Eczema is one of those conditions where parents often get told the right things ("moisturise, use steroids in flares, avoid irritants") without being told how much moisturiser, which steroid, how often, or what to actually do at 2am when your baby is scratching themselves bloody. The result is a lot of well-meaning, undertreated children whose eczema never quite settles.
This article gives you the practical version: what eczema is, how much emollient is enough (it's more than you think), how to use topical steroids properly, and how to tell when something needs a GP rather than another tub of cream.
Logging flares and possible triggers in Healthbooq helps you spot patterns and gives your GP or dermatologist a useful picture of how the eczema actually behaves.
What's Going On in the Skin
Atopic dermatitis (the medical term for eczema) is a problem with the skin barrier. The outermost layer doesn't hold water in or keep allergens, microbes, and irritants out the way healthy skin does. Around 30% of people with eczema have a mutation in the FLG gene that codes for filaggrin, a key barrier protein. The result is a self-reinforcing cycle:
dry skin → irritants and allergens get in → immune system overreacts → inflammation and itch → scratching → more barrier damage → drier skin.
Once you see the cycle clearly, the management approach makes sense: replace what the broken barrier can't deliver (emollient, lots of it), and break the inflammation cycle when it kicks off (topical steroids, properly).
Eczema is one of the "atopic" conditions — children with eczema have a higher chance of also developing food allergies, asthma, and hay fever. Severe eczema in early infancy is associated with higher food allergy risk, which is part of why early allergen introduction (peanut, egg from around 6 months in babies with severe eczema) is now actively recommended rather than delayed.
Emollient: You Are Not Using Enough
Emollients are the foundation. They aren't optional. They aren't only for flares. They go on every day, multiple times a day, regardless of whether the skin looks bad.
How much is enough? NICE guidance for a child with moderate eczema is around 250g of emollient per week. That's a lot — most parents are using a fraction of this. If your tub of moisturiser lasts a month, you're under-treating. Get it on prescription in 500g pots so you have it in volume.
Which emollient? Three families:
- Lotions (like Aveeno, Cetraphil) — lightest, easiest to apply, but least occlusive. Useful in summer or if your child has very mild eczema.
- Creams (like Diprobase, Doublebase, Epaderm cream) — middle ground. The most commonly prescribed.
- Ointments (like 50:50 white soft paraffin / liquid paraffin, Hydromol ointment, Epaderm ointment) — greasiest but most effective at sealing the barrier. Best at night, in winter, and for the worst-affected areas.
A common practical setup: cream during the day, ointment at night. The best emollient is the one your child will tolerate and you'll actually apply.
How to apply: smooth on, don't rub in vigorously (rubbing irritates inflamed skin). Apply in the direction of hair growth. Within 3 minutes of bath time, while skin is still damp, is ideal — this seals in water from the bath.
Bath additives (Oilatum, Dermol, etc.) are widely prescribed but the BATHE trial (BMJ 2018) showed they didn't add measurable benefit on top of leave-on emollient. They also make baths slippery. Plain warm short baths followed by emollient are perfectly adequate for most children.
Avoid soap and bubble bath entirely. Use an emollient as a soap substitute — apply, rinse off in the bath. Adult shampoo and shower gel will trash atopic skin.
Don't use olive oil or other natural oils on baby skin. Olive oil specifically has been shown to increase skin barrier dysfunction (Cooke et al., 2016). Sunflower seed oil is less harmful but still not as good as a proper emollient.
Topical Steroids: Use Them Properly
Most eczema flares need a topical corticosteroid (TCS). The big problem in clinical practice is steroid phobia — parents apply too little, too thinly, for too short a time, and the flare drags on for weeks instead of clearing in days.
Strengths to know:
- Mild: hydrocortisone 1%. Used on face and for mild flares anywhere.
- Moderate: clobetasone butyrate 0.05% (Eumovate), betamethasone valerate 0.025%. Used for moderate flares on the body.
- Potent: mometasone, betamethasone valerate 0.1%. Used short-term on body for severe flares, on specialist advice.
For babies' faces, mild only (hydrocortisone 1%), used short courses.
How much to apply: the fingertip unit (FTU). One FTU is the amount squeezed from a standard tube along the last segment of an adult index finger (from the tip to the first crease). One FTU covers an area equal to two adult palms. Useful guide for a baby:
- One whole arm or leg: 1 FTU
- Whole front of body: 1 FTU
- Whole back of body: 1.5 FTU
- Face and neck: 1 FTU
How often: once or twice daily during the flare, applied to the inflamed areas only, until the skin is back to its baseline (smooth, not red, not itchy). Then stop. A flare typically needs 5 to 14 days of treatment. Stopping too early is one of the most common reasons eczema relapses fast.
Apply emollient and steroid in sequence with a gap. Aim for 15–30 minutes between them so they don't dilute each other. The order doesn't matter much in practice — just don't put one on top of the other immediately.
Topical steroids used appropriately are safe. Skin thinning, the most-feared side effect, is rare with mild-moderate steroids used in courses. Months of daily potent steroid on thin skin areas (face, eyelids, groin) without medical guidance can cause it. Used as directed, it doesn't.
Triggers and Practical Controls
Common triggers worth checking:
- Biological washing powder and fabric conditioner — switch to non-bio (Surcare, Ecover sensitive, etc.) and skip fabric conditioner
- Wool and rough synthetic fabrics — cotton next to skin
- Overheating — bedrooms cooler (16–18°C is ideal), one fewer layer than you'd put on yourself
- Sweat — change out of damp clothes promptly after play
- Saliva and dribble around the mouth — barrier with petroleum jelly
- Some children: house dust mite, pet dander, pollen — relevant if there's a clear pattern
- Some babies with moderate-to-severe eczema: food allergens (cow's milk, egg most common). Don't start eliminating foods on a hunch. Talk to a paediatric allergist or GP first — unnecessary food restriction in a baby is nutritionally risky and can promote allergy rather than prevent it.
Keep your baby's nails short. Cotton mittens at night for a flaring infant can stop them tearing the skin in their sleep.
When to See a Doctor
Same-day GP or NHS 111 if:
- The eczema is weeping, yellow-crusted, or has clusters of small fluid-filled blisters — this looks like infection (bacterial impetigo or eczema herpeticum, the latter being a medical emergency caused by HSV — needs antiviral treatment fast)
- Your baby is feverish or unwell with the eczema
- Skin is hot, spreading red, painful
Routine GP appointment for:
- Eczema not controlled with regular emollient and short courses of appropriate steroid
- Sleep being significantly disrupted by itch
- Suspicion of a food trigger — for proper assessment, not DIY elimination
- You feel you're using steroids weekly and it's still flaring — likely needs a step up in management or specialist input
Key Takeaways
Eczema affects around 1 in 5 children in the UK and most of them get it before their first birthday. The skin barrier doesn't hold moisture or block irritants properly, which produces dry, inflamed, itchy patches that flare and settle in cycles. The two pillars of treatment are emollient (moisturiser) used in much larger amounts than parents think — around 250g per week for a child with moderate eczema — and topical steroids during flares, used at the right strength and stopped once the flare is gone. Most parents under-use both. Steroid phobia leads to undertreated flares, which damage the skin further. Most children improve significantly by school age.
