Atopic eczema (atopic dermatitis) is a chronic inflammatory skin condition characterised by dry, itchy, red skin. It is extremely common, affecting up to 20% of children and 3-10% of adults worldwide. In the UAE, the dry climate and air conditioning can worsen symptoms.
Understanding Eczema
Eczema occurs due to a combination of genetic and environmental factors. The skin barrier does not function properly, leading to:
- Increased water loss (dry skin)
- Increased sensitivity to irritants and allergens
- Overly reactive immune response causing inflammation
Eczema is not contagious.
Common Triggers
Identifying and avoiding personal triggers is a key part of management:
- Dry air: Air conditioning, low humidity, central heating
- Irritants: Soap, detergent, bubble bath, perfumed products, wool and synthetic fabrics
- Allergens: Dust mites, pet dander, pollen, certain foods (in some children)
- Heat and sweating
- Stress
- Infections: Skin infections can trigger or worsen flares
- Hormonal changes: Eczema may worsen before periods or during pregnancy
Treatment: The Stepwise Approach (NICE CG57)
Step 1: Emollients (Moisturisers) - The Foundation
- Use emollients every day, even when the skin is clear
- Apply generously and frequently (at least 2-4 times daily)
- Use emollients as a soap substitute for washing (not regular soap)
- Apply emollients to slightly damp skin after bathing
- Wait 10-15 minutes before applying other treatments on top
NICE states that emollients are the most important part of eczema management at all stages of the condition.
Step 2: Topical Corticosteroids - For Flares
- Used when emollients alone are not enough to control inflammation
- Available in different strengths:
- Mild: Hydrocortisone 1% (safe for face and body in adults; safe for children)
- Moderate: Clobetasone butyrate (Eumovate)
- Potent: Betamethasone valerate, mometasone furoate
- Very potent: Clobetasol propionate (Dermovate) - used short-term for severe flares only
- Apply a thin layer to affected areas only
- Use the lowest effective strength for the shortest time needed to control the flare
- Common fears about topical steroids are often exaggerated - when used correctly as prescribed, they are safe and effective
Step 3: Additional Treatments
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus): For sensitive areas like the face and neck, or when steroids are not suitable
- Bandaging and wet wraps: For severe flares, particularly in children
- Phototherapy: Controlled UV light treatment for moderate to severe eczema
- Oral immunosuppressants or biologics: For severe eczema not responding to other treatments (specialist-led)
Eczema in Children
- Most childhood eczema improves as the child grows, with many children "outgrowing" it
- Common areas: cheeks, elbows (fronts), knees (fronts), wrists, ankles
- Cotton clothing is best - avoid wool and synthetic fabrics next to skin
- Keep nails short to reduce damage from scratching
- Emollient bath additives can help
The Itch-Scratch Cycle
Itching leads to scratching, which damages the skin, causing more inflammation and more itching. Breaking this cycle is essential:
- Regular emollients reduce itch by maintaining the skin barrier
- Cool compresses can provide temporary itch relief
- Distraction techniques for children
- Antihistamines may help nighttime itching (though evidence is limited)
Day-to-Day Management Tips
- Bathing: Lukewarm water (not hot), limit baths to 10-15 minutes, use emollient as a soap substitute
- Clothing: Soft, breathable cotton fabrics. Wash new clothes before wearing
- Laundry: Use non-biological detergent, avoid fabric softener
- Home environment: Vacuum regularly, use dust-mite-proof bedding covers, maintain moderate humidity
- Swimming: Apply thick emollient before swimming. Shower and reapply emollient immediately after
When to See a Doctor
- Eczema not controlled by emollients and mild topical steroids
- Signs of skin infection: increased redness, warmth, crusting, oozing, or pain
- Eczema is significantly affecting sleep, daily activities, or emotional wellbeing
- Widespread or severe flares
This article is for informational purposes only and does not replace professional medical advice. Always consult your doctor for personalised guidance.