Eczema and Dermatitis Explained

What eczema is

Eczema happens when the skin's protective barrier does not work as well as it should. Healthy skin acts like a wall that keeps moisture in and irritants out. In eczema, this barrier is weaker and leakier, so the skin loses water easily, becomes dry, and lets in irritants and allergens that trigger inflammation. The result is patches that are itchy, dry and inflamed, and may look red on paler skin or darker, greyish or purplish on brown and black skin. Scratching damages the barrier further and worsens the itch, creating a frustrating cycle. Understanding this leaky barrier explains why the foundation of treatment is keeping the skin well moisturised.

Common triggers

Many things can set off or worsen eczema, and they vary between people. Common triggers include soaps, detergents and bubble baths, which strip the skin of natural oils; rough fabrics such as wool; heat and sweating; cold, dry weather; stress; and, for some, certain foods, pet fur, house dust mites or pollen. Skin infections can also trigger flares. Learning your own triggers helps you avoid the worst of them. Simple changes, such as swapping harsh soaps for gentle, fragrance-free products and washing clothes in non-biological detergent, can reduce flare-ups. You will not always find a clear cause, and that is normal; consistent daily skin care matters more than chasing every possible trigger.

Emollients: the foundation of care

Emollients are moisturisers, and they are the cornerstone of eczema management. Used generously and often, every day, even when the skin looks clear, they trap water in the skin, repair the weakened barrier and reduce itching. They come as creams, ointments, lotions and soap substitutes; the best one is simply the one you will use regularly and that suits your skin. Smooth them on gently in the direction of hair growth rather than rubbing. Using emollients as a soap replacement, instead of ordinary soap, protects the skin further. Because they are needed in large amounts, do not be sparing. Consistent, everyday moisturising is what keeps most eczema under control.

Treating flare-ups

Even with good daily care, eczema can flare, with skin becoming more inflamed and intensely itchy. For flares, doctors often prescribe topical steroids, creams or ointments that calm inflammation, used for short periods on the affected areas. Used correctly, as directed by your GP or pharmacist, they are safe and effective; the common worry that they always thin the skin is largely unfounded when they are used appropriately. Other treatments exist for more troublesome eczema, and your GP may refer you to a dermatologist if things are hard to control. Keep using emollients during a flare too. If the skin becomes weepy, crusted, hot or painful, see your GP, as it may be infected.

Living well and breaking the itch cycle

Eczema can affect sleep, confidence and daily life, so managing the itch matters beyond the skin itself. Keeping nails short, wearing soft cotton clothing, keeping bedrooms cool at night and using emollients before bed can all help reduce scratching. For children, distraction and gentle reminders work better than telling them off for scratching. Stress can worsen eczema, so looking after general wellbeing helps too. Most children find their eczema improves as they grow older, though the underlying dry-skin tendency often remains. With a steady routine and support from your GP, practice nurse or pharmacist, the great majority of people find their eczema becomes something they manage rather than something that rules their life.