Atopic Dermatitis (Eczema) – Consultant Dermatology Treatment in London

Understanding Atopic Dermatitis

Atopic dermatitis (AD) — commonly called eczema — is a chronic, relapsing inflammatory skin condition characterised by dryness, itching and intermittent flares. It arises from a combination of a weakened skin barrier and an immune system that reacts quickly to minor irritants. Because the barrier leaks water and lets irritants in, the skin dries, itches and becomes inflamed; scratching then damages the barrier further, creating a self-perpetuating cycle. While AD often begins in infancy or childhood, many people continue to have flares as adults, especially on the hands or in body folds.

Why Eczema Happens: Barrier + Immune Factors

Healthy skin keeps moisture in and irritants out. In eczema, the “mortar” between skin cells is less effective. Genetics (for example, variants affecting filaggrin, a key barrier protein), climate, detergents and microbiome shifts all contribute. The immune system becomes primed to over-respond to minor triggers such as heat, sweat, wool, soaps, fragrances and environmental allergens. AD is not a hygiene problem and it is not contagious. Understanding your personal trigger pattern helps target prevention and reduce the need for strong medicines.

Who Gets Eczema and What Eczema Looks Like

• Infants: cheeks, scalp and extensor limbs with weeping or crusting; sleep disturbance from itch is common.
• Children: typical “flexural” eczema in the creases of elbows and knees, neck and ankles; skin can thicken (lichenify) with rubbing.
• Adults: hand eczema (wet work, sanitisers), eyelids, neck and nipple eczema, and stubborn flexural disease; chronic scratching can lead to nodular prurigo.
• Skin of colour: redness may be less obvious; the skin can look grey-violet or ashy; post-inflammatory darkening or lightening after flares is common. Pattern recognition is adjusted so undertreatment is avoided.

Diagnosis: Getting Eczema Right First Time

Diagnosis is clinical: distribution, chronic itch, relapsing course and personal/family atopy (hay fever, asthma) support the picture. We use dermoscopy and a careful history to exclude mimics. When hand eczema persists despite good care, we consider patch testing to rule out allergic contact dermatitis (e.g., fragrances, rubber accelerators, hairdressing chemicals). If infection is suspected we may take a swab; skin biopsy is rarely required.

Common Triggers to Identify

• Dryness: low humidity, hot showers, winter weather.
• Irritants: soaps, fragranced products, rough wool, dust.
• Heat & sweat: exercise, overheating at night; occlusive clothing/gloves.
• Infections: bacterial overgrowth, cold sores (herpes simplex), athlete’s foot.
• Stress: can intensify itch perception and scratching.
• Allergens (selected cases): house dust mite, pet dander, pollens. In infants with moderate–severe eczema, food allergy may coexist but is not the root cause in most cases.

Our Treatment Principles

We build a plan around four pillars: 1) restore and protect the skin barrier, 2) calm inflammation rapidly and safely, 3) control itch and break the scratch cycle, and 4) prevent and treat infection. We aim to minimise medication by optimising skincare and triggers, and we step treatment up or down according to disease activity.

Daily Skincare: Your Foundation

Emollients (Moisturisers)

Emollients are the cornerstone. We’ll help you choose textures you can actually use: lighter creams or lotions for daytime, richer ointments for evenings and flares. Apply generously and frequently, especially after bathing and hand-washing. For widespread eczema, expect to use large amounts; consistency is what prevents flares. Fragrance-free, soap-free products tend to suit sensitive skin best.

Bathing & Cleansing

• Short, lukewarm showers or baths (5–10 minutes).
• Use mild, pH-balanced cleansers or prescribed soap substitutes; avoid foaming and fragranced products.
• Pat dry (do not rub), then apply emollient within minutes to “lock in” moisture.
• For children with frequent flares, a regular routine is more important than bath frequency debates — the key is fast moisturising afterwards.

Anti-Inflammatory Treatments

Topical Corticosteroids (TCS)

Used correctly, topical steroids are safe and highly effective. We match potency to body site and severity (mild for face/folds, stronger for thicker plaques on limbs), and use them in short, focused bursts to regain control. The fingertip unit (FTU) method helps you apply the right amount. Once clear, many people benefit from “weekend therapy” (e.g., twice weekly to past flare sites) to prevent quick relapses. We avoid chronic daily use and review regularly to minimise side-effects such as skin thinning or visible blood vessels.

Non-steroidal Topicals

Calcineurin inhibitors (e.g., tacrolimus/pimecrolimus) and other non-steroidal anti-inflammatories can be used on sensitive areas (face, eyelids, skin folds) and for maintenance. They may sting briefly at first; this usually eases within days. These agents avoid steroid-related thinning and are useful for long-term control in delicate sites.

Wet-Wraps & Dressings

For moderate–severe flares, medicated emollient or topical therapy under damp then dry layers (“wet-wraps”) can calm skin quickly and reduce night-time itch. We show you how to apply wraps safely and how long to continue.

Itch Management

• Cool, emollient-rich routines reduce itch drivers (dryness/heat).
• Behavioural tactics: keep nails short, use cotton gloves for children at night, swap scratching for pressing/cooling.
• Night-time support: in selected cases a short course of sedating antihistamine may help sleep while the skin calms; non-sedating antihistamines help primarily if there is coexisting hay fever/urticaria.

Infection Control & When to Seek Urgent Help

Crusting, oozing, sudden worsening, pustules or “honey-coloured” scabs suggest bacterial infection and may require targeted treatment. If you or your child with eczema develops clusters of painful blisters, fever or rapidly worsening sore skin (especially on the face), this can indicate eczema herpeticum (herpes simplex infection) — this needs prompt medical assessment. We provide clear safety-netting so you know when to get in touch.

Phototherapy

For widespread or stubborn eczema, narrow-band UVB phototherapy can reduce inflammation and itch. Treatment is delivered in short, supervised sessions several times a week over a set course. It is typically well tolerated and can provide months of improved control. We discuss suitability, scheduling and skin-type considerations.

Systemic Options (Consultant-Led)

If eczema remains moderate–severe despite excellent topical care, we may discuss advanced options. These include traditional immunomodulators (used carefully with monitoring) and modern targeted therapies such as biologics and oral JAK inhibitors. Selection depends on age, disease pattern, comorbidities and preferences; we balance speed of response, efficacy, safety checks and convenience, and we review regularly to ensure the lowest effective treatment load.

Hands, Occupation & Lifestyle

Hand eczema is common in adults who do frequent wet work, use disinfectants or wear occlusive gloves. We provide employer-friendly, practical steps: soap substitutes, moisturiser stations, cotton glove liners under nitrile, breaks to air the skin and task rotation where possible. For sport, choose breathable fabrics, rinse sweat promptly and moisturise after showering. Stress management, sleep care and gentle movement support itch resilience.

Skin of Colour Considerations

With higher baseline melanin, redness may present as grey-violet or simply as texture change; post-inflammatory darkening/lightening can follow any flare or scratch. We treat inflammation promptly to reduce pigment change, choose pigment-safe techniques, and advise strict photoprotection while the skin tone resets. On the scalp and in tightly curled hair, cleansing and emollient routines are adapted to protect hair while calming the skin.

Babies, Children & Teenagers

Simple routines and caregiver confidence make the biggest difference: daily or alternate-day bathing with soap substitute, quick moisturising, and short steroid bursts by potency and site. We address “steroid phobia” with clear instructions and review. For school and sport, letters explaining routines (emollient use, hand-washing adaptations) reduce friction and help adherence.

Diet & Allergy — What’s Worth Testing?

Food is not the primary cause of eczema. In infants with moderate–severe eczema, immediate-type food allergy can coexist; testing is guided by history (hives, vomiting, immediate flares). Unsupervised elimination diets risk poor growth and can sensitise children. We coordinate allergy assessment when appropriate and keep skincare front and centre.

Prevention & Flare Plans

• Keep a simple daily routine: emollient morning and evening, more often on hands.
• Trigger control: lukewarm water, breathable cotton layers, fragrance-free products, quick rinse after sweating.
• Maintenance anti-inflammatory: twice-weekly “weekend therapy” to past hot-spots if you flare frequently.
• Early rescue: at the first tingle/roughness, step up moisturiser and start the prescribed topical anti-inflammatory to avoid a full flare.
• Infection watch: know the signs and act early; avoid sharing towels during active infection.

Why Choose Skinhorizon?

We provide high-quality advanced dermatology with consultant oversight. You’ll receive precise diagnosis, a written, stepwise plan that fits your life, clear demonstrations (how much product, where and when), and proportionate follow-up. If you need phototherapy or systemic therapy, we explain the evidence, monitoring and realistic timelines so you can choose confidently. Our goal is simple: fewer flares, better sleep, better skin.

Your First Visit — What to Expect

1. Assessment: history, triggers, pattern mapping; examination with dermoscopy; photos for baseline.
2. Plan: skincare products you’ll actually use; site-specific anti-inflammatories; flare and maintenance steps; written action plan.
3. Support: itch/sleep tactics, work/school letters if helpful, and safety-net advice for infection or severe flares.
4. Follow-up: review response, step down when stable, and consider phototherapy or systemic options if needed.