Atopic eczema

Atopic eczema is the most common form of eczema and tends to run in families. ‘Atopic’ is a term used to describe the tendency to develop eczema, asthma and hay fever. Some people may only have atopic eczema but others may also have asthma and/or hay fever.

Symptoms

In people with white skin, atopic eczema often affects the creases of body joints, such as the back of the knees and the inside of the elbows, while in people of colour the pattern is often reversed, with atopic eczema affecting the front of the knees and the outside of the elbows. However, atopic eczema can occur all over the body, causing dry, reddened or darkened skin that may be very itchy, scaly or cracked.

Constant scratching can split the skin, which may lead to infection – usually characterised by weeping or wet eczema, with yellow crusts.

If someone has been scratching the same area for a long time, the skin will thicken, causing what is known as lichenification. The skin looks like leather and can take weeks or months to return to its normal thickness. Lichenification can also cause changes in skin colour, creating darker or lighter patches which eventually fade. Fortunately, most scratched skin heals well over time and scarring is unusual unless scratching has been intense.

Triggers

Atopic eczema is a genetic and immune condition, which is triggered by environmental factors, these may be irritants or allergens.

Common irritants are soaps, alcohol rubs, detergents and cleansing agents, fragrances, wool and rough clothes; environmental irritants include heat, dry air (low humidity), cold weather, sudden changes in temperature and irritant foods around the mouth, for example citrus fruit; and allergens may include house dust mite, pollen, pet dander, moulds and certain foods.

Many things in our environment can initiate an eczema flare-up. View all of our triggers below to find out how to best manage these.

View all triggers

Treatments

Find out more about the different types of treatments for eczema, from emollients to topical steroids.

View all treatments

FAQs

Constant scratching can split the skin, which may lead to infection - characterised by weeping or wet eczema, with yellow crusts. 

Long-term scratching can thicken the skin, causing lichenification, which has a leathery appearance and can take weeks or months to fade. It can also lead to changes in skin colour, creating darker or lighter patches which eventually fade.  

Most scratched skin heals over time and scarring is unusual unless scratching has been intense. 

Atopic eczema usually starts in childhood and it can improve as the child gets older, but it can also return at any time, as eczema is a chronic condition. If you have Atopic eczema at an early age, your skin is likely to remain sensitive even if there is no recurrence of eczema. 

Research has identified genetic mutations of a protein called filaggrin in approximately 50% of people with Atopic eczema, which lead to a number of changes in the skin. There is often a lack of filaggrin, which acts to bind cells together in the top layer of skin.  

Individuals with Atopic eczema have less fat, oil and natural moisturising factors in the skin with cells often having an irregular shape.  

Lack of filaggrin and natural moisture in the skin results in gaps between the skin cells and an altered skin barrier which allows bacteria, irritants and allergens to enter the skin, causing increased water loss.

Related Downloads ⁽¹⁾

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Living with eczema (for adults) booklet

Supportive, practical information for adults managing eczema, based on the latest research and regularly reviewed by doctors and nurses. 