Eczema

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 19 Mar 2025

Last updated: 07 Aug 2024

Eczema (atopic dermatitis) commonly presents with dry, itchy skin.

Typically there is erythema, scaling, vesicles, or lichenification in skin flexures.

Diagnosis is primarily clinical.

First-line treatment is with emollients and topical corticosteroids.

Other options that may be used in patients unresponsive to first-line therapy include topical calcineurin inhibitors, topical phosphodiesterase-4 inhibitors, topical Janus kinase inhibitors, phototherapy, biological agents, or systemic immunomodulatory agents.

Definition

Eczema (atopic dermatitis) is an inflammatory skin condition characterised by dry, pruritic skin with a chronic relapsing course. It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% to 20% of children. Patients often have a personal or family history of other atopic diseases such as asthma or allergic rhinitis. Food allergies may occur at increased rates in this population.

Eczema can be described as acute or chronic. Acute eczema is used to describe a flare-up of symptoms. Chronic is used to describe the condition when the patient develops signs of chronic inflammation (e.g., lichenification).

History and exam

Key diagnostic factors

presence of risk factors
pruritus
xerosis (dry skin)
sites of skin involvement

Full details

Other diagnostic factors

erythema
scaling
vesicles
papules
keratosis pilaris
excoriations
lichenification
hypopigmentation

Full details

Risk factors

filaggrin gene mutation
age <5 years
family history of eczema
allergic rhinitis
asthma
active and passive exposure to smoke
female sex
African-American ethnicity

Full details

Diagnostic investigations

1st investigations to order

clinical diagnosis

Full details

Investigations to consider

IgE levels
skin-prick testing
oral food challenge
trial elimination diet
patch testing
skin biopsy

Full details

Treatment algorithm

ACUTE

acute flare

ONGOING

chronic or relapsing disease

Contributors

Authors

Adelaide A. Hebert, MD

Professor & Director of Pediatric Dermatology

Clinical Specialist

Department of Dermatology and Pediatrics

University of Texas Health Sciences Center at Houston

Houston

Disclosures

AAH has received research grants paid to UTHealth McGovern Medical School Houston from Pfizer, GSK, Dermavant, Arcutis, and Novan; has received honoraria from Pfizer, Verrica, and Novan; and is on the data safety monitoring boards for GSK, Ortho Dermatologics, and Regeneron-Sanofi.

Alexander Jafari, MD

Dermatology Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

Disclosures

AJ declares that he has no competing interests.

Matthew Dallo, MD

Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

Disclosures

MD declares that he has no competing interests.

Acknowledgements

Dr Adelaide A. Hebert, Alexander Jafari, and Dr Matthew Dallo would like to gratefully acknowledge Dr Eugenio G. Galindo, Dr Quoc-Bao D. Nguyen, Dr Mary D. DarConte, Dr Christina M. Gelbard, and Dr Daniel A. Grabella, previous contributors to this topic.

Disclosures

EGG, QBDN, MDD, CMG, and DAG declare that they have no competing interests.

Peer reviewers

Amor Khachemoune, MD

Assistant Professor

New York University School of Medicine

Disclosures

AK declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals

Nottingham

Disclosures

JE declares that he has no competing interests.

Differentials
- Seborrhoeic dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
More Differentials
Guidelines
- Guidelines of care for the management of atopic dermatitis
- Atopic eczema in under 12s: diagnosis and management
More Guidelines
Patient information
Eczema
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Eczema

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

acute flare

chronic or relapsing disease

Contributors

Authors

Adelaide A. Hebert, MD

Disclosures

Alexander Jafari, MD

Disclosures

Matthew Dallo, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Amor Khachemoune, MD

Disclosures

John English, MBBS, FRCP

Disclosures

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice