Eczema (Atopic Dermatitis) in Ireland — Patient Guide

What is eczema?

Atopic eczema (atopic dermatitis) is a chronic, relapsing inflammatory skin condition. It affects roughly 1 in 5 Irish children and 1 in 12 adults per HSE estimates. It is part of the "atopic triad" alongside asthma and hay fever — these conditions often run together in families. Most childhood eczema improves with age but can persist into adulthood; adult-onset eczema is also increasingly recognised.

Symptoms and pattern

• Itching — often the most distressing symptom, worse at night
• Dry, scaly skin patches — typically in skin folds (elbow creases, behind knees, neck, behind ears)
• Red or inflamed areas, sometimes weeping or crusting during flares
• Skin thickening (lichenification) from chronic scratching
• Sleep disruption and impact on mood
• Babies often present on face and scalp; older children/adults on flexures

Common triggers

Per NICE CKS:

• Skin irritants — soaps, bubble bath, detergents, fragranced products
• Heat and sweating — including overheating from too many bed covers
• Fabrics — wool, synthetics often irritate; cotton is gentler
• Stress
• Viral and bacterial infections — can trigger flares
• Aeroallergens — dust mites, pollen, animal dander (in some patients)
• Food allergens — only in a minority of young children (typically milk, egg, peanut); routine elimination diets not recommended without confirmed allergy

Treatment — the stepped approach

Per NICE and HSE guidance:

1. Daily emollients (foundation)

The single most important intervention. Apply generously (think "litres a week" for severe cases) several times a day, even when skin looks clear. Use as soap substitute. Different formulations suit different people — ointment is greasiest and most effective but cosmetically heavier; creams are lighter.

2. Topical corticosteroids (flares)

Used in courses during flares — short, decisive treatment is more effective and safer than prolonged weak treatment:

• Mild (hydrocortisone 1%) — face, genitals, infants
• Moderate (clobetasone) — body folds, mild-moderate eczema
• Potent (mometasone, betamethasone) — body, severe flares, short courses

Apply once-twice daily for typically 7-14 days during a flare. Used appropriately, topical steroids are safe — concerns about skin thinning relate to long-term continuous use of strong steroids on thin skin.

3. Topical calcineurin inhibitors

Tacrolimus or pimecrolimus — steroid-sparing options useful for face or long-term use.

4. Add-ons

• Antihistamines for itch-related sleep disturbance
• Antibiotic treatment for confirmed bacterial superinfection
• Wet wraps for severe flares (under specialist guidance)
• Specialist referral for severe or refractory eczema — phototherapy, systemic agents (dupilumab and others)

Infection — important to recognise

Eczema can become bacterially infected (gold-yellow crusting, increased redness, weeping, fever) or virally infected — particularly eczema herpeticum (small painful blisters, fever, generally unwell) which is a medical urgency. Eczema herpeticum needs same-day in-person care and oral antiviral treatment.

Online Doctor consultation

An eczema consultation covers: severity assessment via photo, prescription of appropriate emollients and topical steroids, advice on routine, identifying triggers, and referral pathway if severity warrants. For suspected infection (especially eczema herpeticum), in-person assessment is appropriate.