Eczema Treatment In London

Medically Reviewed by Doctor Björn Thomas, GMC: 7084005

Consultant dermatologist Dr Björn Thomas (MBBS, PhD, MRCP) has extensive experience in managing both routine and complex eczema in both his NHS and private healthcare positions. 

His PhD research focused on atopic eczema and environmental stress, work that was recognised with the Royal Society of Medicine Trainee Research Prize. He has held an NIHR Clinical Lectureship, published on eczema severity and pollution, and spent dedicated time in severe eczema and psoriasis clinics at the Royal Free Hospital.

Consult Dr Thomas About Eczema Today

At the Thomas Clinic, we combine this specialist expertise with compassionate, evidence-based care to help you regain comfort and confidence in your skin.

If you are worried about eczema for yourself or your child, or your current treatment is not working, Dr Thomas can help. He will fully assess your condition and discuss tailored treatment options.

What Is Eczema?

Atopic eczema (also called atopic dermatitis) is a common, long-term inflammatory skin condition that causes dry, itchy and sometimes inflamed skin. It can affect people of any age, but is particularly common in children and often runs in families with a history of suffering from asthma or hay fever.

As documented by the NHS, Eczema usually follows a relapsing pattern. Symptoms flare, settle and may improve for periods of time, but the underlying tendency to dry, sensitive skin often remains. Official medical guidance from The National Institute for Health and Care Excellence emphasises that, while eczema cannot be “cured”, most people can achieve good control with the right skin care, prescribed treatments and trigger management.

The British Association of Dermatologists and the Primary Care Dermatology Society both provide detailed patient leaflets that explain how eczema behaves, how it is treated and how families can support children living with the condition. Dr Bjorn Thomas is experienced in helping patients of all ages manage triggers of Eczema and achieve better control of the skin condition. 

Common Symptoms of Eczema

• Intense itching, which frequently prevents sleeping.
• Dry, cracked skin.
• Darkening of the skin around the eyes.
• Anxiety and distress, both for the patient and sometimes the whole family, because of the stress placed on the child and the time-consuming nature of the care required.

Features of Eczema

In the more active phase of eczema, the skin is typically red and raised with visible scratch marks (excoriations). There may be signs of bacterial infection, such as a golden crust similar to impetigo.

As eczema becomes more chronic, repeated rubbing and scratching can cause the skin to thicken. Children are frequently seen rubbing and scratching the affected areas, and the skin is often colonised by bacteria such as Staphylococcus aureus, which can sometimes lead to frank infection. The Primary Care Dermatology Society offers a free patient leaflet on understanding and better managing Atopic Eczema.

Occasionally, herpes simplex virus infection can spread extensively in areas of active eczema. This needs prompt assessment and antiviral treatment by a medical professional.

Common features of Eczema include:

• Dry, sensitive skin.
• Red, inflamed patches.
• Rough, scaly areas.
• Cracks or open sores that may become infected.
• Thickened, leathery skin (lichenification) as a result of chronic scratching.
• Scratch marks.
• Dark or lighter pigmentation changes, especially in darker skin tones.
• Infants: Cheeks are often the first areas to be involved.
• Children: Involvement in front of the elbows and behind the knees, as well as wrists, ankles and neck.
• Adults: Hands, face, eyelids and flexural areas such as around the knees and elbows.

Causes and Triggers of Eczema

The exact cause of eczema is not fully understood, but it is thought to result from a combination of genetic tendency, a weakened skin barrier and an overactive immune response. In people with eczema, the skin barrier is less effective at retaining moisture and keeping out irritants or allergens, which makes the skin more vulnerable to dryness, inflammation, and infection.

Some known triggers of the condition are:

• Dry skin
• Strong soaps and detergents
• Cold weather
• Heat and sweating
• House dust mites, pollen, and pet dander
• Rough clothing, such as wool
• Infection of the skin

Identifying and managing personal triggers is an important part of long-term eczema control. Alongside leading medical treatment, we can also help you to identify triggers if you seek private treatment at the Thomas Clinic.

Note On Food Allergy:

Eczema and food problems are often linked, but in complex ways. It is essential to distinguish between food sensitisation (positive tests without clear symptoms) and true food allergy. The frequency of genuine food allergy tends to increase with the severity of eczema, but the good news is that most children with eczema do not have a dangerous food allergy. The best way to be sure is to have a medical expert conduct a proper diagnosis.

There are two main types of reaction to food that can affect patients with eczema.

1. An immediate response, usually within two hours of eating a food, may cause:

• Swelling of the lips and face
• Itching or hives
• Wheezing or breathing difficulty
• Abdominal pain or nausea

In rare cases, this can lead to a severe anaphylactic reaction. Common trigger foods include eggs, sesame, peanuts, soy, and fish. These responses are mediated through IgE antibodies. Blood tests and skin-prick tests can help identify likely allergens, and food challenges are carried out only in specialist hospital settings.

Immediate (Type I) allergy does not usually cause eczema patches themselves, although both can coexist. If test results are unclear, a time-limited period of avoiding a suspected food under specialist supervision may be considered, followed by careful reintroduction.

2. A delayed reaction, typically around 24 hours after eating a food.

A delayed reaction to food may present as a flare-up of eczema and sometimes produce abdominal symptoms. 

These delayed responses are more commonly seen in those with severe eczema. Foods often associated with this pattern include cow’s milk, eggs, wheat, and soy.

There is no single test that can reliably diagnose delayed food reactions. 

A practical way to explore this is to keep a dietary and symptom diary, looking for consistent patterns. If the same food regularly triggers a flare, it may be contributing. Current evidence presented by The National Institute for Health and Clinical Excellence suggests that introducing small amounts of high-risk foods in the first year of life, under medical guidance, may reduce later allergy in some children.

Eczema Treatment in London

At the Thomas Clinic, we offer a full range of evidence-based treatments for eczema, tailored to the severity of your condition, your age and your medical history. Treatment usually combines regular moisturising (emollients), anti-inflammatory medication, infection control where necessary and support with practical day-to-day management of the condition.

Consulting Dr Thomas means you will be assessed by a professional dermatology consultant, ensuring you receive the right strength and formulation for each area of the body. 

Topical Medications

The main purpose of topical medications is to reduce inflammation in the skin and relieve itching. Topical corticosteroids remain a cornerstone of eczema management. 

They are very effective in reducing inflammation when used correctly, usually in short courses during flares, then intermittently to prevent relapses. There are many different preparations, ranging from mild to very strong, and in forms such as creams, lotions, gels, and ointments.

Non-corticosteroid treatments include the calcineurin inhibitors tacrolimus (Protopic) and pimecrolimus (Elidel). These medicines are also used in tablet form as anti-rejection drugs in transplant patients; in eczema, very small amounts are applied to the skin.

They do not work as quickly as topical steroids in an acute flare, but they are particularly helpful in preventing future flare-ups and in sensitive areas such as the face and skin folds. In mild eczema, they may be sufficient on their own. They can be used daily at first, then reduced to twice-weekly maintenance on previously affected skin.

High-dose tablet forms, taken long term, have been associated with a slightly increased risk of skin cancer and lymphoma in transplant populations. This has not been seen with topical use, where the dose absorbed is tiny.

Ultraviolet Light Therapy

In some patients with more widespread or stubborn eczema, ultraviolet (UV) light therapy can be used to calm the overactive immune response in the skin. Narrowband UVB is now the preferred wavelength.

Treatment is typically given two or three times a week in a hospital or specialist clinics. This can be very effective but may be demanding for busy lifestyles, and the benefits must be balanced against practical considerations.

Systemic medication (oral and injectable drugs).

When eczema is severe and does not respond to topical therapy or phototherapy, systemic treatment may be considered. These are usually prescribed and monitored in specialist centres.

Traditional options include:

• Antihistamines: Helpful for associated hay fever or urticaria, and sedating types may aid sleep, although “hangover” effects the next morning can affect concentration at school or work.
• Methotrexate: A long-established medicine that can control severe eczema at low weekly doses by dampening overactive immune cells. Regular blood tests are required.
• Ciclosporin: A fast-acting drug used for severe acute flares. It is typically given as a daily tablet for a limited period because of potential kidney and blood-pressure side effects.
• Oral corticosteroids: Short courses can rapidly settle very severe flares but are generally avoided for long-term management now that better alternatives are available.
• Oral antibiotics: Used when there is clear evidence of bacterial infection, typically due to Staphylococcus aureus.

Newer treatments include:

• Dupilumab: A biologic (injectable monoclonal antibody) that targets specific pathways involved in eczema. It is usually used for resistant moderate to severe eczema when traditional treatments have not been effective or tolerated.
• JAK inhibitors such as Abrocitinib, Baricitinib and Upadacitinib: These are newer oral medicines approved for atopic dermatitis in selected patients under specialist supervision.

Dr Thomas will discuss the potential benefits and risks of each option and how they fit into your overall treatment plan.

Personalised Plans for Every Patient

At the Thomas Clinic, we believe eczema treatment should be highly individualised. During your consultation, Dr Thomas will examine your skin carefully, review your medical history and previous treatments, and discuss your goals and concerns.

Treatment decisions are based on published evidence, national guidelines, your own preferences and the clinical judgment that comes from many years of treating eczema in both hospital and private settings.

Book a Personalised Eczema Consultation

If you are ready to take more control of your eczema, we offer private consultations at our central London locations, with flexible appointment times.

Why Choose the Thomas Clinic?

the Thomas Clinic is led by Dr Björn Thomas, MBBS, PhD, MRCP, a British-certified consultant dermatologist with specific research expertise in eczema as a chronic condition.

He previously served at Guy’s and St Thomas’ NHS Foundation Trust, within the world-renowned St John’s Institute of Dermatology and contributed to complex skin clinics.

Patients frequently describe his care as thorough, clear and compassionate, and value the time he takes to explain conditions and treatments in understandable language.

Consultations are available at a choice of three central London settings: Harley Street, One Welbeck, and HCA The Shard. the Thomas Clinic offers the option of straightforward self-referral and secure online booking.

Managing Eczema at Home: Practical Advice

Good everyday skin care is fundamental to eczema control, regardless of how severe the condition is. Emollients (moisturisers) help restore and protect the skin barrier and can reduce the frequency of flare-ups when used regularly. The best moisturiser is one that is fragrance-free, well-tolerated and used consistently. 

Modern creams and ointments that contain ingredients such as glycerin, ceramides and other lipids like cholesterol can support the skin barrier. Examples include products such as CeraVe Moisturising Cream and La Roche-Posay Lipikar Balm. Some patients prefer thicker emollients such as petroleum jelly.

The key is to apply moisturiser generously and regularly, especially after bathing and whenever the skin feels dry.

Gentle daily bathing is usually acceptable, provided harsh soaps and fragrances are avoided. 

Aim for:

• Comfortable, lukewarm water rather than hot water.
• Bath time of around 5-10 minutes.
• Patting the skin dry with a soft towel.
• Applying moisturiser straight away to “seal in” water.

Bubble baths, vigorous scrubbing and the use of loofahs are best avoided, as they can further irritate sensitive skin.

FAQs About Eczema

What fears do parents who have children with eczema have?

Parents worry that the inevitable flare-ups that occur may be related to the fact that they may not be treating the child adequately, or that it is their fault in some way. They worry about the physical and emotional strain on their child, who is always scratching and always uncomfortable. There is concern that the eczema may be misdiagnosed and that it is actually an allergy.

Parents also sometimes worry that their child does not get enough sleep. They often have a sense of helplessness when the child is scratching. During school age, the parents are concerned that the child may become isolated because of embarrassment and run a risk of being bullied. 

There is also the chronic concern that the medicine used may, in some ways, be harmful. There is typically an overwhelming anxiety that they are not doing enough and may be missing some better treatment.

Are there natural therapies for eczema?

Some people find relief using oatmeal baths, coconut oil and/or aloe vera.

Moisturising with coconut oil, sunflower seed oil, and aloe vera may help to alleviate some symptoms. It is recommended that these be initially used on small areas of the skin to make sure that there is no reaction to the product.

Evening primrose oil has been recommended, but studies show a very mixed picture. Thus, it is important to consult your physician before trying such new remedies.

There has been an increased interest in the gut microbiome and inflammation. Following this, it has been suggested that oral probiotics should be considered.

Can my diet affect eczema?

It is possible. Common dietary triggers include dairy, eggs, nuts and gluten. Specific food triggers can be identified by an elimination diet or by allergy testing.

Does eczema go away as the child gets older?

Many children may improve as they grow older, but some may continue to have symptoms into adulthood. Although unusual, adult-onset eczema may occur. About 70% of children will have their eczema resolved by the early teens. The percentage of children who outgrow eczema is in part related to the severity of the condition in infancy. 

A good response to treatment is always a good sign. If there is no family history of asthma or hay fever gives a better prognosis. Eczema that appears for the first time in the teenage years or in adults is uncommon. Once the eczema disappears, the child may still have sensitive and dry skin.

When should I see a doctor?

You should see a doctor if your child has rashes that have not been diagnosed.

Eczema Medical Resources

Here are some medical resources selected to help provide patients with more information on Eczema and ways of managing the condition.

NHS: Atopic Eczema

British Association of Dermatologists: Atopic Eczema

Patient Information Leaflet Link: Eczema – Primary Care Dermatology Society

N.I.C.E: Atopic eczema in under 12s: diagnosis and management

N.I.C.E: Eczema – Atopic

N.I.C.E: Eczema Patient Core Knowledge

NHS Scottish Intercollegiate Guidelines Network: Management of atopic eczema in

primary care

Get Expert Help With Eczema

If you feel ready to get more support with eczema, our team is here to help with clear information, evidence-based treatment and compassionate care. 

Consultations are available at our central London locations, with appointments designed to fit busy family and work schedules. Contact us to arrange a consultation.