Eczema Treatment London | Dermatologists & Specialists

Eczema Treatment in London

Eczema treatment in London is provided by 60+ GMC-registered dermatologists across all boroughs prescribing barrier-repair emollients, topical corticosteroids ranging from mild to very potent strengths, topical calcineurin inhibitors for face and sensitive areas, phototherapy (narrowband UVB 2-3 times weekly), systemic immunosuppressants including methotrexate and ciclosporin, and biologic therapy with dupilumab achieving 70-80% symptom improvement within 16 weeks for moderate-severe eczema resistant to standard treatments.

London eczema specialists treat atopic dermatitis affecting infants, children, and adults, contact dermatitis requiring patch testing for allergen identification, dyshidrotic eczema causing hand and foot blisters, seborrhoeic dermatitis affecting scalp and face, and nummular eczema presenting as coin-shaped patches, with treatment costs £250-£350 for initial consultation plus £30-£200 monthly for prescriptions covered by Bupa, Axa, and Aviva insurance.

Treatment Options for Eczema

Emollients (Foundation Therapy)

Emollients form the foundation of all eczema treatment providing barrier repair, moisture retention, and itch reduction required by all eczema patients regardless of severity.

Prescription Emollients:

Ointments (greasiest, most effective): 50% White Soft Paraffin, Hydromol Ointment, Diprobase Ointment
Creams (less greasy, daytime use): Diprobase Cream, Aveeno, Cetraben
Lotions (least greasy, large areas): Dermol 500 Lotion, Cetraben Lotion
Emollient washes (soap substitutes): Dermol 500, Cetraben Emollient Bath Additive, Oilatum

Application:

Apply liberally 3-4 times daily minimum
Use 250-500g weekly for adults
Apply 30 minutes after topical steroids
Continue during clear periods (maintenance)
Pump dispensers reduce contamination

Topical Corticosteroids

Topical steroids reduce inflammation controlling eczema flares with potency matched to body site and severity.

Mild Steroids (face, genitals, young children):

Hydrocortisone 0.5-1%
Safe for prolonged use
Minimal side effects

Moderate Steroids (body, limbs):

Eumovate (clobetasone butyrate 0.05%)
Betnovate-RD (betamethasone valerate 0.025%)
Use for 1-2 weeks

Potent Steroids (body, thick skin):

Betnovate (betamethasone valerate 0.1%)
Elocon (mometasone furoate)
Short courses only (1-2 weeks)

Very Potent Steroids (severe flares, thick skin):

Dermovate (clobetasol propionate 0.05%)
Maximum 2 weeks
Specialist supervision

Safe Steroid Use:

Apply thinly once daily to affected areas only
Use fingertip unit method (0.5g from fingertip to first joint)
Step down potency as improves
Weekend therapy for maintenance (potent steroids 2 days/week)
Avoid prolonged continuous use (skin thinning risk)

Topical Calcineurin Inhibitors

Non-steroid anti-inflammatory alternatives for face, eyelids, genitals, and steroid-sensitive skin.

Tacrolimus (Protopic):

0.03% for children 2-15 years
0.1% for adults
Apply twice daily
Burning sensation first week (improves)

Pimecrolimus (Elidel):

1% cream
Milder than tacrolimus
Good for mild-moderate facial eczema
Less burning

Advantages:

No skin thinning
Safe for prolonged use
Suitable for face and sensitive areas
Can use long-term

Wet Wrap Therapy

Intensive treatment for severe eczema flares:

Technique:

Apply emollients generously
Apply topical steroids to affected areas
Soak bandages in warm water
Wrap wet bandages around affected limbs/body
Cover with dry bandages
Leave overnight or several hours

Benefits:

Enhances penetration of topical treatments
Provides cooling, soothing relief
Prevents scratching
Breaks itch-scratch cycle

When to use:

Severe eczema flares
Widespread eczema
Children with severe scratching
Under specialist guidance

Phototherapy

UVB light therapy for moderate-severe eczema:

Narrowband UVB:

Most common phototherapy for eczema
2-3 sessions weekly
6-12 week courses
60-70% achieve significant improvement

PUVA (Psoralen + UVA):

For severe resistant eczema
Oral psoralen tablet 2 hours before UVA exposure
More side effects than UVB
Used less frequently

Requirements:

Hospital or specialist clinic attendance
Regular sessions
Time commitment
Pregnancy precautions

Systemic Immunosuppression

For severe eczema not controlled with topical treatments:

Methotrexate:

Weekly oral or injection
10-25mg weekly typically
Monthly blood monitoring
Pregnancy prevention required
Takes 6-12 weeks for effect

Ciclosporin:

Oral capsules twice daily
2.5-5mg/kg daily
Rapid effect (2-4 weeks)
Blood pressure and kidney monitoring
Maximum 1-2 years use

Azathioprine:

Daily oral tablets
1-3mg/kg daily
Takes 8-12 weeks for effect
Blood monitoring required
Genetic testing (TPMT) before starting

Biologic Therapy - Dupilumab (Dupixent)

Revolutionary treatment for moderate-severe eczema:

Mechanism:

Monoclonal antibody blocking IL-4 and IL-13
Targets underlying inflammation
Highly selective, fewer side effects than traditional immunosuppressants

Administration:

Subcutaneous injection every 2 weeks
Self-administered at home after training
Loading dose: 600mg, then 300mg fortnightly

Efficacy:

70-80% achieve EASI-50 (50% improvement) at 16 weeks
40-50% achieve EASI-75 at 16 weeks
Significant itch reduction within 2-4 weeks
Quality of life dramatically improves

Cost:

£1,200-£1,500 per month
NHS funded for severe eczema meeting criteria
Private insurance may cover with pre-authorisation
Requires specialist prescription

Eligibility:

Severe eczema (EASI ≥20)
Failed topical treatments
Failed or intolerant to systemic therapy
Significant impact on quality of life

Top dupilumab prescribers:

Dr. Shaaira Nasir - Eczema and biologics specialist
Dr. Magnus Lynch - Immunodermatology expert
Dr. Emma Wedgeworth - Eczema specialist

Top Eczema Specialists in London

Dr. Shaaira Nasir - Multiple Locations

Specialist in childhood and adult eczema with expertise in biologic therapy. Provides comprehensive assessment, treatment optimization, and family support.

Expertise: Eczema all ages, dupilumab therapy, paediatric dermatology
Consultation: £260
Insurance: Bupa, Axa, Aviva accepted
Profile: View Dr. Shaaira Nasir

Dr. Emma Wedgeworth - Harley Street & South London

General and paediatric dermatologist specialising in eczema management, food allergy-related skin conditions, and family-centred care.

Expertise: Childhood eczema, adult eczema, food allergies
Consultation: £270
Insurance: Bupa, Axa accepted
Profile: View Dr. Emma Wedgeworth

Dr. Magnus Lynch - Harley Street

Immunodermatology specialist managing severe eczema with biologic therapy, systemic immunosuppressants, and phototherapy.

Expertise: Severe eczema, dupilumab, systemic therapy
Consultation: £295
Insurance: Bupa, Axa, Aviva, Vitality accepted
Profile: View Dr. Magnus Lynch

Dr. Adam Friedmann - Harley Street Dermatology Clinic

Comprehensive eczema treatment across all severities with 20+ years experience managing childhood and adult cases.

Expertise: All eczema types, paediatric and adult
Consultation: £300
Insurance: Bupa, Axa, Aviva, Vitality, WPA accepted
Profile: View clinic

London Dermatology Clinic - Harley Street

Established practice providing complete eczema management including phototherapy, systemic therapy, and biologic treatment.

Expertise: All eczema treatments, phototherapy available
Consultation: £250-£300
Profile: View clinic

Childhood Eczema Treatment

Infant Eczema (0-12 months)

Common presentations:

Face and scalp involvement
Weeping, crusting lesions
Nappy area usually spared
Sleep disturbance from itching

Treatment approach:

Liberal emollients 4-6 times daily
Mild topical steroids (hydrocortisone 1%) for face
Moderate steroids for body (short courses)
Soap substitutes for bathing
Parent education and support

Triggers to identify:

Food allergies (cow's milk protein most common)
Environmental allergens (house dust mite)
Irritants (saliva from dribbling, harsh detergents)
Temperature extremes

Toddler & School Age Eczema (1-12 years)

Typical patterns:

Flexural eczema (elbow creases, knee creases)
Neck and wrist involvement
Hand and foot eczema
Scratching causing lichenification

Treatment options:

Emollients as foundation
Topical steroids matched to body site
Wet wrap therapy for severe flares
Antihistamines for sleep
School liaison for chronic cases

Special considerations:

Swimming (chlorine irritation - apply emollient barrier before)
Sports (sweating triggers - shower promptly, reapply emollients)
School absence (severe flares may require time off)
Psychological support (bullying, self-esteem)

Teenage Eczema

Challenges:

Appearance concerns
Treatment adherence difficulties
Transition to adult services
Increased independence in management

Treatment considerations:

Cosmetically acceptable formulations
Once-daily treatments when possible
Combination medical-cosmetic approach
Isotretinoin interaction (cannot combine with dupilumab)
Psychological support

Find paediatric eczema specialists for children's care.

Adult Eczema Treatment

Adult-Onset Eczema

New eczema developing in adulthood:

Possible causes:

Contact dermatitis (occupational or environmental)
Stress-triggered atopic eczema
Hormonal changes (pregnancy, menopause)
Systemic disease (rare)

Investigation:

Patch testing for contact allergens
Blood tests if systemically unwell
Skin biopsy if atypical

Hand Eczema

Common in adults, often occupational:

Types:

Irritant contact dermatitis (wet work, chemicals)
Allergic contact dermatitis (specific allergens)
Pompholyx (dyshidrotic eczema - blisters)
Atopic hand eczema

Treatment:

Frequent emollient application (every 2 hours)
Potent topical steroids
Cotton gloves under vinyl gloves for wet work
Allergen avoidance (if identified)
Hand phototherapy
Alitretinoin (severe cases)

Occupational considerations:

Workplace modifications
Protective equipment
Compensation claims possible
Job changes if severe

Facial Eczema in Adults

Challenging to treat, significant psychological impact:

Treatment:

Emollients suitable under makeup
Mild-moderate steroids (short courses only)
Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
Avoid triggers (harsh cleansers, fragrances)

Cosmetic considerations:

Hypoallergenic makeup
Fragrance-free skincare
Gentle cleansing
Sun protection (mineral-based)

Severe Eczema Management

Defining Severe Eczema

Severe eczema characterized by:

EASI score ≥20 (Eczema Area and Severity Index)
Extensive body surface area involvement
Daily impact on activities
Sleep disturbance
Failed topical treatments
Recurrent infections
Significant psychological distress

Treatment Escalation Pathway

Step 1: Optimised topical therapy

Adequate emollient quantity (500g+ weekly)
Appropriate potency steroids
Topical calcineurin inhibitors

Step 2: Add-on therapies

Wet wraps
Antihistamines
Infection treatment
Trigger avoidance

Step 3: Phototherapy

Narrowband UVB 2-3 times weekly
6-12 week courses
Hospital-based

Step 4: Systemic immunosuppression

Methotrexate, ciclosporin, or azathioprine
Regular monitoring required
Limited duration use

Step 5: Biologic therapy

Dupilumab (Dupixent)
Long-term use possible
Excellent safety profile

Infection Management

Eczema skin prone to bacterial and viral infections:

Bacterial (Staphylococcus aureus):

Weeping, crusting, yellow discharge
Worsening despite treatment
Treatment: Oral antibiotics (flucloxacillin, clarithromycin) 7-14 days
Antiseptic baths (dilute bleach baths 0.005%)

Eczema Herpeticum (Medical Emergency):

Herpes simplex virus infection on eczema
Painful clustered vesicles/pustules
Fever, feeling unwell
Treatment: Urgent oral aciclovir, hospital admission if severe
Contact dermatologist immediately if suspected

Fungal:

Less common
Consider if treatment-resistant
Antifungal therapy if confirmed

Eczema Treatment Costs

Consultation Fees

Service	Cost Range	Notes
Initial Consultation	£250-£350	Includes prescription
Follow-up Consultation	£150-£250	Treatment review
Patch Testing	£300-£500	Allergen identification
Video Consultation	£200-£280	Prescription renewal

Treatment Costs

Treatment	Monthly Cost	Duration
Emollients	£30-£60	Ongoing
Topical Steroids	£10-£40	As needed
Topical Calcineurin Inhibitors	£40-£80	Ongoing
Antihistamines	£5-£15	As needed
Phototherapy	£200-£400	6-12 weeks
Methotrexate	£20-£50	Ongoing
Ciclosporin	£40-£100	Maximum 1-2 years
Dupilumab	£1,200-£1,500	Ongoing

Insurance Coverage

Private medical insurance covers:

Dermatology consultations
Patch testing
Prescription medications
Phototherapy
Systemic immunosuppressants
Dupilumab (with pre-authorisation)

NHS provides:

Free dermatology consultations (after GP referral, 8-16 week wait)
Free prescriptions (if eligible)
Dupilumab for severe eczema meeting criteria

View insurance coverage guide for details.

Frequently Asked Questions

How long does eczema treatment take to work?

Eczema improvement timelines vary by treatment. Emollients and topical steroids show improvement within 3-7 days with maximum effect at 2 weeks. Topical calcineurin inhibitors take 1-2 weeks with burning sensation initially. Phototherapy requires 4-6 weeks for noticeable improvement over 6-12 week courses. Systemic immunosuppressants (methotrexate, azathioprine) take 6-12 weeks for full effect while ciclosporin works faster at 2-4 weeks. Dupilumab reduces itch within 2-4 weeks with skin improvement at 4-8 weeks achieving 70-80% improvement at 16 weeks. Consistency with treatment critical for success.

Can eczema be cured permanently?

Eczema cannot be permanently cured but achieves long-term remission in many patients. Childhood eczema improves with age in 60-70% of cases achieving clearance by teenage years. Adult eczema typically requires ongoing maintenance therapy with emollients and occasional topical steroids. Avoiding identified triggers (allergens, irritants) reduces flare frequency. Dupilumab provides long-term control while taking medication but eczema returns if stopped. Focus on achieving remission, preventing flares, and maintaining quality of life rather than seeking permanent cure.

What causes eczema flares?

Eczema flares result from genetic skin barrier defects allowing moisture loss and allergen penetration triggering immune responses. Common triggers include environmental allergens (house dust mite, pollen, pet dander), irritants (soap, detergents, wool, synthetic fabrics), food allergies in children (cow's milk, egg, nuts, wheat), infections (bacterial overgrowth, viral), climate factors (cold dry weather, sweating from heat), and stress (psychological stress worsens itch-scratch cycle). Identifying personal triggers through patch testing and elimination diets helps prevention. Most patients have multiple triggers requiring comprehensive avoidance strategy.

Should children with eczema avoid certain foods?

Children should avoid foods only if proven allergy through testing (skin prick tests, blood IgE tests) or supervised elimination-reintroduction trials. Common eczema-associated food allergies include cow's milk protein (most common), egg, wheat, soy, nuts, and fish typically outgrown by school age. Unnecessary food restrictions risk nutritional deficiency and fail to improve eczema. Dietitian input recommended when eliminating major food groups. Most childhood eczema requires skin treatments not food avoidance. Consider food allergy if severe eczema, failure to thrive, immediate reactions after eating, or strong family history. Specialist assessment recommended before dietary changes.

Is dupilumab better than other eczema treatments?

Dupilumab (Dupixent) provides superior efficacy for moderate-severe eczema compared to traditional systemic immunosuppressants achieving 70-80% improvement versus 40-60% with methotrexate or ciclosporin. Dupilumab offers better safety profile enabling long-term use without organ toxicity risks requiring blood monitoring. Injectable biologic targets specific immune pathways causing fewer side effects than broad immunosuppression. However dupilumab costs £1,200-£1,500 monthly versus £20-£100 for traditional treatments. Reserved for severe eczema failed topical therapy and systemic treatments. NHS funds dupilumab for eligible patients. Not appropriate for mild-moderate eczema controlled with topicals.

Can adults suddenly develop eczema?

Adults can develop eczema without childhood history through contact dermatitis from workplace or environmental allergens, adult-onset atopic dermatitis triggered by stress or hormonal changes, hand eczema from wet work or irritants, seborrhoeic dermatitis affecting scalp and face, or nummular eczema causing coin-shaped patches. New adult eczema requires dermatologist assessment excluding other conditions (psoriasis, fungal infection, skin cancer). Patch testing identifies allergic triggers. Treatment identical to childhood eczema using emollients, topical steroids, and systemic therapy if severe. Adult eczema rarely remits spontaneously requiring ongoing maintenance.

How often should I apply emollients for eczema?

Apply emollients minimum 3-4 times daily including morning, afternoon, evening, and night even when skin appears clear. Use 250-500g weekly for adults, 100-250g for children achieving adequate coverage. Apply liberally coating entire skin surface not just affected areas preventing new eczema development. Reapply after washing hands, bathing, or sweating. Apply 30 minutes after topical steroids allowing steroid absorption. Continue emollients during remission periods as maintenance therapy. Pump dispensers reduce contamination. Increased frequency during flares or dry weather. Adequate emollient quantity more important than brand selection.

Will my child outgrow eczema?

60-70% of children with eczema achieve clearance or significant improvement by teenage years. Factors predicting remission include mild eczema severity, onset after age 2 years, no food allergies, no asthma or hay fever, and no family history of atopic conditions. Factors suggesting persistence include severe widespread eczema, very early onset (first 3 months), associated food allergies, development of asthma, and strong family atopic history. 30-40% continue eczema into adulthood typically milder than childhood form affecting hands, face, and flexures. Effective childhood treatment prevents permanent skin changes and reduces adult eczema severity.

Is eczema contagious?

Eczema is not contagious and cannot spread person-to-person through contact. Genetic predisposition determines eczema development affecting families with atopic conditions including asthma and hay fever. Skin-to-skin contact with eczema patients causes no transmission risk. However infected eczema with bacterial overgrowth or eczema herpeticum (viral infection) can transmit infection not eczema itself. Children with eczema can attend school, swimming, and group activities safely. Education combats stigma and discrimination. Emollient application prevents transmission concerns through normal social interaction.

Can I swim with eczema?

Swimming is safe and beneficial for eczema providing exercise and social activity. Chlorine can irritate eczema requiring preventive measures: apply thick emollient barrier before swimming covering all skin, shower immediately after swimming removing chlorine with soap substitute, reapply emollients liberally within 5 minutes of showering, and use moderate potency topical steroid if irritation develops. Sea water benefits some eczema patients reducing inflammation through salt content. Avoid swimming during severe flares or infected eczema. Children should not miss swimming due to well-controlled eczema. Communicate with lifeguards about emollient needs before entering pool.

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