Eczema in adults: managing the itch and flares

Key takeaways

• Adult eczema is common. It can continue from childhood or appear for the first time in adulthood.
• Moisturiser is the treatment, not an extra. Use it at least twice a day, even when the skin looks fine.
• Prescribed steroid creams, used correctly for short periods, are safe and effective. Unprescribed mixed creams are a different story.
• Hand eczema from detergents, dishwashing and frequent washing is very common in Indian homes.
• Oozing, crusting, pus, sudden spread or fever means possible infection and needs urgent care.

Why do adults get eczema?

People are often surprised. "Doctor, I thought eczema was something children get." It is common in children, but the NHS notes it affects all ages. DermNet describes adult patterns: some people continue the childhood pattern in the elbow and knee creases, some develop it mostly on the hands, some on the eyelids, and some develop it for the first time as adults.

See, what happens is, the skin barrier in eczema-prone skin does not hold water and keep out irritants as well as it should. The skin dries, irritants get in, the immune system overreacts, and it itches. Scratching damages the barrier further. That is the itch-scratch cycle, and most of the treatment is about breaking it.

There is often a family pattern. The NHS notes the risk is higher if a parent has eczema, or if you or a close relative has asthma or hay fever.

What triggers flares in adults?

The NHS and DermNet list the common ones. In Thane and Mumbai homes, these are the ones I hear about most: - Soap and detergents: dishwashing liquid, washing powder, floor cleaners and frequent handwashing - Water work: cooking, cleaning and childcare with wet hands many times a day - Heat and sweat: the humid months, and sudden temperature changes - Dry air: long hours in air conditioning, and the short dry winter - Fabrics: wool and rough synthetics - Fragrances: in soaps, lotions, detergents and room fresheners - Stress and poor sleep - Skin infections

DermNet notes that adult eczema often flares with caregiving, domestic duties or certain occupations, which matches what I see. If your eczema does not improve with good treatment, patch testing for a contact allergy may be worth doing.

How should I look after my skin every day?

This is the part that does the most work. The NHS and DermNet recommend:

1. Moisturise at least twice a day. DermNet suggests two to three times a day and notes adults with widespread eczema may need up to 500 g of cream a week. Most people use far too little.
2. Keep moisturising when the skin is better. That is very important to understand. Stopping when it clears is the most common reason for the next flare.
3. Wash with a soap substitute, an emollient wash or cream instead of soap.
4. Use a pump or a clean spoon, not fingers in the tub, to avoid contaminating it.
5. Choose simple, fragrance-free products. DermNet suggests few ingredients and no sodium lauryl sulfate.
6. Avoid aqueous cream as a leave-on moisturiser; the NHS notes it can irritate.
7. Short, lukewarm baths or showers, then pat dry and moisturise within a few minutes.
8. Protect your hands. Cotton gloves under rubber gloves for wet work, and moisturise after every wash.

The NHS also gives a safety note: emollients soaked into clothes and bedding make fabric burn more easily, so be careful near flames, including the gas stove and diyas.

Are steroid creams safe for eczema?

Prescribed correctly, yes. Topical steroids are a main treatment, alongside moisturisers. DermNet advises the weakest effective strength for the shortest time, with the amount guided by the "fingertip unit" (the length of cream from the tip of your finger to the first crease, which covers about two adult palms).

There is also a useful approach called proactive or weekend therapy. Once a flare is under control, DermNet describes applying the steroid two days a week to the areas that usually flare, which helps prevent the next one. Your doctor will tell you whether this suits you.

What is not safe is using strong steroid creams, or mixed creams with steroids, bought over the counter for months without supervision. I have written about that in the hidden steroid problem. So the question is not "steroid or no steroid". It is the right strength, in the right place, for the right time.

For thin skin, such as the eyelids and folds, DermNet notes non-steroid creams called calcineurin inhibitors, tacrolimus and pimecrolimus, are suitable.

What if creams are not enough?

For moderate to severe eczema, other options exist. These are prescription decisions made after proper assessment:

When should I see a doctor urgently?

The NHS lists signs that may mean infection or a more serious problem: - Blistering, crusting, oozing or pus-filled spots - Pain, swelling or warmth - Sudden worsening or spreading - Fever or feeling unwell

One serious complication, eczema herpeticum, is caused by the cold sore virus and needs same-day medical attention. Do not wait for your next routine appointment.

How we approach this at Dr Tvacha

Under the Second Layer Skin Plan at our Thane, Andheri, Bandra and Dahisar centres, I look at the pattern, your work and home routine, and every product you use. The plan is written down: daily care, what to do in a flare, and when to step back down. Tests such as patch testing are suggested only when they will change treatment, and charged at actual cost. If eczema is severe or not responding, I will tell you plainly when you need a dermatology specialist's care. For dry skin from air conditioning, see dry skin from AC and winter.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.