What is eczema?
Eczema, or atopic dermatitis, is a common skin condition that causes dry, inflamed and itchy skin. Eczema patches can look red, flaky, weepy or cracked. It can develop at any age, but most commonly in childhood. It affects around 15-20% of children. Many improve as they get older, but some continue to have eczema into adulthood or experience relapses. About 1-2% of adults have eczema. People with eczema can have ‘flare-ups’, with individual triggers.
What actually causes eczema?
Eczema is caused by genetic factors and differences in immune system function. People with eczema tend to have a disrupted skin barrier, which allows moisture to escape and irritants/allergens to enter more easily. Eczema often runs in families and is more common if you or a relative has asthma, allergies or hay fever. Eczema flare-ups can be triggered by environmental factors: contact with irritants (soap, washing or cleaning products, to name a few), changes in climate or temperature, stress and exposure to allergens (e.g., dust mites, pet dander, pollen or food allergies).
Do I have eczema because I am intolerant to something I am eating?
Food allergies do not usually cause eczema. However, in some people, particularly infants and young children with moderate to severe eczema, food allergies or sensitivities can trigger or worsen flare-ups. Research suggests that children with eczema can be at higher risk of developing food allergies in the future, so effective treatment is very important.
Should I be referred for an allergy test?
Allergy testing is not normally needed for people with mild eczema. However, it may be considered for those with moderate-to-severe eczema that does not respond well to treatment, when there is suspicion of a contact allergy, if there are immediate and consistent reactions after eating specific foods, or in children with growth/feeding issues. Testing should be guided by a healthcare professional.
How is eczema treated?
The best way to prevent flare-ups is to identify and avoid triggers and keep the skin well moisturised to support the skin barrier. The most effective treatment is regular (at least daily) and generous application of emollients (moisturisers), along with the use of soap substitutes, even when the skin looks good. This helps both treat and prevent flare-ups.
The next step is steroid creams (topical steroids), which come in different strengths. It is important to treat flare-ups promptly, as early treatment can reduce inflammation quickly, reduce the overall amount of medication needed, and reduce the risk of complications like infections. Most eczema flares can be managed effectively with emollients and topical steroids alone, but some patients require additional treatments such as topical calcineurin inhibitors, phototherapy or systemic medications.
Are steroid creams safe?
Topical steroid creams are safe and effective when used correctly. It is important to use the appropriate strength and duration of treatment, ideally under the guidance of a doctor, to avoid under- or over-treatment. In many cases, using a stronger steroid for a short period is more effective and safer than using a weaker steroid for a prolonged time. For most people with eczema, correct use of steroid creams leads to reduced symptoms and improved quality of life.
Do steroid creams have side effects?
Like any medication, topical steroids can have side effects. These may include temporary stinging, acne or rosacea-like changes, stretch marks, thinning of the skin, or changes in skin colour. These are more likely with prolonged or inappropriate use.
What is topical steroid withdrawal (TSW)?
Topical steroid withdrawal (TSW) is not well defined and remains an area of ongoing research and debate. The term is often used by patients to describe worsening redness, flaking, burning, itching and other symptoms that develop after stopping steroid creams. There are a range of different explanations, such as severe or undertreated eczema, skin infections, rebound redness, or contact dermatitis. Although widely discussed on social media, it appears to affect only a small proportion of patients seen in dermatology practice.
If you would like to discuss eczema or any other skin concern with one of our private GPs, please get in touch. At Sloane Street Surgery in Chelsea, we offer private appointments at your convenience – book online or call us on 0207 245 9333.
About the author
MBChB, MRCGP, DRCOG, DFSRH
“General practice offers the privilege of building lasting relationships with patients and their families. I focus on providing holistic, compassionate care tailored to each individual”.
After completing my foundation years of medical training, I moved to Australia where I worked in a busy emergency department, gaining valuable experience in managing acutely unwell patients.
On returning to the UK, I undertook my GP training in North West London, completing it in 2021. During this time, I gained further experience in paediatrics, palliative care and psychiatry. I achieved my MRCGP qualification in 2021 and have since been working as an NHS GP in South Kensington.
I hold advanced diplomas in both Obstetrics & Gynaecology and Sexual & Reproductive Health, areas of particular interest to me.
