Eczema and Atopic Dermatitis: A Complete Management Guide

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

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.