Eczema (Atopic Dermatitis) in Adults and Children

Atopic eczema, also called atopic dermatitis, is a long term itchy skin condition caused by a weakened skin barrier combined with an overactive immune response, leading to dry, inflamed patches that flare and settle. It cannot be cured, but daily moisturising, gentle skin care and prescription treatment for flares keep it well controlled in most children and adults.

It is one of the most common skin conditions in children worldwide, and Indian parents often struggle with conflicting advice about soaps, oils, diets and creams. Adults can have it too, either continuing from childhood or starting later. This guide brings the evidence together.

What causes eczema?

Eczema results from several factors working together:

• A weak skin barrier. Many people with eczema have genetic changes, such as in the filaggrin gene, that make the outer layer of skin leaky. Water escapes and irritants and allergens get in more easily.
• Immune overactivity. The immune system reacts strongly to things that pass through the barrier, causing inflammation and itch.
• Family history. Eczema is often part of the atopic family of conditions, along with asthma, allergic rhinitis and food allergy.
• The itch scratch cycle. Scratching damages the barrier further, which increases itching.

What does eczema look like in children and adults?

Eczema changes with age:

Age	Common sites	Typical appearance
Babies (under 2)	Cheeks, scalp, outer arms and legs, trunk	Red, rough, sometimes oozing patches. The nappy area is often spared
Children	Elbow creases, behind the knees, wrists, ankles, neck	Dry, thickened, scratched patches
Teens and adults	Face, eyelids, neck, hands, flexures	Thick, leathery skin (lichenification), dark patches

On brown and darker skin, eczema often looks dark brown, purple or grey rather than red, which can make it seem less inflamed than it is. Small bumps around hair follicles are also common. After a flare, dark or light marks may remain for weeks to months.

What triggers eczema flares in India?

Triggers vary, but commonly reported ones include:

• Harsh soaps and antiseptic liquids added to bathwater
• Hot water baths and long showers
• Dry winter air in North India, or sweat in humid summers and the monsoon
• Woollen and synthetic clothing against the skin
• Dust mites and pollen
• Fragranced products, including some talcum powders, perfumed oils and ubtans
• Stress and poor sleep
• Skin infections, especially with Staphylococcus bacteria
• Certain foods, in a minority of children, usually with severe early onset eczema

How do I care for eczema skin every day?

Daily care is the foundation of eczema treatment, even when the skin looks clear.

1. Moisturise generously and often. Apply a thick, fragrance free moisturiser (emollient) at least twice daily, and every time after washing. Creams and ointments work better than light lotions.
2. Bathe smart. Use lukewarm water for 5 to 10 minutes. Use a soap free cleanser or a mild syndet bar. Pat dry and moisturise within a few minutes.
3. Avoid irritants. Skip antiseptic liquids in the bath, perfumed products and rough scrubs.
4. Choose soft cotton clothing. Wash new clothes before wearing them and rinse detergent well.
5. Keep nails short, and use cotton gloves at night for young children who scratch in their sleep.
6. Manage sweat. In humid weather, rinse off sweat after school, play or exercise, then moisturise with a lighter cream.

For babies, many traditional oil massages are fine on healthy skin, but on eczema skin, stick to plain emollients recommended by your doctor. Mustard oil in particular can irritate.

How is eczema treated during a flare?

Flares need treatment to calm inflammation, not just more moisturiser. Your dermatologist may consider:

• Prescription topical corticosteroids of a strength suited to the body site and age, used for a set period and then tapered or switched to maintenance. Used this way, they are safe and very effective.
• Topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, which are steroid free and useful on the face, eyelids and folds.
• Proactive treatment, applying an anti-inflammatory cream twice a week to areas that often flare, to prevent relapse.
• Wet wrap therapy for severe flares, under guidance.
• Treatment of infection, if the eczema is weeping, crusted or painful.
• Antihistamines occasionally, mainly to help sleep, since they do not treat the eczema itself.

For moderate to severe eczema not controlled with creams, options include:

• Phototherapy
• Oral immune suppressing medicines such as ciclosporin or methotrexate, with monitoring
• Biologic injections and oral JAK inhibitors, newer targeted treatments for selected patients

Are steroid creams safe for eczema?

Fear of steroids, sometimes called steroid phobia, often leads parents to under treat eczema, leaving children itchy and sleepless. The opposite problem is also common in India: strong steroid creams, or mixtures of steroid, antifungal and antibiotic, bought over the counter and used for months, especially on the face.

The balanced answer:

• Prescribed steroid creams, used correctly, are safe.
• Self medication with strong or combination creams is not. It can cause thinning, stretch marks, acne, light patches and rebound flares.

Read more in our article on topical steroid misuse.

Does diet matter for eczema?

• Most children with eczema do not need any food restrictions.
• Food allergy is more likely in infants with severe eczema that starts early, especially if a food clearly causes hives, vomiting or swelling.
• Avoid cutting out milk, eggs, wheat, nuts or fish without proper testing and advice, since this can harm growth.
• For infants at risk, current guidance generally supports introducing common allergenic foods at the right age rather than delaying them, but discuss this with your paediatrician.

How can I help my child sleep better with eczema?

Itch is often worst at night, and poor sleep affects the whole family. Things that help many children:

• A lukewarm bath followed immediately by a thick layer of moisturiser before bed.
• Applying prescribed flare creams in the evening, as directed.
• Keeping the bedroom cool, with a fan or air conditioner set to a comfortable temperature, since overheating worsens itch.
• Soft cotton nightwear and cotton bedsheets.
• Short nails and, for younger children, cotton mittens.

If your child wakes repeatedly because of itch, that is a sign the eczema needs a stronger treatment plan, not just more patience.

Is it eczema or something else?

Other conditions can mimic eczema, including fungal infection, scabies, psoriasis, contact dermatitis and seborrheic dermatitis. If an itchy rash is ring shaped with a raised edge, or the whole family is itchy, see our guide on fungal infections and ringworm in India. Hives that come and go within hours are a different condition, explained in our urticaria guide.

When to see a dermatologist

See a dermatologist if:

• Eczema is not improving with regular moisturising.
• Itching disturbs sleep, school, work or mood.
• Skin is weeping, crusted, has yellow crusts or pus, or becomes painful.
• Clusters of painful blisters or punched out sores appear, which can be a serious viral infection and needs urgent care.
• Eczema affects the eyelids or the area around the eyes.
• You are using steroid creams frequently and are unsure if it is safe.
• You suspect a food allergy in your child.

Eczema care works best with a clear plan for daily care and flares. Dr. Maria offers online consultations for children and adults, to review the skin, simplify the routine and agree when to step treatment up or down.