Eczema is an inherited chronic inflammatory skin condition that results in dryness, itching and reddened skin patches. Treatment options include moisturisers, corticosteroids, creams and ointments, calcineurin inhibitor ointments (pimecrolimus), coal tar, ultraviolet radiation therapy (phototherapy) and, for severe cases, oral medications. There is no cure for eczema, but it can be managed.
Eczema is a chronic inflammatory skin condition with symptoms including dry, itching and reddened skin patches. Affected skin is susceptible to bacterial and viral infection. Infected skin can ooze a clear or honey-coloured fluid. The genetic basis of eczema was discovered in 2008. It is caused by mutations to the filaggrin gene that impair the skin’s barrier function.
Causes of eczema
There are a variety of risk factors for atopic (allergic) eczema including:
- A family history of eczema
- A family history of allergic conditions, including hay fever and asthma
- Contact with irritants in the environment
- Heat, which can make itching worse and make affected people more likely to scratch
- Food allergy may aggravate atopic eczema, causing redness and swelling around the lips within minutes of eating the offending food.
Treatment for eczema
Treatment options for eczema include:
- Emollients (moisturisers)
- Corticosteroids (anti-inflammatories)
- Pimecrolimus cream (a steroid-free medication applied to the skin)
- Coal tar
- Dietary adjustments
- Ultraviolet radiation therapy (phototherapy)
- Oral medications.
Emollient creams add moisture to the skin. Apply moisturisers each day to clean, dry skin. It is especially important to moisturise after showering and bathing, and when living or working in an air-conditioned or heated environment. You may need to try several different brands until you find the emollient that works best for you. See your doctor, dermatologist or pharmacist for advice.
Eczema responds well to anti-inflammatory creams. Topical steroids (corticosteroids) come in various strengths and are available by prescription from your doctor. Generally, it is better to use the lowest strength that works adequately. Using high-strength topical steroids for extended periods, especially on delicate areas like the face, can cause side effects, including thinning of the skin. It is best to apply the cream to the reddened areas after bathing, but make sure the skin is thoroughly dry.
In severe cases of eczema, a short course of oral corticosteroids may be necessary. This must be done under careful medical supervision because symptoms may become worse once the tablets are stopped.
Pimecrolimus cream is a non-steroid anti-inflammatory cream that can help reduce flares of eczema if applied at the first signs of eczema.
Applying coal tar to affected areas is another way to reduce the itch associated with eczema. Coal tar has a strong smell and tends to stain any fabric it touches. It can also irritate some people’s skin. Only use it under supervision of a doctor who is experienced in managing eczema.
Occasionally, a person’s symptoms are aggravated by eating certain foods, such as dairy products. Seek professional advice from an allergist before making any dietary alterations. Self-diagnosis and self-imposed dietary restrictions can lead to avoidable nutrition problems.
Ultraviolet radiation therapy (phototherapy)
Exposure to ultraviolet radiation can help reduce the symptoms of chronic eczema. Exposure under medical supervision can be carefully monitored with the use of specially designed ‘cabinets’ – the person stands naked within the cabinet and fluorescent tubes lining the device emit ultraviolet radiation. The risks of unsupervised ultraviolet radiation therapy can be the same as for sunbathing – accelerated ageing of the skin and increased risk of skin cancer. A person with stubborn eczema may need up to 30 sessions.
Oral anti-inflammatory medication
The vast majority of people affected by eczema can manage the condition with creams and ointments alone. While oral medications can be used for cases that are resistant to treatment, their side effects can include high blood pressure, increased susceptibility to all types of infections, and mood and behavioural changes. Because of the risk of significant side effects, and the need for close and regular monitoring, oral anti-inflammatory treatment is only considered in severe cases of eczema that are difficult to control with other therapies.
Complications of eczema
An intact skin surface is the best defence against skin infections. This is why a person with eczema is prone to bacterial and viral infections including:
- Staphylococcus aureus – which causes impetigo, thrives on skin affected by eczema. The infection is characterised by inflamed blisters that pop, weep and form crusts. Treatment options include antiseptic creams and antibiotic tablets
- Herpes simplex virus – or cold sores, can easily spread over wide areas. See your doctor for prompt treatment
- Warts – these small, raised lumps are caused by viral infections. Warts often clear up by themselves, but this can take up to 12 months in some cases.
Where to get help
- Your doctor
- Eczema Association of Australasia Tel. 1300 300 182
Things to remember
- Eczema is a type of inflammatory skin condition with symptoms including dry, itching and reddened skin patches.
- Treatment options for eczema include moisturisers, corticosteroids, pimecrolimus cream, coal tar, ultraviolet radiation therapy (phototherapy) and oral anti-inflammatory medications
You might also be interested in:
Want to know more?
Go to More information for support groups, related links and references.
This page has been produced in consultation with and approved by:
(Logo links to further information)
Logo Epworth Dermatology
Last reviewed: February 2013
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.
For the latest updates and more information, visit www.betterhealth.vic.gov.au
Copyight © 1999/2013 State of Victoria. Reproduced from the Better Health Channel (www.betterhealth.vic.gov.au) at no cost with permission of the Victorian Minister for Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission.