.
• Fragrances: Scented lotions, perfumes, and air fresheners can trigger flare-ups in people with eczema.
• Wool or synthetic fabrics: Certain rough or scratchy materials can rub against the skin and cause irritation.
• Dust and pollution: Airborne particles can irritate and dry out sensitive skin.

Allergies

Patients with eczema have an overactive immune system and therefore are more like to overreact to a usually harmless substance. An allergic reaction releases a cocktail of chemicals that lead to swelling, rashes and itching. Common allergens include:

• Dust mites: These tiny creatures live in bedding, carpets, and soft furnishings, and their presence can trigger allergic reactions.
• Pet dander: Skin flakes and fur from animals, especially cats and dogs, can worsen eczema symptoms in sensitive individuals.
• Mould: Damp environments where mould grows can also be a trigger for some people with eczema.
• Certain foods: Although food allergies are not a major trigger for most people, some may experience eczema flare-ups after eating foods like dairy, eggs, or nuts.

Yeast overgrowth

Some types of eczema, like seborrhoeic dermatitis, can have specific causes beyond general environmental and genetic factors. For seborrhoeic dermatitis, a key trigger is an overgrowth of a type of yeast called Malassezia that naturally lives on the skin. While this yeast is usually harmless an overgrowth can cause the skin to become inflamed and scaly, especially in areas with a lot of oil glands, such as the scalp, face, and chest.(4)

Microflora imbalance

The skin has its own ecosystem of microorganisms, known as the microflora. In people with eczema there is often an overgrowth of some bacteria, such as Staphylococcus aureus, and the imbalance in the microflora is thought to contribute to flare-ups.(5)

An alkaline pH

The skin’s pH level also plays a crucial role in maintaining its health. Healthy skin usually has a slightly acidic pH, which helps maintain a balanced microflora in addition to keeping the skin barrier strong. However, in people with eczema, the skin’s pH can become less acidic, making it harder for the barrier to function optimally.

Who is most affected by eczema?

Eczema can affect people of all ages, but it is more common in certain groups. Children, in particular. It’s also more prevalent in black and Asian populations.

Children and babies

Eczema is especially common in infants and young children. Around 1 in 5 children in the UK experience eczema at some point. It often starts within the first six months of life, and the symptoms can range from mild to severe. Many children outgrow eczema as they get older, but for a minority, it continues into adolescence and adulthood.

Adults

While eczema is more common in children, adults can still be affected. Around 1 in 10 adults in the UK have eczema, with many cases continuing from childhood. However, some may develop eczema for the first time as adults, this is known as adult-onset eczema.

Gender differences

Research suggests that eczema affects boys and girls equally. However, in adulthood, women are more likely to experience eczema than men.(6) This may be due to hormonal changes.

Ethnic groups

Eczema can affect people from all ethnic backgrounds. Some suggest that black and Asian children are more likely to develop eczema compared to white children.(7) While other sources report no differences between ethnicities.(8)

Family history

People with a family history of eczema, asthma, or hay fever are more likely to develop eczema. These conditions are often linked, and having a close relative with one of these conditions increases the likelihood of experiencing eczema.(8)

How to treat eczema

There is currently no cure for eczema, treatment involves managing symptoms and preventing flare-ups. The best treatment approach combines avoiding triggers with maintaining a healthy skin barrier. Skincare routines, medications, and lifestyle changes each help to keep eczema under control.

Moisturising creams

A key component of treating eczema is keeping the skin moisturised. Applying a thick emollient several times a day helps to lock in moisture, repair the skin barrier, and reduce irritants getting into the skin that may trigger itching. Here’s a list of the different types of creams to consider:

• Humectants: These attract and retain moisture in the skin, helping keep it hydrated. Common humectants include glycerin, hyaluronic acid, and urea.
• Emollients: Emollients soften and smooth the skin by filling in gaps between skin cells, making the skin feel less rough. Examples include shea butter and fatty acids.
• Occlusives: Occlusives form a protective layer over the skin to prevent water loss. These are ideal for very dry skin and include ingredients like petroleum jelly and caster oil.
• Barrier repair creams: These creams restore the skin’s protective barrier, often with ceramides and cholesterol, essential for reducing moisture loss and protecting against irritants.
• Anti-inflammatory creams: These contain ingredients to reduce redness and irritation, such as aloe vera and liquorice extract.

What ingredients should you look for in a moisturising cream for eczema?

Choosing the right moisturising cream takes a bit of trial and error. What works for one doesn’t always work for another so it’s recommended to patch test any new creams. Avoid creams with added fragrances, alcohol, or harsh chemicals, as these can further irritate the skin. Look for creams suitable for sensitive skin that contain some of the ingredients below:

Ceramides

Ceramides are natural fats found in the skin that help maintain the skin's barrier. Moisturisers containing ceramides help to restore this barrier, keeping moisture in and irritants out.

Hyaluronic acid

Hyaluronic acid is a powerful humectant that draws moisture into the skin, helping it stay hydrated and plump.

Urea

Urea helps to remove dead skin cells and increase moisture content in the skin. It's especially effective for very dry, cracked skin, helping it feel smoother and more comfortable.

Colloidal Oatmeal

Colloidal oatmeal has anti-inflammatory properties, making it helpful for reducing itching and irritation. It forms a protective barrier on the skin and can soothe redness and dryness.

Petroleum Jelly

Petroleum jelly is known by its household brand name, Vaseline. It forms a protective layer over the skin, sealing in moisture. It’s particularly useful for very dry or cracked skin and is highly effective at preventing water loss.

What are the best moisturising creams for eczema?

No one can say which moisturising cream is the absolute best, but we can recommend some popular options. When in doubt, choose hypoallergenic products and remember, it can take some trial and error to find a suitable cream:

CeraVe moisturising cream

CeraVe is widely recommended by dermatologists for its gentle, hydrating formula. It contains ceramides and hyaluronic acid, which help to repair the skin barrier and lock in moisture. CeraVe is also fragrance-free and non-irritating, making it ideal for sensitive skin.

Cetaphil moisturising cream

Cetaphil is another well-known brand for sensitive skin. Its moisturising cream is designed to provide long-lasting hydration without clogging pores. It contains glycerin and panthenol, which soothe the skin and help maintain moisture. Like CeraVe, Cetaphil is fragrance-free, making it safe for daily use on eczema-affected areas.

Doublebase

The active ingredients in Doublebase are isopropyl myristate and liquid paraffin, which are known as emollients. The product helps to soften, moisturise, and protect skin by trapping moisture and restoring its normal protective function.

Aveeno cream

Aveeno’s range is specially formulated for eczema-prone skin. It contains colloidal oatmeal, which soothes itching and irritation. The cream is gentle, non-greasy, and provides long-lasting hydration.

Medicated creams and ointments

Topical steroids

Topical steroids work by reducing inflammation and itchiness in the skin. When eczema flares up, the immune system overreacts to irritants or allergens, causing redness, swelling, and itching. Steroids calm this immune response, helping to soothe the skin and allow it to heal. While effective, they should only be used in short bursts, and only as directed by a healthcare professional as overuse can cause thinning of the skin and possible dependence.(9)

They are available in different strengths, or potencies, depending on the severity of the eczema and the area of the body being treated. Doctors usually prescribe the lowest effective potency to manage symptoms while minimising the risk of side effects. Stronger steroids are often used for more severe eczema or on thicker skin, while milder steroids are better suited for delicate areas like the face or groin.

Below is a table of topical steroids and their potencies:

Calcineurin inhibitors

Calcineurin inhibitors are a type of non-steroid medication used to treat eczema. They reduce inflammation and calm the immune response, similar to topical steroids, but they work in a different way.

Calcineurin inhibitors are particularly useful for sensitive areas of the skin, such as the face and neck, where steroids may not be suitable for long-term use due to their potential side effects. By blocking calcineurin, these medications reduce inflammation and help the skin heal without the risk of skin thinning, a common side effect of long-term steroid use.

They may cause a mild burning sensation or tingling when first applied, which usually subsides with continued use.

Calcineurin inhibitor ointments

For moderate to severe eczema.

 
Comparing medicated creams and ointments for the treatment of eczema

When treating eczema, it’s essential to understand the different roles of moisturisers and medicated creams and ointments. Daily use of moisturisers is crucial to keep the skin hydrated and maintain the skin barrier, regardless of symptoms. In contrast, medicated treatments such as steroids and calcineurin inhibitors are used intermittently to manage flare-ups, targeting redness and inflammation.

All three treatments can be used together as part of a treatment plan. To ensure safe and effective use, it’s advisable to speak with your doctor, who can guide you on how to incorporate each into your routine.

Oral medication you can buy from the pharmacy to treat eczema

Antihistamines

Antihistamines are medications often used to relieve symptoms of allergic reactions, such as itching, sneezing, hayfever or hives. They work by blocking the action of histamine, a chemical that the body releases during allergic reactions. By reducing the effects of histamine, antihistamines can help ease itching and swelling to reduce further irritation from scratching.

They are not a cure for eczema. They are usually used alongside other treatments, such as moisturisers and topical steroids, to help manage symptoms. For people with eczema antihistamines may not be as effective as they would be for other allergic reactions.

There are two main types of antihistamines: sedating antihistamines, and non-sedating antihistamines. Non-sedating antihistamines generally have fewer side effects but may not be as effective for severe itching.

Sedating antihistamines

As the name implies, sedating antihistamines also cause drowsiness which in some situations is desirable. For example, when children have chicken pox, sedating them helps them rest, recover and reduces the urge to scratch. They can be useful in patients with eczema by both reducing the itch, and also helping them sleep. A lack of sleep has been shown to worsen eczema symptoms. They are not recommended for long-term use.

Examples include chlorphenamine (Piriton)  and hydroxyzine (Atarax)

Non-sedating antihistamines

These antihistamines cause little to no drowsiness and are generally preferred for long-term and daytime use. Their effectiveness in treating eczema-related itching varies from person to person.

Examples include cetirizine, levocetirizine, loratadine and rupatadine.

Frequently Asked Questions (FAQs)

Where can I buy eczema treatments online?

Oxford online pharmacy sells a variety of creams for eczema. We sell moisturisers, over the counter pharmacy medicines, and following a consolation with our doctors, we can also supply stronger prescription only medicines.

How can you ensure the products you buy are genuine and safe?

We recommend you only buy your medicines from an accredited pharmacy such as Oxford Online Pharmacy.

How to cure eczema permanently?

One of the most common questions we get about eczema is whether it can be cured, or if it’s something that lasts a lifetime. Unfortunately, eczema is a lifelong condition without a known cure. For many, it’s a minor nuisance that can be managed effectively. For others, eczema is more severe, covering larger areas of the body and requiring ongoing management to prevent flare-ups and infections.

By understanding individual triggers, using appropriate treatments, and following a consistent skincare routine, most people with eczema can maintain comfort and reduce symptoms over time.

What should you do if your eczema cream is not working?

Consult with your doctor.

What are the differences between over-the-counter and prescription medicines?

Prescription only medicines, including creams and ointment, tend to be stronger than those available over the counter without a prescription. Oxford Online Pharmacy is able to offer stronger prescription only medicines following a consultation with one of our prescribers.  

How do you determine the best formulation for your skin type?

People with eczema have dry and sensitive skin. We recommend creams and ointment designed for dry and sensitive skin. It’s best to use fragrance-free and hypoallergenic products.

What does an eczema rash look like?

Eczema can appear differently depending on a person’s skin tone. On darker skin tones, eczema rashes may look purple, brown, or grey, while on lighter skin tones, they often appear pink, red, or purple.(3)

Is there a permanent cure for eczema? 

Unfortunately, there is no permanent cure for eczema. While various therapies exist, none can eliminate symptoms. Eczema is a chronic condition, meaning it can come and go. Treatments are highly effective in alleviating itching and dry skin symptoms.

How to manage eczema? 

Although a permanent cure is lacking, lifestyle changes and therapies can help alleviate itching and prevent flare-ups. Adopting healthy habits, such as regular cleaning to remove allergens, using unscented products, staying hydrated, and managing stress through activities like exercise and meditation, can contribute to symptom relief.

When to use ointment vs. cream?

The choice between ointments and creams depends on the individual's needs. Creams, with lower oil content, are adept at sealing in moisture and are less oily to the touch. Ointments, being thicker, serve well for extremely dry skin as occlusive moisturisers. Careful reading of labels is advised, as creams may contain stabilisers or preservatives that could be harsh on the skin.

References

1. Nelson S. Eczema Basics: What You Need to Know [Internet]. National Eczema Association. 2022 [cited 2024 Oct 21].
2. blue_admin. National Eczema Society. 2019 [cited 2024 Oct 21]. Our skin and eczema.
3. Cleveland Clinic [Internet]. [cited 2024 Oct 27]. Eczema: What It Is, Symptoms, Causes, Types & Treatment.
4. blue_admin. National Eczema Society. 2020 [cited 2024 Oct 27]. Seborrhoeic dermatitis in adults. 
5. Nelson S. The Human Skin Microbiome and its Changes in Atopic Dermatitis [Internet]. National Eczema Association. 2021 [cited 2024 Oct 27].
6. Eczema Stats [Internet]. National Eczema Association. [cited 2024 Oct 27].
7. Lusignan S de, Alexander H, Broderick C, Dennis J, McGovern A, Feeney C, et al. The epidemiology of eczema in children and adults in England: A population?based study using primary care data. Clin Exp Allergy. 2020 Nov 26;51(3):471.
8. Prevalence | Background information | Eczema - atopic | CKS | NICE [Internet]. [cited 2024 Oct 27].
9. GOV.UK [Internet]. [cited 2024 Oct 27]. Topical steroid withdrawal reactions: a review of the evidence.