Get same-day medical help for eczema that suddenly becomes painful and rapidly worse with clusters of blisters or small punched-out sores, especially with fever or feeling unwell (possible eczema herpeticum, a herpes infection). Get help the same day, too, for redness covering most of the body, or widespread pus-filled spots on red skin, in someone with psoriasis (erythrodermic or generalised pustular psoriasis).
Key points
- Atopic eczema (atopic dermatitis) causes intensely itchy, dry, inflamed skin. Psoriasis causes thick, red, scaly plaques, most often on the scalp, elbows and knees. Both are long-term immune-related conditions that flare and settle. Neither is contagious.
- Emollients are the foundation of eczema care and should be used every day, even when the skin is clear.
- Topical corticosteroids are safe and effective when the right potency is used on the right area for the right length of time. Using too little can prolong treatment.
- Psoriasis is linked to psoriatic arthritis and to higher cardiovascular risk. Report joint pain, swelling or stiffness early.
- For severe disease, options include phototherapy, methotrexate or ciclosporin, biologic injections and JAK inhibitor tablets. Oral JAK inhibitors carry an FDA boxed warning for serious infections, cancer, heart events and blood clots.
Recognising eczema and psoriasis
Atopic eczema
The US National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) describes atopic eczema as usually starting in infancy or childhood, although it can first appear in adulthood. Itch is the main symptom and can be severe. Scratching causes redness, swelling, cracking, weeping and crusting. Where it appears depends on age:
- Infants: face, scalp and skin around the joints; rarely the nappy area.
- Children: the bends of the elbows and knees, neck and ankles.
- Teens and adults: hands, neck, elbow and knee creases, around the eyes, ankles and feet.
On darker skin, inflamed areas may look darker or lighter rather than red. Eczema often occurs with asthma, hay fever and food allergy, and is more likely with a family history of these. Complications include bacterial and viral skin infections, poor sleep, hand eczema and eye inflammation.
Psoriasis
In psoriasis, an overactive immune system makes skin cells multiply too quickly. NIAMS lists several types:
- Plaque psoriasis: the most common type, with raised, red patches covered in silvery-white scale, often symmetrical on the scalp, trunk, elbows and knees.
- Guttate psoriasis: small red spots, mainly in children and young adults, often after a throat infection.
- Inverse psoriasis: smooth red patches in skin folds such as the groin, armpits or under the breasts.
- Pustular psoriasis: pus-filled bumps on red skin, usually on the hands and feet, with a rare form that covers most of the body.
- Erythrodermic psoriasis: rare but severe red, scaly skin over most of the body. Triggers can include severe sunburn or medicines such as corticosteroids.
Nails may become thick, ridged or pitted. Infections, smoking, obesity and some medicines can trigger or worsen psoriasis.
Emollients and skin care
NICE guidance on eczema in children under 12 (CG57) is the most detailed NICE advice. Its principles are widely applied:
- Use unperfumed emollients every day, in larger amounts and more often than other treatments, over the whole body, both when the skin is clear and during flares. NICE suggests 250 to 500 g of leave-on emollient a week for children.
- Smooth emollients onto the skin rather than rubbing them in. When using more than one product at the same time of day, apply one, wait several minutes, then apply the next.
- Use emollients or emollient soap substitutes instead of soap and detergent-based washes. NICE no longer recommends emollient bath additives for children, based on trial evidence.
- If an emollient stings or is not acceptable, try a different product.
Topical corticosteroids: safe, effective use
The UK medicines regulator (MHRA) groups topical steroids into 4 potencies: mild (for example hydrocortisone), moderate (clobetasone), potent (beclometasone) and very potent (clobetasol). The key rules from NICE and the MHRA:
- Match potency to severity and site. In children, NICE advises mild potency for mild eczema, moderate for moderate, potent for severe, and mild potency on the face and neck (a moderate one for only 3 to 5 days in a severe flare). Use moderate or potent steroids in the armpits or groin for 7 to 14 days at most. Very potent steroids should not be used in children without specialist advice, and potent steroids not under 12 months without specialist supervision.
- Apply once or twice daily only to active eczema, or eczema active in the past 48 hours.
- Use enough. The MHRA notes that underuse can prolong treatment. Ask how much to apply and for how long.
- Prevent frequent flares: once eczema is controlled, applying steroid to problem areas on 2 days a week can reduce flares in children with 2 or 3 flares a month.
- In psoriasis (NICE CG153): for the trunk and limbs, a potent steroid once daily plus a vitamin D analogue once daily for up to 4 weeks. Use a potent steroid for up to 4 weeks on the scalp, and only mild or moderate steroids for up to 2 weeks on the face, skin folds or genitals. Aim for a 4-week break between courses of potent or very potent steroids.
Fear versus real risks. NICE advises explaining that the benefits of topical steroids outweigh the harms when they are used correctly. Continuous use of potent or very potent steroids can cause permanent skin thinning and stretch marks, can make psoriasis unstable, and can cause whole-body side effects if applied to large areas (more than 10% of the body). The MHRA reported in 2021 that rare but severe topical steroid withdrawal reactions can occur after stopping long-term continuous or inappropriate use of moderate to high potency steroids. These reactions involve intense redness, stinging and burning that can spread beyond the treated area. If the skin worsens within 2 weeks of stopping, the MHRA advises seeing a doctor before restarting.
Other topical treatments
- Calcineurin inhibitors (tacrolimus, pimecrolimus): NICE does not recommend them first-line or for mild eczema. They are second-line options when steroids have not controlled moderate to severe eczema and further steroid use risks important side effects, particularly permanent skin thinning. The FDA tacrolimus ointment label carries a boxed warning: long-term safety is not established and rare skin cancers and lymphoma have been reported, although a causal link has not been shown. Use it short term or intermittently, only on affected areas, and not under age 2.
- Ruxolitinib cream: a topical JAK inhibitor approved by the FDA for short-term, non-continuous treatment of mild to moderate atopic eczema from age 2 when other topical prescription treatments have failed. It carries the JAK inhibitor boxed warning.
- Vitamin D analogues and coal tar are steroid-free options in psoriasis.
Systemic and biologic treatments
These are started by specialists. Availability and approved ages differ between countries.
- Atopic eczema, FDA-approved biologics: dupilumab (from 6 months of age), tralokinumab (from 12 years), lebrikizumab (from 12 years and at least 40 kg) and nemolizumab (from 12 years, with topical treatment) for moderate to severe eczema not controlled by topical prescription treatments. The dupilumab label warns about eye inflammation (conjunctivitis, keratitis) and advises reporting new eye symptoms promptly.
- Atopic eczema, oral JAK inhibitors: abrocitinib and upadacitinib are FDA-approved from age 12 for refractory moderate to severe eczema not controlled by other systemic medicines, including biologics. Their boxed warning covers serious infections including tuberculosis, higher death rates, cancers (including lymphoma and lung cancer), major cardiovascular events and blood clots. People need a TB test before starting.
- Psoriasis: NICE recommends conventional systemic treatment when psoriasis is extensive (for example more than 10% of the body) or severely affects function or wellbeing, and topical treatment has failed. Methotrexate is usually first choice. Ciclosporin is preferred when rapid control is needed or when someone (man or woman) is planning a pregnancy. Acitretin is an option for pustular psoriasis and needs a pregnancy prevention programme. NICE also lists phototherapy and many targeted treatments, including biologics such as adalimumab, ustekinumab, secukinumab, guselkumab, risankizumab and bimekizumab, and oral options such as apremilast and deucravacitinib.
Red flags / when to get urgent help
- Eczema herpeticum: rapidly worsening painful eczema, clustered blisters like early cold sores, uniform punched-out sores 1 to 3 mm across, sometimes with fever or lethargy. NICE advises starting antiviral treatment immediately and same-day specialist review, plus same-day eye review if it is near the eyes.
- Erythroderma or generalised pustular psoriasis: NICE advises immediate referral for same-day specialist assessment.
- Eczema not settling: if a mild or moderate steroid has not controlled eczema within 7 to 14 days, NICE advises checking for bacterial or viral infection and reviewing treatment.
- Joint symptoms in psoriasis: stiff, swollen or painful joints, back pain or heel pain. NIAMS warns that untreated psoriatic arthritis can cause permanent joint damage.
Comorbidities in psoriasis: NICE advises yearly checks for psoriatic arthritis, especially in the first 10 years, and a cardiovascular risk assessment for people with severe psoriasis, repeated at least every 5 years. NIAMS also links psoriasis with depression, diabetes, obesity, Crohn's disease and liver disease, and NICE notes a higher risk of blood clots in veins.
Frequently asked questions
Are steroid creams safe for my child?
Yes, when the right potency is used on the right area for the recommended time. NICE advises using them only on active eczema and labelling the tube with its potency. Ask your prescriber how much to use.
Is psoriasis contagious?
No. It is an immune-mediated condition, and many people have a family history of it.
Will eczema go away as my child grows?
For many children it improves or clears before the teenage years, but NIAMS notes it can persist into adulthood or first appear in adults.
Sources
- NIAMS. Atopic dermatitis. niams.nih.gov
- NIAMS. Psoriasis. niams.nih.gov
- NICE. Atopic eczema in under 12s: diagnosis and management (CG57), last updated 2025. nice.org.uk/guidance/cg57
- NICE. Psoriasis: assessment and management (CG153). nice.org.uk/guidance/cg153
- MHRA Drug Safety Update. Topical corticosteroids: information on the risk of topical steroid withdrawal reactions, 2021. gov.uk
- US FDA-approved labeling: dupilumab, tralokinumab, lebrikizumab, nemolizumab, abrocitinib, upadacitinib, ruxolitinib cream and tacrolimus ointment, via the openFDA drug label API. open.fda.gov
This article is for education and does not replace advice from a doctor, dermatologist or pharmacist who knows the person's history.
