GP · dermatological-presentations
Atopic eczema
Also known as Atopic dermatitis · Eczema · Infantile eczema
GP-fellowship guide to atopic eczema: age-based morphology and diagnosis, emollients in quantities that work, the topical corticosteroid ladder with fingertip units and site-matched potencies, calcineurin inhibitors for face and flexures, flare and wet-wrap management, infection recognition including eczema herpeticum as an emergency, bleach-bath evidence, dupilumab for severe disease, and the sleep-psychological burden.
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Red flags
- Punched-out erosions, clustered vesicles, fever or rapid worsening in eczema = suspected eczema herpeticum — same-day systemic aciclovir
- Weeping crusted skin with pustules suggests staphylococcal impetiginisation — swab and treat, do not simply escalate steroids
- Failure to thrive or growth faltering with eczema raises food allergy or severe disease needing specialist review
- Eczema with unrelenting night-time itch breaking sleep every night is a medical problem, not a parenting issue — escalate therapy
Overview
Atopic eczema is a chronic, relapsing, intensely itchy inflammatory skin disease driven by skin-barrier dysfunction and type 2 immune activation. It affects a substantial minority of children in high-income countries, usually begins in the first years of life, and follows a relapsing course through childhood with flexural predominance; many children clear by adolescence while a subset carry disease into adulthood.[8]
It sits at the top of the atopic triad — eczema, asthma, allergic rhinitis — and its burden is dominated by itch: sleep disruption mediates a significant slice of the emotional and behavioural problems seen in affected children, independent of how long they sleep.[11]
References11ShowHide
- [1]Long CC et al. The finger-tip unit--a new practical measure. Clin Exp Dermatol, 1991.PMID 1806320
- [2]Simpson EL et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med, 2016.PMID 27690741
- [3]Blauvelt A et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet, 2017.PMID 28478972
- [4]George SM et al. Interventions to reduce Staphylococcus aureus in the management of eczema. Cochrane Database Syst Rev, 2019.PMID 31684694
- [5]Stacey SK et al. Topical Corticosteroids: Choice and Application. Am Fam Physician, 2021.PMID 33719380
- [6]Axon E et al. Safety of topical corticosteroids in atopic eczema: an umbrella review. BMJ Open, 2021.PMID 34233978
- [7]Bakaa L et al. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol, 2022.PMID 35367346
- [8]Chu DK, Schneider L, Asiniwasis RN, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol, 2024.PMID 38108679
- [9]Lax SJ et al. Topical Anti-Inflammatory Treatments for Eczema: A Cochrane Systematic Review and Network Meta-Analysis. Clin Exp Allergy, 2024.PMID 39219446
- [10]LeBovidge JS et al. Depression and anxiety in patients with atopic dermatitis: Recognizing and addressing mental health burden. Ann Allergy Asthma Immunol, 2025.PMID 40117438
- [11]Bao A et al. Mediation of pediatric atopic dermatitis in emotional and behavioral outcomes by sleep disturbance. Ann Allergy Asthma Immunol, 2025.PMID 40456485