Atopic eczema: the right skincare for a weakened skin barrier

With atopic eczema, regular use of emollients aims to:

• Reduce water loss from the skin
• Add and bind moisture
• Soften dry and scaling skin
• Support the function of the skin barrier
• Reduce irritation and discomfort

A good cream usually combines humectant ingredients with lipids or other emollients that help reduce transepidermal water loss.

How rich the cream should be depends on the state of the skin. For very dry skin, a rich cream or ointment is often more suitable than a light lotion. At the same time, tolerance and usability matter: a cream that feels pleasant and is therefore used regularly is in practice often a better choice than a very greasy one that gets avoided.

There is no single cream that suits everyone. The choice should reflect the degree of dryness, the area of skin, age and how irritated the skin is. For dry, eczema-prone skin, products with few and well-tolerated ingredients are generally recommended. Fragrance can irritate sensitive skin, so fragrance-free products are often the sensible choice.

Very dry skin: a rich cream or ointment with a high lipid content can be particularly useful, forming a more occlusive surface that reduces water loss. Ingredients such as glycerol and urea can increase the skin's water content. Urea can, however, sting on very irritated, cracked or actively eczematous skin, so concentration and tolerance should be taken into account.

Milder dryness: a somewhat lighter cream can be sufficient. What matters most is that the product provides enough moisture to keep the skin soft and that it is used regularly.

Eczema on the face can be especially troublesome. Facial skin is often more sensitive and is exposed to many potential irritants through skincare, cosmetics, weather and temperature changes. Keep the routine simple:

• Gentle cleansing
• A hydrating and protective serum
• A barrier-supporting moisturiser
• Sun protection during the day

During an active flare, be careful with potentially irritating ingredients such as acids, retinoids, strong peels, fragrance and essential oils. If the skin is clearly red, inflamed and itchy, remember this is not only a moisture problem — active atopic eczema may require medical anti-inflammatory treatment in addition to regular emollient use.

Hands are especially vulnerable because they are washed frequently and come into contact with water, soap, cleaning agents, cold and other irritants. With hand eczema it is important to combine good skincare with reducing the load on the skin.

Apply a rich, softening cream after hand washing and as needed through the day. In the evening, apply a thicker layer before bed. For pronounced dryness, cotton gloves over the cream at night are a simple way to increase contact time between the skin and the product.

For eczema on the body a complicated routine is unnecessary. What matters is the regular use of a suitable emollient. Apply cream shortly after showering or bathing, once the skin has been gently patted dry. This helps reduce drying out and maintain the skin's moisture level. For very dry skin an ointment or rich cream may be appropriate, while a lighter cream can be enough for milder dryness.

Atopic eczema is most common in children, and children's skin is thinner and more absorbent. Use fragrance-free products with simple formulations, apply generously and often, and avoid actives entirely. Always follow the advice of your child's doctor or health visitor about treatment of an active flare, and seek medical advice rather than experimenting when a child's eczema worsens.

Itching is one of the most characteristic symptoms of atopic eczema and can have a major impact on sleep and quality of life. It arises partly from inflammation and dryness. Scratching in turn damages the skin barrier and intensifies inflammation — often called the itch-scratch cycle. To help break it:

• Moisturise regularly
• Avoid very hot water
• Use mild, fragrance-free products
• Avoid clothing that irritates the skin
• Keep the skin and the bedroom reasonably cool

With pronounced itching it is important to treat the eczema and the inflammation itself. Moisturiser alone is not always enough during an active flare.

It is important to distinguish between dry skin and active atopic dermatitis. If the skin is markedly red, inflamed, weeping or painful, or if the itching is pronounced and affects sleep and daily function, contact a doctor. A medical assessment is also relevant if:

• The eczema does not improve with regular moisturising
• The skin becomes warm, swollen or painful
• There is weeping, yellow crusting or other signs of infection
• You are unsure what it is
• The eczema significantly affects sleep or quality of life

For active atopic dermatitis a doctor can assess the need for topical anti-inflammatory treatment, for example corticosteroids or other prescription medicines. These treatments can be used alongside regular moisturising.

With atopic eczema the aim is not only to add moisture, but to reduce water loss and support the skin barrier over time. Good basic care means regular use of a suitable emollient, adapted to the degree of dryness and the area of the body. With active inflammation, medical treatment may be necessary in addition.