Approximately 8 million people in the UK suffer from eczema of some form, meaning it’s one of the most common skin conditions around. However, it’s also often highly misunderstood—from what actually causes eczema to the best preventative measures and ways to treat it, there’s an overwhelming amount of information online, making it difficult to determine what’s really true. We spoke to three experts to demystify eczema.

What actually is eczema?

Those who suffer with eczema will be familiar with how it manifests, as well as individual triggers. But taking it back to basics, eczema is a condition “characterised by itchy, red and inflamed skin,” notes EV Expert and Cosmetic Doctor Dr Emmaline Ashley. It is also known—more so in the medical community—as ‘atopic dermatitis.’
 
“At its core, the problem is a dysfunction of the normal skin barrier. When the barrier isn't working properly, the skin becomes more vulnerable to dehydration, irritation, and infection,” says Ashley. Eczema can appear anywhere on the body, including the face.

What causes it, and why are some more prone than others?

As mentioned, this is primarily a skin barrier issue: your skin barrier maintains things like hydration levels and also keeps out irritants that could trigger your skin. When it’s compromised, you can experience everything from acne and redness to, in this case, eczema.

Interestingly, genetics play a part in skin barrier strength. “Eczema often runs in families and is linked to genes that build the skin barrier, particularly filaggrin,” explains EV Expert and Aesthetic Practitioner, Dr Raquel Amado. “If that barrier is genetically weaker, the skin dries out more easily and becomes prone to irritation and allergy.”

Because of this, some of us are naturally more prone to the condition, along with asthma and hayfever, two other atopic conditions with similar features. “If parents have atopic conditions, their children are more likely to develop eczema themselves. Worldwide, it affects about 13 per cent of children and 7 per cent of adults, so it's incredibly common,” says Dr Ashley.

However, genetic factors aren’t the only ones to consider; it’s often a combination of being pre-determined genetically, along with certain lifestyle triggers. “It's a complex condition involving genetic factors, immune dysregulation, and environmental triggers that all contribute to disrupting the skin's protective barrier,” Ashley concludes.

Can you prevent eczema? 

On the whole, the answer to this is generally no, but with several caveats. For one, while you can’t prevent being genetically predisposed to eczema, you can learn about your individual triggers and the way your condition works in order to prevent flare-ups. These may include fragranced beauty products and sustained exposure to central heating, or very cold weather.

“Moisturise daily (especially after bathing), use gentle fragrance-free products, avoid known triggers, and keep nails short to limit scratch damage,” says Dr Amado, in terms of preventative care. “An anti-inflammatory diet and elimination of some carbohydrates can also help,” she adds, although this is something you should always work with a specialist on.

There is also promising new research that may prove there are more intentional, practical steps you can take in order to limit your chances. “Research has evolved significantly, with current evidence looking at everything from skin barrier enhancement to probiotics, vitamin D supplementation, and dietary modifications,” explains Dr Ashley. However, while further evidence is needed, she adds, “the most promising approach [still] seems to be early and regular use of emollients to maintain skin barrier health, particularly in high-risk individuals.”

The best eczema treatment options 

No matter when you developed the condition or what your triggers are, discovering the best ways to manage your eczema is essential. This will likely take different forms depending on whether you’re currently going through a flare-up, or are just in more of a ‘maintenance’ phase.

For the latter, it’s important to commit to consistency. “Long-term management is based on daily emollients to restore the barrier,” says Consultant Dermatologist Dr Sidra Khan. Frequency and amount are crucial, adds Dr Ashley. “The cornerstone is generous and frequent use of emollients—I'm talking every two-to-three hours during bad patches! This helps maintain the skin barrier and lock in moisture.” Stick to non-fragranced, gentle but highly emollient formulas, which ideally have been recommended by a dermatologist for you specifically.

For skin that’s particularly vulnerable—such as on the eyelids—you may want to take an even gentler approach. “The eyelids need extra care because the skin there is so much thinner and more sensitive,” notes Ashley, who suggests using emollients like on the rest of the face, “just with gentler, more carefully selected products.” Dr Khan recommends seeking out specialised treatments for areas like this if necessary. “On eyelids, only mild corticosteroids (short courses) or non-steroid options like topical calcineurin inhibitors are recommended to reduce risk of skin thinning.”

In terms of flare-ups, you may need to opt for more of a targeted approach, says Ashley. “Topical corticosteroids are the first-line treatment, with topical calcineurin inhibitors like pimecrolimus and tacrolimus being important alternatives—these medications should be prescribed by your doctor.”

If you’re experiencing more moderate-to-severe symptoms (that don’t tend to respond to topical treatments) however, you may need to work with a specialist on something different. “There are now excellent systemic medications including biologics and phototherapy,” adds Ashley.

In clinic solutions

There may also be aesthetic treatments that can help, but only during the maintenance phase. “While these aren't treatments for active eczema flare-ups, there are some fantastic aesthetic treatments that can help strengthen and repair the skin barrier in eczema-prone skin during remission periods," says Ashley. "These work particularly well as preventative and maintenance treatments." She recommends trying Profhilo, Polynucleotides or plant-based exosomes—although again, it’s important for your practitioner to assess and recommend based on your individual case.