What lifestyle and environmental modifications should I recommend to patients with atopic eczema?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Patients with atopic eczema should be advised on several lifestyle and environmental modifications to help manage their condition and reduce flares .

  • Emollient Use:
    • Encourage the frequent and liberal use of emollients, even when the skin is clear, as they are the basis of management ,.
    • Explain that emollients should be used in larger amounts and more often than other treatments, applied to the whole body .
    • Demonstrate how to smooth emollients onto the skin rather than rubbing them in .
    • Advise patients that if they are using emollients and other topical products at the same time, they should apply one product at a time and wait several minutes before applying the next .
    • Be aware of the Medicines and Healthcare products Regulatory Agency (MHRA) warnings about fire hazards associated with emollient residue on clothing and bedding .
  • Avoiding Trigger Factors:
    • Advise patients to avoid known trigger factors that can exacerbate eczema .
    • Recommend avoiding synthetic fibres in clothing .
    • Suggest using emollient substitutes instead of soaps or detergents .
    • Advise keeping rooms cool to avoid heat as a trigger .
    • If animals, irritants, temperature, humidity, or stress are known to worsen eczema, they should be avoided where possible .
  • Managing Itch and Scratching:
    • Advise patients to avoid scratching the eczema if possible, and instead rub the area with their fingers to alleviate itch .
    • Recommend keeping nails short .
    • For babies with eczema, suggest using anti-scratch mittens .
  • Dietary Modifications:
    • Patients should be advised not to alter their diet unless under specialist advice .
    • There is no evidence of benefit from milk and egg-free exclusion diets in people without a known allergy .
    • Any dietary exclusion or elimination diets should be implemented and monitored by a specialist .
    • Mothers of breastfed infants with suspected allergy causing moderate or severe eczema may require referral for dietary advice .
  • Complementary Therapies:
    • Complementary therapies, such as homeopathy, herbal medicine, massage, and food supplements, are not recommended for the management of atopic eczema due to insufficient evidence .
    • If patients insist on using complementary therapies, they should continue to use emollients frequently and liberally .
    • Inform patients that "natural" or "herbal" products are not necessarily safe and can have adverse effects or interact with other medicines .
  • House-Dust Mite Avoidance:
    • House-dust mite avoidance strategies are generally not recommended as they are time-consuming and of limited benefit .
  • Patient Education and Support:
    • Provide patient information leaflets and details of eczema support groups, such as the British Association of Dermatologists or the National Eczema Society .
    • Address any concerns patients may have regarding adverse effects of topical corticosteroids to improve adherence .
    • Explain how to recognise flares of atopic eczema and provide clear instructions on how to manage them .

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