Eczema

Also called Atopic dermatitis, Atopic eczema

A skin barrier that leaks moisture and lets irritants in. Itchy, exhausting, and very often undertreated.

What it is

Eczema gets filed under dry skin, which is like filing asthma under cough. It affects around one in five children and one in ten adults in the UK, and at its worst it wrecks sleep for a whole household.

The skin barrier does not hold water properly and does not keep irritants out. So the skin dries, cracks, gets inflamed, and itches. Scratching damages the barrier further, which is the itch-scratch cycle everybody with eczema knows and nobody can simply decide to stop.

It runs with asthma and hay fever. Doctors call that the atopic triad.

Signs you might notice

Dry, itchy, red or darker patches, classically in the creases of elbows and knees, and on the face in babies.

Skin that weeps, crusts or thickens where it has been scratched for a long time.

Sleep broken by itching, night after night.

Flare-ups after soap, wool, heat, stress or a change in washing powder.

Sudden worsening with painful blisters or golden crusting means infection, and that needs seeing the same day.

How it can affect day-to-day life

The under-treatment problem is specific and widespread: steroid phobia. Parents and adults are frightened of topical steroids, so they use too little for too short a time, the eczema never settles, and they end up using more steroid over a year than a proper short course would have taken.

Sleep loss is the hidden cost. A child scratching from two until four in the morning means a family running on nothing, and it shows up at school as inattention.

Eczema also affects mood and confidence more than people admit, particularly in teenagers.

Supporting someone well

Emollient is the treatment, not the moisturiser. Use it generously, several times a day, even when the skin looks fine. Most people use a fraction of what is needed: an adult with widespread eczema may get through 500g a week.

Use steroids properly when there is a flare. Enough, for long enough, then stop. The fingertip unit is the measure to ask a pharmacist about.

Apply emollient before steroid, and leave a gap.

Avoid soap entirely. Use a soap substitute, and beware that some emollients are flammable on clothing and bedding.

Keep nails short. Cotton clothing. Cool rooms at night.

Find the trigger rather than guessing at food. Food allergy causes a minority of eczema, and unnecessary exclusion diets do real harm to children's nutrition.

Where to get help

A GP or pharmacist can review the emollient and steroid strength. Ask for a referral to dermatology if it is not controlled, and ask about eczema that is infected.

The National Eczema Society have a helpline and clear guidance on steroid strengths.