What is Eczema?

Eczema and dermatitis are terms for a group of skin conditions that cause the skin to become inflamed or irritated. There a lot of kinds of eczema types:

  • Atopic dermatitis
  • Contact dermatitis
  • Seborrheic dermatitis
  • Dyshidrotic eczema
  • Neurodermatitis
  • Nummular dermatitis
  • Stasis dermatitis

Contact Dermatitis

Dermatitis describes a type of inflammation of the skin. Dermatitis and eczema mean the same thing. Contact dermatitis describes inflammation that is caused by direct skin contact with something in your environment. It is sometimes called contact eczema.

There are two main types of contact dermatitis:

  • Irritant contact dermatitis develops when the skin is in contact with irritating substances like detergents and solvents. These strip the skin surface of it’s natural oils. Dermatitis develops when there is regular or prolonged contact with these irritating substances. The most important factors in causing this type of contact dermatitis are the amount and the concentration of the irritating substance touching the skin. It is very common in people who have their hands in water a lot such as nurses, hairdressers, bartenders, cooks and cleaners. People in these occupations often develop hand dermatitis. Anyone can develop an irritant contact hand dermatitis from handling irritating substances or with frequent hand washing.


  • Allergic contact dermatitis occurs when allergy develops to a specific chemical or substance that has been in contact with the skin. Examples of these substances include metals such as nickel, rubber, chemicals in hair dye and perfumes or preservatives in creams and cosmetics. It is not known why some people develop allergy to these substances while others do not.Less commonly substances in fruits and vegetables can cause an immediate allergic reaction when touched. This leads to itchy skin swellings known as contact urticaria(hives). This can lead to a flare of pre-existing dermatitis (eczema). Contact dermatitis is not infectious and cannot be caught from or spread to other people.

Itching of the skin is the commonest symptom and can be intense. Sometimes the skin becomes sore and red with development of small blisters or painful cracks (fissures).

  • Irritant contact dermatitises diagnosed by the history of exposure to irritating substances and from the appearance of the rash.
  • Allergic contact dermatitises diagnosed by a test available in specialist dermatology departments known as skin patch testing. This involves placing patches containing known allergens on the back. The patches are taken off after 2 days, and the skin that has been tested is examined for the development of dermatitis.

Avoidance of skin contact with irritants or allergens will prevent development of contact dermatitis. Sometimes this may entail the need for a change in occupation e.g. if a hairdresser is allergic to hair dyes.

The main way of managing contact dermatitis is to identify the cause and remove the source of the irritant chemical or allergen from contact with the skin. Complete avoidance is not always easy. Therefore, measures to protect the skin, such as wearing gloves, improving the skin barrier with regular emollient creams and avoiding contact with soaps and detergents are important. Exposure to irritants or allergens in certain occupations may be the cause and may lead to the need for a change of working practice or job. It may take several months for contact dermatitis to settle. Steroid creams and moisturizers are used to reduce the inflammation of the skin. Topical steroid creams (Topical Corticosteroids) come in different strengths. It is important that you use the right strength for the right length of time.

If you think you might have contact dermatitis, you should think about measures to protect your skin, such as wearing gloves and avoiding skin contact with soaps and detergents. Also:

  • Improve your skin barrier by applying non-perfumed emollient creams (moisturizers) several times a day.
  • You should avoid the chemicals or substances which are causing your irritant or allergic reaction.
  • Take time to look after your skin both at home and at work and follow your doctor’s advice on using the various creams and treatments.

Atopic Dermatitis

Atopic eczema is a very common skin condition due to skin inflammation. It may start at any age but the onset is often in childhood. It may also start later in life in people who did not have disease as a child.

Many factors in a person’s environment can make AE worse; these include heat, dust, woollen clothing, pets and irritants such as soaps, detergents and other chemicals.

  • Being unwell, for example having a common cold can cause a flare-up
  • Infections with bacteria or viruses can worsen AE
  • Bacterial infection(usually with a bacteria called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need specific treatment
  • Dryness of the skin
  • Teething in babies
  • In some, food allergens may rarely cause a flare up
  • Stress

Seborrhoeic dermatitis is managed with treatment that reduces the level of skin yeast – these include creams and shampoo, which can be used safely on a long-term basis. Mild steroid creams can be used for short periods to settle any irritation, and the newer non-steroid anti-inflammatory eczema creams (calcineurin inhibitors) are also effective though not licensed for this complaint.

Treatment can improve and sometimes clear seborrhoeic dermatitis, but there is no permanent cure and the complaint tends to come back when treatment is stopped.

Treatment is usually needed on a long-term basis, though sometimes it is possible to take a break. The choice depends on which areas of the body are affected and whether there is a lot of irritation:

  • In the scalp: medicated, anti-dandruff shampoos containing agents such as zinc pyrithione, selenium sulphide or ketoconazole can be used regularly.
  • Elsewhere: anti-yeast creams or ointments are usually effective and can be used safely as long-term treatment. Examples include clotrimazole, miconazole and nystatin. They are sometimes combined with a mild steroid for a few weeks to settle inflammation.
  • Washing your body with an antifungal shampoo containing ketoconazole may also help. Leave the shampoo on for ‘5 minutes or so before rinsing it off.
  • In the ear canals: medicated ear-drops may help. Do not clean the ears with cotton buds as this causes more irritation.
  • On the eyelids: carefully cleaning between the lashes with an eyelid cleanser or baby (non-sting) shampoo helps to lift skin flakes and reduce inflammation.Occasionally, if the rash is widespread or resistant to the treatments listed above, your doctor may suggest a short course of an oral anti-yeast medication.

Seborrheic Dermatitis

Dermatitis’ is a red, itchy, flaky (inflamed) skin complaint; ‘seborrhoeic’ means that the rash affects greasy (sebaceous) skin zones such as the face, scalp and centre of the chest. Seborrhoeic dermatitis is very common and many people don’t even know they have it. Overall it has been reported to affect about 4% of the population, and dandruff (which is mild seborrhoeic dermatitis of the scalp) can affect almost half of all adults. It can start at any time after puberty and is slightly commoner in men. Babies can also get a short lived type of seborrhoeic dermatitis in the scalp (cradle cap) and nappy area, which usually clears after a few months.

It is thought that seborrhoeic dermatitis is triggered by an overgrowth of a harmless yeast called Malassezia that lives on the skin, or an over-reaction by the skin’s immune system to this yeast. These are not the same as the yeasts that cause thrush or those that are present in foods.Tiredness and stress can sometimes trigger a flare of seborrhoeic dermatitis. It is more common in cold than in warm weather, and it is not related to diet.

No, it cannot be cured, but there are many ways of controlling it. As they get older, most children with atopic eczema will see their AE improve with 60% clear by their teens. However, many of these people continue to have dry skin and so need to continue to avoid irritants such as soaps, detergents and bubble baths. AE may be troublesome for people in certain jobs that involve contact with irritant materials, such as catering, hairdressing, cleaning or healthcare work.In later life, AE can present as hand dermatitis and as result exposure to irritants and allergens must be avoided both in the home and at work.

Moisturizers (emollients): Topical steroid creams or ointments

Antibiotics and antiseptics: Topical calcineurin inhibitors

Antihistamines: Avoidance of Allergens

  • Moisturize your skin as often as possible, ideally at least 2-3 times each day. The most greasy, non-perfumed moisturizer tolerated is best. This is the most important part of your skin care.
  • Wash with a moisturizer instead of soap (known as a soap substitute), and avoid soap, bubble baths, shower gels and detergents.
  • Wear non-powdered non-rubber gloves (e.g vinyl gloves) to protect your hands and avoid contact with irritants, such as when doing housework.
  • Rinse well after swimming and apply plenty of your moisturizer after drying. •Wear comfortable clothes made of materials such as cotton and avoid wearing wool next to your skin.
  • Try to resist the temptation to scratch. It may relieve your itch briefly, but it will make your skin itchier in the long term. Smooth a moisturizer onto itchy skin.
  • Avoid close contact with anyone who has an active cold sore as patients with eczema are at risk of getting a widespread cold sore infection.
  • Do not keep pets to which there is an obvious allergy.
  • Keep cool. Overheating can make eczema itch more.
  • Treat eczema early – the more severe it becomes, the more difficult it is to control.
  • Wash clothes with a non-biological washing powder and use a double rinse cycle to remove detergent residues from the clothing.