Inflammatory

Medically reviewed by Dr. A.M. van Coevorden, dermatologist

± 4 min read

Atopic eczemaeczema from a hereditary predisposition

Learn what atopic eczema is, what causes it and how to keep the symptoms under control yourself. In plain language, based on the leaflet from the Nationaal Constitutioneel Eczeem Project.

What is atopic eczema?

With eczema you have itchy patches on the skin. They are red and have scales, bumps, cracks, blisters or crusts. The skin is often dry, and with long-standing eczema it can become rough and thick. No extra testing is needed for the diagnosis: a doctor can see from the skin that you have eczema.

Atopic eczema is common, especially in young children. It usually starts before a baby is 6 months old, but you can get it at any age. In many children the symptoms disappear before the age of 5; the predisposition remains, however, so the symptoms can return later in life.

No. Eczema is not contagious. Touching and cuddling are perfectly fine.

How does it develop?

The hereditary predisposition has a lot of influence. Because of it, the skin is different: in the top skin layer the cells lie together less tightly and the protective barrier works less well.

This has two consequences:

Moisture evaporates more easily: the skin becomes dry and itches sooner.
Substances and irritants penetrate more easily.

On top of that, the immune system in the skin is too active, which causes the inflammation that produces eczema. The hereditary predisposition cannot be cured, but the symptoms can be treated well.

How do you treat eczema?

You treat eczema with a base ointment and a medicated ointment. The type and amount differ from person to person.

Base ointment

An ointment or cream without medicine. Apply it every day to your whole body, ideally several times, even when you have no eczema. This helps the skin hold more moisture and keeps the protective barrier intact.

Medicated ointment with a corticosteroid

You apply this only to the eczema patches, usually once a day. Start as soon as you feel or see a patch and taper off slowly as the itch eases. There are 4 classes, from mild (class 1) to strong (class 4).

Other medicated ointments

Ointments without a corticosteroid, such as pimecrolimus cream and tacrolimus ointment. Suitable when the eczema is reasonably under control.

When ointment is not enough

Then there are other treatments, such as light therapy or medicines via a tablet or injection. Often you still keep applying base ointment and medicated ointment alongside these.

What can you do yourself?

Symptoms can worsen because of irritants from your surroundings. Eczema is not an allergy, and which irritants bother your skin differs from person to person. You can try to avoid these.

Scratching

Keep your nails short. Tap or gently blow on the itch and put something cool on it, instead of scratching.

Showering

Keep it short (5–10 min), water no hotter than 37–38°C, at most once a day and with as little soap as possible. Pat dry and then apply base ointment.

Clothing

Wear cotton, silk or bamboo, choose loose clothes and cut out scratchy labels.

Heat and sweat

Heat and sweat can make eczema worse. Rinse sweat off and then apply base ointment; keep your home cool and fresh.

Dry air

In winter the air is drier. Apply more often or use a greasier base ointment, keep the heating no higher than 19°C and make the air more humid.

Other conditions that occur more often

People with eczema from a hereditary predisposition are also more likely to have:

Hay fever and animal allergy
Asthma
Food allergy

These conditions cause different symptoms from eczema and are not its cause. Because of the hereditary predisposition you are more sensitive to ordinary substances and irritants. You may have one or several at the same time, or only eczema.

Frequently asked questions about eczema

At what age does atopic eczema start?

Usually before the age of 6 months. In many children the symptoms disappear before the age of 5, but the hereditary predisposition remains. As a result, the symptoms can return later in life.

Is a medicated ointment with a corticosteroid safe?

Yes. Research shows that, used correctly, this ointment is safe for children and adults. Apply enough (use the fingertip unit), usually once a day, and taper off slowly as the itch eases.

Can I swim with eczema?

Yes, in the pool and in the sea. After swimming, shower briefly with lukewarm water and then apply base ointment all over your body.

Why do I need to keep moisturising when the eczema is gone?

Base ointment keeps the skin supple and restores the protective barrier. This makes new eczema patches less likely. So keep applying it even at times when you have no eczema.

Is eczema an allergy?

No. The symptoms can worsen because of irritants from your surroundings, but eczema itself is not an allergy. You do, because of the predisposition, have a greater chance of hay fever, asthma and food allergy.

Sources and more information

Nationaal Constitutioneel Eczeem Project, NCEP (nvdv.nl)
Thuisarts.nl (thuisarts.nl)
Vereniging voor Mensen met Constitutioneel Eczeem, VMCE (vmce.nl)
Eczeemwijzer (eczeemwijzer.nl)

Source: Nationaal Constitutioneel Eczeem Project (NCEP).

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All conditions A–Z

Contact eczema

Redness and itching after contact with an irritating or allergenic substance.

Seborrhoeic eczema

Scaly, greasy patches on the scalp and face.

Psoriasis

A chronic condition with thick, scaly, red patches.