Eczema (Atopic Dermatitis) — NZ Condition Guide | KiwiMeds

What is Eczema?

Eczema (atopic dermatitis) is a common inflammatory skin condition that causes the skin to become itchy, red, dry, and cracked. It is not contagious. New Zealand has among the world’s highest rates of eczema — around 1 in 3 children and 1 in 10 adults are affected. It often begins in childhood and may improve with age, though it can persist into adulthood. Eczema frequently occurs alongside asthma and hay fever (this combination is called the “atopic triad”).

Symptoms

Eczema typically causes intense itching, dry and sensitive skin, red to brownish-grey patches, small raised bumps that may weep fluid and crust over, thickened, cracked, or scaly skin, and raw, swollen skin from scratching. It most commonly affects the creases of the elbows and knees, wrists, hands, face, and neck. Symptoms flare and remit — there are periods of worsening (flares) and periods of improvement. Severe scratching can lead to skin infections.

Causes and Risk Factors

Eczema is caused by a combination of genetic factors affecting the skin barrier and immune system dysregulation. People with eczema have a less effective skin barrier, making skin more vulnerable to irritants, allergens, and moisture loss. Risk factors include family history of eczema, asthma, or hay fever, and exposure to certain irritants (soaps, detergents, fragrances). Common triggers include dry skin, sweating, dust mites, pet hair, certain fabrics (wool), stress, cold weather, and some foods (though true food allergy as a cause is less common than often thought).

Diagnosis

Eczema is usually diagnosed by a GP or dermatologist based on the appearance and distribution of the skin rash and your personal and family history. There is no specific blood test for eczema. Allergy testing may be recommended in some cases to identify specific triggers.

Treatment in New Zealand

Eczema treatment focuses on controlling symptoms and preventing flares. The cornerstones of treatment are regular moisturising (emollients) — applied at least twice daily — and topical corticosteroid creams for flares (such as hydrocortisone for mild eczema, betamethasone for moderate to severe). These are funded by Pharmac. For more severe eczema, topical calcineurin inhibitors (tacrolimus/Protopic), phototherapy, or systemic medications may be used. Dupilumab (Dupixent), an injectable biologic, is now Pharmac-funded for severe eczema meeting specific criteria.

NZ-Specific Information

New Zealand’s cold, damp housing contributes to high eczema rates. Pharmac funds emollients, topical corticosteroids, and dupilumab (for eligible severe cases). The New Zealand Dermatological Society and Eczema Association of NZ provide support and resources. GPs can refer to dermatologists for specialist management of moderate to severe eczema.

Frequently Asked Questions

Can eczema be cured? There is no cure, but most people can achieve excellent control with the right treatment. Is eczema caused by food allergy? While food allergies can worsen eczema in some children, eliminating foods without proper testing and guidance is not recommended. Can stress trigger eczema? Yes — stress is a recognised trigger for eczema flares in many people.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Vitamin D — Vitamin D plays a central role in skin barrier function and immune modulation. Supplementation has demonstrated improvements in eczema severity scores in randomised trials, particularly in patients with confirmed deficiency.
• Omega-3 Fatty Acids — EPA and DHA reduce pro-inflammatory eicosanoid production relevant to allergic skin inflammation. Supplementation may reduce itch severity and skin barrier dysfunction, complementing topical therapy.
• Evening Primrose Oil / Borage Seed Oil (GLA) — Gamma-linolenic acid (GLA) supports skin barrier lipid synthesis. GLA-containing oils (500–3000 mg/day) are widely used for atopic dermatitis symptom management, particularly for itch reduction.
• Probiotics (Lactobacillus rhamnosus GG) — Strongest evidence exists for prevention in high-risk infants when mothers supplement during pregnancy. In established eczema, probiotics may modestly reduce severity through immune modulation and microbiome diversity support.
• Zinc — Zinc has anti-inflammatory and wound-healing properties supporting skin barrier repair. Supplementation at 15–30 mg/day may provide complementary benefit in those with inadequate dietary intake.

Relevant Vaccinations

Individuals living with eczema (atopic dermatitis) may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Viral infections are common eczema triggers. Annual influenza vaccination reduces the risk of flare-precipitating illness.
• COVID-19 — People on systemic immunosuppressants for eczema (dupilumab, cyclosporine) should ensure COVID-19 vaccinations are current.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of eczema (atopic dermatitis). The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Anti-inflammatory Mediterranean dietary pattern — A Mediterranean diet rich in oily fish, vegetables, and olive oil is associated with reduced eczema severity in epidemiological studies.
• Oily fish (omega-3 source) — Regular consumption provides EPA and DHA which reduce allergic skin inflammation and support skin barrier function.
• Probiotic-rich foods (yoghurt, kefir) — Supports gut microbiome diversity and immune modulation, potentially reducing atopic sensitisation.
• Identify and avoid confirmed food triggers (under allergy testing) — True food allergies exacerbating eczema require confirmation by allergy testing before elimination, as unnecessary restriction can cause nutritional deficiency.
• Adequate hydration — Sufficient fluid intake supports skin moisture from within and complements topical moisturiser use.

Related Conditions & Medications

Related conditions: Asthma. Related medications: Hydrocortisone cream.