Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Eczema doesn't go in a straight line. It flares, settles, and flares again, and most of the questions people search in the middle of a bad patch, what cream to use, how to stop the itching, whether it's the steroid or the moisturiser that's needed, come down to the same two-part answer: emollient every day to keep the skin's barrier intact, and a short course of something stronger when it breaks through. Here's how to do both properly, and what else is quietly making it worse.
What does an eczema flare-up look like?
Patches of skin that are dry, itchy, rough and inflamed: red on lighter skin, darker brown, purple or grey on darker skin, sometimes with tiny blisters, weeping or crusting if it's been scratched. In adults it favours the hands, the insides of the elbows, the backs of the knees, the neck and the face; in babies it often starts on the cheeks and scalp. The itch is the defining feature. It's worse at night, and scratching makes the skin thicker and itchier, which is the cycle a flare has to be broken out of.
What causes eczema flare-ups?
Atopic eczema runs in families alongside asthma and hay fever, and the underlying problem is a skin barrier that leaks moisture out and lets irritants in. Flares are set off by whatever gets through: soap, bubble bath and shower gel (the biggest one), biological washing powder, wool and synthetic fabrics against the skin, heat and sweating, cold dry weather and central heating, dust mites and pet dander, stress and poor sleep, hormonal shifts before a period, and skin infections. A patch that's always in the same place, say under a watch strap or where a ring sits, is more likely contact dermatitis, an allergy to the thing touching it, and the fix is removing it.
How to use emollients so they actually work
This is where most eczema care goes wrong: too little, too rarely, and the wrong kind. The rules:
- Twice a day minimum, every day, flare or no flare. Emollient is the treatment, not the aftercare. Most adults need 250 to 500g a week to do this properly, so buy the big pump, not the small tube.
- Smooth it on in the direction the hair grows, don't rub it in. Rubbing irritates and blocks follicles.
- Replace soap entirely. Wash with the emollient or a soap substitute; every bar of soap strips the oils you're trying to put back.
- Within three minutes of a bath or shower, while the skin is still damp, is when it works best. Keep the water warm, not hot, and short.
- Use a pump or a clean spoon to get cream out of a tub; fingers in the pot seed it with bacteria.
- Leave 30 minutes between emollient and a steroid cream so one doesn't dilute the other.
What's the best cream for eczema?
The one you'll use enough of. Greasier is more effective but less pleasant, so many people use a lighter cream by day and an ointment or balm at night.
| Type | Examples | Best for |
|---|---|---|
| Lotions and light creams | Aveeno Dermexa Daily Emollient Cream, E45 Cream | Daytime, large areas, hairy skin, mild dryness. Dermexa adds oat and ceramides, which calm itch. |
| Richer creams | Cetraben, Oilatum Cream | Everyday moderate eczema; the workhorses GPs prescribe. |
| Balms and ointments | Aveeno Dermexa Night-Time Balm | Night, hands, very dry or thickened patches. Greasy, so socks or cotton gloves over the top help. |
| Wash and bath | Dermexa Body Wash, Oilatum bath emollient, Cetaphil cleanser | Replacing soap and shower gel. The single biggest change most people can make. |
Avoid aqueous cream as a leave-on moisturiser; it contains a detergent and makes eczema worse. Plain petroleum jelly is fine as an occlusive layer over a damp patch but does nothing on its own. The full range is in our skin treatments collection.
When to use hydrocortisone cream
When a patch is inflamed, itchy and not settling with emollient alone, a mild steroid cream for a few days brings it down faster and breaks the scratch cycle. Hydrocortisone 1% is sold over the counter for adults and children over ten, for up to a week, on the body and limbs but not the face, genitals or broken skin; our guide to hydrocortisone cream covers the detail. Apply a thin layer once or twice a day to the flare only. Used like that, short bursts when needed, it's safe; the thinning-skin fear comes from months of continuous use, not a week. Patches that need steroid more than a couple of times a month, or on a child's face, are a GP conversation about a stronger or more regular plan.
How to stop eczema itching at night
Emollient before bed, a cool bedroom, cotton bedding and nightwear, and short nails (cotton gloves or scratch mitts for children). A cool damp flannel on the itchiest patch for five minutes numbs it. If the itch is still wrecking sleep, a sedating antihistamine such as promethazine for a few nights helps you sleep through it, though it doesn't treat the eczema itself; non-drowsy antihistamines do little for eczema itch. Stress and tiredness feed the itch, so a bad week at work often shows up on the skin a few days later.
Signs of infected eczema: see a GP
Scratched eczema lets bacteria in. See a GP urgently if a patch is weeping, crusted yellow, blistered or has pus spots, is hot, swollen and spreading, or you have a fever. Clusters of small painful blisters that are punched-out and spreading fast, especially on the face, could be eczema herpeticum, which is a same-day emergency. Also see a GP if eczema is widespread, not responding to a week of steroid, affecting sleep or school, or you're unsure it's eczema at all; psoriasis, ringworm and scabies all get mistaken for it.
Frequently asked questions
Can eczema be cured permanently?
No, but it can be controlled so well it's rarely seen. Many children grow out of it by their teens; adults manage it with daily emollient and occasional steroid.
Is eczema contagious?
Never. Infected eczema can pass the infection on, but not the eczema.
Is Sudocrem good for eczema?
Not as a treatment. It's a barrier cream for nappy rash and minor grazes; the zinc oxide and lanolin can irritate eczema, and it contains no emollient to speak of. Use a proper emollient.
Does diet cause eczema?
Rarely in adults. In babies with severe eczema, cow's milk or egg allergy can be a factor, but cutting foods out on a hunch does harm; ask a GP or health visitor first.
Is it eczema or psoriasis?
Eczema is itchy, ill-defined and sits in the creases; psoriasis is well-defined, silvery-scaled, more sore than itchy, and favours elbows, knees and the scalp. Emollients help both, but the stronger treatments differ, so a patch that doesn't behave like eczema deserves a proper look.
Can I use eczema cream on my baby?
Emollients, yes, as often as you like, and they're the mainstay of baby eczema. Over-the-counter hydrocortisone isn't licensed under ten; a GP or health visitor can prescribe a mild steroid for a baby when it's needed.