Most eczema fails to improve because it is under-treated, not because treatment does not work.
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Eczema — atopic dermatitis — is a chronic inflammatory skin condition causing dry, itchy, inflamed skin that flares and settles in cycles. It affects roughly one in five children and one in ten adults in the UK, making it the commonest inflammatory skin condition there is.
Two things are happening at once. The skin barrier is defective, often because of a change in the filaggrin gene that helps build it, so moisture escapes and irritants, allergens and bacteria get in. And the immune system over-responds to what gets through. The result is inflammation, itch, scratching, further barrier damage, and more inflammation — the itch-scratch cycle that makes eczema so difficult to break out of.
It sits alongside asthma and hay fever in what is called the atopic triad. Having one raises the chance of the others, which is why a child with eczema is worth asking about wheeze.
Eczema is not contagious, and it is not caused by poor hygiene or bad parenting — both of which people are still told. It cannot currently be cured, but it can be controlled well, and most children improve substantially by adolescence.
The single most important thing on this page is not a prescription. It is how much emollient to use and how to apply topical steroids properly, because undertreatment is far and away the commonest reason eczema stays out of control.
Food is a far less common trigger than parents are led to believe. It matters mainly in infants with moderate-to-severe eczema that is not responding to good topical treatment, where cow's milk protein is the usual candidate. In older children and adults, food is rarely the driver.
Exclusion diets started without proper assessment carry real harm — nutritional deficiency, faltering growth, and in some cases the development of a genuine allergy to a food that was removed and later reintroduced. IgG food intolerance panels are not clinically validated and we will not arrange one.
Eczema is a clinical diagnosis. There is no blood test that confirms it, and none is needed in most cases. The diagnosis rests on an itchy skin condition plus a typical pattern — the right distribution for the person's age, onset in early childhood, generally dry skin, and a personal or family history of atopy.
Where testing is used, it is to answer a specific question rather than to confirm the diagnosis:
Two things worth ruling out where the picture is atypical: psoriasis, which produces thicker, better-defined plaques with silvery scale on the outer surfaces of joints rather than the creases, and scabies, which itches intensely at night and typically involves the finger webs and wrists. Scabies is regularly treated as eczema for months before anyone reconsiders.
Skin is one of the conditions that genuinely assesses well remotely, provided the photographs are good. Send a wide shot and a close-up in natural daylight before your appointment — see our guide to photographing a skin problem.
Emollients are the foundation and the step most often done inadequately. The realistic target is 250 to 500g per week for a child with active eczema, and more for an adult. Most people use a fraction of that.
The commonest problem with topical steroids is not overuse. It is undertreatment — people apply too little, too briefly, out of a well-founded but misdirected fear of skin thinning, so the flare never clears and the skin is inflamed for months instead of days.
The fingertip unit is how to get this right. One fingertip unit is the amount squeezed from the tube along an adult fingertip, from the tip to the first crease. One unit treats an area the size of two adult palms. A whole adult arm needs about three units; a leg about six. Written that way, most people discover they have been using a tenth of what was needed.
The GP selects potency to match the site and severity — mild preparations for the face and skin folds, stronger ones for thicker skin on the limbs and trunk, used for a defined course of one to two weeks to clear a flare rather than dabbed on indefinitely.
Proactive therapy — applying a topical steroid twice a week to areas that usually flare, even when they look clear — substantially reduces how often flares happen. It is one of the most effective and least used strategies in eczema care.
For the face, eyelids and skin folds, or where steroids are needed too often, calcineurin inhibitors such as tacrolimus and pimecrolimus control inflammation without thinning skin, and can be used long term. They commonly sting for the first few applications, which is expected and settles — knowing that in advance stops people abandoning them on day two.
Weeping, golden crusting or a flare that suddenly worsens suggests bacterial infection, and we prescribe oral antibiotics where that is the case. Antibiotics are not helpful for eczema that is simply inflamed, and using them routinely drives resistance without improving the skin.
Eczema that remains uncontrolled despite proper topical treatment should go to dermatology for phototherapy, systemic treatment, or a biologic such as dupilumab, which is highly effective in moderate-to-severe disease and is initiated by specialists. We arrange that referral rather than leaving you cycling through creams.
We cannot patch test, take a swab, perform a biopsy, or give phototherapy. Where those are what you need, we say so and refer.
Call 999 or go to A&E for suspected eczema herpeticum. This is herpes virus infecting eczematous skin and it is a genuine emergency requiring intravenous antiviral treatment. Signs are:
Also seek emergency care for eczema covering almost the whole body surface with shivering and feeling unwell — erythrodermic eczema affects temperature control and fluid balance and needs admission.
Seek same-day assessment for:
Book a routine consultation if flares are not controlled by treatment that used to work, if you need a topical steroid more than a couple of times a month, if sleep is being lost regularly, if eczema is affecting work, school or mood, or if it appeared for the first time in adulthood — which is worth assessing properly rather than assuming.
Eczema cannot be prevented, but the frequency and severity of flares is substantially within your control. This is the part that determines how much of your life eczema takes up.
Scratching damages the barrier further and releases more inflammatory signals, so the itch worsens. Interrupting it matters as much as any cream.
Emollients are the treatment for eczema, and they are cheap over the counter and available in large quantities on NHS prescription. Your NHS GP treats eczema free, and NHS dermatology is free on referral.
The single most useful thing about eczema care is unglamorous and free: use far more emollient than you think, every day, including when the skin looks fine. Most people use a fraction of what is needed — an adult with widespread eczema needs several hundred grams a week — and use it only during flares, which is precisely backwards.
The second most useful thing is to stop being frightened of steroid creams. Steroid phobia causes more harm in eczema than steroids do: undertreated eczema stays itchy, gets scratched, becomes infected, and needs stronger treatment than it would have. The correct approach is enough potency for long enough, then stop — not a thin smear of hydrocortisone for months.
Where a consultation earns its fee is getting the potency right for the site, recognising infection, and building an actual step-up and step-down plan — which is what most people have never been given.
What needs urgent care: painful clustered punched-out sores with feeling unwell. Eczema herpeticum is an emergency, and a potent steroid makes it worse.
NICE CG57, Atopic eczema in under 12s, and NICE Clinical Knowledge Summary, Eczema — atopic, are the principal references. Both establish emollients as the foundation of treatment, used liberally and continued between flares, and set out a stepped approach to topical corticosteroid potency matched to severity and body site.
CG57 recommends emollients in large quantities — specifying 250 to 500g per week for widespread eczema — which is the basis for the point above about quantity.
NICE guidance addresses topical corticosteroid phobia directly, recommending clinicians explain that appropriately used topical steroids are safe and that undertreatment carries its own risks.
CKS sets out eczema herpeticum as a dermatological emergency requiring same-day assessment and systemic aciclovir.
NICE TA81 and subsequent guidance cover topical calcineurin inhibitors — tacrolimus and pimecrolimus — as steroid-sparing options for the face and flexures.
Probably, at least substantially. Most children with eczema improve considerably by adolescence, and many clear completely. The skin often remains dry and easily irritated for life, so emollients tend to stay useful even after flares stop.
Used correctly, no. Skin thinning is a real effect but it comes from prolonged use of potent steroids on delicate skin — the face, eyelids and skin folds — not from clearing a flare on an arm with an appropriate strength for a fortnight.
The far commoner harm is the opposite one. Fear of steroids leads to using too little for too short a time, the flare never clears, and the skin stays inflamed for months. Inflamed skin does its own damage. Use enough, for long enough, then stop.
Usually because the emollient stopped too. Steroids treat the flare; emollients are what keep it away, and they need to continue indefinitely. If flares still return quickly on good emollient use, proactive twice-weekly steroid application to the usual sites is the next step.
Rarely, in adults. Food matters mainly in infants with moderate-to-severe eczema not responding to good topical treatment. Cutting foods out without proper assessment risks nutritional harm and can create a genuine allergy where none existed. Get it assessed rather than guessed.
On brown and black skin eczema often appears grey, purple, or simply darker than the surrounding skin rather than red, and the inflammation can be harder to see. It also more commonly leaves lighter or darker marks after a flare. Those marks are not scars and do fade, though it can take months. This is a well-documented reason eczema is under-diagnosed and under-treated in darker skin.
No. Potency varies enormously between preparations that look identical in the tube, and a strong steroid on the face can do lasting damage. Site and strength have to be matched.
Stress is a genuine trigger through measurable effects on immune function and the skin barrier, not a way of implying the problem is psychological. Eczema also causes stress — through sleep loss, appearance and constant discomfort — so the relationship runs both ways.
No. It cannot be passed to anyone by contact, however severe it looks. Infected eczema involves bacteria that can spread, which is a different matter and one reason infection is treated promptly.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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