Atopic Eczema: Symptoms, Causes, and Management in the UK

Atopic eczema, also known as atopic dermatitis, is a chronic condition that causes the skin to become itchy, dry, cracked, and sore. It is particularly common in children, often developing before their first birthday, but it can also affect adults for the first time or persist throughout a person's life.

The term 'atopic' refers to a group of conditions involving the immune system, including asthma and hay fever. People with eczema often have a sensitive immune system that reacts to certain environmental factors, causing inflammation in the skin barrier. This barrier usually helps retain moisture and protects the body from external irritants. In those with eczema, the barrier is less effective, leading to moisture loss and increased vulnerability to irritants.

The main symptom of atopic eczema is an intense itch, which can be severe enough to interfere with sleep and daily activities. Other common signs include:

• Areas of very dry, flaky skin.
• Redness and inflammation (on lighter skin tones) or patches that appear dark brown, purple, or grey (on darker skin tones).
• Small bumps that may leak fluid when scratched.
• Cracked skin that may bleed or sting.
• Thickened, leathery patches of skin (known as lichenification) caused by chronic scratching.

Eczema can affect any part of the body, but in adults and older children, it is most frequently found in the creases of the elbows, behind the knees, and around the neck, eyes, and wrists.

While the exact cause of atopic eczema is not fully understood, it is widely believed to be a combination of genetics and environmental factors. Many people with the condition have a variation in the gene responsible for creating filaggrin—a protein that helps maintain the skin barrier.

Flare-ups occur when the skin reacts to specific triggers. Common UK-specific triggers include:

• Irritants: Soaps, detergents, bubble baths, and fragrances.
• Environmental factors: Dust mites, pet dander, pollen, and mould.
• Weather: Cold, dry air in winter or humid heat in summer.
• Clothing: Woollen or synthetic fabrics which can be abrasive.
• Dietary factors: Specifically in children, though food allergies are less common as a trigger in adults.
• Stress: While not a direct cause, emotional stress is known to worsen symptoms.

Managing atopic eczema focuses on repairing the skin barrier and reducing inflammation. In the UK, NICE guidelines recommend a stepped approach to treatment:

Emollients (Moisturisers)

Emollients are the cornerstone of eczema care. These are non-cosmetic moisturisers applied directly to the skin to reduce water loss. They should be used every day, even when the skin appears clear. They come in various forms, including creams, ointments, and lotions, as well as soap substitutes.

Topical Corticosteroids

During a 'flare-up' where the skin is red and particularly itchy, a GP may prescribe a topical steroid. These work by reducing inflammation quickly. They are available in different strengths (mild, moderate, potent, and very potent) and should only be used on affected areas for short periods as directed.

Other Treatments

If standard treatments are unsuccessful, specialists may recommend topical calcineurin inhibitors (like tacrolimus), bandages (wet wraps), or phototherapy (UV light treatment). In severe cases, systemic immunosuppressant medications may be considered.

Alongside medical treatments, self-care plays a vital role in keeping eczema under control. Consider these practical tips:

• Avoid scratching: Keep fingernails short. For children, anti-scratch mittens can be helpful at night.
• Bath time: Use lukewarm water instead of hot water, and limit baths or showers to 10-15 minutes. Always use an emollient soap substitute.
• Gently pat dry: Never rub the skin with a towel; blot it dry gently and apply moisturiser immediately while the skin is still slightly damp.
• Cotton clothing: Wear loose-fitting garments made of natural fibres like cotton or silk, which are less likely to irritate the skin.
• Cool environment: Keep your home and bedroom cool, as overheating is a common trigger for itching.

If you are struggling to manage your skin condition with over-the-counter products, consulting a GP is an important next step. An online GP can review your symptoms via video or photos, provide a formal diagnosis, and issue prescriptions for stronger emollients or steroid creams.

You should book a consultation if:

• Your eczema is causing significant distress or affecting your sleep.
• The skin is painful or looks different than usual.
• Home treatments are not providing relief.
• You need a repeat prescription for your maintenance treatments.
• You are experiencing a flare-up and need guidance on the correct strength of corticosteroid to use.