Eczema and Dermatitis: Types, Flare-Ups and Infected Eczema
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Eczema and Dermatitis: Types, Flare-Ups and Infected Eczema
A UK guide to eczema and dermatitis: the main types, what causes flares, how it’s treated step by step, how to spot infected eczema, and when to get help.
This is our main eczema guide. All our eczema articles are listed in our eczema and dermatitis health guides.
Get urgent help first. Call 999 or go to A&E if you have swelling of the lips, face or tongue or difficulty breathing, widespread blistering or peeling skin with a fever, or red, inflamed skin covering most of your body and you feel unwell. Contact NHS 111 or your GP the same day if eczema suddenly gets much worse with clusters of painful blisters or punched-out sores and a fever (possible eczema herpeticum), or the skin becomes hot, swollen, weeping or crusted and you feel unwell. Online treatment isn’t suitable in these situations.
The headline: eczema is a long-term condition where the skin barrier doesn’t work properly, so skin becomes dry, itchy and inflamed. Daily emollients are the foundation of treatment, with a steroid cream of the right strength for flares. Weeping, golden crusts or feeling unwell can mean the eczema is infected, which needs a different approach.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor’s online eczema service is for adults aged 18 and over, and can’t supply treatment if you’re pregnant or breastfeeding: your GP or midwife can help. Children with eczema should see their GP or a pharmacist.
What is eczema?
Eczema is a long-term inflammatory skin condition that makes skin dry, itchy and inflamed. The word comes from the Greek for “to boil over”, which describes the hot, weepy skin of a bad flare. The most common form is atopic eczema, also called atopic dermatitis, but the term covers a family of related conditions that share the same core problem: a weakened skin barrier combined with inflammation.
Eczema isn’t contagious, and it isn’t caused by poor hygiene. It isn’t simply dry skin either. It’s driven by genes and the immune system, which is why moisturisers alone often don’t control a flare and an anti-inflammatory treatment is usually needed.
Types of eczema and dermatitis
“Dermatitis” simply means inflamed skin. Several conditions fall under the eczema and dermatitis umbrella, each with a different cause and pattern:
| Type | Key features | Common sites | Cause or trigger |
|---|---|---|---|
| Atopic eczema | Comes and goes; linked to asthma and hay fever; usually starts in childhood | Inside elbows, behind knees, face, hands, scalp | A weak skin barrier and an overactive immune response |
| Contact dermatitis | Irritant (from repeated exposure) or allergic | Hands most often; wherever contact happens | Soaps, detergents, nickel, latex, fragrances |
| Discoid eczema | Coin-shaped patches; usually adults | Lower legs and forearms | Not fully understood; skin injury; dry skin |
| Seborrhoeic dermatitis | Flaking and redness in oily areas; linked to a yeast called Malassezia | Scalp (dandruff), sides of the nose, eyebrows, chest | Malassezia; stress |
| Dyshidrotic eczema (pompholyx) | Small, intensely itchy blisters | Palms, soles, sides of fingers and toes | Sweating, heat, stress |
| Venous (varicose) eczema | Itchy, brown, thickened skin | Lower legs, around the ankles | Poor circulation in the leg veins |
This guide focuses mainly on atopic eczema, the most common type seen in UK primary care. For contact dermatitis, a dermatologist may suggest patch testing to find the cause.
What causes eczema?
A weak skin barrier
Many people with atopic eczema make less filaggrin, a protein that holds the outer skin layer together. The leaky barrier loses water and lets irritants and allergens in.
An overactive immune response
The same type of immune response behind asthma and hay fever drives the inflammation and itch of eczema.
Bacteria on the skin
Staphylococcus aureus bacteria live on most eczema skin during flares. Their toxins damage the barrier further and make flares worse.
Family history
Atopic eczema runs in families, often alongside asthma and hay fever. A child is more likely to have it if one or both parents do.
Common triggers
Triggers don’t cause eczema, but they set off flares in people who have it. Spotting and reducing your own triggers is a key part of long-term control:
- Soap and detergents: the most common irritant. Use an emollient instead of soap.
- Sweat and heat: both increase itching and scratching.
- Fabrics: wool and some synthetics irritate; cotton is usually better tolerated.
- Stress: can make inflammation worse.
- Dry air and cold weather: central heating and winter both dry the skin.
- Allergens: house dust mite, pet dander and pollen, especially where an allergy has been confirmed.
- Food: in young children, milk, egg, peanut, wheat or soy can sometimes play a part. In adults, food is a trigger less often than people think.
- Skin infection: bacteria both result from and drive flares. See infected eczema below.
How eczema is diagnosed
Eczema is diagnosed by examining the skin and asking about your history; there’s no blood test for it. UK prescribers use the UK Working Party diagnostic criteria (Williams and colleagues, 1994): an itchy skin condition in the last 12 months, plus three or more of:
- Started before age 2
- A history of eczema in skin creases (inside the elbows, behind the knees)
- Visible eczema in skin creases now
- A history of generally dry skin
- A personal history of asthma or hay fever (or a close relative with one, in a child under 4)
Patch testing may be offered if contact dermatitis is suspected, and allergy tests if a food or airborne allergy might be contributing.
The NHS treatment ladder for atopic eczema
NICE recommends a step-by-step approach, matching the steroid strength to how bad the eczema is and where it is. Emollients are the foundation at every step.
| Step | Treatment | Used for |
|---|---|---|
| Every step | Emollients, applied generously and often | Always, including between flares |
| Mild | Mild steroid, such as hydrocortisone 0.5% to 1% | Mild eczema; the face; children |
| Moderate | Moderate steroid, such as clobetasone 0.05% (Eumovate) | Moderate eczema |
| Severe | Potent steroid, such as betamethasone valerate 0.1% (Betnovate) or mometasone (Elocon) | Severe eczema on the body, arms and legs |
| Stubborn | Very potent steroid, clobetasol propionate 0.05% (Dermovate), short courses only | Severe eczema that a potent steroid hasn’t controlled, often on thick skin |
| Specialist | Light therapy, tablets that calm the immune system, or newer injected treatments | Severe eczema not controlled with creams |
For more, see our guides to emollients for eczema and steroid cream strengths.
Eczema in darker skin tones
Eczema is often missed or under-treated in darker skin. The redness that’s obvious on lighter skin can look purple, brown or grey, and is easy to overlook. Other things to look for:
- Darker patches that stay after the inflammation settles
- Small bumps around hair follicles rather than flat patches
- Thickened skin developing earlier from scratching
Lighter or darker patches can be more distressing than the eczema itself. Treating the inflammation properly is the best way to help them fade.
The itch-scratch cycle
Itch is the defining symptom of eczema, and scratching damages the skin barrier further, which makes the itch worse. Over time, repeated scratching thickens the skin into leathery patches that need stronger treatment. Itching is often worse at night. Sedating antihistamines are sometimes used for a short time to help sleep, but antihistamines don’t do much for eczema itch itself.
Infected eczema: signs, treatment and when it’s urgent
Eczema skin is more prone to infection because the barrier is damaged and bacteria are already living on it. Knowing the signs matters, because infected eczema needs a different approach from an ordinary flare.
Signs your eczema may be infected
- Weeping or oozing, with yellow fluid
- Golden or honey-coloured crusts
- Small pus-filled spots
- Skin that’s hot, swollen or painful, or a flare that’s getting worse quickly
- Feeling unwell, or a fever
Infected, or just a bad flare?
Bacteria live on most eczema skin during a flare without causing a true infection, and a weepy patch isn’t always infected. That’s why a prescriber looks at the whole picture, rather than starting an antibiotic for every flare.
How infected eczema is treated
NICE guidance (NG190) says:
- If you’re not otherwise unwell, antibiotics usually aren’t needed. Treating the eczema itself with the right-strength steroid is the main step, because antibiotics add little on top.
- For a small, localised infected patch, an antibiotic cream such as fusidic acid may be used for 5 to 7 days.
- For widespread or severe infection, antibiotic tablets are used instead, usually flucloxacillin for 5 to 7 days (clarithromycin if you’re allergic to penicillin, but not in pregnancy).
- Courses are kept short, because repeated use of fusidic acid makes bacteria resistant to it. Creams that combine a steroid with an antibiotic are covered below.
Eczema herpeticum is an emergency. If someone with eczema suddenly develops clusters of small, punched-out blisters or sores, often with a fever and feeling very unwell, the cold sore virus may be spreading across the skin. Get same-day help from NHS 111 or A&E, or call 999 in an emergency. Don’t use a steroid cream on it.
Other infections
Molluscum contagiosum, small pearly bumps caused by a virus, spreads more easily across eczema skin. Fungal infections can also look like eczema, and a steroid cream on its own can make them worse, which is one reason a new or unusual rash should be checked.
Steroid creams with an antibiotic or antifungal
Some prescription creams combine a steroid, to calm the eczema, with an antibiotic, an antifungal or both, to treat infection in the same patch. They’re used for short courses, usually up to a week, on eczema that is, or may be, infected, and they aren’t needed for every flare.
| Cream | Steroid | Treats |
|---|---|---|
| Fucidin H | Hydrocortisone (mild) | Bacteria (fusidic acid) |
| Fucibet | Betamethasone (potent) | Bacteria (fusidic acid) |
| Trimovate | Clobetasone (moderate) | Bacteria and yeast (oxytetracycline and nystatin) |
| Nystaform HC | Hydrocortisone (mild) | Yeast and bacteria (nystatin and chlorhexidine) |
| Betamethasone with clioquinol | Betamethasone (potent) | Bacteria and fungi |
| Betamethasone with neomycin | Betamethasone (potent) | Bacteria (neomycin) |
- Short courses only: longer or repeated use makes bacteria resistant to the antibiotic and raises the chance of skin allergy.
- Matched to the cause: fusidic acid creams don’t treat fungal infections, and a steroid can make an untreated fungal rash worse.
- Strength still matters: creams with a potent steroid aren’t usually used on the face or genitals.
Our online service supplies Fucibet and Fucidin H only for a small infected patch in someone who’s otherwise well, as one tube for up to 7 days. For how each cream compares, see our guide to steroid and antibiotic creams for infected eczema, and for the full range, our eczema and dermatitis treatment page.
When to see a doctor
- Eczema is affecting your sleep, work or daily life
- Pharmacy treatments haven’t controlled it after a few weeks
- Signs of infection: weeping, crusting, pus spots, fever or a flare getting worse quickly
- Any possible eczema herpeticum (see above), which is same-day urgent
- Eczema spreading to new areas or changing in appearance
- A child whose eczema isn’t controlled by emollients and a mild steroid
- Eczema appearing for the first time after age 40, which should be checked to rule out other causes
Eczema not settling with pharmacy treatments?
Our GPhC-registered pharmacist independent prescribers can assess your eczema online and, if suitable, prescribe a steroid of the right strength for the area. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Eczema Consultation →UK safety and prescribing information
- What you can buy: emollients and hydrocortisone 1% cream are sold in pharmacies. Pharmacy hydrocortisone is for adults and children aged 10 and over, not for the face or genitals, and for up to 7 days. Moderate, potent and very potent steroids are prescription-only medicines.
- Babies and children: potent and very potent steroids must not be used on babies under 1 year. In children, stronger steroids are used only on a prescriber’s advice and for short, reviewed courses.
- Topical steroid withdrawal (MHRA): rarely, stopping a moderate or stronger steroid after long-term daily use causes burning and spreading redness. If your skin gets worse within 2 weeks of stopping, speak to a doctor or pharmacist before restarting.
- Fire risk (MHRA): clothing, bedding and dressings with emollient on them, paraffin-based or paraffin-free, burn more easily, even after washing. Don’t smoke or go near naked flames.
- Pregnancy and breastfeeding: emollients are safe. If a steroid is needed, your GP or midwife will advise the smallest amount for the shortest time. Our online service can’t supply treatment during pregnancy or breastfeeding. If breastfeeding, don’t apply steroids to the breasts.
- NHS route: your GP can prescribe emollients and steroids and refer you to a dermatologist. Prescription charges apply in England unless you’re exempt; prescriptions are free in Scotland, Wales and Northern Ireland.
- Reporting side effects: tell your pharmacist or doctor, or report it to the MHRA through the Yellow Card scheme.
Eczema treatment from Access Doctor
When emollients and pharmacy treatments aren’t enough, our prescribers can assess you online and supply a steroid cream or ointment matched to the strength your eczema and the area need. See our eczema and dermatitis treatment page for the full range, and our guides below for each treatment.
Frequently Asked Questions
What is eczema?
Eczema is a long-term inflammatory skin condition that makes patches of skin dry, itchy, red and cracked. The most common type is atopic eczema (atopic dermatitis), which affects around 1 in 5 children in the UK as well as many adults. It isn’t contagious and isn’t caused by poor hygiene.
What causes atopic eczema?
Atopic eczema is caused by a combination of a weakened skin barrier, often linked to changes in the filaggrin gene, and an overactive immune response. This lets irritants and allergens into the skin and triggers inflammation. It often runs in families alongside asthma and hay fever.
Is eczema contagious?
No. Eczema can’t be passed from person to person. It’s an inflammatory condition with a genetic basis. Infected eczema can involve bacteria or viruses that spread, but the eczema itself doesn’t.
Is eczema the same as dermatitis?
The terms are often used interchangeably. Dermatitis simply means inflamed skin, and eczema is a type of dermatitis with dry, itchy, inflamed skin. Atopic eczema, contact dermatitis and seborrhoeic dermatitis are all forms of dermatitis. In everyday use, eczema usually means atopic eczema.
What are the main types of eczema?
The main types are atopic eczema (the most common, linked to allergies), contact dermatitis (caused by irritants or allergens), discoid eczema (coin-shaped patches), seborrhoeic dermatitis (oily areas such as the scalp and face), dyshidrotic eczema (small blisters on the hands and feet) and venous eczema (linked to poor circulation in the legs).
What are common eczema triggers?
Common triggers include soap and detergents, sweat and heat, wool and some synthetic fabrics, stress, dry air, house dust mites, pet dander and skin infections. Triggers vary from person to person, so working out your own is a key part of keeping eczema under control.
Does eczema go away?
There’s no cure, but eczema often improves a lot as children grow up, and many grow out of it. In adults, it tends to come and go, with flares and calmer spells. Daily emollients, avoiding triggers and treating flares early can keep it well controlled.
When should I see a doctor about eczema?
See a doctor or prescriber if eczema is affecting your sleep or daily life, if pharmacy treatments aren’t controlling it, or if it looks infected (weeping, crusting, more redness, heat or a fever). Get same-day help for sudden, severe worsening with punched-out blisters, which could be eczema herpeticum.
Can I get eczema treatment on the NHS?
Yes. Your GP can diagnose eczema, prescribe emollients and steroids, and refer you to a dermatologist if needed. Prescription charges apply in England unless you’re exempt, and prescriptions are free in Scotland, Wales and Northern Ireland. Stronger steroids always need a prescriber’s assessment, on the NHS or from a regulated online pharmacy.
How do I know if my eczema is infected?
Signs include weeping with yellow fluid, golden or honey-coloured crusts, small pus spots, skin that’s hot, swollen or painful, a flare getting worse quickly, or feeling unwell or feverish. Clusters of punched-out sores with a fever could be eczema herpeticum, which needs same-day help.
Do I always need antibiotics for infected eczema?
No. NICE says that if you’re not otherwise unwell, antibiotics usually aren’t needed, and treating the eczema with the right steroid is the main step. A small infected patch may be treated with an antibiotic cream for 5 to 7 days, and widespread infection with antibiotic tablets.
Can I use a steroid cream on infected eczema?
A steroid cream is often still part of treatment, because settling the eczema helps the skin clear the infection. But a steroid alone isn’t right if the infection is spreading, you feel unwell or it could be eczema herpeticum. Get advice first, and don’t use a steroid on a cold sore type rash.
Is infected eczema contagious?
The eczema isn’t, but the infection can be. Bacteria such as Staphylococcus aureus and the cold sore virus can spread through close contact, so wash your hands after touching the area, don’t share towels, and keep the skin covered if it’s weeping.
What is eczema herpeticum?
Eczema herpeticum is a serious infection where the cold sore virus (herpes simplex) spreads across eczema skin. It causes clusters of painful, punched-out blisters or sores, often with a fever and feeling unwell. It needs same-day medical assessment through NHS 111 or A&E, and antiviral treatment.
References
- NICE Clinical Knowledge Summaries. Eczema – atopic. cks.nice.org.uk
- NICE. Atopic eczema in under 12s: diagnosis and management (CG57). nice.org.uk
- NICE. Secondary bacterial infection of eczema and other common skin lesions: antimicrobial prescribing (NG190). nice.org.uk
- Williams HC et al. The UK Working Party’s diagnostic criteria for atopic dermatitis. Br J Dermatol. 1994;131(3):383–396.
- Palmer CN 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.
- MHRA. Topical corticosteroids: information on the risk of topical steroid withdrawal reactions. Drug Safety Update, September 2021. gov.uk
- NHS. Atopic eczema. nhs.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Always speak to a qualified healthcare professional for diagnosis and treatment. Stronger steroid creams are prescription-only medicines and need a clinical consultation before they can be supplied. In a medical emergency, call 999.
