VOLUME TWO — UNDERSTANDING SKIN CONDITIONS
CHAPTER 9

Eczema (Atopic Dermatitis): Why Your Skin Is Dry, Flaky, Itchy & Inflamed

“Eczema isn’t simply dry skin. It’s a chronic inflammatory condition where the skin barrier and immune system behave differently.”

What Is Eczema?

Dry. Tight. Itchy. Flaky. Red. Sometimes cracked, weeping or incredibly uncomfortable.
Eczema is often described as simply having “very dry skin”, but there is much more happening beneath the surface.

Atopic dermatitis, the most common form of eczema, is a chronic inflammatory skin condition associated with changes in both skin barrier function and immune activity.

The outermost layers of healthy skin help keep water in and potential irritants, allergens and microorganisms out.

In eczema-prone skin, this protective barrier does not function as effectively.

Water escapes more readily, contributing to dryness, while external substances can penetrate the barrier more easily and provoke irritation and inflammation.

This helps explain something people with eczema know very well:
Skin can appear relatively calm one week and suddenly flare the next.

Why Does Eczema Develop?

There isn’t one single cause.

Eczema appears to develop through a combination of:

• Genetics
• Altered skin-barrier function
• Immune-system activity
• Environmental exposure
  
• The skin microbiome
• Individual triggers
  

Some people with atopic dermatitis have variations involving filaggrin, a protein important for maintaining the structure and hydration of the skin barrier.

But not everyone with eczema has a filaggrin mutation, and eczema is considerably more complex than one defective protein.

What matters practically is that eczema-prone skin tends to be more vulnerable to moisture loss, irritation and inflammation.

The Skin Barrier Connection

Think of the skin barrier as your body’s external protective wall.

A healthy barrier helps: KEEP IN

• Water
• Natural moisturising factors
• Lipids
  

KEEP OUT

• Irritants
• Allergens
• Environmental stressors
• Potential pathogens
  

When barrier function is impaired, transepidermal water loss (TEWL) can increase.

The result can be skin that feels:

• Dry
• Rough
• Tight
• Flaky
• Sensitive
• Easily irritated
  

But eczema isn’t simply a damaged barrier.

Inflammation also affects barrier function, creating a cycle in which barrier dysfunction and inflammation can reinforce one another.

Skin Code Perspective™

“With eczema-prone skin, barrier care isn’t an occasional rescue treatment. It needs to be part of everyday skincare.”

Why Is Eczema So Itchy?

Itch is one of the defining symptoms of atopic dermatitis — and it can be much more significant than people without eczema realise.

Inflammatory signalling within the skin can activate sensory nerves and create intense itching.

Then comes the itch–scratch cycle:

Inflammation → itching → scratching → barrier damage → more inflammation → more itching

Scratching may provide temporary relief, but it can further damage the barrier and potentially increase the risk of infection.

For some people, itching also becomes particularly troublesome at night and can interfere with sleep.

This is one reason eczema management isn’t purely cosmetic.

What Can Trigger an Eczema Flare?

Triggers differ considerably between individuals.
Common aggravating factors can include:

• Harsh skincare - Strong cleansers, fragranced products, excessive exfoliation and inappropriate active ingredients can irritate already vulnerable skin.
• Heat and sweating - Hot weather, exercise and sweating can increase itching or irritation in some people.
• Cold or dry weather - Low humidity can increase moisture loss and dryness.
  Fragrance
• Fragrance is a potential irritant or allergen and may be problematic for some eczema-prone skins.
• Hot showers - Long, very hot showers can strip surface lipids and aggravate dryness.
• Fabrics - Wool and rough or irritating fabrics can aggravate itching in some people.
• Stress - Stress doesn’t “cause” eczema, but psychological stress can influence inflammatory pathways and may contribute to flares in susceptible individuals.
• Allergens and contact irritants - Individual environmental or contact triggers may contribute to symptoms.
  

Importantly, not everyone with eczema has the same triggers.

Trying to eliminate everything at once can create unnecessary restrictions without actually identifying what matters.

Eczema vs Dry Skin

They are not the same.

Dry skin primarily describes a skin state characterised by insufficient moisture and/or lipids.

Atopic dermatitis is a chronic inflammatory skin disease.

Someone with eczema will commonly experience dryness, but someone with dry skin doesn’t necessarily have eczema.

Dry skin may present as:

• Tightness
• Fine flaking
• Rough texture
• Dullness
• Mild discomfort

Eczema may include:

• Significant itching
• Red or inflamed patches
• Recurrent flares
• Scaling
• Cracking
• Thickened skin from chronic scratching
• Sometimes weeping or crusting

If you’re unsure which you’re experiencing, don’t rely on social media photographs for diagnosis.

Where Does Eczema Appear?

Atopic dermatitis can occur almost anywhere, and its distribution can change with age.

Common areas include:

• Face and neck
• Hands
• Inside the elbows
• Behind the knees
• Wrists and ankles

Adults can also experience persistent hand, facial or eyelid involvement.

Not every red, flaky rash is eczema, however.

Rosacea, perioral dermatitis, psoriasis, seborrhoeic dermatitis, allergic contact dermatitis and other conditions can sometimes look similar.

Correct assessment matters.

Skincare for Eczema-Prone Skin

When skin is reactive, complicated routines aren’t necessarily better.

The foundation should generally be gentle cleansing, moisturisation, barrier support and sun protection appropriate to the individual skin.

1. Cleanse gently - Avoid leaving skin feeling squeaky-clean or tight.

Consider:

• Gentle cleansers
• Soap-free formulations where appropriate
• Lukewarm rather than very hot water
• Avoiding unnecessary cleansing

2. Moisturise consistently

Moisturisers and emollients are an important component of eczema management.

Look for formulations designed to reduce moisture loss and support barrier function.

Depending on the individual, useful ingredients can include:

• Ceramides
• Glycerin
• Petrolatum
• Squalane
• Colloidal oatmeal
• Panthenol
• Hyaluronic acid

The best moisturiser isn’t necessarily the most expensive or most active.

It’s the one your skin tolerates and that you will use consistently.

Ceramides & Eczema-Prone Skin

Ceramides are naturally occurring lipids found within the outer layer of our skin.

Along with cholesterol and fatty acids, they form part of the lipid matrix helping maintain barrier integrity and limit excessive water loss.

Barrier lipid composition can be altered in atopic dermatitis.

This is why ceramide-containing moisturisers can be useful as part of a barrier-supportive routine.

They don’t cure eczema.

They help support something eczema-prone skin frequently struggles to maintain: effective barrier function.

What About Active Ingredients?

This is where people can inadvertently make things worse.

Retinoids, exfoliating acids and strong active formulations may be excellent ingredients for certain skin concerns.

But an ingredient being evidence-based doesn’t mean it is appropriate for every skin, every day or during an eczema flare.

When eczema is active, priorities change.

Instead of asking:

“What active should I add?”

ask:

“What does my skin need removed?”

During a flare, simplifying skincare and following the treatment plan recommended by your medical practitioner may be more appropriate than introducing additional actives.

What About Niacinamide?

Niacinamide can support barrier function and has anti-inflammatory properties.

However, eczema-prone skin can be highly individual.

A product that one person tolerates beautifully may sting or irritate another — particularly during an active flare.

This is why we don’t believe in universal “eczema ingredient lists”.

Formulation, concentration and the current condition of the skin all matter.

Can Professional Facials Help Eczema?

This requires caution.

Active eczema should not simply be treated as dry skin with a stronger facial.

Aggressive exfoliation, peels, skin needling, heat-based treatments and other procedures can potentially aggravate inflamed or compromised skin.

At The Skin Code, our priority with eczema-prone clients is first understanding the current state of the skin.

When the skin is stable, carefully selected professional treatments may sometimes be incorporated to support hydration and general skin health — but they should be chosen conservatively and individually.

An active or unexplained rash may instead require assessment by a GP or dermatologist.

 

The Skin Code Perspective™

“Knowing when not to treat the skin is part of treating skin responsibly.”

 

What About PDRN, Polynucleotides, Growth Factors & Exosomes?

These emerging ingredients are being investigated and used for their potential roles in skin repair, hydration, inflammatory modulation and tissue recovery.

However, the evidence base varies considerably between ingredients, formulations and delivery methods, and they should not currently be presented as established treatments for atopic dermatitis.

For an eczema-prone client whose condition is stable, certain professionally selected regenerative or barrier-supportive products may eventually form part of a broader skin-health strategy.

But during an active eczema flare, they are not a substitute for established eczema management or medical treatment when required.

Why “Natural” Doesn’t Automatically Mean Better

Eczema-prone clients are often encouraged to switch to “natural” skincare.

Unfortunately, natural doesn’t automatically mean gentle or hypoallergenic.

Essential oils, botanical extracts and fragrance compounds can still irritate or sensitise skin.

Likewise, expensive skincare isn’t necessarily superior.

For eczema-prone skin:

Tolerability matters more than marketing.

The Role of Lifestyle

Eczema cannot be cured through lifestyle changes alone.

However, everyday habits can influence skin comfort and potential triggers.

Helpful strategies can include:

• Avoiding excessively hot showers
• Moisturising consistently
• Managing known individual triggers
• Wearing comfortable, non-irritating fabrics
• Managing overheating where possible
• Maintaining comfortable indoor humidity in very dry environments
• Supporting good sleep
• Managing stress
• Avoiding scratching where possible
• Using appropriate sun protection
• Lifestyle should support medical and skincare management — not replace it.

When Should You See a Doctor?

Professional medical assessment is particularly important when:

• Eczema is persistent or worsening
• Itching significantly affects sleep or daily life
• Large areas of skin are involved
• The skin becomes painful
• There is weeping, crusting or suspected infection
• Your normal management is no longer controlling symptoms
• You’re unsure whether the condition is actually eczema
• Prescription treatments can be an important part of eczema management.
  

And this brings us to an important misconception.

Are Steroid Creams Bad for Your Skin?

Not inherently.

Topical corticosteroids are established medical treatments for inflammatory skin conditions including eczema.

Problems can occur with inappropriate potency, location, duration or unsupervised use, but fear of topical steroids can also result in undertreatment of eczema.

This is very different from the perioral dermatitis chapter, where topical corticosteroids can be an important trigger or perpetuating factor.

For eczema, prescribed topical corticosteroids should be used according to the instructions of the treating doctor.

Can Eczema Be Cured?

There currently isn’t a simple cure for atopic dermatitis.

Some people experience significant improvement over time, while others continue to experience periods of remission and flare.

Successful management therefore isn’t necessarily about achieving permanently “perfect” skin.

It’s about: reducing symptoms, controlling inflammation, supporting barrier function, identifying meaningful triggers and extending the periods when skin feels comfortable and stable.

Key Takeaways

✓ Eczema is more than simply dry skin.


✓ Atopic dermatitis involves both barrier dysfunction and inflammation.

✓ Consistent moisturisation and gentle skincare matter.


✓ More active skincare isn’t always better.


✓ Individual triggers vary.


✓ Professional treatments should be approached cautiously.


✓ Prescription treatment can be an important and appropriate part of eczema management.


✓ Persistent, severe or changing symptoms deserve medical assessment.

The Skin Code Perspective™

Eczema teaches us something important about skin health: Healthy skin isn’t necessarily skin that never experiences a flare.

For someone living with eczema, success may mean fewer flares, less itching, better barrier function and longer periods where the skin feels comfortable and resilient.

Rather than continually chasing symptoms with stronger products, we believe in understanding the skin in front of us, respecting its limitations and supporting it appropriately.

And sometimes, the most responsible thing a skin therapist can do is recognise when skincare isn’t the answer.

Continue Your Skin Journey

Next: Chapter 10 — When to See a Professional: When Skincare Isn’t Enough

In our final chapter of Volume Two, we explore the signs that your skin needs professional assessment, when to see a skin therapist versus a GP or dermatologist, and why recognising the limits of skincare can lead to better — and safer — outcomes.