Eczema#

Plain-language guide to eczema (atopic dermatitis, contact dermatitis, dyshidrotic, nummular). Triggers, at-home care, prescription treatment options, pregnancy considerations, and when to see in-person care.

Eczema is a long-term skin condition in which the skin barrier doesn't hold moisture well, the immune system over-reacts to small irritants, and the skin becomes dry, red, and intensely itchy. With the right daily routine and short bursts of prescription anti-inflammatory cream for flares, most adults can keep their skin comfortable most of the time.

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What eczema is

Types of eczema

Triggers and what makes eczema worse

At-home and OTC first steps

How much cream to use - the fingertip unit rule

When prescription treatment is needed

Flare-up vs maintenance treatment

Pregnancy and breastfeeding

What TeleTest can and cannot offer

Common questions

When to see in-person care urgently

Cost and coverage

What eczema is#

Eczema (the most common form is called atopic dermatitis) is a long-term inflammatory skin condition. Your skin barrier is leaky, so water escapes and irritants get in. Your immune system reacts by releasing chemicals that cause redness, dryness, and itching. Scratching breaks the barrier further, which lets in more irritants and bacteria - this is the "itch-scratch cycle." It can begin in infancy or appear for the first time in adulthood.

Eczema is not contagious. You cannot give it to or catch it from a partner, child, or pet.

Dry skin is not the same as eczema. Dry skin is dry but not inflamed. Eczema is dry skin plus inflammation. Plain moisturizer is enough for dry skin; eczema usually needs a moisturizer and an anti-inflammatory cream when it flares.

Types of eczema#

Type	Where it appears	What sets it apart
Atopic dermatitis	Often the folds of elbows and knees in kids; hands, neck, eyelids, face in adults	The classic chronic, itchy form. Tends to run in families along with asthma and seasonal allergies.
Contact dermatitis	Wherever skin touches the trigger (hands, face, around the navel from belt buckles, ear lobes from earrings)	An irritant or allergic reaction to a specific substance (detergents, fragrance, nickel, latex, certain plants).
Dyshidrotic eczema	Sides of fingers, palms, soles of feet	Small itchy blisters. Often worsens with stress or sweating.
Nummular eczema	Trunk, arms, legs	Coin-shaped patches. Can look like ringworm but isn't.
Seborrheic dermatitis	Scalp, eyebrows, sides of nose, chest	Greasy, flaky scale. Covered on our separate seborrheic dermatitis info.

If you don't know which type you have, the treatment principles overlap, but a clinician helps pin down the right approach.

Triggers and what makes eczema worse#

Cold, dry winter air and dry indoor heating.
Hot showers and long baths.
Soaps, body washes, shampoos with fragrance or harsh detergents.
Laundry detergents, especially fragranced ones. Fabric softeners and dryer sheets too.
Rough fabrics (wool, scratchy synthetics).
Sweat and overheating.
Stress and lack of sleep.
Skin infections (especially staph bacteria). If eczema oozes yellow or crusts, suspect infection.
Specific allergens (dust mites, pet dander, pollen in some people).
Foods in some young children with eczema, rarely in adults.

Keeping a simple flare diary (date, where, what you noticed in the prior week) can help you spot patterns.

At-home and OTC first steps#

These are the foundation of eczema care. They reduce flare frequency by 30 to 50% on their own.

Bathing#

Lukewarm water, not hot. Hot water strips skin oils.
Short showers (5 to 10 minutes).
Gentle, fragrance-free cleanser only where needed (armpits, groin, feet). You don't need to soap your whole body daily.
Pat dry with a soft towel. Don't rub.

The "soak and seal" rule#

Within 3 minutes of getting out of the bath or shower, apply a thick moisturizer to slightly damp skin. This locks water in.

Choosing a moisturizer#

Ointments (petrolatum, Vaseline, Aquaphor) are most effective but greasy. Best for very dry skin and overnight.
Creams (anything sold in a tub or large tube) are the everyday workhorse. Look for ceramides, glycerin, or colloidal oatmeal.
Lotions (pump bottles) are the thinnest. OK for mild eczema and hairy areas, less helpful for very dry skin.

Use a lot. An adult with moderate eczema needs roughly 250 to 500 grams a week. If a tube lasts you a month, you're not using enough.

Avoid moisturizers with fragrance, essential oils, or alcohol. "Natural" doesn't mean gentle - tea tree oil and many essential oils cause reactions.

Other helpful steps#

Switch to a fragrance-free laundry detergent. Skip fabric softeners.
Wear cotton or silk. Avoid wool and tight synthetics next to skin.
Run a humidifier in winter (aim for ~40% indoor humidity).
Trim fingernails short to reduce damage from scratching.
For itch at night, a cool, damp washcloth on the area works well. OTC antihistamines (the sedating kind) at bedtime can help you sleep through the itch, though they don't treat the eczema itself.

OTC anti-inflammatory#

OTC hydrocortisone 0.5% or 1% cream is mild and useful for small mild flares on the body. Apply twice a day for up to 7 to 10 days. Don't use on the face for more than a few days without clinician input. Don't use long-term.

How much cream to use - the fingertip unit rule#

A fingertip unit (FTU) is the amount of cream squeezed from a standard tube along the tip of an adult finger, from the tip to the first crease. One FTU is roughly 0.5 grams and covers an area about the size of two adult palms.

Area	FTUs per application
Face and neck	2.5
One arm (front and back, including hand)	4
One leg (front and back, including foot)	8
Front of trunk	7
Back and buttocks	7
Genital area	0.5

Using too little is a common reason eczema treatment "doesn't work." Using too much (especially of stronger prescription anti-inflammatory creams) raises side-effect risk.

When prescription treatment is needed#

Book a consultation if any of these apply:

Eczema isn't controlled with moisturizer plus OTC hydrocortisone after 1 to 2 weeks.
You have moderate to severe areas of red, itchy, weeping, or thickened skin.
It's affecting your sleep, work, or quality of life.
It involves the face, eyelids, hands, or genitals.
You've been using OTC hydrocortisone or a leftover prescription steroid for more than 2 weeks at a stretch.
You see signs of infection (yellow crust, ooze, fever, spreading redness).

Prescription treatment for eczema comes in three classes:

1. Prescription topical steroids (anti-inflammatory creams)#

These are the workhorse for flares. They come in different potencies (strengths). The right strength depends on where on the body you're using it:

Body area	Potency tier used
Face, eyelids, neck, groin, armpits, under breasts	Low (mildest)
Trunk, arms, legs	Medium
Hands, feet (tops), skin folds (resistant areas)	Medium-high
Palms, soles, very thick patches	High to ultra-high, short bursts only

Used correctly - short bursts (typically 5 to 14 days), the right strength for the area, with breaks - prescription topical steroids are very safe. Used incorrectly (high-strength creams on the face long-term, or daily continuous use for months), they can thin the skin, cause stretch marks, or other side effects.

Rules of thumb:

Apply once or twice a day during a flare.
Stop once skin is clear, or shift to weekend-only use as maintenance.
Don't put a high-strength steroid on your face unless your clinician specifically said so.

2. Prescription non-steroid anti-inflammatory creams#

These work differently from steroids. They don't thin the skin and are safe to use long-term on delicate areas (face, eyelids, folds). Two main classes:

Prescription calcineurin inhibitor ointment. Steroid-free. Safe for face, eyelids, neck, folds. Often used as a step-down after a steroid flare burst, or as long-term maintenance. May sting for the first few days. Approved in Canada since the early 2000s.
Prescription PDE-4 inhibitor cream. A newer non-steroid option. Once-daily application, no skin-thinning concern, well tolerated. Often more expensive without a drug plan.

These are excellent for maintenance (preventing flares) on flare-prone areas, especially face and folds.

3. Stronger systemic treatment (in-person dermatology only)#

For severe, widespread eczema that doesn't respond to topicals, options include:

Phototherapy (UVB light treatment) - through a dermatology clinic.
Oral systemic medications that calm immune over-activity (older medications and newer targeted options).
Biologic injections - very effective for moderate-to-severe eczema. Dermatologist-prescribed.

TeleTest does not initiate phototherapy, systemic immune-modulating medication, or biologic therapy, and does not arrange a dermatology referral. If your eczema may need this level of treatment, your TeleTest clinician can give you a clear written summary of what you've tried to bring to an in-person clinician - you would arrange that visit yourself through your family doctor or a local clinic.

Flare-up vs maintenance treatment#

Flare-up plan (skin is red, itchy, weeping)#

Apply prescription anti-inflammatory cream twice daily (or as prescribed) until the skin is clear or nearly clear - usually 5 to 14 days.
Moisturize 2 to 3 times daily, including right after the anti-inflammatory.
Identify the trigger if you can.
If skin isn't improving after 2 weeks, or worsens, get back in touch.

Maintenance plan (skin is clear but flare-prone)#

Use one of two strategies, started only if the same spot flares again within 4 weeks or flares twice in 3 months. Stop maintenance once the area has stayed clear for 12 weeks.

Weekend therapy. Apply a low-to-medium strength prescription anti-inflammatory cream twice on weekends to the spots that usually flare.
Non-steroid maintenance. Apply a prescription calcineurin inhibitor or PDE-4 inhibitor twice a week to flare-prone areas (great for face and folds).

Daily moisturizer doesn't stop.

Pregnancy and breastfeeding#

Most eczema treatments can be used in pregnancy with sensible limits:

Moisturizers and gentle cleansers: Always safe.
OTC hydrocortisone 0.5 to 1%: Generally safe in small amounts.
Prescription topical steroids: Safe in pregnancy when used on limited areas for short courses. Low-to-medium potency is preferred. Avoid potent steroids on large areas long-term.
Prescription non-steroid anti-inflammatory creams: Discuss with your clinician - data are reassuring but more limited.
Newer non-steroid creams (PDE-4 class) - the version approved for eczema: Generally avoided in pregnancy because data are limited. Same caution while breastfeeding.

If you're pregnant, trying to conceive, or breastfeeding, tell your TeleTest clinician so they can choose the safest option.

What TeleTest can and cannot offer#

TeleTest can:

Assess your eczema, including history of triggers, prior treatments, and what's worked or hasn't.
Prescribe prescription topical steroids (low, medium, and higher potencies, matched to the body area).
Prescribe prescription non-steroid anti-inflammatory creams (calcineurin inhibitor and PDE-4 inhibitor classes) for sensitive areas or long-term maintenance.
Prescribe a short course of an oral antihistamine for itch when needed.
Treat infected eczema with a prescription antibiotic when needed.
Provide follow-up consultations to step down treatment, switch to maintenance, or escalate.

TeleTest does not:

Initiate phototherapy (light treatment) or arrange a dermatology referral for it.
Initiate biologic injections or systemic immune-modulating tablets for severe eczema, or arrange a dermatology referral for them.
Perform or arrange patch testing for contact allergies - this is an in-person dermatology test you would arrange through your family doctor or a local clinic.

Common questions#

Are steroid creams safe? Won't they thin my skin?#

When used correctly, prescription topical steroids are very safe. The rules:

Match the potency to the body area. Low potency for face, eyelids, groin. Medium for arms, legs, trunk. Higher only for palms, soles, or stubborn plaques.
Use short bursts (5 to 14 days for a flare).
Take breaks between courses (use a non-steroid or moisturizer-only for a couple of weeks).
Use the fingertip unit rule so you're not over-applying.

Skin thinning, stretch marks, and other side effects mostly happen with high-strength steroids used continuously for months on thin skin.

How long can I safely use a steroid cream?#

A typical flare burst is 5 to 14 days. After that:

For ongoing prevention, twice-weekly weekend application on flare-prone areas is safe long-term.
Continuous daily use of a strong steroid for more than 2 to 4 weeks is generally avoided.

If your eczema needs daily strong-steroid use for more than a month, the plan probably needs to change - either adding a non-steroid option, treating an infection, or moving up to systemic treatment.

What's the difference between cream, ointment, and lotion?#

Ointment: Thickest, greasiest, most effective at sealing in moisture. Best for very dry skin and overnight.
Cream: Balanced. The everyday go-to.
Lotion: Thinnest, spreads easily. Good for hairy areas and large surface coverage. Less moisturizing.

For prescription anti-inflammatory products, the ointment form usually works better on thick or dry plaques; the cream is more comfortable on the face.

Can I use my prescription steroid cream every day?#

Not long-term. Use it daily during a flare for up to about 2 weeks, then either stop or shift to weekend-only application. Long-term daily use raises the chance of skin thinning, stretch marks, or rebound flares when stopped.

What if the steroid cream isn't working?#

If you've used it correctly for 2 weeks and your eczema isn't clearer, possible reasons:

The strength may be too low for the area.
There may be a skin infection in the eczema (look for yellow crust, oozing, spreading redness).
The diagnosis may not be eczema (it could be a fungal infection, contact dermatitis, scabies, or another condition).
A non-steroid anti-inflammatory may be a better fit.

Book a follow-up rather than just using more of the same cream.

What are non-steroid prescription options, and when are they used?#

Two main classes:

Calcineurin inhibitor ointments. Steroid-free, safe on face/eyelids/folds, used twice daily during a flare and twice weekly for maintenance. May sting for the first 3 to 5 days.
PDE-4 inhibitor creams. Once daily, very well tolerated, no skin thinning. Newer to the Canadian market and generally pricier without a drug plan.

These are first-line for sensitive areas (face, eyelids, folds) and for long-term flare prevention.

Why does my non-steroid cream sting at first?#

About half of people using prescription calcineurin inhibitor ointment feel a stinging or burning sensation in the first 3 to 5 days. It almost always settles down. Tips:

Apply a moisturizer 30 minutes before the cream.
Keep the tube in the fridge.
Apply to dry skin (not right after a shower).

If burning is intolerable past a week, talk to your clinician.

Can I use antihistamines for the itch?#

They don't treat the eczema, but they can help with sleep when itch is bad:

Non-drowsy options (e.g. the second-generation antihistamines) during the day.
Sedating options at bedtime if itching keeps you awake.

Not meant for daily long-term use.

Is eczema linked to allergies or asthma?#

Often, yes. Atopic dermatitis is part of a group of conditions called "atopy" - eczema, asthma, hay fever, and food allergies tend to cluster in the same person or family. This doesn't mean every flare is caused by allergies, but if you have a clear food or environmental trigger, allergy testing through a family doctor or allergist can be worth doing.

Should I get patch testing for contact allergies?#

If your eczema is in a specific pattern that suggests contact dermatitis (eyelids only, hands only, around the navel where a belt buckle sits, etc.) and avoiding obvious triggers hasn't helped, patch testing can identify the culprit. This is an in-person dermatology test, typically over a few visits. Your family doctor can arrange the referral - TeleTest does not arrange dermatology referrals.

What about food allergies? Should I cut out dairy or gluten?#

For most adults with eczema, no. Food allergies can worsen eczema in a minority of children and rarely in adults with a clear reaction within minutes to hours of eating a specific food. Cutting out major food groups without proper testing can cause more harm than benefit. If you suspect food is a trigger, talk to a clinician or dietitian before doing elimination diets.

My eczema keeps getting infected. What do I do?#

Infected eczema looks like:

Yellow crusting or weeping clear-then-yellow fluid.
Spreading redness that goes beyond the usual eczema patches.
Pain, warmth, fever.

Common cause is staph bacteria, sometimes herpes simplex (in eczema this is called "eczema herpeticum" and is a medical urgency - small painful blisters, especially on the face). For a typical bacterial infection your TeleTest clinician can prescribe an oral or topical antibiotic. For eczema herpeticum, go to an urgent care or emergency department.

Prevention:

Treat flares early so skin doesn't stay broken.
Diluted bleach baths (half a cup of household bleach in a full bathtub, twice a week) can reduce surface bacteria. Discuss before starting.
Wash hands before applying creams.

What ingredients should I look for - and avoid - in moisturizers?#

Look for:

Ceramides (rebuild the skin barrier)
Colloidal oatmeal (soothes itch)
Glycerin or urea (draw water in)
Petrolatum (seals moisture)

Avoid:

Fragrance ("parfum") or essential oils
Alcohol-based gels
Methylisothiazolinone (MI) and similar harsh preservatives

Are natural products better?#

Not necessarily. "Natural" doesn't mean non-irritating. Tea tree oil, for example, is a common cause of allergic reactions. Coconut oil works for some, irritates others. Always patch-test a new product on a small area for 2 to 3 days before using it widely.

How long until I see improvement on prescription treatment?#

Steroid creams: Itch usually settles within 1 to 2 days, visible redness over 3 to 7 days.
Calcineurin inhibitor: May feel better in a few days; full effect in 2 to 4 weeks.
PDE-4 inhibitor cream: Improvement in days to 2 weeks.

If nothing is improving by day 10 to 14, talk to your clinician.

Can I swim in chlorinated pools?#

Yes, and short pool sessions may actually reduce surface bacteria. Just rinse off within 5 minutes of getting out, and moisturize.

Will eczema ever go away for good?#

Some adults outgrow eczema, especially if they keep a good routine and avoid major triggers. Many people keep a tendency to flare during stress, winter, or after illness. With today's treatments, most people can have skin that looks and feels normal most of the time.

What about diet changes - probiotics, vitamin D, omega-3?#

The evidence is weak for any specific supplement clearing eczema. Vitamin D may help in deficient patients. Probiotics may help young children but the data in adults is inconsistent. A balanced diet is reasonable; expensive supplements aren't going to do what your topical treatments do.

I want to get pregnant - what should I change?#

Mostly nothing if you're using gentle moisturizers and short bursts of low-to-medium potency prescription anti-inflammatory cream. Avoid newer non-steroid creams in the PDE-4 class during conception and pregnancy. Tell your TeleTest clinician your plans so the treatment fits.

When to see in-person care urgently#

Go to a walk-in or emergency department for:

Eczema with fever, spreading redness, severe pain - signs of skin infection that needs urgent assessment.
Small painful blisters (especially on the face or around the eyes) developing on or near eczema - possible eczema herpeticum, a medical urgency.
Eczema affecting your eyes with vision changes, severe redness, or pain.
A severe allergic reaction to a new product (widespread rash, swelling of lips or tongue, trouble breathing) - call 911.
Widespread weeping rash in an infant or young child with poor feeding or lethargy.

Cost and coverage#

Consultations: Self-pay. See the intake page for current pricing.
OTC moisturizers and hydrocortisone: Pay at the pharmacy.
Prescription topical steroids: Generic options are inexpensive and often covered by provincial drug plans.
Prescription calcineurin inhibitor ointments: Many are partly covered through provincial plans or private benefits.
Newer prescription PDE-4 inhibitor creams: Usually more expensive and may need private insurance to cover; check with your pharmacy.

You can have your prescription sent to the pharmacy of your choice. We encourage price-shopping; some chains and independents are noticeably cheaper than others.

Rosacea - sometimes confused with eczema on the face
Acne
Cosmetic dermatology - for pigment changes after long-term eczema