The skin has an outermost layer of horn cells held together by fats (ceramides, cholesterol, fatty acids) like mortar between bricks. In eczema the mortar is defective, often for hereditary reasons (the filaggrin gene in atopic eczema), amplified by washing, cold, dry air, friction and chemicals: the skin loses moisture, becomes dry and cracked, and allergens, irritants and bacteria get in. The immune system responds with inflammation (redness, swelling, blisters) and itch, and the itch drives the scratching, which tears the barrier further, so the eczema becomes a cycle of dryness, inflammation and scratch wounds. Atopic eczema is the hereditary form with dry skin and itch since childhood, often with asthma and allergy in the family, sitting in the elbow and knee creases, on the neck, eyelids and hands, and running in flares. Hand eczema affects one in ten adults, most often from wet work, detergents, gloves and cleaning agents (irritant eczema) or from substances you have become allergic to (nickel, fragrance, preservatives, rubber: allergic contact eczema), and gives cracks, blisters and scaling on fingers and palms. Dry eczema (asteatotic) appears on the lower legs, arms and trunk in older people and in winter, as a dry, cracked, itchy "riverbed" pattern. Seborrhoeic eczema sits where the sebaceous glands are dense (the scalp as dandruff, the sides of the nose, eyebrows, behind the ears, the chest) and is due to a yeast. The diagnosis is made on appearance and location; with suspected contact allergy, patch testing is done at a dermatologist. Eczema is not contagious, is not due to poor hygiene (on the contrary it is worsened by too much washing), and is not "just dry skin": it is an inflammatory disease that should be treated as one.
Which eczema do you have?
| Type | Where | What it looks like | Typical cause | Treatment in brief |
|---|---|---|---|---|
| Atopic eczema | Elbow creases, knee creases, neck, eyelids, hands, face; symmetrical | Dry, red, itchy patches, thickened skin from long-term scratching, scratch wounds | Hereditary barrier defect + triggers | Emollients daily, steroid in flares, calcineurin inhibitors, for severe forms tablets/injections |
| Hand eczema (irritant) | Fingers, backs of hands, between the fingers | Dryness, cracks, scaling, stinging; worse in winter | Wet work, detergents, hand sanitiser, gloves | Protection, emollient after every wash, steroid in flares, avoid the cause |
| Allergic contact eczema | Where the substance touched the skin: hands, face, neck, earlobes, navel | Red, swollen, blisters, itchy, comes 1–3 days after contact | Nickel, fragrance, preservatives, rubber, hair dye, essential oils | Patch test, avoid the substance completely, steroid |
| Dry eczema (asteatotic) | Lower legs, arms, trunk; older people, winter | Dry, cracked, itchy "crazy paving" pattern | Dry skin, hot showers, soap, dry indoor air | Rich emollient, shorter and cooler showers, steroid briefly |
| Seborrhoeic eczema | Scalp, sides of the nose, eyebrows, behind the ears, chest | Pink-yellow scaly patches, dandruff | The yeast Malassezia, stress, winter | Antifungal shampoo/cream (ketoconazole), mild steroid briefly; oils often make it worse |
| Discoid (nummular) eczema | Legs, arms, trunk | Round, coin-shaped, weeping or scaly patches | Dry skin, often after an injury or insect bite | Steroid, emollients; sometimes antibiotics |
Seek care when the eczema is widespread, weeps, gets yellow crusts or becomes painful (bacterial infection), when it spreads quickly with small blisters and fever (eczema herpeticum, urgent), when hand eczema doesn't heal in four weeks with self-care (work-related, needs investigation), when the itch disturbs sleep several nights a week, when steroid cream is needed for more than a few weeks at a time, and when you suspect contact allergy (eczema that follows a pattern: the watch, the button, the necklace, new gloves).
Why it flares: triggers to recognise
- Washing and water: every wash dissolves the skin's fats; hot, long showers, soap and foaming cleansers are the biggest aggravators of all eczema. Hand sanitiser dries but is often gentler than soap and water for the hands.
- Weather: cold and dry indoor air in winter, sweat and heat in summer, rapid changes between them.
- Stress and sleep deprivation: cortisol and the nervous system increase itch and inflammation; most with atopic eczema can date flares to stressful periods.
- Scratching: gives a few seconds of relief and hours of worsening; scratching at night in your sleep is often what keeps the eczema going.
- Fragrance, essential oils, preservatives in skincare, laundry detergent, fabric softener and "natural" products: eczema skin should have fragrance-free, and lavender, tea tree and citrus oils are common contact allergens.
- Wool and synthetics directly against the skin, tight clothes, sweat.
- Hormones: before a period, during pregnancy and in menopause many flare.
- Infections: colds, and the bacterium staphylococcus that colonises eczema skin and worsens it.
- Diet: in adults, food allergy is rarely the cause of eczema; elimination diets without proven allergy don't help and can harm. Alcohol worsens in some.
Skincare that heals the barrier
- Emollients, a lot and often: this is the core treatment for all eczema and halves the need for steroids. Fragrance-free cream or ointment with high fat content (ceramides, glycerin, urea 5–10% on the body but not on cracked skin, petroleum jelly on the driest), at least twice a day and always within three minutes after showering and hand washing. An adult needs 250–500 grams a week for the whole body; most use a tenth. Keep a tube by every sink.
- Wash right: lukewarm water, five to ten minutes at most, soap only where needed (armpits, genitals, feet), fragrance-free oil cleanser or shower oil, pat dry, emollient straight away.
- Hands: cotton gloves under rubber gloves for wet work, emollient after every wash, rich ointment and cotton gloves overnight with hand eczema, rings off during work (soap residue and water under the ring is a classic eczema cause).
- Clothes: cotton, bamboo, silk or merino next to the skin; wash new clothes before wearing; fragrance-free detergent, no fabric softener, extra rinse.
- Indoor climate: 18–20 degrees in the bedroom, a humidifier in winter if the air is under 30 per cent, not too warm a duvet.
- The itch: cold (cream from the fridge, a cool shower, an ice pack in a towel), press or pinch beside it instead of scratching, short nails, cotton gloves at night, an antihistamine at night if the itch disturbs sleep (helps mostly through sleep), and treat the inflammation: eczema that is treated stops itching.
Treatment: steroids without fear, and what comes next
Steroid cream is first-line treatment for eczema flares and the most misunderstood. Used correctly, in the right strength for the right place (mild on the face, creases and genitals; moderate to strong on the body, hands and feet), once a day for one to two weeks until the eczema is gone, and then as maintenance twice a week on places that tend to flare, it is safe, and the side effects (thin skin, stretch marks) are seen with months of daily strong steroid on thin skin, not with courses. The most common mistake is using too little, too briefly and too weak, so the eczema never heals and the steroid is used "a little all the time". The fingertip unit: a line of cream from the fingertip to the first joint is enough for an area of two palms. Calcineurin inhibitors (tacrolimus, pimecrolimus) are used on the face, eyelids and creases when steroids aren't suitable, and as maintenance. For moderate to severe atopic eczema there are now effective systemic medicines (dupilumab and other biologics, JAK inhibitors) via a dermatologist, which have changed life for many; light treatment (UVB) is an alternative. Infected eczema is treated with antibiotics or antiseptic baths. Seborrhoeic eczema is treated with antifungals, not oil. And contact allergy is not cured with cream but by finding and avoiding the substance: patch testing at a dermatologist, and reading ingredient lists thereafter.
Massage, oil and cupping with eczema: what applies
Eczema skin needs fat and protection, and an emollient oil can be part of the care: pure mineral oil, paraffin oil, jojoba or almond oil without fragrance and essential oils, applied to damp skin after showering, and not as a replacement for cream but as an addition on the driest skin. Oils with lavender, tea tree, citrus, cinnamon or "natural scents" should be avoided completely: they are among the most common causes of contact allergy on eczema skin. Coconut oil is tolerated by some and worsens in others; test on a small area. Massage on healthy skin beside eczema is okay and can be valuable against the stress that drives flares, but not over eczema in a flare: friction, heat and pressure increase the itch and inflammation, and scratch wounds and cracks can become infected. Cupping follows the same rule, more strictly: never over eczema, whatever the phase, not over recently healed skin (thin and fragile for weeks after a flare), not near weeping, infected or cracked eczema, and not at all during a period when the eczema is widespread. On healthy skin, when the eczema is calm and limited, it is fine to cup back, buttocks, thighs and calves with light suction and plenty of fragrance-free oil, keeping at least a hand's width from eczema areas; suction over already dry and barrier-damaged skin bruises more easily and can start a flare where there was none (the Koebner phenomenon, where eczema and psoriasis can appear where the skin is irritated). Face cupping with atopic eczema on the face or eyelids: no, not until the skin has been calm for several weeks, and then with the lightest suction and fragrance-free oil, only on the parts that are healthy. Always rinse off oil after cupping if the skin tends to react. This is also in when to avoid cupping. For those who want to use cupping against the stress that worsens eczema, light cupping of the back and neck with static cups, on skin that is healthy, is a reasonable way, together with sleep and the other measures in stress. More on the skin in dry hands and feet and massage oil.
Read more
Psoriasis, rosacea, dry hands and feet, skincare routine, face oil, massage oil, stress and when to avoid cupping.
Frequently asked questions
What is the difference between atopic eczema and ordinary dry eczema?
Atopic eczema is the hereditary form with a defective skin barrier, dry and itchy skin since childhood and often asthma or allergy in the family; it sits in the elbow and knee creases, on the neck, eyelids and hands and runs in flares. Dry eczema (asteatotic) is due to skin dried out by washing, soap, hot showers and dry air, sits on the lower legs, arms and trunk, mostly in older people and in winter, and looks like a cracked, crazy-paving pattern. Both are treated with emollients and steroids in flares, but atopic eczema requires long-term maintenance.
What helps eczema best?
Emollients in large amounts at least twice a day and straight after every wash (250–500 grams a week for the whole body), lukewarm and short showers without soap, fragrance-free in everything, cotton next to the skin, steroid cream in the right strength once a day until the flare is gone and then twice a week as maintenance, calcineurin inhibitors on face and creases, itch control with cold and short nails, and for moderate to severe eczema biologics via a dermatologist. Find and avoid triggers, especially contact allergens via patch testing.
Is steroid cream dangerous?
No, used correctly: the right strength for the right place (mild on the face and creases, stronger on body, hands and feet), once a day for one to two weeks until the eczema is gone, then twice a week on places that tend to flare. Side effects such as thin skin are seen with months of daily strong steroid on thin skin, not with courses. The most common mistake is too little, too briefly and too weak, so the eczema never heals and the steroid is used a little all the time.
Which oil is good for eczema?
Fragrance-free oil without essential oils: pure mineral oil, paraffin oil, jojoba or almond oil, on damp skin after showering, as an addition to cream on the driest skin. Avoid lavender, tea tree, citrus, cinnamon and everything scented: they are common contact allergens. Coconut oil is tolerated by some and worsens in others. With seborrhoeic eczema (dandruff, sides of the nose, eyebrows) oil often makes it worse; there antifungals are right.
Can you cup if you have eczema?
Never over eczema, whatever the phase, not over recently healed skin, not near weeping, infected or cracked eczema, and not at all when the eczema is widespread: suction and friction increase the itch and inflammation and can start new flares where the skin is irritated. When the eczema is calm and limited, it is fine to cup healthy skin on back, buttocks, thighs and calves with light suction and fragrance-free oil, at least a hand's width from eczema areas. Face cupping with eczema on the face: no, not until the skin has been calm for weeks.
Related guides
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
