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Eczema (Atopic Dermatitis)

Dry, intensely itchy, inflamed skin that comes and goes in flares. It usually starts in babies and young children but can begin at any age. There is no cure, but daily skin care and the right treatment can calm it — and some infections need care the same day.

Get same-day medical care — or go to an emergency room — if someone with eczema has:

  • Painful, spreading clusters of blisters or sores, with a fever or feeling unwell. This can be eczema herpeticum, a serious infection with the cold sore virus (herpes simplex): itchy, watery or dome-shaped blisters that may spread quickly and hurt, with fever, tiredness or swollen glands. Untreated, the blisters can bleed, crust and look like open sores (American Academy of Dermatology, AAD). In babies, children and anyone with a weakened immune system it can be life-threatening and needs immediate care (AAD). Act fastest for a baby or for a rash near the eyes, which may need an eye specialist (AAD).
  • Signs of a skin infection: spreading redness or streaks, pus-filled blisters, yellow or honey-colored crusts, or skin that is painful, swollen or warm (AAD, NHS). With a fever (100.4°F or higher) or flu-like symptoms, get immediate care (AAD). The NHS says eczema that is blistered, crusty, leaking or suddenly worse, especially with a high temperature or feeling unwell, may be infected or may be eczema herpeticum (NHS). MedlinePlus advises calling your provider for fever, redness or pain (MedlinePlus).

Stop wet wraps or covering the skin until a doctor says it’s safe (AAD). No herb, oil or complementary approach treats these infections. See our Cold Sores and Cellulitis guides.

What is eczema?

“Eczema” names a group of conditions that cause rashes, itch and very dry skin. Atopic dermatitis is the most common type (AAD): a long-lasting inflammatory skin disease that usually begins in childhood but can start at any age, and comes in flares with calmer spells between. It is not contagious (NIAMS). There is no cure, but treatment can bring clearer — sometimes completely clear — skin (AAD). The National Eczema Association estimates that about 31.6 million people in the U.S. (roughly 10%) have some form of eczema, including about 16.5 million adults and 9.6 million children with atopic dermatitis (NEA).

The skin barrier and the itch-scratch cycle

Healthy skin works like a brick wall. In atopic dermatitis the wall has gaps: water escapes and the skin dries out, while irritants, allergens and germs get in more easily (AAD). Genes (including changes in a barrier protein called filaggrin), the immune system and the environment all play a part (NIAMS, NEA). It is often called “the itch that rashes”: itch comes first and scratching brings out the rash (AAD). Inflammation drives itch, and scratching damages the skin further and invites infection (NIAMS); over time scratched skin can thicken and itch almost constantly (AAD). Breaking this itch-scratch cycle is a big part of treatment.

In babies it usually shows on the face and scalp; in children, the elbow and knee creases, neck and ankles; in teens and adults, the hands, neck, creases and around the eyes (NIAMS). On lighter skin it looks pink or red; on brown and Black skin it may look dark brown, purple or gray — see Eczema on brown and Black skin.

Common triggers

Triggers differ from person to person, and some people never find one (AAD). Common ones are soaps, detergents, fragrances and other skin care products; wool and rough fabrics; cold, dry air, heat, sweat and sudden temperature changes; stress; pollen, dust mites, mold and pets; colds, flu and skin infections; hormone changes; and tobacco smoke (AAD, MedlinePlus, NHS, NIAMS). Foods matter less often than many parents expect — see MBHA Wellness Coach before cutting foods out.

Skin infections

Cracked skin and scratching let germs in, so infections are common and make eczema harder to control (NIAMS). People with atopic dermatitis carry more Staphylococcus aureus (“staph”) on their skin (NEA); golden crusts often mean a staph infection (AAD), and eczema that suddenly stops responding to treatment may be infected (AAD). Children with eczema are also more prone to impetigo, cellulitis, molluscum, warts and herpes simplex (AAD). Keep anyone with eczema away from skin contact with a cold sore (AAD). People with atopic dermatitis should not get the smallpox vaccine or have close contact with someone who just did (NIAMS).

The “atopic march”: food allergy, hay fever and asthma

Eczema is usually not caused by an allergy, but many people with it later develop food allergy, hay fever or asthma — the “atopic march.” About one-third of children with atopic dermatitis later develop asthma and two-thirds hay fever, though not everyone does (AAD). About 40% of babies and young children with moderate or severe atopic dermatitis have food allergies (AAD). See our Allergies and Asthma guides. Hives and ADHD are also more common in children with atopic dermatitis (AAD); MBHA plans a Hives guide.

Sleep and mood

Itch and lost sleep are what patients and caregivers name as the hardest parts (NEA); sleep problems affect 67% of children with atopic dermatitis (NEA), and sleepless nights can lead to a child being misdiagnosed with a behavior or learning problem (AAD). Adults with atopic dermatitis have about 2.5 to 3 times the risk of anxiety or depression, and children 2 to 6 times (NEA). Some teens say eczema makes them think about suicide (AAD). Controlling the eczema often helps, and so does counseling (AAD, NIAMS). In a crisis, call or text 988, the free 24/7 Suicide & Crisis Lifeline (988 Lifeline).

Other types of eczema

  • Contact dermatitis: a rash where something touching the skin irritates it (soaps, frequent hand washing) or causes an allergy (nickel, fragrance). Avoiding the cause is the only way to clear it (AAD, AAD).
  • Dyshidrotic eczema (pompholyx): tiny, intensely itchy blisters on the hands or feet, set off by things like soaps, nickel, sweat, heat, stress or wet hands (AAD).
  • Nummular eczema: itchy, coin-shaped spots, often on very dry skin or after a scrape or bug bite. Ringworm and psoriasis can look similar (AAD) — see our Athlete’s Foot guide for fungal skin infections. A Psoriasis guide is planned.
  • Seborrheic dermatitis: a scaly rash on oily areas such as the scalp, eyebrows and sides of the nose; in babies it is cradle cap, which usually clears within a few months (AAD).

Stasis dermatitis and neurodermatitis are other types (NEA); MBHA plans a broader Skin Problems guide.

How is it diagnosed?

No lab test confirms atopic dermatitis (NEA). A clinician looks at the skin and asks about symptoms and family history of eczema, asthma or hay fever; sometimes a skin biopsy or blood tests rule out other causes (AAD, NIAMS). If allergic contact dermatitis is suspected, patch testing can find the cause: small amounts of possible allergens are taped to the back for 48 hours and checked again days later (AAD).

When to see a doctor: if you or your child have eczema symptoms, or treatment isn’t helping or symptoms get worse (NHS, MedlinePlus). Dermatologists, allergists, pediatricians and family doctors all treat it (NIAMS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Gentle bathing and moisturizer as the foundation; steroid creams; non-steroid creams (tacrolimus, pimecrolimus, crisaborole, roflumilast, ruxolitinib, tapinarof); light therapy; biologic injections (dupilumab, tralokinumab, lebrikizumab, nemolizumab) or JAK-inhibitor pills for moderate to severe eczema; antibiotics or antivirals for infections. People with atopic dermatitis report a median of about $600 a year out of pocket; 42% spend $1,000 or more. Visit and generic cream prices: cost estimate being researched. No cure, but most people can control it with skin care, trigger management and medicine; finding the right treatment can take a few tries. Some medicines carry boxed warnings — ask about risks and benefits.
Chiropractic No role in treating eczema. We found no clinical trials — only a single 1999 case report. Not a treatment for eczema, so no cost is listed. Don’t let any treatment delay care for infected skin or the warning signs above.
Acupuncture Needle treatment aimed at itch, added to usual eczema care; self-acupressure has been tried in a pilot study. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Small studies suggest it may ease itch, but a 12-week trial found no change in overall eczema severity. Evidence is limited. Avoid needling broken or infected skin.
Herbal medicine Colloidal oatmeal baths; coconut or sunflower seed oil as moisturizers; probiotics and evening primrose or borage oil are often tried. Cost estimate being researched. Evening primrose and borage oil don’t work, and probiotics probably make little or no difference. Colloidal oatmeal can ease itch. Some “herbal” creams have contained hidden steroids, and essential oils can cause allergic rashes.
Massage therapy Gentle massage by a parent while applying the child’s skin medicine or moisturizer — without essential oils. A private therapist about $60–$120 for 45–60 minutes; massage at home by a parent costs little. One small study found daily parent massage for a month eased redness, scaling and itch. Skip raw, weeping or infected skin.
MBHA Wellness Coach A trigger diary, a bath-and-moisturize routine, fragrance-free products, soft cotton clothes, short nails, steady room temperature and humidity, stress and sleep habits, food allergy testing only with a clinician, and NEA support. Cost estimate being researched. Daily habits reduce flares and help medicine work. They support medical care — never replace it for flares, infections or the warning signs above.

Approach 1 of 6

Conventional medicine (AMA)

A treatment plan aims to reduce flares, ease itch, keep skin hydrated, prevent thickened skin and lower the risk of infection, usually by combining skin care, trigger management and medicine (American Academy of Dermatology, NIAMS). The AAD updated its guidelines for adults in 2023 (creams) and 2024 (light therapy and medicines that work throughout the body) (AAD topical guideline, 2023, AAD systemic guideline, 2024). We don’t list doses or strengths — follow your prescriber and the label.

1. Moisturizer and gentle skin care

Dermatologists recommend moisturizer for everyone with atopic dermatitis, to prevent the cracks that lead to rash, itch and infection (AAD). The 2023 guideline strongly recommends moisturizers and conditionally recommends bathing and wet wraps (AAD guideline). See Daily skin care below.

2. Steroid creams and ointments

Topical corticosteroids are the most-used eczema medicine, in strengths from low (such as over-the-counter hydrocortisone) to super-potent (AAD, MedlinePlus). Side effects are rare when used as directed; the most serious is skin thinning, more likely with strong steroids on the face or neck. Call your dermatologist about thinning skin, stretch marks, bruising or acne-like bumps, or if there is no improvement within 2 weeks. Children are more sensitive, so use only what is prescribed (AAD). Steroid pills are generally avoided because eczema can rebound when they stop (NIAMS, AAD guideline).

Topical steroid withdrawal (TSW). The National Eczema Association describes TSW (also called red skin syndrome) as a possible result of long-term or high-potency steroid use, with redness, burning or bumps days to weeks after stopping. It is under-researched and easily confused with an eczema flare or infection — which can lead to eczema going under-treated. Talk with your clinician rather than stopping suddenly on your own (NEA).

3. Non-steroid creams and ointments

The 2023 guideline strongly recommends steroid, calcineurin-inhibitor, PDE-4 and JAK creams, and recommends against antimicrobial, antiseptic and antihistamine creams (AAD guideline).

4. Light therapy

If creams aren’t enough, a dermatologist may prescribe ultraviolet light treatment, usually 2 to 3 sessions a week for at least a few months. Tanning beds and sunbathing are not substitutes (AAD, NIAMS).

5. Biologic injections

For moderate to severe eczema not controlled with prescription creams: dupilumab (Dupixent), from 6 months of age; tralokinumab (Adbry) and lebrikizumab (Ebglyss), from age 12; and nemolizumab (Nemluvio), from age 12, used with steroid or calcineurin-inhibitor creams (Dupixent label, Adbry label, Ebglyss label, Nemluvio label). Common side effects of dupilumab, tralokinumab and lebrikizumab include injection-site reactions and red, itchy eyes (and cold sores with dupilumab); nemolizumab’s include headache, joint pain and hives (AAD).

6. JAK-inhibitor pills

Upadacitinib (Rinvoq) and abrocitinib (Cibinqo) are approved from age 12 for moderate to severe eczema not controlled by other systemic medicines, including biologics (Rinvoq label, Cibinqo label). Both carry a boxed warning for serious infections, death, cancers including lymphoma, heart attack and stroke, and blood clots; tell your clinician if you smoke or have had heart problems, stroke or clots (Rinvoq label, FDA). Baricitinib is recommended in the 2024 AAD guideline but is not FDA-approved for eczema in the U.S. (AAD guideline, AAD). Older immune-suppressing pills such as cyclosporine and methotrexate are still used for some people (AAD).

7. Infections and bleach baths

Infections need medicine: antibiotics for staph, an antiviral such as acyclovir for herpes (AAD). For frequent infections a dermatologist may suggest bleach baths — a small, measured amount of regular bleach in bath water to reduce bacteria and inflammation. Use them only if your dermatologist recommends it, follow their instructions exactly, and never put bleach directly on the skin (AAD, AAD, NIAMS).

What it costs

  • In NEA research, people with atopic dermatitis reported a median of about $600 a year out of pocket; 42% spent $1,000 or more (NEA).
  • Petroleum jelly is an inexpensive, fragrance-free moisturizer that works for many children (AAD).
  • Dermatology visits, generic steroid creams, newer creams and biologics: MBHA cost estimate being researched.

How well it works — what to expect

Working with a dermatologist, most people can relieve the itch and dryness, see clearer skin and have fewer flares, though it can take a few tries to find the right treatment (AAD). Many children outgrow it by their teens; for some it lasts for life (NIAMS).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating eczema. Searching PubMed, we found no clinical trials — only a single 1999 case report (case report, PubMed), which can’t show whether a treatment works. Don’t let any treatment delay care for infected skin or the warning signs at the top of this page.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied mainly for eczema itch, in small trials. The evidence is limited; it is an add-on to usual care, not a replacement.

Safety: complications are uncommon, but non-sterile needles or poor technique can cause infections (NCCIH). Since eczema skin infects easily (AAD), avoid needling broken or infected skin and choose a licensed practitioner.

Cost: about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Some natural products help a little, several don’t work, and some carry real risks for eczema-prone skin. Talk with your clinician or pharmacist first, especially for a child (NCCIH). We don’t list doses.

Colloidal oatmeal

Colloidal (finely ground) oatmeal is an FDA-recognized skin protectant ingredient; labels may say it temporarily helps relieve minor irritation and itching due to eczema (FDA rules, 21 CFR 347). Dermatologists suggest an oatmeal bath for temporary itch relief, followed by moisturizer; it makes the tub slippery (AAD).

Coconut and sunflower seed oil

In a trial of 117 children with mild to moderate eczema, virgin coconut oil for 8 weeks improved eczema scores more than mineral oil (trial, International Journal of Dermatology). A 2019 review said more study is needed before recommending coconut or sunflower seed oil, and that olive oil may make eczema worse (review, Pediatric Dermatology).

Evening primrose and borage oil, and probiotics

A Cochrane review of 27 studies found evening primrose and borage oil taken by mouth are not effective for eczema; evening primrose oil may also increase bleeding with warfarin (Cochrane review, NCCIH). Another Cochrane review of 39 trials found probiotics probably make little or no difference to eczema symptoms (Cochrane review); the NIH notes only preliminary evidence for some strains in adults (NCCIH).

Hidden steroids. When a London hospital tested 11 Chinese herbal creams that patients were using for skin conditions, 8 contained dexamethasone, a potent steroid; all had been applied to sensitive areas such as the face and skin folds (study, BMJ, 1999). Show any “natural” cream to your clinician or pharmacist.

Essential oils can cause allergic rashes. Tea tree oil can irritate skin and cause contact dermatitis, and must never be swallowed (NCCIH, Memorial Sloan Kettering). Nearly 80 essential oils have caused contact allergy (review, Dermatitis), and people with atopic dermatitis are at higher risk of contact dermatitis, even from “natural” products (AAD).

Cost: cost estimate being researched.

Approach 5 of 6

Massage therapy

In a 1998 study, parents massaged their young children with eczema for 20 minutes a day for a month, alongside standard skin care. Compared with standard care alone, the massaged children improved in redness, scaling, thickening, scratch marks and itch, and were less anxious (study, Pediatric Dermatology); the massage was given while applying the child’s skin medicine (review, Dermatologic Clinics). It was one small study. In another small study, adding essential oils to massage gave no extra benefit, and eczema later worsened with continued aromatherapy massage, possibly from allergy to the oils (study, Phytotherapy Research).

  • Use the child’s own fragrance-free moisturizer or prescribed medicine, not essential oils, and scoop it with a clean spoon or pump (AAD).
  • As a precaution, skip raw, weeping, crusted or infected skin, and get possible infections checked.
  • Massage is generally low-risk; rare serious injuries have mostly involved vigorous techniques (NCCIH).

Cost: massage by a parent costs little; a private therapist typically charges about $60–$120 for 45–60 minutes (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help turn your clinician’s plan into habits you can keep — alongside medical care, never instead of it.

Food allergy testing — only with a clinician

Removing foods rarely stops eczema flares, and cutting out many foods (milk, eggs, wheat, soy, nuts) can cause poor growth and nutrient deficiencies in children. Testing is suggested mainly when moderate to severe eczema isn’t controlled by good care, or after an immediate reaction to a food; a positive test must be confirmed, often with a supervised food challenge (AAD, AAD). The NHS advises not changing your diet — even while breastfeeding a baby with eczema — unless a doctor says to (NHS). A dietitian can help if a food truly must go (AAD).

Find support

The National Eczema Association (nationaleczema.org) offers education and support, including support groups and telephone support (NEA, AAD).

Another approach

Daily skin care: moisturizers, bathing and wet wraps

Daily skin care can cut down the need for medicine (MedlinePlus).

  1. A short bath or shower in lukewarm water — about 5 to 10 minutes for children, no more than once a day (AAD, NIAMS).
  2. A mild, fragrance-free cleanser only where needed; no bubble bath or scrubbing (AAD, MedlinePlus).
  3. Pat partly dry, put prescribed medicine on the eczema, then moisturizer everywhere else within about 3 minutes (AAD, AAD).

Wet wraps

For severe itch, a dermatologist may suggest wet wraps: moisturizer or medicine, a damp layer of bandages or snug pajamas, then a dry layer. They help skin absorb medicine and protect it from scratching (AAD). Use them only with your doctor’s guidance (NIAMS); they can raise the risk of infection (MedlinePlus) and should stop if skin looks infected (AAD).

Another approach

Babies and children with eczema

Atopic dermatitis often appears between 2 months and 5 years of age (American Academy of Dermatology). Many children outgrow it before their teens; some keep it into adulthood (NIAMS). Early treatment can keep it from getting worse (AAD).

Can eczema be prevented?

Nothing is guaranteed. For high-risk babies (a parent with eczema, asthma or hay fever), studies suggest a fragrance-free cream or ointment applied regularly before age 2 may reduce the risk. Probiotics, vitamin D, special foods and avoiding dust mites have not proven effective (AAD). For babies with severe eczema, ask your pediatrician about introducing peanut foods — see our Allergies guide.

The whole family: caregivers report a burden similar to adults with eczema, and 20% to 40% of school-aged children and teens with atopic dermatitis are bullied because of it (NEA). Coping skills and professional help make a difference (AAD).

Another approach

Eczema on brown and Black skin

If itchy patches keep coming back but don’t look “red,” say so, and ask about lasting color changes.

Member stories

Living with Eczema (Atopic Dermatitis)? Share your experience

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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