Eczema (atopic dermatitis)

Overview

Atopic eczema (also called atopic dermatitis) is the most common long-term inflammatory skin disease. The skin becomes dry, itchy and sore, and scratching makes it worse. It usually begins in early childhood: most cases start before the age of two, many in the first year of life. It is common, affecting roughly one in ten to three in ten children and a smaller share of adults in studies from richer countries.

The word 'atopic' means a tendency to allergic conditions. People with eczema, and their families, often also have asthma, hay fever (allergic rhinitis) or food allergy. Eczema is not catching. It happens because the outer layer of skin does not work well as a barrier, so it loses water and lets irritants in, and the immune system in the skin over-reacts.

Eczema tends to flare up and settle down. Many children improve as they grow, and more than half are clear by about age 12, but it can carry on or come back in the teenage years or adult life. There is no cure, but good daily skin care with moisturisers (emollients), and treating flares early with the right strength of steroid cream, keep most people comfortable. Eczema can affect sleep, school, work and mood, so these are worth discussing with your doctor too.

Symptoms

• Itchy skin, which is the main symptom and is often worse at night
• Dry, rough or scaly skin, even when the eczema is not flaring
• Red or inflamed patches; on brown or dark skin the patches may look darker brown, purple or grey and redness is harder to see
• In babies, patches on the cheeks, face, scalp and the outer sides of the arms and legs
• In older children, patches in the skin creases, such as the inside of the elbows and behind the knees
• In adults, long-standing patches, often on the hands, with thickened skin and deep skin lines (lichenification)
• Scratch marks, cracking, bleeding or oozing during bad flares
• Patches of lighter or darker skin after a flare, which usually fade slowly

Causes and risk factors

Causes

• A weak skin barrier: the outer layer of skin holds less water and lets irritants and allergens through more easily
• Changes in a skin protein called filaggrin, which some people inherit and which weakens the skin barrier
• An over-active immune response in the skin, which causes inflammation and itch
• An itch-scratch cycle: scratching damages the skin and makes the inflammation and itch worse
• Flares set off by triggers such as soaps and detergents, skin infection, heat and sweating, house-dust mites, pets, pollen, stress or, in some children, certain foods

What makes it more likely

• A parent, brother or sister with eczema, asthma or hay fever; the chance is higher if both parents are affected
• Having asthma, hay fever or food allergy yourself
• Inherited changes in the filaggrin gene
• Early childhood, as most eczema starts before age two
• Regular contact with irritants such as soap, detergents, bubble bath, perfumes and rough or synthetic fabrics
• Heat, sweating and changes in temperature
• Smoking, which has been linked with eczema that starts in adult life

Complications

Broken eczema skin can become infected with bacteria, usually staphylococcus or streptococcus. Infected eczema may weep, crust, form pus spots or get worse quickly. A more serious complication is eczema herpeticum, an infection with the cold sore (herpes simplex) virus. It causes painful, clustered blisters and small punched-out sores and needs treatment the same day. Constant itching can disturb sleep for the child and the whole family, and eczema can affect school, work, confidence and mood. Eczema can leave patches of lighter or darker skin, which usually fade with time. Overuse of strong steroid creams, especially on thin skin, can thin the skin, which is why the strength and length of use should be guided by a doctor.

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Diagnosis

Eczema is diagnosed from the history and by looking at the skin. No blood test is needed in most cases. NICE describes eczema in children as an itchy skin condition plus at least three of these: visible eczema in the skin creases (or on the cheeks and outer limbs in young babies), a past history of this, dry skin in the last year, asthma or hay fever (or a close relative with allergy in children under four), and onset before age two. The doctor also asks about triggers, sleep, mood and how eczema affects daily life.

Most people with mild eczema do not need allergy tests. Food allergy is considered if a child reacted straight away to a food, or has moderate to severe eczema that does not settle with good treatment, especially with tummy problems or poor growth. Specialists may then use skin prick or blood (IgE) tests, but a positive result does not always mean that food is a trigger. Allergy tests sold in shops or online are not useful. Skin swabs are not routine, and a skin biopsy is rarely needed.

Treatment

1. Use an unperfumed emollient (moisturiser) every day over the whole body, even when the skin is clear. Use an emollient wash instead of soap. Smooth it gently onto the skin rather than rubbing it in.
2. Treat flares early with a topical corticosteroid (steroid cream or ointment) on the active patches only. The strength is matched to how bad the eczema is: mild for mild eczema, moderate for moderate, and potent for severe. Keep going for about two days after the flare settles.
3. Use only mild steroid creams on the face and neck unless a doctor advises a short course of something stronger. Very strong steroids, and strong steroids in babies under one year, are only used on specialist advice.
4. If flares keep coming back, your doctor may suggest using the steroid on problem areas on two days in a row each week to prevent flares, with regular review.
5. If steroid creams are not working or cannot be used safely, for example on the face, a skin specialist may offer a topical calcineurin inhibitor cream or ointment instead.
6. Infected eczema is treated as well as the eczema itself. Antibiotics are usually only needed if the infection is spreading, severe, or you are unwell. Suspected eczema herpeticum needs antiviral medicine straight away.
7. Severe eczema that does not respond to creams may be treated by a skin specialist with light therapy (phototherapy), immune-suppressing tablets or injections. Your doctor decides the medicine and the dose.

Medicines in Pakistan

Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Emollients (moisturisers), including emollient wash products, Tacrolimus ointment (the tablets and capsules are a different use), Pimecrolimus cream, Fusidic acid cream (for small areas of infection), Flucloxacillin (oral antibiotic for infected eczema), Mycophenolate mofetil, Dupilumab, tralokinumab, lebrikizumab and nemolizumab (biologic injections, specialist use), Crisaborole ointment, Phototherapy (light treatment)

Self-care and prevention

Self-care

• Moisturise often, at least morning and evening, and keep going when the skin looks clear
• Wash with an emollient instead of soap, bubble bath or shower gel; avoid aqueous cream, which can irritate the skin
• Take emollient out of a tub with a clean spoon or use a pump, and do not share it
• Keep nails short, use cotton mittens on babies, and gently rub an itchy patch with a finger instead of scratching
• Keep cool and notice your own triggers, such as heat, certain fabrics, detergents or pets
• Do not cut foods out of your or your child's diet, including while breastfeeding, unless a doctor advises it
• Do not smoke or go near flames: emollient soaked into clothes, bedding or dressings can catch fire easily
• Tell your doctor about any herbal or home remedy; some unlabelled herbal creams have been found to contain steroids

Prevention

• Use emollients every day to protect the skin barrier and reduce flares
• Avoid soaps, detergents, perfumed products and other irritants that set off your eczema
• Start treatment as soon as a flare begins rather than waiting
• Use fresh tubs of creams after a skin infection, because opened tubs can carry germs
• Ask your doctor about weekend (two days a week) steroid use if flares come back often

Common questions

Is eczema contagious?

No. Eczema cannot be caught from or passed to another person. It is caused by a weak skin barrier and an over-active immune response in the skin. Infected eczema can spread germs, so see a doctor if the skin weeps, crusts or has pus spots.

Are steroid creams safe for children?

Yes, when used correctly the benefits of steroid creams outweigh the harms. The strength should match how bad the eczema is and where it is, with mild strengths on the face. Apply them only to active eczema and follow your doctor's advice on how long to use them.

Will my child grow out of eczema?

Many children improve as they get older, and more than half are clear by about age 12. Some people still have eczema as teenagers or adults, or it comes back later. Good daily skin care helps at any age.

Is eczema caused by food allergy?

Most eczema is not caused by food. Food allergy is more likely in babies and young children with moderate to severe eczema that does not settle, especially if they react straight after eating a food or have tummy problems. Do not cut out foods without a doctor's advice, and avoid shop or online allergy tests.

Why does eczema leave dark or light marks on my skin?

Inflammation from eczema can make the skin temporarily lighter or darker, which shows more on brown skin. These colour changes usually fade slowly once the eczema is controlled.

Sources

1. NICE. Atopic eczema in under 12s: diagnosis and management (CG57) (2021).
2. NICE. Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing (NG190) (2021).
3. StatPearls (NCBI Bookshelf). Atopic Dermatitis - StatPearls - NCBI Bookshelf (2026).
4. NHS. Atopic eczema - NHS (n.d.).
5. Journal of Pakistan Association of Dermatologists (via WHO EMRO IMEMR). Pattern of skin diseases in a tertiary care private hospital, Karachi (2014).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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