Eczema Awareness Month: What the Itch Is Actually Telling You
October is Eczema Awareness Month. Eczema is common enough that most people know someone with it, and misunderstood enough that most people have been given advice that does not work. It is not caused by being unclean, it is not contagious, and it is not simply stress. It is a chronic inflammatory condition with a known mechanism, and understanding that mechanism is what makes the treatment make sense.
October is Eczema Awareness Month. Eczema is common enough that almost everyone knows someone who has it, and misunderstood enough that most people have been given advice that does not help. It is not caused by being dirty, it is not catching, and it is not just stress. It is a long-lasting inflammatory condition with a known cause, and once you understand the cause, the treatment makes sense.
Eczema: the essentials
The short version
A group of inflammatory skin conditions; atopic dermatitis is the most common form
A group of skin conditions that cause itching and inflammation. The most common is called atopic dermatitis.
A 2024 US national survey estimated atopic dermatitis in about 7.6% of adults and 12.7% of children
A 2024 national survey in the United States found about 8 in 100 adults and 13 in 100 children have atopic dermatitis.
A leaky skin barrier, an overactive immune response and an itch that feeds on itself
A skin barrier that lets too much through, an immune system that overreacts, and an itch that keeps itself going.
No, and it is not caused by poor hygiene
No. You cannot catch it, and it is not caused by being unclean.
Gentle skin care, a thick fragrance-free moisturiser, and anti-inflammatory treatment matched to severity
Gentle washing, a thick plain moisturiser, and treatment that calms the inflammation, matched to how bad it is.
When it is persistent, severe, uncertain, infected, disrupting sleep or not controlled by basic care
When it will not go away, is severe, might not be eczema, looks infected, keeps you awake, or is not controlled by basic care.
A leaky wall and an overactive alarm
A leaky wall and an alarm that is too sensitive
Two things go wrong together. The first is the barrier. Many people with atopic dermatitis inherit a skin barrier that is short of one of its key protective proteins, filaggrin, so it loses water faster and lets irritants and allergens in. The second is the immune response. Signalling molecules in the skin, including interleukin-4 and interleukin-13, push it towards inflammation, and the result is redness, dryness and itch.
Two things go wrong at the same time. The first is the skin barrier. Many people with atopic dermatitis are born with a barrier that is short of a protective protein called filaggrin, so it loses water faster and lets irritants and allergy triggers through. The second is the immune system. Chemical signals in the skin, including ones called interleukin-4 and interleukin-13, push it towards inflammation, and that gives you redness, dryness and itch.
Changes in the filaggrin gene were identified in 2006 as a major risk factor for the condition, and they help explain why eczema runs in families, often alongside asthma and hay fever. They are not the whole story. Many people with the variants never develop eczema and many with eczema do not carry them, a good reminder that genes and environment work together. The barrier itself is described in The Twenty-Micron Wall That Keeps You Alive.
Changes in the filaggrin gene were found in 2006 to be a major risk factor, and they help explain why eczema runs in families, often together with asthma and hay fever. They are not the whole story. Many people with the gene change never get eczema, and many people with eczema do not have it, so genes and surroundings clearly work together. The barrier itself is explained in The Twenty-Micron Wall That Keeps You Alive.
This also explains something patients often find puzzling, which is that eczema is not an allergy to one thing that can be found and removed. It is a skin that reacts more easily to many ordinary things, and the treatment follows from that: repair the barrier, and calm the inflammation.
This also explains something people often find puzzling. Eczema is not an allergy to one thing that you can find and remove. It is skin that reacts too easily to many ordinary things, so treatment has two jobs: mend the barrier and calm the inflammation.
The itch that feeds itself
The itch that keeps itself going
Itch is the symptom that does the damage, because scratching is the one response the skin cannot tolerate. Each scratch breaks the barrier a little further, which lets in more irritants, which produces more inflammation and more itch. The cycle runs fastest at night, when distraction is gone and skin temperature rises, which is why sleep is so often the first casualty.
Itch does the real harm, because scratching is the one thing the skin cannot cope with. Every scratch breaks the barrier a little more, which lets in more irritants, which causes more inflammation and more itch. The cycle runs fastest at night, when nothing distracts you and your skin warms up, which is why sleep is so often the first thing to go.
Long-term scratching also changes the skin itself, which becomes thicker, rougher and more leathery in the places it is scratched most. That thickening is itchy in its own right, so a flare can leave behind patches that stay irritating long after the original inflammation has gone. Broken skin is also open to infection, and honey-coloured crusting, increasing pain or warmth, or a fever are reasons to be seen promptly.
Scratching for a long time also changes the skin. It becomes thicker, rougher and leathery in the places that get scratched most, and that thickened skin is itchy in its own right. So a flare can leave patches that stay irritating long after the original inflammation has gone. Broken skin can also become infected. Honey-coloured crusts, pain or warmth that keeps growing, or a fever are reasons to be seen quickly.
The burden of eczema is not only on the skin. Poor sleep, visible patches and constant itch wear people down, and the effect on mood and concentration is well documented in both children and adults. Treating it properly is a way of treating all of that, not only the rash.
Eczema is not only a skin problem. Poor sleep, visible patches and constant itching wear people down, and the effect on mood and concentration is well documented in both children and adults. Treating it properly treats all of that, not just the rash.
Why it flares as the weather cools
Why it flares as the weather turns cold
Many people notice eczema worsening in autumn and winter, and the reasons are mechanical. Cold outdoor air holds little moisture, indoor heating dries it further, and the skin loses water through a barrier that was already leaky. Longer, hotter showers, wool against the skin and a return to the frequent handwashing of the school and work year add to it.
Many people see eczema get worse in autumn and winter, and the reasons are simple. Cold outdoor air holds very little moisture, indoor heating dries it out even more, and your skin loses water through a barrier that was already leaky. Longer, hotter showers, wool against the skin and the constant handwashing of the school and work year all add to it.
Triggers differ from person to person and include dryness, heat and sweat, friction, fragrance and other irritants, contact allergens and stress. Hunting for a single culprit rarely helps, and removing whole groups of foods without evidence can do harm. The more reliable approach is to reduce the load: lukewarm water, short baths, fragrance-free products, soft cotton next to the skin, and moisturiser applied every day, including on the days the skin looks well.
Triggers differ from person to person. They include dryness, heat and sweat, rubbing, perfume and other irritants, things you are allergic to on contact, and stress. Hunting for one single culprit rarely helps, and cutting out whole groups of foods without good reason can do harm. A more reliable approach is to lighten the load: lukewarm water, short baths, products without perfume, soft cotton next to the skin, and moisturiser every day, including on days when your skin looks fine.
That last point is the one most often missed. Moisturising a clear patch looks unnecessary, and it is the reason the patch stays clear.
That last part is the one people most often miss. Moisturising skin that looks clear seems pointless, and it is exactly why the skin stays clear.
What it looks like, and what it can be mistaken for
What it looks like, and what else it could be
Eczema looks different on different skin. On lighter skin it is usually pink or red. On darker skin it can look purple, grey or dark brown, or simply darker and rougher, and the redness that doctors are taught to look for can be hard to see, which is one reason it is under-recognised.
Eczema looks different on different skin. On lighter skin it is usually pink or red. On darker skin it can look purple, grey or dark brown, or just darker and rougher, and the redness that people are told to look for can be hard to see. This is one reason it is so often missed.
It is also not the only itchy rash. Contact dermatitis, nummular eczema, seborrhoeic dermatitis, psoriasis, scabies and fungal infection can all look similar, and they are treated differently. This matters in practice, because a steroid cream used for a fungal rash can make it worse, and a rash that does not respond to eczema treatment should be re-examined rather than treated harder.
Eczema is also not the only itchy rash. Contact dermatitis, coin-shaped eczema, flaking on the scalp and face, psoriasis, scabies and fungal infections can all look alike, and they are treated differently. This matters, because a steroid cream used on a fungal rash can make it worse, and a rash that does not respond to eczema treatment should be looked at again rather than treated harder.
A dermatologist considers the pattern, the distribution, the history and sometimes a skin scraping, patch test or biopsy to settle the diagnosis. Reading about it is useful, but the label has to be confirmed by someone who has looked at your skin.
A dermatologist looks at the pattern, where it is on the body and your history, and sometimes does a skin scraping, an allergy patch test or a small biopsy to settle the diagnosis. Reading about it helps, but the label has to be confirmed by someone who has examined your skin.
What actually helps
What actually helps
Treatment is stepped to severity. The foundation for everyone is daily barrier care: short lukewarm baths or showers, then a fragrance-free cream or ointment applied within a few minutes of drying, and continued when the skin is clear. A thick ointment or cream is preferred over a thin lotion.
Treatment goes up in steps depending on how bad things are. The base for everyone is daily barrier care: short lukewarm baths or showers, then a plain, unperfumed cream or ointment put on within a few minutes of drying, and carried on even when your skin is clear. A thick cream or ointment works better than a thin lotion.
On top of that sit anti-inflammatory treatments applied to the skin: topical corticosteroids matched to the site and the severity, non-steroid options such as calcineurin inhibitors, and newer topical medicines that act on specific inflammatory pathways. The 2023 guidelines of the American Academy of Dermatology strongly recommend moisturisers and these topical options for adults. Used at the right strength, for the right length of time, steroid creams are effective and safe, and under-treatment from fear of them is as common a problem as over-use.
On top of that come treatments for the inflammation, put on the skin: steroid creams matched to the body area and how bad it is, non-steroid creams that calm the immune response, and newer creams that block specific inflammatory signals. The 2023 guidelines of the American Academy of Dermatology strongly recommend moisturisers and these creams for adults. Used at the right strength for the right length of time, steroid creams are effective and safe, and undertreating out of fear of them is as common a problem as overusing them.
For moderate to severe disease that topical treatment does not control, there are further steps: supervised wet wraps for selected flares, office-based light therapy, and prescription medicines that target the inflammatory signals directly, including injectable biologic treatments. These are newer than most people realise and have changed what is possible for severe eczema, and they need diagnosis, screening and monitoring. The aim at every step is the least treatment that still controls the inflammation.
For moderate to severe eczema that creams do not control, there are further steps: supervised wet wraps for some flares, light therapy given in the office, and prescription medicines that block the inflammatory signals directly, including injected medicines called biologics. These are newer than most people realise and have changed what is possible for severe eczema, and they need a proper diagnosis, checks and monitoring. At every step the aim is the least treatment that still keeps the inflammation under control.
Questions patients ask
Is eczema contagious?
Is eczema catching?
No. Atopic dermatitis and the common eczemas cannot be passed from person to person, and they are not caused by poor hygiene. A skin infection that develops on top of eczema can be contagious, which is a separate matter that needs its own treatment.
No. You cannot catch eczema from anyone, and it is not caused by being unclean. An infection that develops on top of eczema can spread, which is a separate problem that needs its own treatment.
Will my child grow out of it?
Will my child grow out of it?
Many children improve as they grow, and some clear completely, but a substantial number continue into adult life or return later. It is not possible to promise either outcome, and good control in childhood is worth having whichever way it goes.
Many children get better as they grow, and some clear completely. But quite a lot carry on into adult life or come back later, and nobody can promise which way it will go. Good control in childhood is worth having either way.
Do antihistamines help eczema?
Do antihistamines help eczema?
Not for the underlying inflammation, and they are not routinely recommended as an eczema treatment. A sedating antihistamine is sometimes used briefly to help sleep, and a separate allergy may need its own treatment, but neither replaces barrier care and anti-inflammatory treatment.
Not for the inflammation itself, and they are not routinely recommended for eczema. A drowsy antihistamine is sometimes used for a short time to help with sleep, and a separate allergy may need its own treatment, but neither replaces moisturiser and treatment that calms the inflammation.
Should I cut foods out of my diet?
Should I cut foods out of my diet?
Not routinely. Broad food-elimination diets rarely control eczema and can cause harm, particularly in children. If a food allergy is suspected because of a clear reaction soon after eating, it should be evaluated with proper testing rather than managed by guesswork.
Not as a rule. Cutting out lots of foods rarely controls eczema and can cause harm, especially in children. If you suspect a food allergy because of a clear reaction soon after eating, get it tested properly instead of guessing.
What moisturiser should I use?
What moisturiser should I use?
A fragrance-free cream or ointment is generally better than a thin lotion, applied within minutes of bathing and once or twice a day. The best product is the one you can use consistently without irritation, and it is sensible to try a new one on a small area first.
A plain, unperfumed cream or ointment is usually better than a thin lotion. Put it on within minutes of bathing and once or twice a day. The best one is the one you can keep using without irritation, and it is sensible to try a new one on a small patch first.
When is eczema an emergency?
When is eczema an emergency?
Seek urgent care for widespread blistering or peeling, rapidly worsening painful skin, significant facial swelling, breathing difficulty, or fever with an extensive rash. Signs of a skin infection, such as oozing, honey-coloured crusts or increasing pain, also need prompt medical attention.
Get urgent help for widespread blistering or peeling, painful skin that is getting worse fast, a badly swollen face, trouble breathing, or a fever with a large rash. Signs of infection, such as oozing, honey-coloured crusts or growing pain, also need quick medical attention.
- Sidbury R, Alikhan A, Bercovitch L, et al. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023;89(1):e1-e20. Source
- Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38(4):441-446. Source
- Prevalence of atopic dermatitis in the United States from 2021 to 2024: data from the National Health Interview Survey. J Am Acad Dermatol. Source
Where to go next
Talk it through with a physician first.
Every plan starts with an assessment of your skin, your anatomy and what you actually want to change.
This page is general health information, not medical advice. It cannot tell you whether a treatment is right for you. Approved uses, risks and results differ from person to person, and product labelling changes. Ask us at Dermatology and Laser Centre about your own situation, or make an appointment, and seek urgent care for any serious symptom.
