Wellness Goals · Skin condition
Eczema (Atopic Dermatitis)
Atopic dermatitis · also called Eczema, atopic eczema, atopic dermatitis, eccema, dermatitis atópica
Eczema (atopic dermatitis) is a long-lasting skin condition that causes inflamed, red, very itchy skin in flares and calmer periods. Here are its symptoms and causes, what moisturizers and prescribed care involve according to the NHS, NIAMS and the American Academy of Dermatology guideline, what colloidal oatmeal, coconut oil and other natural options have shown, and when infection needs urgent help. Evidence for natural options is mostly low certainty, and signs of infection need a clinician.
General information, not medical advice. Last substantive update · Not medically reviewed. A named clinician has not signed off on this page. How this page is made
About Eczema (Atopic Dermatitis)
Eczema (atopic dermatitis) is a long-lasting, itchy, inflamed skin condition that is not contagious. Its causes combine a weak skin barrier, genes and the immune system. Prescribed care centres on moisturizers and steroid creams, chosen with a clinician. For natural options, regular moisturizers have the best support, colloidal oatmeal and coconut oil have low-certainty support, many popular extras showed no benefit, and signs of infection need urgent help.
What eczema (atopic dermatitis) is, and its symptoms
Atopic dermatitis, often called atopic eczema or just eczema, is a long-lasting condition that causes inflamed, red, extremely itchy skin, says NIAMS. It is not contagious. It often starts in infancy or childhood, comes in flares followed by calmer periods, and improves by adulthood for many people but not all. The NHS says it has no cure, but treatment can control the symptoms.
Skin may be dry, cracked, scaly or thickened, may blister, ooze or bleed, and its colour varies with skin tone: in darker skin, patches can look darker or lighter. In babies the face is often affected; in older children the elbows, knees and neck; in teens and adults the hands, neck, eyelids and feet. People with eczema often also have asthma, hay fever or food allergies, and eczema can disturb sleep and mood.
Causes and triggers
The cause is not fully known. NIAMS names three contributors: a weakened skin barrier that lets moisture escape, genetic changes and an overactive immune system. The risk is higher if a parent, brother or sister has eczema, hay fever or asthma.
The NHS lists triggers such as soap, washing detergent, some fabrics, pets, house-dust mites, pollen, certain foods, heat and temperature changes, skin infections, stress and hormone changes such as in pregnancy. NIAMS adds tobacco smoke, some air pollutants and fragrances in skin products. Scratching worsens the skin and raises the risk of infection.
How eczema is evaluated
NIAMS says a doctor takes a medical history, including family history of allergies, hay fever or asthma, sleep problems, past treatments and exposure to irritants, then examines the skin. Blood tests or a skin biopsy may be used to rule out other causes, and several visits may be needed to confirm the diagnosis.
Doctors and researchers also rate how severe eczema is with scores such as SCORAD and EASI, and with the patient's own questionnaire (POEM).
Established care, in general terms (prescribed care)
The NHS says the main treatments are moisturizers (emollients), used regularly even when skin looks better and for washing in place of soap, and steroid creams or ointments for flares. A GP may add other treatments or refer you to a dermatologist. NIAMS adds that severe disease can need light therapy, oral medicines or injected biologic medicines under close monitoring, and antibiotics when skin infection develops.
The 2023 American Academy of Dermatology guideline for adults made strong recommendations for moisturizers and for prescription topical anti-inflammatory treatments, and conditional recommendations for bathing and wet wrap therapy. A joint 2023 task force of the two main US allergy societies agreed 25 recommendations covering topical treatments, dilute bleach baths, dietary avoidance, immunotherapy, systemic treatments and light therapy. A clinician chooses the treatment.
What moisturizers, colloidal oatmeal, coconut oil and other natural options show
Regular moisturizers have the best support, with fewer flares in a Cochrane review of 77 trials (moderate certainty). Colloidal oatmeal creams reported itch and dryness improvements as an add-on to prescribed care (low certainty), and one trial of 117 children found virgin coconut oil beat mineral oil (low certainty). Dilute bleach baths probably help moderate to severe disease but are for a clinician to set up.
Group education has moderate-certainty support. Probiotics, vitamin D, acupuncture and Chinese herbal medicine show small, uncertain or mixed effects, evening primrose oil and borage oil were no better than placebo, and bath additives, water softeners and silk clothing did no better than usual care. A 40-study review found insufficient evidence to recommend complementary treatments for eczema. See the Health Benefits and Evidence tabs.
When infection needs urgent help
The NHS says to get an urgent appointment or use NHS 111 (UK) if eczema is blistered, crusty, leaking fluid or has pus-filled spots; is painful, swollen or warm; suddenly worsens or spreads; or you have a fever or feel unwell. These can be signs of infection or eczema herpeticum. If you feel very unwell, use your local emergency number. Other safety points are in the Safety tab.
At a glance
Traditional uses history, not proof
Studied for research
- Regular moisturizers, moderate certainty
- Education programmes, moderate certainty
- Dilute bleach baths (clinician-led), moderate certainty
- Colloidal oatmeal, low certainty
- Virgin coconut oil, low certainty
- Probiotics, low certainty
- Vitamin D, low certainty
- Acupuncture and Chinese herbal medicine, mixed evidence
- Evening primrose oil, bath additives, water softeners and silk clothing, evidence against
Main compounds
- Colloidal oatmeal
- Virgin coconut oil
- Probiotics
- Vitamin D
- Evening primrose oil
- Borage oil
Common forms
- Moisturizers and emollients
- Skin-applied oils and washes
- Oral supplements
Research links: AAD adult topical guideline, 2023 · NHS: Atopic eczema · NIAMS: Atopic dermatitis · AAAAI/ACAAI guideline, 2023 · Moisturizers for eczema, Cochrane review · MedlinePlus: Eczema · Research Library · Genes & Biomarkers Library
What it is and its history
- Accepted scientific name
- Eczema (atopic dermatitis)
- Common names
- Eczema (English); Atopic eczema (English); Atopic dermatitis (English); Eccema, dermatitis atópica (Spanish)
What is inside, and how it may work
What it contains and how those compounds act in cells and animals. Laboratory and animal mechanisms are not proven effects in people.
Main compounds
| Compound | Family | Where it is concentrated | Activity studied | Level of evidence |
|---|---|---|---|---|
| Colloidal oatmeal | ground grain | Studied in skin creams and washes. 6 | Human data | |
| Virgin coconut oil | plant oil | Studied on the skin of children. 5 | Human data | |
| Probiotics | live microbes | Studied by mouth. 11 | Human data | |
| Vitamin D | vitamin | Studied as a supplement. 12 | Human data | |
| Evening primrose and borage oil | plant oils | Studied by mouth; no benefit over placebo. 3 | Human data |
Mechanisms, receptors and pathways
| Target or pathway | Gene or receptor | What was found | Level |
|---|---|---|---|
| How eczema develops | NIAMS: researchers have identified three contributors: changes in the skin's protective barrier that let moisture escape, genetic changes, and an overactive immune system. Tobacco smoke, some air pollutants, fragrances in products and very dry skin may affect the barrier. 23 | Agency summary | |
| Moisturizers and the barrier | Moisturizers are proposed to help the weakened skin barrier hold water; the Cochrane review measured fewer flares but did not test the mechanism. 25 | Proposed |
Isolated compounds versus whole extracts
The studies read tested isolated products (oatmeal creams, oils, supplements, probiotics) and complex herbal formulas separately; they did not compare whole foods.
3 moderate certainty2 mixed findings5 low certainty2 evidence against
What was looked at
The 12 benefits and uses checked for Eczema (Atopic Dermatitis), each with how strong the evidence is. Tap one to open it.
- Regular moisturizers (emollients)Moderate certainty
- Colloidal oatmeal moisturizers and cleansersLow certainty
- Virgin coconut oil on the skinLow certainty
- Dilute bleach bathsModerate certainty
- Bath additives, water softeners and silk clothingEvidence against
- Eczema education and psychological approachesModerate certainty
- Moisturizing babies to prevent eczemaMixed findings
- ProbioticsLow certainty
- Vitamin DLow certainty
- Evening primrose oil and borage oil by mouthEvidence against
- Cutting foods out of the dietLow certainty
- Acupuncture and Chinese herbal medicineMixed findings
Lab markers tracked in the studies
SCORAD (SCORing Atopic Dermatitis)EASI (Eczema Area and Severity Index)POEM (Patient-Oriented Eczema Measure)Eczema flares
What is Eczema (Atopic Dermatitis) good for?
The natural and lifestyle approaches that have been studied for eczema, and how strong the human evidence is for each. These describe what studies found, not advice to use them. They do not replace the care described in the About tab.
Benefits, one by one
Each card is a research question, not a promise. Tap a goal to filter. Open a card to see the studies, doses and limits.
Regular moisturizers (emollients)
Moderate certaintyA Cochrane review of 77 trials found fewer flares (risk ratio 0.40) and a longer time to flare with moisturizers than without, plus a small fall in severity scores. Guidelines from the American Academy of Dermatology and the NHS name moisturizers as the base of care, used alongside any prescribed treatment.
3 studiesCreams, ointments and lotions as reported; the NHS describes using th…
Studies, doses and limits
What the trials found
Cochrane review of 77 trials (6,603 people), plus the 2023 American Academy of Dermatology adult topical guideline and the NHS.
Results
SCORAD 2.42 points lower (CI -4.55 to -0.28), below the 8.7-point minimal important difference. Flares: risk ratio 0.40 (CI 0.23 to 0.70). People using moisturizer used less steroid cream over 6 to 8 weeks. Creams with glycyrrhetinic acid, urea or glycerol did better than their controls. Moisturizer alone brought more flares than moisturizer with a prescribed steroid.
Effect sizes as reported
See results
Why this rating
Moderate, the compiler's rating: consistent fewer-flare results and a strong guideline recommendation, but the review calls most evidence low or moderate quality and only 7 of 77 trials had low risk of bias.
Form and dose studied
Creams, ointments and lotions as reported; the NHS describes using them at least twice a day and for washing in place of soap. No amounts are advised here.
Who was studied
Children and adults with mild to severe eczema.
Limits
Many different products; severity changes were small compared with the clinical benchmark; moisturizer alone did not replace prescribed anti-inflammatory treatment.
Why researchers looked
Eczema skin loses moisture through a weakened skin barrier, and moisturizers are the long-standing first step in care.
Proposed mechanism Hypothesis
Proposed: moisturizers add water-holding ingredients and a protective layer to a weakened skin barrier. Not tested directly in the review read.
A proposed mechanism does not show that the effect happens in people.
Avoid aqueous cream, which the NHS says can irritate. The NHS warns that emollient residue on clothes, bedding and dressings can make fabric catch fire more easily, so keep away from smoking and naked flames.
Colloidal oatmeal moisturizers and cleansers
Low certaintyA review of studies in people aged 3 months to 60 years with mild to moderate eczema reported that oatmeal creams and washes used alongside prescribed treatment improved itch, dryness and severity scores. It is an add-on to care, not a replacement for it.
1 studiesOatmeal moisturizers and cleansers used daily as reported; no amounts…
Studies, doses and limits
What the trials found
A 2012 review of company-linked studies in all age groups; no trial counts given in the abstract.
Results
Daily use significantly improved investigator assessment, EASI, itch, dryness and quality-of-life scores from baseline and was well tolerated.
Effect sizes as reported
No numbers in the abstract
Why this rating
Low, the compiler's rating: results are changes from baseline in mostly industry-linked studies, with no sample sizes or comparison group summarised in the abstract.
Form and dose studied
Oatmeal moisturizers and cleansers used daily as reported; no amounts advised.
Who was studied
People aged 3 months to 60 years with mild to moderate atopic dermatitis who continued prescribed medicines.
Limits
Narrative review; baseline comparison; industry links; effect of oatmeal alone not separated from usual care.
Why researchers looked
Finely ground oats have been used on itchy skin for decades.
Proposed mechanism Hypothesis
Proposed in the review: anti-inflammatory, barrier-repair and moisturizing properties seen in laboratory and skin studies. Not tested in the abstract read.
A proposed mechanism does not show that the effect happens in people.
Well tolerated in the studies reviewed. Oat products can rarely cause skin reactions; stop a product that burns, itches or rashes.
Virgin coconut oil on the skin
Low certaintyIn one randomised trial of 117 children with mild to moderate eczema, virgin coconut oil lowered severity scores more than mineral oil over 8 weeks. It is one trial in children, so the evidence is limited.
1 studiesVirgin coconut oil applied to the skin for 8 weeks in the trial; no a…
Studies, doses and limits
What the trials found
One double-blind randomised trial of 117 children.
Results
SCORAD fell 68.23% with coconut oil vs 38.13% with mineral oil (P less than 0.001). Water loss through the skin fell from 26.68 to 7.09 vs 24.12 to 13.55; skin hydration rose more with coconut oil.
Effect sizes as reported
See results
Why this rating
Low, the compiler's rating: a single 8-week trial in children, compared with mineral oil rather than no treatment or a standard moisturizer.
Form and dose studied
Virgin coconut oil applied to the skin for 8 weeks in the trial; no amounts advised.
Who was studied
Children with mild to moderate atopic dermatitis.
Limits
One trial; no comparison with standard moisturizers; oil allergy was not the focus.
Why researchers looked
Coconut oil is a common home skin remedy and is being studied as a moisturizer.
Proposed mechanism Hypothesis
Proposed: it forms a barrier and may lower water loss and bacteria on the skin. Not tested directly beyond the water-loss measure in the trial.
A proposed mechanism does not show that the effect happens in people.
People with a coconut allergy should not use it on the skin without advice. Stop it if the skin burns or the rash worsens.
Dilute bleach baths
Moderate certaintyA 2022 meta-analysis of 10 trials found dilute bleach baths probably improve eczema severity in moderate to severe disease (22 percent vs 32 percent improved by half). This is a method for a clinician to set up, not a home recipe.
2 studiesDilute bleach baths in the trials; the concentration and frequency ne…
Studies, doses and limits
What the trials found
Meta-analysis of 10 randomised trials with 307 people (median average age 7.2 years).
Results
EASI improved by 50% in 22% vs 32%, ratio of means 0.78 (credible interval 0.59 to 0.99, moderate certainty). Staphylococcus colonisation RR 0.89 (CI 0.73 to 1.09, low certainty). Other outcomes were low or very low certainty.
Effect sizes as reported
Ratio of means 0.78
Why this rating
Moderate, the compiler's rating: the review itself grades the severity result moderate, but the trials were small, short (4 to 10 weeks) and for moderate to severe disease.
Form and dose studied
Dilute bleach baths in the trials; the concentration and frequency need a clinician. No amounts are advised here.
Who was studied
Mostly children with moderate to severe atopic dermatitis.
Limits
Small short trials; side effects were mostly dry skin and irritation but harder to compare.
Why researchers looked
Eczema skin often carries Staphylococcus aureus bacteria, and bleach baths were tried to lower them.
Proposed mechanism Hypothesis
Proposed: reducing skin bacteria lessens infection and inflammation; the review found only a small, uncertain fall in bacteria.
A proposed mechanism does not show that the effect happens in people.
Never use bleach undiluted or without a clinician's instructions; bleach can irritate or burn skin and eyes and should be kept away from children.
Bath additives, water softeners and silk clothing
Evidence againstThree large UK trials of everyday add-ons found no clear benefit: emollient bath additives in 483 children, home water softeners in 336 children and silk clothing in 300 children did no better than usual eczema care.
3 studiesBath additives prescribed for 12 months; a home water softener for 12…
Studies, doses and limits
What the trials found
Three UK randomised trials in children (BATHE, water softener and CLOTHES).
Results
Bath additives: POEM difference 0.41 points (CI -0.27 to 1.10), below the 3-point benchmark. Water softener: difference 0.66 on the SASSAD score (CI -1.37 to 2.69). Silk clothing: ratio of EASI 0.95 (CI 0.85 to 1.07).
Effect sizes as reported
See results
Why this rating
Against, the compiler's rating: three well-run randomised trials found no clinical benefit over usual care.
Form and dose studied
Bath additives prescribed for 12 months; a home water softener for 12 weeks; silk garments worn for 6 months, all as reported.
Who was studied
Children aged 6 months to 16 years with eczema, UK only.
Limits
Not blinded to participants; UK settings; leave-on moisturizers were used in both groups.
Why researchers looked
Parents are often told or tempted to try bath products, softer water or special fabrics.
Proposed mechanism Not established
No mechanism was tested in these trials.
A proposed mechanism does not show that the effect happens in people.
No safety problems were highlighted in the trials. They found no benefit to justify extra cost.
Eczema education and psychological approaches
Moderate certaintyA 2024 Cochrane review of 37 trials found that group education about eczema care probably lowers clinical signs and long-term symptoms. The effects may be small, but it is a low-risk lifestyle support that sits alongside medical care.
3 studiesGroup or individual teaching sessions, apps and psychological techniq…
Studies, doses and limits
What the trials found
Cochrane review of 37 trials with 6,170 people.
Results
Group education: SCORAD -9.66 short term (CI -19.04 to -0.29) and -7.22 long term (CI -11.01 to -3.43), moderate certainty. Habit reversal and arousal reduction therapy also reported favourable results. The authors judge the effects of uncertain clinical significance.
Effect sizes as reported
See results
Why this rating
Moderate for group education, the compiler's rating (the review calls it moderate certainty); lower for other approaches.
Form and dose studied
Group or individual teaching sessions, apps and psychological techniques as reported.
Who was studied
Children, parents and adults with atopic dermatitis.
Limits
Only 3 of 37 trials at low risk of bias; no trials of self-help psychological therapies or printed education.
Why researchers looked
Eczema is a long-term condition where daily routine, itch and stress all matter, so teaching and psychological techniques have been tested.
Proposed mechanism Hypothesis
Proposed: understanding care and breaking the itch-scratch cycle helps people stick to treatment. Not tested directly.
A proposed mechanism does not show that the effect happens in people.
Low risk. The NHS and NIAMS note eczema can affect sleep and mood; talk to a clinician if you feel overwhelmed or low.
Moisturizing babies to prevent eczema
Mixed findingsWhether daily moisturizing from birth stops eczema is unresolved: the 1,394-infant BEEP trial and a 2022 Cochrane review found no prevention benefit, while a 2025 trial of 1,247 infants found a modest reduction.
3 studiesDaily whole-body emollient in the first year as reported; no products…
Studies, doses and limits
What the trials found
BEEP randomised trial (1,394 infants), Cochrane individual-participant-data review (5,217 infants in meta-analyses) and a 2025 US trial (1,247 infants).
Results
BEEP 5 years: eczema 31% vs 28% (adjusted RR 1.10, CI 0.93 to 1.30). Cochrane: RR 1.03 (CI 0.81 to 1.31), with more skin infection (RR 1.33) and possibly more food allergy (low certainty). 2025 US trial: 36.1% vs 43.0% (RR 0.84, CI 0.73 to 0.97).
Effect sizes as reported
See results
Why this rating
Mixed, the compiler's rating: moderate-certainty reviews find no effect, one recent large trial finds a small benefit.
Form and dose studied
Daily whole-body emollient in the first year as reported; no products or amounts are advised.
Who was studied
Babies, mostly with a family history of eczema or allergy.
Limits
Trials differed in product, risk group and how eczema was defined.
Why researchers looked
Eczema begins with a weak skin barrier in many babies, so researchers tested protecting it early.
Proposed mechanism Hypothesis
Proposed: early moisturizer protects the barrier and may keep allergens out. Not shown by the trials.
A proposed mechanism does not show that the effect happens in people.
The Cochrane review found possible increases in skin infection and parent-reported food reactions. Ask a paediatrician or health visitor about care for a baby.
Probiotics
Low certaintyA 2018 Cochrane review of 39 trials found probiotics probably make little or no difference to how patients rate eczema symptoms. A 2025 Cochrane review found they may slightly reduce eczema in babies, but not in the best-quality trials.
2 studiesMany different Lactobacillus and Bifidobacterium products and doses b…
Studies, doses and limits
What the trials found
Cochrane review of 39 trials (2,599 people) for treatment and Cochrane review of 24 trials (7,077 mother-infant pairs) for prevention.
Results
Treatment: patient-rated symptoms 0.44 points lower (CI -1.22 to 0.33) and SCORAD 3.91 lower (CI -5.86 to -1.96, low quality), below the 8.7-point benchmark. Prevention: eczema RR 0.87 (CI 0.78 to 0.97, low certainty); 0.86 (CI 0.69 to 1.07) in the lowest-risk-of-bias studies.
Effect sizes as reported
See results
Why this rating
Low, the compiler's rating: reviews report little or no meaningful benefit, wide differences between trials and low-certainty evidence.
Form and dose studied
Many different Lactobacillus and Bifidobacterium products and doses by mouth, with or without prebiotics; no strain or amount is advised.
Who was studied
Children and adults with eczema; infants and pregnant or breastfeeding mothers for prevention.
Limits
Many strains; large unexplained differences; the prevention benefit vanishes in low-bias studies.
Why researchers looked
The gut and skin microbes are linked to immune function, and probiotics are widely sold for eczema.
Proposed mechanism Hypothesis
Proposed: changing gut bacteria may change immune responses in the skin. Not tested directly.
A proposed mechanism does not show that the effect happens in people.
No serious adverse events were linked to probiotics; gut symptoms were reported.
Vitamin D
Low certaintyA 2024 meta-analysis of 11 randomised trials in 686 people found vitamin D supplements lowered eczema severity scores. The trials differed widely and the authors want larger, longer studies.
1 studiesVitamin D supplements by mouth as reported; the abstract gives no dos…
Studies, doses and limits
What the trials found
Meta-analysis of 11 randomised trials, 686 children and adults.
Results
Severity lowered (standardised mean difference -0.41, CI -0.67 to -0.16; I2 58%).
Effect sizes as reported
SMD -0.41
Why this rating
Low, the compiler's rating: a modest pooled effect from small, varied trials with substantial differences between them.
Form and dose studied
Vitamin D supplements by mouth as reported; the abstract gives no doses.
Who was studied
Children and adults with atopic dermatitis.
Limits
Moderate-to-large differences between trials; short follow-up; baseline levels unknown from the abstract.
Why researchers looked
Low vitamin D has been linked with worse eczema, and vitamin D helps skin immunity.
Proposed mechanism Hypothesis
Proposed: vitamin D influences skin immune cells and the skin barrier. Not tested directly.
A proposed mechanism does not show that the effect happens in people.
Too much vitamin D can be harmful; check with a doctor before taking it, especially for children.
Evening primrose oil and borage oil by mouth
Evidence againstA Cochrane review of 27 studies in 1,596 people found these oils no better than placebo for eczema symptoms, and the authors conclude they are not effective.
1 studiesCapsules by mouth as reported; no amounts advised.
Studies, doses and limits
What the trials found
Cochrane review of 27 randomised trials, 1,596 people.
Results
Evening primrose oil: patient scale MD -2.22 (CI -10.48 to 6.04), doctor scale MD -3.26 (CI -6.96 to 0.45) vs placebo. Borage oil also failed to improve symptoms.
Effect sizes as reported
No benefit over placebo
Why this rating
Against, the compiler's rating: well-designed placebo-controlled trials found no benefit.
Form and dose studied
Capsules by mouth as reported; no amounts advised.
Who was studied
Children and adults with atopic eczema.
Limits
Short trials; long-term effects unknown.
Why researchers looked
Both oils contain gamma-linolenic acid, a fatty acid thought to help the skin.
Proposed mechanism Hypothesis
Proposed: gamma-linolenic acid is converted into anti-inflammatory compounds. Not borne out in trials.
A proposed mechanism does not show that the effect happens in people.
The review reports mild, mostly gut-related side effects similar to placebo; it cites a warning that evening primrose oil may raise bleeding in people on warfarin, and a case report about risks with long-term use.
Cutting foods out of the diet
Low certaintyA 2022 meta-analysis of 10 trials found elimination diets may slightly improve eczema severity and sleep in mild to moderate disease, with low certainty, and may carry a risk of developing food allergy. The NHS says not to change your diet unless a doctor advises it.
3 studiesElimination of suspected foods, with or without allergy tests; no foo…
Studies, doses and limits
What the trials found
Meta-analysis of 10 randomised trials, 599 mostly young children.
Results
Severity improved by the minimal important difference in 50% vs 41% (risk difference 9%, CI 0 to 17); sleeplessness score 0.47 lower (CI -0.80 to -0.13); itch not clearly different. Harms were barely reported.
Effect sizes as reported
Risk difference 9% (CI 0 to 17)
Why this rating
Low, the compiler's rating (the review grades it low certainty): the benefit is slight and the harms are poorly studied.
Form and dose studied
Elimination of suspected foods, with or without allergy tests; no foods or amounts advised.
Who was studied
Mostly young children with mild to moderate atopic dermatitis.
Limits
Few harm data; trial diets differed.
Why researchers looked
Foods such as eggs and milk are sometimes blamed for flares, so removing them has been tried.
Proposed mechanism Hypothesis
Proposed: removing a food that triggers an immune reaction reduces skin inflammation. Applies mainly to proven allergy.
A proposed mechanism does not show that the effect happens in people.
Indirect evidence suggests elimination diets can raise the risk of developing IgE-mediated food allergy; they can also miss nutrients. The NHS says breastfeeding parents should not change their diet without medical advice.
Acupuncture and Chinese herbal medicine
Mixed findingsA 2024 review of 8 trials found acupuncture lowered eczema scores and itch with no serious side effects, but the trials were small. A Cochrane review of 28 trials of Chinese herbal medicine found no conclusive evidence because most studies were at high risk of bias. A 40-study review found insufficient evidence for complementary treatments in general.
3 studiesNeedle acupuncture sessions; oral and topical herbal formulas as repo…
Studies, doses and limits
What the trials found
Meta-analysis of 8 acupuncture trials (463 people), Cochrane review of 28 Chinese herbal medicine trials (2,306 people), and a 40-study review of complementary treatments.
Results
Acupuncture: SCORAD -10.61 (CI -17.77 to -3.45), itch -14.71 on a 0 to 100 scale (CI -18.20 to -11.22), quality of life -2.37; EASI and IgE changes not significant. Chinese herbs: effectiveness RR 2.09 vs placebo (2 small trials) and 1.43 vs conventional medicines (very low quality). The 40-study review: insufficient evidence.
Effect sizes as reported
See results
Why this rating
Mixed, the compiler's rating: acupuncture shows promising effects in 8 small trials, herbs are inconclusive, and the overall review finds insufficient evidence.
Form and dose studied
Needle acupuncture sessions; oral and topical herbal formulas as reported, which differ trial to trial. No formula or amount is advised.
Who was studied
Children and adults with atopic dermatitis.
Limits
Small, unblinded or high-risk-of-bias trials; each herbal formula differs.
Why researchers looked
Acupuncture and herbal formulas are widely used in East Asia for itchy skin.
Proposed mechanism Hypothesis
Proposed: acupuncture may alter nerve and immune signalling for itch; herbs act through many compounds. Not tested directly.
A proposed mechanism does not show that the effect happens in people.
The herbal review reports minor side effects that reversed after stopping and one person leaving a trial because of worsening. Herbal products can contain steroids or irritants; ask a clinician, and tell them about every product you use.
Connections to the rest of health
How Eczema (Atopic Dermatitis) connects to the rest of our health knowledge graph. Every link says what kind of connection it is. A safety link (for example to the liver) is a warning, not a benefit. A study that merely mentions a topic never creates a benefit link.
Explore every connection: goals, body systems, organs, symptoms, genes
A. Wellness goals
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Skin Health | Moderate certainty | Regular moisturizers (emollients): A Cochrane review of 77 trials found fewer flares (risk ratio 0.40) and a longer time to flare with moisturizers than without, plus a small fall in severity scores. Guidelines from the American Academy of Dermatology and the NHS name moisturizers as the base of care, used alongside any prescribed treatment. Colloidal oatmeal moisturizers and cleansers: A review of studies in people aged 3 months to 60 years with mild to moderate eczema reported that oatmeal creams and washes used alongside prescribed treatment improved itch, dryness and severity scores. It is an add-on to care, not a replacement for it. | 25 15 22 6 5 2 1 14 18 19 17 24 4 9 16 11 20 12 3 13 10 7 8 | |
| Stress Management | Moderate certainty | Eczema education and psychological approaches: A 2024 Cochrane review of 37 trials found that group education about eczema care probably lowers clinical signs and long-term symptoms. The effects may be small, but it is a low-risk lifestyle support that sits alongside medical care. | 17 22 24 | |
| Gut Health | Low certainty | Probiotics: A 2018 Cochrane review of 39 trials found probiotics probably make little or no difference to how patients rate eczema symptoms. A 2025 Cochrane review found they may slightly reduce eczema in babies, but not in the best-quality trials. | 11 20 |
B. Body systems
I. Biomarkers
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| SCORAD (SCORing Atopic Dermatitis) | Biological association | Low certainty | Measured in trials: fell with moisturizers, coconut oil, probiotics, vitamin D, education and acupuncture; mostly by less than 8.7 points. A lab change is not the same as a health benefit. | 25 5 11 17 10 |
| EASI (Eczema Area and Severity Index) | Biological association | Moderate certainty | Measured in trials: lower with bleach baths; unchanged with silk clothing. A lab change is not the same as a health benefit. | 2 19 |
| POEM (Patient-Oriented Eczema Measure) | Biological association | Moderate certainty | Measured in trials: no meaningful change with bath additives. A lab change is not the same as a health benefit. | 14 |
| Eczema flares | Biological association | Low certainty | Measured in trials: fewer flares with regular moisturizers. A lab change is not the same as a health benefit. | 25 |
L. Active compounds
| Connected to | Kind of connection | Evidence status | Context | Studies |
|---|---|---|---|---|
| Colloidal oatmeal | Biological association | Human | Studied in skin creams and washes. | 6 |
| Virgin coconut oil | Biological association | Human | Studied on the skin of children. | 5 |
| Probiotics | Biological association | Human | Studied by mouth. | 11 |
| Vitamin D | Biological association | Human | Studied as a supplement. | 12 |
| Evening primrose and borage oil | Biological association | Human | Studied by mouth; no benefit over placebo. | 3 |
Each connection is stored with the ingredient, the connected record, the kind of connection, the evidence status, the supporting studies, the preparation or compound involved, and a review date (last reviewed October 31, 2026).
Evidence at a glance: what the research found for 12 outcomes
Each outcome below is one thing researchers measured. Certainty is how far the evidence can be trusted, not how well it works. The full studies are on the next tab.
The evidence
The research centre for Eczema (Atopic Dermatitis). Every record here was checked against PubMed or the publisher's page; we never list a study we have not verified.
Evidence by outcome
Bars show how many studies we found for each outcome, not how well it works. People are added up across trials only (reviews are not added, to avoid double counting).
How we rate evidence
High certainty
Several well-run trials or reviews agree; further research is unlikely to change the picture much.
Moderate certainty
Good trials point the same way, but some doubt remains.
Low certainty
Small, short or inconsistent trials. The finding could change with better research.
Very low certainty
Very little or very weak human data. Treat as a possibility only.
Mixed findings
Trials or reviews disagree with each other.
Not enough evidence
Not enough human research to say either way.
Evidence against
Good research found no benefit, or found harm.
We take the reviewers' own risk-of-bias and GRADE statements where they exist, and otherwise judge from study size, design, consistency, directness and whether a product matches what is sold. Many publications do not make evidence high. Method note: We searched PubMed, read the abstract of every review and guideline cited, and read the NHS, NIAMS, NCCIH and MedlinePlus pages through a tool that summarises pages. Certainty ratings are the compiler's own reading unless a review gives its own grade.
Study library: every study we checked 25
| Study | Design | People | Product, dose, length | Result |
|---|---|---|---|---|
| Ann Allergy Asthma Immunol 2024 Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations Ann Allergy Asthma Immunol · PMID 38108679 · DOI |
Clinical guideline |
People with mild, moderate and severe atopic dermatitis | Topical treatments, dilute bleach baths, dietary avoidance, immunotherapy, systemic treatments and light therapy · vs Varies by recommendation |
A joint task force of two US allergy societies, including patients and caregivers, agreed 25 recommendations, using GRADE. The abstract lists the areas covered: topical treatments (including barrier moisturization devices and wet wrap therapy), dilute bleach baths, dietary avoidance or elimination, allergen immunotherapy, systemic treatments and light therapy. It does not give the direction of each recommendation. 25 recommendations Methods, limits and fundingOutcomes: Recommendations to gain and maintain control of atopic dermatitis Limitations: The abstract does not state the individual recommendations; only the topics covered were read. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Bakaa 2022 Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE Ann Allergy Asthma Immunol · PMID 35367346 · DOI |
Meta-analysis |
307 10 randomised trials, 307 mostly children (median average age 7.2 years) with moderate to severe atopic dermatitis |
Bleach (dilute) baths · vs Control baths or no bleach |
Bleach baths probably improve severity (22% vs 32% improved EASI by 50%; ratio of means 0.78, 95% credible interval 0.59 to 0.99; moderate certainty) and may slightly reduce S. aureus colonisation (RR 0.89, CI 0.73 to 1.09; low certainty). Side effects, mostly dry skin and irritation, did not differ clearly; other outcomes were low or very low certainty. Ratio of means 0.78 Methods, limits and fundingOutcomes: Eczema Area and Severity Index (EASI), Staphylococcus aureus, harms Limitations: Small trials of 4 to 10 weeks; a clinician decides whether and how to use them. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Bamford 2013 Oral evening primrose oil and borage oil for eczema Cochrane Database Syst Rev · PMID 23633319 · DOI |
Meta-analysis |
1596 27 studies, 1,596 people with atopic eczema (19 evening primrose oil, 8 borage oil) |
Evening primrose oil or borage oil by mouth · vs Placebo |
Evening primrose oil did not improve global symptoms compared with placebo (patient scale MD -2.22, CI -10.48 to 6.04, 7 trials; doctor scale MD -3.26, CI -6.96 to 0.45, 8 trials). Borage oil also failed to improve symptoms. The authors conclude both oils are not effective. Side effects were mild and mostly gut-related and similar to placebo; long-term safety was not studied. No benefit over placebo Methods, limits and fundingOutcomes: Global eczema symptoms rated by patients and doctors Limitations: Short studies; long-term effects unknown. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Bradshaw 2023 Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial Allergy · PMID 36263451 · DOI |
Controlled trial |
1394 1,394 term infants with a family history of atopic disease, followed to age 5 |
Daily emollient in the first year of life plus standard skin-care advice · vs Standard skin-care advice alone |
Atopic dermatitis was reported for 188 of 608 (31%) in the emollient group and 178 of 631 (28%) of controls (adjusted RR 1.10, CI 0.93 to 1.30). Doctor-diagnosed food allergy by 5 years was 15% vs 14%. The authors concluded daily emollient in the first year did not prevent atopic dermatitis, food allergy, asthma or hay fever. Adjusted RR 1.10 (CI 0.93 to 1.30) Methods, limits and fundingOutcomes: Parent-reported doctor diagnosis of atopic dermatitis at 12 to 60 months Limitations: Long-term follow-up relied on parent questionnaires. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Evangelista 2014 The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial Int J Dermatol · PMID 24320105 · DOI |
Controlled trial |
117 117 children with mild to moderate atopic dermatitis |
Virgin coconut oil on the skin for 8 weeks · vs Mineral oil |
Mean SCORAD fell 68.23% with virgin coconut oil and 38.13% with mineral oil (P less than 0.001). Moderate improvement 47% vs 34%, excellent response 46% vs 19%. Water loss through the skin fell from 26.68 to 7.09 with coconut oil, vs 24.12 to 13.55 with mineral oil; skin hydration (capacitance) rose more with coconut oil. SCORAD fall 68% vs 38% Methods, limits and fundingOutcomes: SCORAD, transepidermal water loss, skin capacitance Limitations: One trial, 8 weeks, children only, compared with mineral oil rather than no treatment or standard moisturizer. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Fowler 2012 Colloidal oatmeal formulations as adjunct treatments in atopic dermatitis J Drugs Dermatol · PMID 22777219 |
Narrative review |
People aged 3 months to 60 years with mild to moderate atopic dermatitis who kept their prescribed topical medicines | Colloidal oatmeal moisturizers and cleansers · vs Baseline, vehicle or usual care |
The review reports that daily use of oatmeal moisturizers or cleansers significantly improved investigator assessment, EASI, itch, dryness and quality of life from baseline, and that products were well tolerated in babies, children and adults. The abstract gives no numbers or trial counts. No numbers in the abstract Methods, limits and fundingOutcomes: Investigator assessment, EASI, itch, dryness, quality of life Limitations: A narrative review of mostly company-linked studies without a control summary; the abstract gives no sample sizes. Results are changes from baseline while on prescribed treatment. Funding and conflicts: Several authors are listed with industry affiliations in the record; details not read. Read: abstract |
| Gu 2013 Chinese herbal medicine for atopic eczema Cochrane Database Syst Rev · PMID 24018636 · DOI |
Meta-analysis |
2306 28 randomised trials, 2,306 children and adults with atopic eczema |
Chinese herbal medicine by mouth or on the skin · vs Placebo, conventional medicines or no treatment |
Against placebo, 2 trials (85 people) showed a higher effectiveness rate (RR 2.09, CI 1.32 to 3.32) and lower itch. Against conventional medicines (21 studies, 1,868 people) the effectiveness rate was higher (RR 1.43), but evidence was very low quality. Most studies were at high risk of bias and results were inconsistent. Minor side effects were reported in 24 studies that reversed on stopping; one person left a trial because of worsening. The authors found no conclusive evidence that Chinese herbal medicine reduces eczema severity. Effectiveness RR 2.09 (placebo) and 1.43 (conventional) Methods, limits and fundingOutcomes: Overall effectiveness rate, itch, quality of life, adverse events Limitations: High risk of bias in most trials; each formula was different, so results cannot be applied to a single product. Funding and conflicts: Eight studies had government funding; other details not read. Read: abstract |
| Jones 2021 Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis JAAD Int · PMID 34409356 · DOI |
Meta-analysis |
40 studies of complementary treatments for acne, atopic dermatitis and psoriasis | Complementary and alternative treatments (many types) · vs Varied |
For atopic dermatitis the pooled EASI difference was SMD -0.70 (CI -1.19 to -0.21) but the SCORAD difference was 0.94 (CI -0.83 to 2.71). The authors conclude there is insufficient evidence to support or recommend complementary treatments for acne, atopic dermatitis or psoriasis. EASI SMD -0.70; SCORAD SMD 0.94 (CI includes no effect) Methods, limits and fundingOutcomes: Eczema Area and Severity Index (EASI) and SCORAD Limitations: Different study designs, sizes, outcome measures and treatment lengths limit what can be concluded. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Kelleher 2022 Skin care interventions in infants for preventing eczema and food allergy Cochrane Database Syst Rev · PMID 36373988 · DOI |
Meta-analysis |
5217 Healthy term infants without eczema, 11 trials in the meta-analyses (5,217 infants; 33 trials identified) |
Skin care in infancy, mostly emollients · vs Standard care or no treatment |
Skin care in infancy probably does not change eczema risk (RR 1.03, CI 0.81 to 1.31; 7 trials, 3,075 infants; moderate certainty). It may increase IgE-mediated food allergy (RR 2.53, CI 0.99 to 6.49; one trial; low certainty) and probably increases skin infection during the intervention (RR 1.33, CI 1.01 to 1.75; 6 trials; moderate certainty). Slipperiness (infant slippage) may also rise. Eczema RR 1.03; skin infection RR 1.33 Methods, limits and fundingOutcomes: Eczema incidence by 1 to 3 years, food allergy, harms Limitations: Most evidence was low certainty; the food allergy result rests on one trial and varied with how missing data were handled. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Liang 2024 Acupuncture for atopic dermatitis: a systematic review and meta-analysis BMJ Open · PMID 39638592 · DOI |
Meta-analysis |
463 8 randomised trials, 463 people with atopic dermatitis (mostly from China) |
Acupuncture · vs Control treatments (varied) |
Acupuncture lowered SCORAD (MD -10.61, CI -17.77 to -3.45), itch on a 0 to 100 scale (MD -14.71, CI -18.20 to -11.22) and the dermatology quality-of-life score (MD -2.37). Differences in EASI (MD -3.95, CI -8.35 to 0.45) and IgE were not significant. No serious adverse events were reported. The authors call for larger, better trials. SCORAD -10.61; itch -14.71 Methods, limits and fundingOutcomes: SCORAD, itch score, quality of life, adverse events Limitations: Few small trials; control treatments differed; most studies are from one region. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Makrgeorgou 2018 Probiotics for treating eczema Cochrane Database Syst Rev · PMID 30480774 · DOI |
Meta-analysis |
2599 39 trials, 2,599 people of all ages with doctor-diagnosed eczema (most in Europe or Asia) |
Oral probiotics (mainly Lactobacillus and Bifidobacteria) · vs No probiotics or placebo |
Probiotics probably make little or no difference to patient- or parent-rated symptoms (13 trials, 754 people; 0.44 points lower on a 0 to 20 scale, CI -1.22 to 0.33). Quality of life did not differ. SCORAD was 3.91 points lower (CI -5.86 to -1.96; 24 trials, 1,596 people; low-quality evidence), below the 8.7-point minimal important difference. Adverse events did not differ clearly (RR 1.54, CI 0.90 to 2.63); gut symptoms were reported. Symptoms -0.44; SCORAD -3.91 Methods, limits and fundingOutcomes: Patient-rated symptoms, SCORAD, quality of life, adverse events Limitations: Large unexplained differences between trials; many products and doses; most trials unclear risk of bias. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Nielsen 2024 Vitamin D Supplementation for Treating Atopic Dermatitis in Children and Adults: A Systematic Review and Meta-Analysis Nutrients · PMID 39683522 · DOI |
Meta-analysis |
686 11 randomised trials, 686 children and adults with atopic dermatitis |
Vitamin D supplements · vs Control (placebo or no vitamin D) |
Supplementation lowered severity (standardised mean difference -0.41, CI -0.67 to -0.16; heterogeneity I2 58%). The authors say larger, longer studies are needed. SMD -0.41 (CI -0.67 to -0.16) Methods, limits and fundingOutcomes: SCORAD or EASI severity Limitations: Moderate-to-large differences between trials; short follow-up; doses and baseline vitamin D varied. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Oykhman 2022 Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis J Allergy Clin Immunol Pract · PMID 35987995 · DOI |
Meta-analysis |
599 10 randomised trials, 599 mostly young children (average age 1.5 years) with mild to moderate atopic dermatitis |
Dietary elimination (guessed or guided by testing) · vs No elimination |
Elimination may slightly improve eczema severity (50% vs 41% improved by the minimal important difference; risk difference 9%, CI 0 to 17), itch (not clear) and sleeplessness (-0.47 on a 0 to 3 scale, CI -0.80 to -0.13), all low certainty. Harms were barely reported; indirect evidence suggests elimination diets may raise the risk of IgE-mediated food allergy. Risk difference 9% (CI 0 to 17) Methods, limits and fundingOutcomes: SCORAD, itch, sleeplessness, harms Limitations: Low certainty; few data on harm; mostly young children. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Santer 2018 Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness BMJ · PMID 29724749 · DOI |
Controlled trial |
483 483 children aged 1 to 11 with eczema in 96 UK practices |
Emollient bath additives prescribed for 12 months · vs No bath additives |
Average POEM was 7.5 with bath additives and 8.4 without; after adjustment the difference was 0.41 points (CI -0.27 to 1.10), below the 3-point minimal important difference. No differences in secondary outcomes or adverse effects. The authors found no evidence of clinical benefit from adding bath additives to standard care. Difference 0.41 POEM points Methods, limits and fundingOutcomes: Patient-oriented eczema measure (POEM) over 16 weeks Limitations: Open-label; children bathed at least once a week; leave-on emollients were used in both groups. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Sidbury 2023 Guidelines of care for the management of atopic dermatitis in adults with topical therapies J Am Acad Dermatol · PMID 36641009 · DOI |
Clinical guideline |
Adults with atopic dermatitis | Topical therapies, including moisturizers, bathing, wet wraps, prescription topical anti-inflammatories and antimicrobials · vs Varies by recommendation |
The workgroup made 12 recommendations using the GRADE approach. Strong recommendations were made for moisturizers, topical calcineurin inhibitors, topical corticosteroids, and topical PDE-4 and JAK inhibitors. Conditional recommendations were made for bathing and wet wrap therapy, and against topical antimicrobials, antiseptics and antihistamines. 12 recommendations Methods, limits and fundingOutcomes: Strength of recommendations for topical treatment Limitations: Limited to English-language randomised trials, so other languages and long-term follow-up may be missing. It covers adults and topical treatment only. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Simpson 2025 Emollients to Prevent Pediatric Eczema: A Randomized Clinical Trial JAMA Dermatol · PMID 40699587 · DOI |
Controlled trial |
1247 1,247 infants not selected for eczema risk, from 25 US clinics |
Daily full-body emollient from before 9 weeks of age · vs No emollient |
At 24 months atopic dermatitis had occurred in 36.1% of the emollient group and 43.0% of controls (RR 0.84, CI 0.73 to 0.97). The effect was larger in infants not at high risk (RR 0.75). A dog at home changed the effect (RR 0.68). No difference in skin side effects. RR 0.84 (CI 0.73 to 0.97) Methods, limits and fundingOutcomes: Doctor-diagnosed atopic dermatitis by 24 months Limitations: Unblinded; diagnosis taken from medical records. It conflicts with the BEEP trial and the Cochrane review, which found no prevention benefit. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Singleton 2024 Educational and psychological interventions for managing atopic dermatitis (eczema) Cochrane Database Syst Rev · PMID 39132734 · DOI |
Meta-analysis |
6170 37 trials, 6,170 people with atopic dermatitis, mostly in high-income countries |
Education programmes and psychological techniques added to standard care · vs Standard care |
Group education probably reduces clinical signs both short term (SCORAD -9.66, CI -19.04 to -0.29; 731 people) and long term (-7.22, CI -11.01 to -3.43; 1,424 people), and probably long-term patient-reported symptoms, with moderate certainty. Individual education, technology-mediated education, habit reversal and arousal reduction therapy also reported favourable effects. All effects are of uncertain clinical significance as they may not pass the minimal important difference. Group education SCORAD -7.22 long term Methods, limits and fundingOutcomes: SCORAD, patient-reported symptoms, quality of life, well-being Limitations: Only 3 of 37 trials at low risk of bias in all areas; no trials of self-help psychological therapies or printed education. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Thomas 2011 A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children PLoS Med · PMID 21358807 · DOI |
Controlled trial |
336 336 children aged 6 months to 16 years with moderate or severe eczema in hard-water areas |
Ion-exchange water softener at home plus usual care · vs Usual care alone |
Severity improved by 20% with the softener and 22% with usual care (difference 0.66, CI -1.37 to 2.69). No difference in steroid use. Small differences in some parent-reported outcomes were thought to be response bias because families knew their group. Mean difference 0.66 (CI -1.37 to 2.69) Methods, limits and fundingOutcomes: Eczema severity (SASSAD) at 12 weeks Limitations: 12 weeks; families were not blinded; hard-water areas only. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Thomas 2017 Silk garments plus standard care compared with standard care for treating eczema in children: A randomised, controlled, observer-blind, pragmatic trial (CLOTHES Trial) PLoS Med · PMID 28399154 · DOI |
Controlled trial |
300 300 children aged 1 to 15 with moderate to severe eczema in the UK |
Silk clothing worn for 6 months plus standard care · vs Standard care alone |
EASI scores were similar in both groups at every visit (adjusted ratio of geometric means 0.95, CI 0.85 to 1.07). Skin infections occurred in 25% (silk) and 28% (standard care). The authors judged the garments unlikely to be cost-effective. Ratio 0.95 (CI 0.85 to 1.07) Methods, limits and fundingOutcomes: Eczema severity (EASI) assessed by blinded nurses Limitations: Participants could not be blinded; garments worn more at night than by day. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| Wang 2025 Probiotics in infants for prevention of allergic disease Cochrane Database Syst Rev · PMID 40511642 · DOI |
Meta-analysis |
7077 24 trials of infants in the first 6 months of life without allergic disease (7,077 mother-infant pairs) |
Probiotics or synbiotics given to the mother or infant · vs Placebo or no treatment |
Probiotics may slightly reduce eczema by 2 years (RR 0.87, CI 0.78 to 0.97; 18 studies, 3,494 infants; low certainty), but studies at low risk of bias showed little or no difference (RR 0.86, CI 0.69 to 1.07). Synbiotics: very uncertain (RR 0.88). Little or no difference in asthma, hay fever or food allergy, and no serious adverse events related to probiotics. Eczema RR 0.87 (CI 0.78 to 0.97) Methods, limits and fundingOutcomes: Eczema, asthma, rhinitis, food allergy by 2 years; harms Limitations: Low certainty; combining different eczema definitions needed assumptions; effect disappears in the best-quality studies. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
| s-nccih-aloe NCCIH: Aloe vera (updated February 2025) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-nhs-eczema NHS: Atopic eczema (last reviewed 6 September 2024) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-niams-ad NIAMS: Atopic dermatitis (reviewed November 2022) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| s-niams-ad-treatment NIAMS: Atopic dermatitis diagnosis, treatment and steps to take (reviewed November 2022) · Source |
Health agency n/a |
Methods, limits and fundingRead: full-text | ||
| van Zuuren 2017 Emollients and moisturizers for eczema: abridged Cochrane systematic review including GRADE assessments Br J Dermatol · PMID 28432721 · DOI |
Systematic review |
6603 77 randomised trials of people with eczema, 6,603 participants |
Moisturizers and emollients · vs No moisturizer, vehicle, or other treatment |
Moisturizer vs no moisturizer: SCORAD lower by 2.42 points (CI -4.55 to -0.28), which did not reach the minimal important difference of 8.7. Fewer flares (risk ratio 0.40, CI 0.23 to 0.70) and a longer time to flare. Moisturizer groups used less topical corticosteroid over 6 to 8 weeks (9.30 g less, CI 3.27 to 15.3). Creams with glycyrrhetinic acid, urea or glycerol worked better than their controls. More flares with moisturizer alone than with moisturizer plus twice-weekly steroid (RR 2.17), and adding a moisturizer to anti-inflammatory treatment worked better than the treatment alone. SCORAD -2.42; flare risk ratio 0.40 Methods, limits and fundingOutcomes: Eczema severity (SCORAD), flares, steroid use Limitations: Only 7 of 77 trials were at low risk of bias; evidence quality for most outcomes was low or moderate. Funding and conflicts: Funding and conflict-of-interest statements were not read in full. Read: abstract |
What we do not know yet
- No head-to-head trial of natural options against standard eczema care was read.
- The colloidal oatmeal review abstract gives no numbers and reflects industry-linked studies.
- Coconut oil rests on one 8-week trial in children.
- Primary trials of vitamin D, probiotics and acupuncture were not read; only review abstracts.
- The NIAMS pages read do not list warning signs, so the red flags rest on the NHS page.
- No fish-oil or omega-3 treatment review for eczema was read.
How new research is added
New studies are found by a saved PubMed search and placed in a review queue before the page changes.
Lab markers
What changed in blood or saliva tests during trials. A changed number is not the same as feeling or being healthier, and we give no "normal ranges".
Other 4
SCORAD (SCORing Atopic Dermatitis)
Fell with moisturizers, coconut oil, probiotics, vitamin D, education and acupuncture; mostly by less than 8.7 points in trials
A score from 0 to 103 that combines a clinician's rating of the rash with the patient's itch and sleep loss. The smallest change felt to matter is about 8.7 points.
Low certaintyResults and what it means
Why it was measured
The most common measure of eczema severity in trials.
Statistical vs. clinical meaning
A standard measure, but most changes were smaller than the 8.7-point benchmark.
| Study | Result | People | Product |
|---|---|---|---|
| 25 | Moisturizer vs none: 2.42 points lower (CI -4.55 to -0.28). | 77 trials, 6,603 people | Moisturizers |
| 5 | Fell 68.23% with virgin coconut oil and 38.13% with mineral oil over 8 weeks. | 117 children | Virgin coconut oil |
| 11 | 3.91 points lower with probiotics (CI -5.86 to -1.96). | 24 trials, 1,596 people | Probiotics |
| 17 | Group education: -7.22 points long term (CI -11.01 to -3.43). | 3 studies, 1,424 people | Group education |
| 10 | Acupuncture: -10.61 points (CI -17.77 to -3.45). | 8 trials, 463 people | Acupuncture |
EASI (Eczema Area and Severity Index)
Lower with bleach baths; unchanged with silk clothing in trials
A clinician-scored measure of how much skin is affected and how red, thick and scratched it is.
Moderate certaintyResults and what it means
Why it was measured
A common trial endpoint that blinded nurses and doctors can score.
Statistical vs. clinical meaning
Clinician-rated and fairly objective.
POEM (Patient-Oriented Eczema Measure)
No meaningful change with bath additives in trials
A seven-question patient or parent questionnaire about itch, sleep, bleeding and dryness, scored 0 to 28. A change of about 3 points is felt to matter.
Moderate certaintyEczema flares
Fewer flares with regular moisturizers in trials
A return or worsening of the rash after calmer skin.
Low certaintySafety
What studies and official sources say about side effects, medicines and who should check first. Each point shows what kind of evidence it comes from.
Main points to know 7
- See a doctor if eczema looks infected, or you or your child feels unwell. The NHS says to get an urgent GP appointment or use NHS 111 (UK) if eczema is blistered, crusty, leaking fluid or has pus-filled spots; is painful, swollen or warm; suddenly gets worse or spreads; or if there is a high temperature or the person feels generally unwell. These can be signs of infection or eczema herpeticum, which may need antibiotics. If someone is very unwell, use your local emergency number. Health agency guidance 22
- Natural options do not replace the care your clinician prescribes. The NHS lists moisturizers (emollients) as the main treatment, with topical steroid creams for flares, and says a GP can add other treatments or refer you to a skin specialist. NIAMS adds that treatment plans are tailored to location, severity and triggers, and that severe cases may need light therapy, oral medicines or injected biologic medicines under close monitoring. Everything on this page is education, not a treatment plan. Health agency guidance 22 24
- Do not self-treat with bleach, strong herbs or elimination diets. Dilute bleach baths are used only with a clinician's instructions. Cutting foods out can lead to nutrient gaps and may raise the risk of developing IgE-mediated food allergy in children, and the NHS says not to change your diet, including while breastfeeding, unless a doctor advises it. Herbal and supplement products can irritate skin or interact with medicines. Systematic review and health agency guidance 13 22 1 7
- Babies and young children. Eczema is most common in young children, and the NHS says it often affects a baby's face. The 2022 Cochrane review of skin care in infants found possible increases in skin infection and parent-reported food reactions with routine moisturizing, so talk with a paediatrician or health visitor about a baby's skin care. Keep nails short; for babies the NHS suggests anti-scratch mittens. Systematic review and health agency guidance 9 22
- Pregnancy and breastfeeding. The NHS says hormone changes in pregnancy can trigger or worsen eczema, and that breastfeeding parents should not change their diet without medical advice. NCCIH says aloe taken by mouth may be unsafe during pregnancy and breastfeeding. Ask a doctor or pharmacist before using any supplement, herbal product or oil in pregnancy. Health agency guidance 22 21
- Emollient fire risk. The NHS warns that emollient residue on clothing, bedding and dressings can make fabric catch fire more easily, so keep away from smoking and naked flames when using them. It also says not to use aqueous cream, which can irritate, and to scoop moisturizer out with a spoon or pump instead of dipping fingers into a pot. Health agency guidance 22
- Eczema can affect sleep and mood. NIAMS lists depression, anxiety and sleep loss among conditions linked with atopic dermatitis and advises talking to a doctor if itching prevents restful sleep or if you feel overwhelmed or anxious; a mental health professional may help. The NHS says a referral to a mental health specialist may be offered if eczema affects mental health. If you have thoughts of harming yourself, contact a doctor or your local emergency services right away. Health agency guidance 23 24 22
Side effects 5
| Effect | How often | Severity and recovery | Evidence |
|---|---|---|---|
| Skin infection | Probably more skin infection with routine infant moisturizing (RR 1.33) in the Cochrane review; infection is also a known complication of eczema. | Can need antibiotics | Systematic review and health agency guidance 9 23 |
| Dry skin and irritation from bleach baths | Reported, not clearly different from control baths; no rate given. | Mostly mild | Systematic review 2 |
| Mild gut symptoms with oils and probiotics | Mild, mostly gut-related effects similar to placebo with evening primrose and borage oil; gut symptoms with probiotics (RR 1.54, CI 0.90 to 2.63). | Mild | Systematic review 3 11 |
| Burning, itching, rash from topical aloe | Occasionally reported by NCCIH. | Mostly mild | Health agency guidance 21 |
| Minor side effects from Chinese herbal medicine | Reported in 24 of 28 studies; one person withdrew because of worsening. | Minor, reversed on stopping | Systematic review 7 |
Medicines and supplements 3
| With | Why it matters | Importance | Evidence | What to do |
|---|---|---|---|---|
| Warfarin (blood thinner) prescription | The Cochrane review cites a study finding that evening primrose oil may increase bleeding in people on warfarin. | Reported in the review, not confirmed in its own trials. | Systematic review Low certainty 3 | Ask your doctor or pharmacist before using evening primrose oil with any blood thinner. |
| Digoxin and similar heart medicines (cardiac glycosides) prescription | NCCIH says overuse of aloe latex may raise the risk of side effects from cardiac glycosides. | Applies to aloe latex taken by mouth, not aloe gel on the skin. | Health agency guidance Low certainty 21 | Do not swallow aloe latex or leaf products without asking a doctor. |
| Prescribed eczema treatments prescription | No study of natural options with prescribed eczema treatments was read. | Absence of a study is not proof of safety. | Absence of evidence Not enough evidence 24 | Tell your doctor or pharmacist about every supplement, herbal product and skin product you use. |
Who should check first 4
| Situation | Advice | Evidence |
|---|---|---|
| Signs of infection (crusting, pus, fever, painful and warm skin) | Do not self-treat. Seek an urgent appointment or NHS 111 (UK), or local emergency services if very unwell. | Health agency guidance 22 |
| Babies, children and pregnancy or breastfeeding | Ask a clinician before supplements, herbs, bleach baths or food changes. | Health agency guidance 22 21 |
| Known allergy to a product (coconut, oats, aloe) | Stop the product if skin burns, itches or comes up in a rash. | Health agency guidance 21 |
| Proven or suspected food allergy | Diet changes should be directed by a clinician, not by guesswork. | Systematic review 13 22 |
Overdose, product quality and regulators
| Body | Action | Date |
|---|---|---|
| NHS (England) (United Kingdom) | Lists emollients and topical corticosteroids as the main treatments; advises not changing diet unless a doctor says so; says to get an urgent appointment or NHS 111 for signs of infection or eczema herpeticum. source | 2024-09-06 |
| American Academy of Dermatology (United States) | 2023 guideline for adults: strong recommendations for moisturizers and prescription topical anti-inflammatory treatments; conditional recommendations for bathing and wet wrap therapy and against topical antimicrobials, antiseptics and antihistamines. source | 2023 |
When to get medical help
- Blistered, crusty, weeping or pus-filled skin, or skin that is painful, swollen or warm: get an urgent appointment (NHS 111 in the UK).
- Eczema that suddenly spreads or worsens, especially with fever or feeling very unwell (possible eczema herpeticum): seek urgent care; if very unwell use your local emergency number.
- A baby with widespread, weeping or very red skin, or who is feeding poorly or unusually sleepy: seek urgent medical help.
- A rash, swelling or trouble breathing after a food, product or supplement: stop it and seek medical help.
- Itch that stops you sleeping, or low mood or anxiety: talk to a doctor; if you have thoughts of self-harm contact local emergency services right away.
Stop using the product and contact a clinician or emergency service. In the US, Poison Control is 1-800-222-1222.
General information only, not medical advice. Ask a clinician or pharmacist before use, especially with medicines, in pregnancy or with a health condition. See the Natural Remedy Safety guide.
Frequently asked questions
What is eczema (atopic dermatitis)?
NIAMS says atopic dermatitis is a chronic condition that causes inflamed, red, irritated and very itchy skin that comes in flares and calmer periods. It is not contagious.
What causes eczema?
Can eczema be cured?
The NHS says there is currently no cure, though many children improve with age and treatment helps control symptoms.
How is eczema evaluated?
NIAMS says a doctor takes a medical and family history, examines the skin, and may order blood tests or a skin biopsy to rule out other causes.
What does prescribed care for eczema look like?
Do moisturizers help eczema?
A Cochrane review of 77 trials found fewer flares (risk ratio 0.40) and a longer time to flare with moisturizers, with small falls in severity scores. They work best alongside prescribed treatment.
Does colloidal oatmeal help eczema?
A review of studies in people aged 3 months to 60 years reported improved itch, dryness and severity scores when oatmeal products were used alongside prescribed treatment. It is an add-on, not a replacement.
Does coconut oil help eczema?
One randomised trial of 117 children found virgin coconut oil lowered severity scores more than mineral oil over 8 weeks. It is a single trial in children, so the evidence is limited.
Should I change my diet for eczema?
Do probiotics or vitamin D help eczema?
Is eczema contagious, and can it affect mood?
When does eczema need urgent help?
The NHS says to get an urgent appointment or NHS 111 (UK) if the skin is blistered, crusty, leaking fluid, has pus-filled spots, is painful, swollen or warm, suddenly worsens or spreads, or there is a fever. These can be signs of infection or eczema herpeticum.
Explore by health goal
Editorial transparency
- Written by
- AlternativeMed editorial team. Research compiled with AI assistance, then checked against PubMed records.
- Medical review
- None. This page has not been reviewed by a physician or pharmacist.
- First published
- 2026-10-31
- Last substantive update
- 2026-10-31
- How we research
- We searched PubMed, read the abstract of every review and guideline cited, and read the NHS, NIAMS, NCCIH and MedlinePlus pages through a tool that summarises pages. Certainty ratings are the compiler's own reading unless a review gives its own grade.
- How we rate evidence
- See "How we rate evidence" in the Evidence tab.
- Independence
- No product is promoted on this page. No affiliate links are shown.
Sources 25
Each source was opened and checked. Where we read only the abstract, it says so. The small numbers in the text point here.
- , Chu DK, Schneider L et al.. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024. PMID 38108679. DOI 10.1016/j.anai.2023.11.009. (abstract)
- Bakaa L, Pernica JM, Couban RJ et al.. Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE. Ann Allergy Asthma Immunol. 2022. PMID 35367346. DOI 10.1016/j.anai.2022.03.024. (abstract)
- Bamford JT, Ray S, Musekiwa A et al.. Oral evening primrose oil and borage oil for eczema. Cochrane Database Syst Rev. 2013. PMID 23633319. DOI 10.1002/14651858.CD004416.pub2. (abstract)
- Bradshaw LE, Wyatt LA, Brown SJ et al.. Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial. Allergy. 2023. PMID 36263451. DOI 10.1111/all.15555. (abstract)
- Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. Int J Dermatol. 2014. PMID 24320105. DOI 10.1111/ijd.12339. (abstract)
- Fowler JF, Nebus J, Wallo W et al.. Colloidal oatmeal formulations as adjunct treatments in atopic dermatitis. J Drugs Dermatol. 2012. PMID 22777219. (abstract)
- Gu S, Yang AW, Xue CC et al.. Chinese herbal medicine for atopic eczema. Cochrane Database Syst Rev. 2013. PMID 24018636. DOI 10.1002/14651858.CD008642.pub2. (abstract)
- Jones VA, Patel PM, Wilson C et al.. Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis. JAAD Int. 2021. PMID 34409356. DOI 10.1016/j.jdin.2020.11.001. (abstract)
- Kelleher MM, Phillips R, Brown SJ et al.. Skin care interventions in infants for preventing eczema and food allergy. Cochrane Database Syst Rev. 2022. PMID 36373988. DOI 10.1002/14651858.CD013534.pub3. (abstract)
- Liang S, Huang KY, Zhang L et al.. Acupuncture for atopic dermatitis: a systematic review and meta-analysis. BMJ Open. 2024. PMID 39638592. DOI 10.1136/bmjopen-2024-084788. (abstract)
- Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ et al.. Probiotics for treating eczema. Cochrane Database Syst Rev. 2018. PMID 30480774. DOI 10.1002/14651858.CD006135.pub3. (abstract)
- Nielsen AY, Høj S, Thomsen SF et al.. Vitamin D Supplementation for Treating Atopic Dermatitis in Children and Adults: A Systematic Review and Meta-Analysis. Nutrients. 2024. PMID 39683522. DOI 10.3390/nu16234128. (abstract)
- Oykhman P, Dookie J, Al-Rammahy H et al.. Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2022. PMID 35987995. DOI 10.1016/j.jaip.2022.06.044. (abstract)
- Santer M, Ridd MJ, Francis NA et al.. Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness. BMJ. 2018. PMID 29724749. DOI 10.1136/bmj.k1332. (abstract)
- Sidbury R, Alikhan A, Bercovitch L et al.. Guidelines of care for the management of atopic dermatitis in adults with topical therapies. J Am Acad Dermatol. 2023. PMID 36641009. DOI 10.1016/j.jaad.2022.12.029. (abstract)
- Simpson EL, Michaels LC, Ramsey K et al.. Emollients to Prevent Pediatric Eczema: A Randomized Clinical Trial. JAMA Dermatol. 2025. PMID 40699587. DOI 10.1001/jamadermatol.2025.2357. (abstract)
- Singleton H, Hodder A, Almilaji O et al.. Educational and psychological interventions for managing atopic dermatitis (eczema). Cochrane Database Syst Rev. 2024. PMID 39132734. DOI 10.1002/14651858.CD014932.pub2. (abstract)
- Thomas KS, Dean T, O'Leary C et al.. A randomised controlled trial of ion-exchange water softeners for the treatment of eczema in children. PLoS Med. 2011. PMID 21358807. DOI 10.1371/journal.pmed.1000395. (abstract)
- Thomas KS, Bradshaw LE, Sach TH et al.. Silk garments plus standard care compared with standard care for treating eczema in children: A randomised, controlled, observer-blind, pragmatic trial (CLOTHES Trial). PLoS Med. 2017. PMID 28399154. DOI 10.1371/journal.pmed.1002280. (abstract)
- Wang HZ, Hayles EH, Fiander M et al.. Probiotics in infants for prevention of allergic disease. Cochrane Database Syst Rev. 2025. PMID 40511642. DOI 10.1002/14651858.CD006475.pub3. (abstract)
- . NCCIH: Aloe vera (updated February 2025). . . (full-text)
- . NHS: Atopic eczema (last reviewed 6 September 2024). . . (full-text)
- . NIAMS: Atopic dermatitis (reviewed November 2022). . . (full-text)
- . NIAMS: Atopic dermatitis diagnosis, treatment and steps to take (reviewed November 2022). . . (full-text)
- van Zuuren EJ, Fedorowicz Z, Arents BWM. Emollients and moisturizers for eczema: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol. 2017. PMID 28432721. DOI 10.1111/bjd.15602. (abstract)
