In people with eczema or dermatitis, there tends to be increased water loss from the skin as their oily skin barrier is reduced. There also is an increased inflammatory process where immune cells release chemicals causing inflammation affecting the skin. Genetic factors are thought to play a role in atopic eczema, but it is unclear why these changes occur in some people.

Dermatitis means inflammation of the skin. It includes atopic eczema (which usually starts in childhood) and contact dermatitis which tends to occur later in life (it is where the skin reacts to something it comes into contact with which can either be an irritant or an allergen). 

Contact irritant dermatitis is caused by substances that irritate the skin. These may include detergents, solvents, powders, soil, dust, water, and chemicals. 

Allergic contact dermatitis is where the immune system reacts to a specific substance. You can develop a skin allergy to something you have been in contact with numerous times before. common causes include cosmetics, preservatives, additives in leather and rubber, plants, nickel and cobalt.

Patch testing can help to find the cause of the substance involved in allergic contact dermatitis. Speak to your GP to find out how this can be arranged if necessary.

The following factors may play a role in aggravating atopic eczema:

• pollution
• dust mite and pollen allergies
• dietary factors
• infections
• climate changes
• exposure to chemicals

Avoid trigger factors and irritants

Certain factors may trigger flare-ups of eczema, making your symptoms worse. These include:

1. Cleansing products

Many skin products can irritate and dry out the skin. Avoid using soaps, shower gels, and bubble baths when you wash. Use a soap substitute instead. 

2. Irritating clothing fabrics

Certain fabrics may irritate the skin or cause it to overheat. These include wool and many synthetic (man-made) fibres. Cotton tends to be suitable as a fabric choice.

3. Harsh washing detergents for clothes

Certain chemicals can irritate the skin such as biological washing products. Try and choose gentle or natural plant-based detergents instead. It may be helpful to put your clothes through an extra rinse after washing them.

4. Scratching

As difficult as it may be, try to avoid scratching your skin and keep your nails short to avoid further damage. 

5. Extremes of temperature

Try to avoid getting too hot or too cold as this may irritate your skin.

6. House dust mite

Many people are allergic to the house dust mite. They are commonly found in bedding and on mattresses. Vacuum your mattress regularly and try to wash your bedding weekly at 60°C. Consider using dust mite covers on your pillows, duvet, and mattress to keep the levels of the allergen to a minimum. 

7. Stress

May cause people to itch more. 

8. Allergies to certain foods

Common foods that cause allergies include cow's milk, eggs, fish, soya, wheat, and nuts.

9. Pet Dander

An animals hair or saliva may trigger an allergic response. 

10. Mould and pollen

Using a regular emollient throughout the day is one of the most important steps in helping to manage your eczema better, reducing flare-ups. Use it at least twice a day as a minimum, but more frequent applications are ideal where possible. 

There are many types of moisturisers available specifically for eczema, speak to your pharmacist if you are unsure about which one to select. It can help to try a few different ones to see which one suits your skin best. Some people may be sensitive to certain ingredients in some moisturisers so it can be useful to test patch them first. If it seems to worsen your eczema then speak to your pharmacist about selecting a different one. 

There are two main types of moisturisers:

1. Mineral oil based products which are made from paraffin.
2. Plant-based products which use natural ingredients. Some people find that natural plant-based formulas work better for their skin. You can find these in health food shops and online.  

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Topical steroids are creams or ointments used to settle inflamed skin. Steroids help to improve a flare-up and relieve symptoms but do not cure eczema. They should only be used now and again when eczema worsens and should not be used continuously. Moisturisers, however, are to be used daily on a long-term basis. A seven-day course of topical steroid treatment is usually adequate to improve an exacerbation. 

There are four strengths of steroids:

• Mild: Hydrocortisone
• Moderate: Betnovate RD and Eumovate
• Potent (strong): Betnovate
• Very potent (very strong): Dermovate

Moderate and potent steroids must not be used on the face. 

Mild and moderately potent topical steroids are associated with few side effects. Potent and very potent steroids have a higher risk of side-effects with continued use and should be used with care.

Creams (which tend to be white) are usually best to treat moist or weeping areas of inflamed skin. Ointments (which are clear) are usually best to treat areas of inflamed skin which are dry or thickened.

Most types of medicines can cause potential side effects. However, not everyone will experience them. Side effects are uncommon if the topical steroids are used correctly and for short periods of time. If any of the side effects continue or become troublesome, then speak with your doctor or pharmacist. 

Courses of steroids lasting less than four weeks are usually safe and do not cause problems. If steroids are used for long periods of time, or short courses are frequently used then side effects may occur. 

Side effects affecting the area of skin where the steroid is used include:

• stinging or burning sensation 
• thinning the skin (this is uncommon and mainly occurs when using high strength steroids for long periods)
• skin changes such as stretch marks, bruising, spider veins and discoloration with long-term use
• worsening of certain conditions such as acne, perioral dermatitis, and rosacea
• skin irritation caused by sensitivity to an ingredient in the topical steroid 

Side effects affecting the rest of the body are uncommon and usually only when strong steroids are used long-term. They include:

• thinning of the bones
• high blood pressure
• Cushing's syndrome
• adrenal suprresion

Always read the patient leaflet before starting treatment.

Visual disturbance

Tell your doctor or call NHS 111 and stop the steroid immediately if you notice any blurred vision or other problems with your vision.

There is a rare risk of Central Serous Chorioretinopathy (CSCR) which is where fluid builds up underneath the retina and can lead to retinal detachment. It tends to affect one eye.

An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the medication. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. For Medical Emergencies please call 999.

If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance using 999 or go to A&E if the symptoms are severe.

• Wheeze
• Difficulty in Breathing
• Swelling of the eyelids, face or lips
• A rash particularly if affecting your entire body

Please make an appointment to see your GP to discuss further options if you experience any of the following:

• your eczema or dermatitis does not improve within 7 days of using the steroid cream
• your rash becomes infected (crusty and weeping or if red, hot area develops around the affected area)

You should see your GP regularly to review your treatment.