Eczema & Dermatitis

What are eczema and dermatitis? 

Eczema is the collective name for a group of inflammatory skin conditions, including atopic dermatitis, that cause your skin to become dry, itchy and bumpy[3].  

Eczema occurs as flare-ups in response to specific triggers[4].On average, these flare-ups can last for between one and three weeks. Though this depends on the type of eczema, the trigger involved and your individual immune response[5].  

There are seven different kinds of eczema:  

• Atopic dermatitis – the most common type of eczema, which causes dry, itchy skin, rashes and inflammation 

• Contact dermatitis – termed ‘contact’ dermatitis because it is triggered by contact with an allergen, which causes inflamed, itchy skin 

• Dyshidrotic eczema – triggers including stress, irritants and excessive moisture on the hands and feet, cause small, painful, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. As they heal, these blisters cause cracked, scaly skin  

• Neurodermatitis – a patch of itchy skin that only gets worse the more you scratch it, leading to a vicious cycle. This type of dermatitis is triggered by stress or localised irritation 

• Nummular eczema – round patches of itchy, inflamed or oozing skin, often triggered during the winter months or following a cut, insect bite or burn 

• Seborrheic (seb) dermatitis – affects oily areas of the body, such as the scalp, face or upper chest. Sometimes known as “cradle cap” in infants, it causes greasy and inflamed skin and yellowish scaly patches  

• Stasis dermatitis – poor circulation in your legs can lead to swollen, itchy skin that may become dry and scaly over time and even cause open sores  

Importantly, while some types of dermatitis fall under the eczema umbrella, others, such as perioral dermatitis, do not.  

On white skin, eczema tends to appear red in colour. However, eczema makes brown and black skin appear darker. This can make the condition difficult to identify in people with darker skin types as it’s not as obvious. Yet, children with darker skin are more likely to develop atopic dermatitis and six times more likely to develop severe eczema than children with white skin[6].  

Eczema and dermatitis symptoms 

The specific symptoms you have will depend on the type of eczema you have. As a result, an eczema flare-up can present with any of the following symptoms:

• Itchy skin 

• Dry skin 

• A rash 

• Swollen, inflamed skin 

• Discoloured skin 

• Rough, leathery skin 

• Scaly patches 

• Oozing or crusting skin 

• Blisters 

How are eczema and dermatitis diagnosed? 

Eczema and dermatitis can usually be diagnosed by your GP. They will examine the affected area(s) and ask you to tell them about your symptoms and your history of the condition. Based on this information, they may be able to diagnose the specific type of eczema you’re struggling with[7].  

 From here, either your GP or a pharmacist should work with you to try to determine what your triggers are. For example, you may be asked to keep a food diary and note down any flare-ups you have, to try to identify whether flare-ups tend to occur whenever you eat a specific food.   

What causes eczema and dermatitis? 

While the underlying cause of eczema is still unclear, you are more likely to have eczema if you have[8]:  

• A family history of eczema 

• A family history of asthma or hay fever  

• An overactive immune system 

• A weakened skin barrier (the protective outer layer of the skin) 

Eczema can be triggered by[9]:

• Exposure to an irritant or allergen – being exposed to a substance you’re allergic to will cause your immune system to produce inflammation which can lead to eczema  

• Stress – high levels of stress, anxiety or depression can lead to more frequent eczema flare-ups  

• Temperature changes – seasonal and temperature changes, humidity, and extreme heat or cold can all trigger flare-ups 

• Skin infections – when bacteria (e.g. via a staph infection) penetrates the skin barrier, it can trigger the immune system and cause a flare-up 

• Hormonal changes – if you get periods, you may find your eczema is exacerbated in the days before you’re due to menstruate. Many people also find their symptoms get worse during pregnancy 

Common allergens or irritants that can trigger eczema include: 

• Foods – common food allergies include eggs, dairy and nuts  

• Fabrics or clothing materials – wool, latex and synthetic fabrics 

• Metals – chromium, cobalt chloride, copper, gold and nickel 

• Pets and insects – pet fur, dust mites, cockroaches and insect bites and stings 

• Environment – pollen, mould, damp and cigarette smoke 

• Fragrances – perfumes, scented cosmetic products (e.g. soap, moisturiser) and detergents 

How can eczema and dermatitis be treated? 

While there is no cure for eczema, you can reduce your chances of experiencing a flare-up by avoiding your triggers as much as possible[10].  

There are also treatments that can help you manage the condition: 

Topical corticosteroids 

Topical corticosteroids are creams, lotions and gels that contain steroids, a group of hormones produced naturally by the body. For example, hydrocortisone cream, Eumovate and Betnovate. Topical corticosteroids can be used to reduce inflammation and speed up healing.  

However, they should not be used around the eyes or on the face, on broken or infected skin, on the anal or genital areas, or by pregnant people. Additionally, hydrocortisone and Eumovate should not be used by anyone under the age of 10 and 12, respectively, with eczema. Newborns and babies, however, may be prescribed other topical corticosteroids, as they are a first-line treatment for babies with eczema. 

Topical calcineurin inhibitors (TCI) 

TCIs are eczema creams that block calcineurin, a protein that contributes to inflammation in atopic eczema. When applied to the skin, they can soothe the symptoms of a flare-up.  

There are two types of TCI: 

• Protopic ointment (tacrolimus) – for treating moderate to severe eczema. Protopic is available in 0.1% and 0.03% strength varieties 

• Elidel cream (pimecrolimus) – for mild to moderate eczema 

TCIs may be prescribed as an alternative to topical corticosteroids. For example, for use on delicate areas, such as the face and genitals.  

Emollients 

Emollients are unperfumed, medical moisturisers that soothe, moisturise and protect the skin. They work by adding an oily layer to the surface of your skin, which traps moisture beneath it to improve your skin’s hydration. It also helps to keep irritants and allergens from entering your skin, to prevent eczema flare-ups. 

There is no best cream for dermatitis or best face lotion for eczema; however, there is only the cream, gel or lotion that works best for you. Just make sure you choose an emollient approved for use by the NHS. Some of these can be prescribed, but others can be bought over the counter.  

Severe eczema treatments 

If other treatments are not adequately treating your eczema, then you may need to speak to a dermatologist or your GP to see if they can provide you with a stronger treatment. These can include:  

• Oral tablets – these calm the immune system and fight inflammation. They include abrocitinib, azathioprine, baricitinb, ciclosporin, methotrexate, mycophenolate mofetil, tralokinumab, upadacitinib 

• Injections – dupilumab is given as an injection and works by targeting specific proteins or receptors in the body to regulate the immune response 

• Oral steroids – prednisolone is the most common oral steroid used in the UK. It works by suppressing the immune system 

• Phototherapy – phototherapy uses ultraviolet light to reduce the number of T-cell lymphocytes in the skin, which are involved in the inflammatory response 

Sources 

1. https://healthtalk.org/experiences/eczema/eczema-symptoms-what-does-eczema-look-and-feel-like/
2. https://cks.nice.org.uk/topics/eczema-atopic/background-information/prevalence/  
3. https://my.clevelandclinic.org/health/diseases/9998-eczema  
4. https://nationaleczema.org/eczema/ 
5. https://www.healthcentral.com/condition/eczema/how-long-does-eczema-last  
6. https://eczema.org/information-and-advice/living-with-eczema/skin-pigmentation/  
7. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/atopic-eczema/#diagnosing-atopic-eczema  
8. https://www.nhs.uk/conditions/atopic-eczema/  
9. https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/atopic-eczema/#causes-of-atopic-eczema  
10. https://eczema.org/information-and-advice/living-with-eczema/skin-infections-and-eczema/