Eczema (Atopic Dermatitis)
Atopic dermatitis is the most common inflammatory skin disease worldwide. It is a long-term condition of dryness, itch and recurrent rash — and while it cannot be cured, it can be controlled well with the right routine.
At a glance
- What it is
- A chronic, relapsing inflammatory skin condition driven by a combination of skin barrier dysfunction and immune factors.
- Who it affects
- Up to 20% of children; around 80% of affected children develop it before age 6. It can begin at any age and persists in 5–15% of young adults.
- Common sites
- Cheeks and scalp in infants; the elbow and knee creases, neck, wrists and ankles in older children and adults.
- Main symptom
- Itch. It is the itch, and the scratching that follows, that drives much of the damage and the sleep disruption.
- Treatment
- Daily emollients as the foundation, topical anti-inflammatory treatment for flares, and systemic options when disease is severe.
What is atopic dermatitis?
Healthy skin forms a barrier that holds water in and keeps irritants and microbes out. In atopic dermatitis that barrier does not work properly, so the skin loses moisture, dries out and allows irritants through. The immune system then responds with inflammation, producing the familiar itchy, red or discoloured rash.
This creates the cycle that makes eczema so persistent: dry skin leads to itch, itch leads to scratching, and scratching damages the barrier further, provoking more inflammation. Effective treatment works by interrupting this cycle at more than one point.
Atopic dermatitis typically clusters with an atopic tendency — a personal or family history of asthma, hay fever or food allergy. Around 230 million people worldwide are affected, and it is the most common inflammatory skin disease globally.
Eczema at different ages
The condition tends to move to different sites as a person grows, which is one reason it can seem to change character over the years.
Infants
From shortly after birth to around two years.
- May begin as scalp and skin-fold involvement resembling cradle cap
- Then affects the cheeks and face prominently
- Skin feels dry and rough all over
- Babies who cannot scratch will rub — often the back of the head, sometimes causing temporary hair loss
Children
The classic flexural pattern.
- Creases of the elbows and behind the knees
- Neck, wrists and ankles
- Skin becomes thickened from chronic scratching
- Sleep disturbance is common and affects the whole family
Adults
Often more localised but can be widespread.
- Hands, eyelids and neck are frequently involved
- Thickened, lichenified patches from long-standing rubbing
- Darkening of the skin around the eyes
- May flare with occupational irritant exposure
Eczema in deeper skin tones
Eczema presents differently in richly pigmented skin, and this matters clinically. The redness that doctors traditionally look for is much harder to see; inflamed skin may instead appear violet, greyish or simply darker than the surrounding skin. As a result, severity is sometimes underestimated.
A pattern of small raised bumps is a common presentation. And once a patch settles, it frequently leaves behind pale or dark marks that persist for months. These pigment changes are not scars and generally resolve, but they are often what prompts a consultation.
Singapore's climate adds its own considerations. Heat, humidity and sweating are recognised triggers for many people, while air-conditioned environments are drying — so both extremes of the day can provoke a flare.
How eczema is managed
Treatment is layered. Everyone needs the foundation; additional steps are added according to how active and how severe the condition is.
Everyday foundation
The part that never stops, even when the skin looks clear.
- Emollients applied liberally and regularly
- Gentle, soap-free cleansing
- Identifying and reducing individual triggers
- Understanding the condition — education genuinely improves outcomes
Topical treatment
Applied during flares to control inflammation.
- Topical corticosteroids, matched in strength to the site and severity
- Topical calcineurin inhibitors, useful on the face and other delicate areas
- Treatment of secondary bacterial or viral infection when present
- Correct formulation matters — ointment, cream, lotion or gel
When more is needed
For severe or resistant disease, under specialist supervision.
- Phototherapy
- Systemic immunomodulatory medication
- Biologic therapy such as dupilumab
- Regular monitoring alongside treatment
Living with eczema
Small habits, applied consistently, make a substantial difference to how often flares occur.
Helpful
- Moisturise every day, including when the skin looks clear
- Use lukewarm rather than hot water, and keep showers short
- Pat skin dry and apply emollient while it is still slightly damp
- Wear loose, smooth-textured clothing
- Keep fingernails short to limit scratch damage
- Treat a flare properly and early rather than waiting
Unhelpful
- Hot showers and vigorous towel-drying
- Fragranced soaps, bubble baths and harsh cleansers
- Stopping emollients as soon as the skin improves
- Starting exclusion diets without medical advice
- Using someone else's steroid cream
- Scratching — rubbing with the flat of the hand is less damaging
When to see a dermatologist
It is reasonable to arrange a specialist assessment if:
- Eczema is not controlled despite regular emollients and prescribed topical treatment
- Itch is disturbing sleep, school, work or daily life
- Flares are frequent, or the skin never fully settles between them
- You are unsure whether the rash is eczema at all
- Treatment is needed for a young child and you would like a clear plan
- There are repeated skin infections
Dr Chen Qiping
Consultant Dermatologist · MBBS, MRCP (UK), M.Sc, FAMS (Dermatology)
Dr Chen practises general adult and paediatric dermatology, including eczema, alongside surgical, laser and cosmetic dermatology. Consultations are available in English and Mandarin.
Eczema — frequently asked questions
Is eczema curable?
Are topical steroids safe to use on my child?
How much moisturiser should I be using?
Does food cause my eczema?
Why does eczema look different on darker skin?
When should I see a dermatologist about eczema?
References
- DermNet. Atopic dermatitis and Treatment of atopic dermatitis. dermnetnz.org
- Mayo Clinic. Atopic dermatitis (eczema) — Symptoms, causes, diagnosis and treatment. mayoclinic.org
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). Atopic Dermatitis. niams.nih.gov
Page last reviewed: 28 July 2026.
Struggling to keep eczema under control?
Arrange a consultation with Dr Chen Qiping at our Collyer Quay clinic — two minutes' walk from Raffles Place MRT. Adults and children welcome.