Eczema — more precisely, atopic dermatitis — is a chronic, relapsing inflammatory skin condition characterised by intensely itchy, dry, and inflamed skin. It affects approximately 10–20% of children and 1–3% of adults globally, making it one of the most prevalent skin diseases worldwide. Although eczema cannot currently be cured, advances in understanding its pathophysiology — including the central role of the skin barrier defect and type-2 immune skewing — have led to highly effective targeted treatments that allow most patients to achieve and maintain clear or nearly clear skin.
Causes and Triggers
Atopic dermatitis results from an interaction between genetic susceptibility (particularly mutations in the filaggrin gene, which impairs the skin barrier), immune dysregulation (excess type-2 inflammatory signalling mediated by IL-4 and IL-13), and environmental exposures. The broken skin barrier allows allergens, irritants, and microorganisms (particularly Staphylococcus aureus) to penetrate, perpetuating the inflammatory cycle. Common triggers include: dry air and cold weather; fragrances and harsh soaps or detergents; wool and synthetic fabrics; sweat; stress; certain foods (most relevant in infants and young children); environmental allergens (house dust mites, pet dander, pollen); and infections. Trigger identification through a diary and guided allergy testing helps individualise management.
Treatment Approach
Baseline Skincare
Daily moisturisation with thick emollients (creams or ointments rather than lotions) is the foundation of eczema management regardless of disease severity. Applying emollient within three minutes of bathing ("soak and seal") maximises retention of skin hydration. Lukewarm (not hot) baths, gentle fragrance-free cleansers, and avoidance of identified triggers reduce flare frequency.
Anti-Inflammatory Therapies
Topical corticosteroids remain the first-line treatment for acute flares — applied in the lowest effective potency for the shortest effective duration. Topical calcineurin inhibitors (tacrolimus, pimecrolimus) are corticosteroid-free alternatives suitable for sensitive areas (face, neck, skin folds). For moderate-to-severe disease inadequately controlled by topicals, dupilumab — a biologic antibody blocking IL-4 and IL-13 signalling — has demonstrated transformative efficacy with an excellent long-term safety profile. JAK inhibitors (abrocitinib, upadacitinib for systemic use; ruxolitinib for topical use) offer additional options, with particularly rapid itch relief.
Frequently Asked Questions
Will my child outgrow eczema?
Many children improve significantly or achieve remission by adolescence — approximately 60% of childhood eczema resolves by adulthood. However, a substantial proportion persists into adult life, and adults may develop new-onset eczema for the first time. The "atopic march" — sequential development of eczema, food allergy, allergic rhinitis, and asthma — means children with eczema warrant vigilant monitoring for these comorbidities.
Is eczema contagious?
No. Eczema is an immune-mediated inflammatory condition — not an infection. The inflamed skin can, however, become secondarily infected with bacteria or viruses. Eczema herpeticum — disseminated infection with herpes simplex virus in eczema-affected skin — is a medical emergency requiring urgent antiviral treatment.
Sources
- National Eczema Association. Atopic Dermatitis. 2023.
- Weidinger S, et al. Atopic dermatitis. Nature Reviews. 2018.
- Mayo Clinic. Atopic dermatitis (eczema). 2023.