Eczema (Atopic Dermatitis)

Eczema is a chronic, itchy skin condition that can range from being quite minor to something that can have a negative impact on quality of life. The good news is that by having an appropriate management plan in place, symptoms and discomfort can be significantly reduced.

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What is Eczema?

Eczema occurs when the skin barrier does not work properly causing it to become dry, itchy, rough, and more prone to infections and inflammation (redness).

Eczema, also known as atopic dermatitis, commonly affects young children, but can occur at any age.

People with a family history of eczema, asthma and hay fever (allergic rhinitis) are more likely to develop eczema. It is believed to happen due to both family genetic makeup and different things in the environment.

Eczema flares occur when eczema suddenly gets worse. Flares are commonly triggered by a wide range of things that irritate the skin, but sometimes flares happen for no obvious reason. It is important to keep moisturising your skin, following your management routine and doing what you can to help prevent a flare.

There is no cure for eczema but for most people it can be managed very well, and the good news is that 70% of children grow out of it.

Everyday Eczema Management

Eczema management may be required for many months or even years, but by having the right plan in place, the condition can be manageable.

It is important to see your allergy specialist/dermatologist/eczema nurse/eczema nurse practitioner/GP regularly so that you have a treatment plan, and access to the latest management advice and treatment options available.

Bathing

It’s best to take short (5 minute) warm (not hot) baths or showers once daily, preferably in the evening using a non-soap based wash or oil – avoid soap or bubble bath.

Gently remove any eczema crusts while in the bath or shower, as it will help the steroid cream/ointment you apply after bathing work more effectively.

If shampooing your hair, use a product that is made for people with sensitive skin to avoid irritation.

When you finish your bath/shower, pat yourself dry with a soft towel and apply steroid cream first (if using) and then moisturiser, as recommended by your doctor or nurse practitioner.

Topical Steroid Creams & Ointments

Topical steroid creams and ointments are commonly used to treat eczema flares to help control inflammation (redness) and itch. Treating the eczema early and following advice from your doctor/nurse practitioner will help stop the eczema getting worse or becoming infected.

You should use your prescribed topical steroid cream/ointment as soon as there is any sign of an eczema flare (such as redness, itch, rough skin) and continue until the eczema has cleared (that is when your skin feels smooth and is no longer itchy).

Moisturiser still needs to be used at least twice daily even when there is no eczema flare.

Moisturising

Moisturising the skin reduces water loss, improves dryness, decreases itch and protects the skin from things that can make eczema worse such as pollen, dust mites, sand and wind.

It is important to moisturise regularly (twice daily or more often if the skin is dry) and in adequate amounts. The best time to apply is straight after bathing while the skin is still damp, as this is when it will be best absorbed by the skin.

Apply moisturiser to the whole body and face, even if no eczema is present. Apply in a downward direction (the direction the little hairs grow on your skin) and be careful not to miss anywhere like behind the ears, ankles, feet and eyelids, or to ignore areas that don’t get eczema. The skin is one organ so you need to moisturise all your skin.

What Moisturiser to Use?

It is best to use creams and ointments as they are thicker and last longer than lotions.

Lotions are water based and thin, so they won’t keep your skin moist for as long and may also cause stinging if skin is already red and itchy.

Do not use moisturisers that contain common allergy causing foods such as cow’s milk, goat’s milk, oats and nut oils as they may lead to the development of food allergies in babies, children and sometimes even adults. Plant extracts such as lavender and tea tree oil may irritate the skin so avoid them.

Everyday Eczema Management

Potential Eczema Triggers

People with eczema should avoid what they know makes their skin worse. Below are some helpful tips on how to do this.

TRIGGER	TRY
Skin, beauty products, sunscreen, clothes washing powder	Options that don’t contain perfume, fragrance, plant extracts and common allergy causing foods
Getting too hot	Soft cotton or silk bedsheets without heavy blankets or quilts. It is also best to avoid electric blankets and heaters in the bedroom
Clothing fabrics such as wool, synthetic materials such as nylon	100% cotton clothing that is loose fitting
Chlorinated swimming pools	Rinse immediately after swimming and apply a thick layer of moisturiser
Tomato sauce or citrus fruits	Apply thick moisturiser around the mouth before enjoying
Playing/sitting on sand, carpet or grass	If you know you/your child will be on these surfaces, consider long, lightweight cotton pants or a towel or rug to sit on
Dribbling (babies)	Gently pat dry and apply a thick moisturiser around mouth and chin
Pollens	When there is a high pollen count, try to stay indoors with windows and doors closed
Scratching	Keep fingernails short and consider cotton gloves to prevent scratching while in bed

Common Triggers

There are also common, unavoidable triggers such as infections, stress and vaccinations, so it is important to moisturise and manage flares when they happen as well as avoiding other triggers where possible.

Managing Eczema Flares

Skin damage can be prevented by applying creams or ointments prescribed by your doctor as soon as redness and/or itching occurs and ongoing moisturising of your skin. In contrast, not using enough of the treatments can cause skin damage due to itching, which can lead to scarring.

There are a few other options to help control flares, such as baths with a small amount of bleach in them (bleach baths) and wet dressings.

Watered-down bleach baths

Bleach baths are an effective and safe way for babies, children and adults to stop skin with eczema from getting infected. The amount of bleach in a bleach bath is like the amount of chlorine in a swimming pool. Bleach baths are typically recommended for people who have repeated infected eczema.

Wash and dry your hands
Using a 10-litre bucket, fill bath to desired level
Add 12mls of unscented (plain, not with lemon, etc) household White King bleach per 10L of bath water
If using, also add 1/3 cup of salt per 10L of water, and 1-2 capfuls of bath oil
Wash yourself/your child in bath including face but be careful not to get the water in the eyes
Gently clean any eczema sores and remove crusts
Once clean, get out of the bath without rinsing. Gently pat dry with a soft towel.
Apply steroid cream/ointment and moisturiser as directed by your doctor or nurse practitioner

Wet dressings

Wet dressings help to keep moisture in the skin and reduce the itch.

Wash and dry your hands
Half fill a large mixing bowl with slightly warm water.
If recommended, add 1 capful of bath oil
Add 1 pair of cotton pants/leggings and 1 long-sleeved cotton t-shirt to the bowl.
As advised, apply topical steroid cream/ointment to all areas with eczema, and moisturiser
Put wet clothing (the wet dressing) on
Then put dry clothing over the wet clothing
When you remove the wet dressings, apply moisturiser to the whole body and face again
Leave wet dressings on for the time specified by your doctor/nurse practitioner. This can be for 20 minutes, a few hours, or sometimes overnight. Follow the advice of your doctor/nurse practitioner.

Frequently Asked Questions about Eczema

Do people with eczema usually have other allergic conditions?

Many people with eczema have other allergic conditions. Studies have shown that up to 30% of babies with eczema who have a family history of allergy will develop food allergy, and up to 40% develop asthma or hay fever (allergic rhinitis).

Are steroid creams/ointments that are used to treat eczema bad for you?

Topical steroid creams and ointments are a safe and effective treatment when they are used as directed by your doctor or nurse practitioner. Skin damage can be prevented by applying creams/ointments, including steroids, prescribed by your doctor as soon as itchy or rough skin is noticed. Not using enough of the eczema treatments can cause skin damage due to itching, which can lead to sores, scabs and scarring. Additionally, people who have eczema that is not well managed are more likely to have skin infections.

How can eczema itch be controlled?

The following actions may reduce itch, to help control the scratch and itch cycle of eczema:

Keep skin well moisturised every day.
Use cold compresses (such as a wet face cloth) and wet dressings/wraps, as directed.
If advised to use antihistamines, use non-sedating antihistamines. Sedating antihistamines are generally not recommended and should not be used in young children without specialist supervision.

Will a restrictive diet help eczema e.g. removing dairy or wheat from the diet?

Eczema is not caused by food, but food may trigger eczema flares. It is important to seek professional medical advice for eczema management and not restrict foods from the diet unless under medical direction. Removing foods can affect growth and nutrition.

What skincare products are best for eczema?

It is best to use skincare products that do not contain any food products, fragrances or plant extracts. Just because a product claims to be ‘natural’ does not mean it is good for eczema. Talk to your doctor or nurse practitioner for the best options to suit your needs.

Is eczema the same as dermatitis?

Eczema is a type of dermatitis (atopic dermatitis), which simply means red and inflamed skin.

What can I do if I follow my management plan and my eczema will not clear?

It is important to go back to your specialist (dermatologist/clinical immunology allergy specialist/ GP/paediatrician) to discuss treatment options. There are new and very effective treatments available in Australia for severe eczema.

Download this information here: Understanding Eczema starter kit722.43 KB and Eczema flares391.45 KB

Eczema Resources and Links

Learn how to manage eczema in children and babies at the Nip Allergies in the Bub website.

For information on how to manage eczema for teens and young adults go to the Allergy 250K website.

ASCIA Eczema (Atopic Dermatitis) Frequently Asked Questions (FAQ)
Read here the answers to some frequently asked questions about Eczema from the Australasian Society of Clinical Immunology and Allergy

ASCIA Action Plan for Eczema and ASCIA Stepwise Management Plan for Eczema
Ask your doctor to fill in an ASCIA Action Plan and Stepwise Management Plan for Eczema so that you have a written management plan

Managing Atopic Dermatitis (Eczema) Brochure
Download here: Managing Atopic Dermatitis (Eczema)1.19 MB

Webinars
Nutrition, Food Allergy & Eczema
Adults with Eczema (Atopic Dermatitis)
Understanding and managing childhood eczema

A practical guide to eczema care from the Department of Dermatology at Perth Children’s Hospital is a handy resource for health care professionals and parents/carers of children with eczema.
Download here: A practical guide to eczema care4.84 MB

Content created August 2023