Atopic dermatitis, the commonest form of eczema, is a long-term inflammatory skin condition that causes dry, intensely itchy skin which flares and settles. It usually begins in infancy or early childhood, and many children improve as they grow, but it can persist into or start in adulthood.
Two things go wrong together: the skin barrier leaks water and lets irritants in, and the immune system in the skin overreacts. It is not contagious and not simply caused by diet. There is no cure, but daily skin care and a widening range of treatments keep most people comfortable and sleeping well.
Symptoms
- Itch, often worse at night
- Dry, rough, scaly skin
- Red patches on lighter skin, or darker brown, purple or grey patches on darker skin
- Rash on the cheeks and outer limbs in babies, and in the creases of elbows, knees, neck and wrists later
- Weeping, crusting or small blisters during flares
- Thickened, lined skin from long-term scratching
- Disturbed sleep and tiredness
- Hand or eyelid eczema in adults
Causes and risk factors
A family tendency to eczema, asthma and hay fever is typical. Variants in the filaggrin gene weaken the skin barrier in a proportion of people. Flares are provoked by soap and detergents, dry cold air, heat and sweat, wool and rough fabrics, stress, infections, house dust mite, animal dander and pollen. Skin carrying staphylococcus bacteria flares more. Food allergy coexists in some young children with severe eczema, but it is an accompanying condition more often than the cause.
How it is diagnosed
- Clinical examination: Diagnosis is based on the appearance, distribution, itch and personal or family history. No test is required.
- Skin swabs: When crusting or weeping suggests bacterial infection, or clustered painful blisters suggest herpes virus.
- Allergy tests: Only when the history suggests an immediate food reaction or a specific trigger.
- Patch testing: For eczema of hands, face or eyelids that does not respond, to look for a contact allergy.
- Skin biopsy: Occasionally in adults to exclude psoriasis, scabies or cutaneous lymphoma.
Treatment options
- Emollients: Generous moisturiser at least twice daily and a soap substitute for washing, continued when the skin is clear.
- Topical corticosteroids: The right strength for the site and age, once daily until the flare settles, then weekend maintenance on trouble spots. Fear of steroids causes more undertreatment than harm.
- Topical calcineurin inhibitors and newer creams: Tacrolimus or pimecrolimus for the face, eyelids and skin folds. Crisaborole and topical JAK inhibitors are available in some countries.
- Treating infection: Antibiotics for infected flares and urgent antivirals for eczema herpeticum.
- Phototherapy: Narrowband UVB two or three times a week for 8 to 12 weeks for widespread eczema.
- Biologic injections: Dupilumab, tralokinumab or lebrikizumab for moderate to severe disease, some licensed from infancy.
- Oral JAK inhibitors and immunosuppressants: Upadacitinib, abrocitinib, baricitinib, or ciclosporin and methotrexate, with blood test monitoring.
- Habit and sleep measures: Short nails, cotton clothing, cool bedrooms, wet wraps in children and habit-reversal for scratching.
When it is urgent
Seek same-day medical care locally for rapidly worsening painful eczema with clusters of punched-out sores or blisters and fever, which suggests eczema herpeticum, especially in a child or near the eyes. Also for widespread weeping infection, or redness covering most of the body with shivering.
Travelling to Türkiye for treatment
Eczema is managed over years and needs a doctor you can return to, so a trip cannot replace local care. It can offer a dermatology second opinion, patch testing over a week, or a clear written plan when treatment at home has stalled. Biologics need repeated prescriptions and monitoring, and phototherapy takes 2 to 3 months, so neither suits a short visit. Seawater and moderate sun help some people and sweat and heat worsen others.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Will my child grow out of it?
Many do. Most children improve markedly by school age or adolescence, though the skin often remains dry and sensitive, and some have eczema that continues.
Should we cut out milk or eggs?
Not without evidence of allergy and dietetic advice. Unsupervised exclusion diets in children can impair growth and rarely clear eczema.
Are steroid creams safe?
Used at the correct strength and duration they are safe and effective. Skin thinning comes from prolonged use of potent products on delicate areas.
Is dupilumab a cure?
No. It controls the disease well for many people while it is taken. Eye irritation is its most frequent side effect.