Causes and Triggers
| Trigger | Mechanism | Avoidance |
|---|---|---|
| Irritants | Soap, detergent, shampoo, chlorine damage skin barrier | Use soap substitutes; pH-neutral cleansers |
| Allergens | Dust mite, pet dander, pollen, food (children) | Allergen avoidance; allergy testing |
| Sweat and heat | Stimulates itch receptors | Cool showers; loose cotton clothing |
| Stress | Neurogenic inflammation; impairs barrier function | Stress management; CBT |
| Staph aureus | Skin colonisation worsens inflammation | Bleach baths; topical antimicrobials if infected |
| Food allergens (children) | Egg, milk, peanut, wheat in some cases | Supervised elimination and reintroduction |
Treatment Pyramid
- Daily emollients — the foundation of care (apply to whole body; use soap substitutes)
- Topical corticosteroids — used during flares; strength matched to severity and site
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus) — for face and flexures; steroid-sparing
- Wet wraps — for severe flares in children; dramatically reduce itch
- Phototherapy (UVB narrowband) — for widespread poorly-controlled eczema
- Biologics: dupilumab (Dupixent) — highly effective for moderate-severe; blocks IL-4/IL-13
- JAK inhibitors: abrocitinib, baricitinib — oral; for moderate-severe; monitor for infections
Emollient Application TechniqueApply emollient in downward strokes (direction of hair growth) to avoid folliculitis. Apply within 3 minutes of bathing while skin is still moist — 'soak and smear.' Use 250–500g per week for widespread eczema.
Why does eczema itch so much?
The itch in eczema is driven by disrupted skin barrier (allowing allergen penetration), immune activation (Th2 skew releases IL-4, IL-13, IL-31), and sensitised itch nerve fibres. IL-31 is the primary itch cytokine — dupilumab reduces it dramatically.
Do topical steroids cause skin thinning?
Only with excessive or inappropriate use. Potent steroids on the face, neck, and flexures should be limited to 2–4 weeks. Following prescribed regimens and using the lowest effective strength prevents thinning.
Can eczema be cured?
No, but it often improves significantly with age — especially childhood eczema. Modern biologics (dupilumab) achieve 75–90% skin clearance in adults with moderate-severe disease previously resistant to treatment.
Should I get allergy testing for eczema?
Food allergy testing is most useful in young children with early-onset severe eczema and suspected food triggers. In adults, aeroallergen testing (house dust mite, pet dander) is more relevant. Testing is guided by clinical history — avoid blanket testing.
Medical Disclaimer: This page is for general education only and does not replace professional medical advice. Always consult a qualified healthcare provider.