Eczema and Dermatitis: Causes, Treatment, and Online Options in Australia
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Eczema and dermatitis are terms that are often used interchangeably, and for good reason. Dermatitis is the broader medical term for inflammation of the skin. Eczema, technically speaking, refers to a specific group of conditions within the dermatitis family, though in everyday language most Australians use "eczema" to describe the itchy, red, dry patches that characterise the most common form: atopic dermatitis.
The confusion between the terms is understandable. Even within clinical practice, the language varies depending on context. A GP might describe a presentation as "eczema" when speaking with a patient and "atopic dermatitis" in clinical notes. What matters more than the label is understanding that dermatitis is an inflammatory skin condition, not an infection, and not something caused by poor hygiene. That misconception still lingers, and it causes real harm. People delay seeking help because they feel embarrassed, or they assume they should be able to manage it on their own.
At its core, eczema involves a disruption to the skin barrier. Healthy skin acts as a protective wall, keeping moisture in and irritants out. In people with eczema, this barrier is compromised. The skin loses moisture more easily, becomes dry and vulnerable, and reacts more intensely to environmental triggers. The immune system then mounts an inflammatory response, leading to the redness, swelling, and itch that define the condition.
The itch is worth pausing on, because it is often the most distressing symptom. The itch-scratch cycle is a hallmark of eczema: the skin itches, scratching provides temporary relief but damages the skin further, the damaged skin becomes more inflamed, and the itch intensifies. Breaking this cycle is one of the central goals of treatment.
Dermatitis is not a single condition. It encompasses several distinct types, each with its own triggers, typical presentation, and approach to management. Understanding which type is at play is important because it shapes the treatment plan.
Atopic Dermatitis
Atopic dermatitis is the most common form and what most people mean when they say "eczema." It is a chronic, relapsing condition closely linked to the body's immune response. People with atopic dermatitis often have a personal or family history of other atopic conditions, including asthma and hay fever. The Australasian College of Dermatologists notes that atopic dermatitis affects up to 20 per cent of children and around 5 per cent of adults in Australia, making it one of the most prevalent chronic skin conditions in the country.
In infants and young children, atopic dermatitis commonly appears on the face, scalp, and outer surfaces of the arms and legs. In older children and adults, it tends to favour the creases: the insides of the elbows, behind the knees, around the neck, and on the wrists and hands. The severity ranges widely. Some people experience mild, intermittent patches. Others deal with widespread, persistent inflammation that significantly impacts daily life.
Genetics play an important role. Research published in the Journal of Allergy and Clinical Immunology has identified mutations in the filaggrin gene as a significant risk factor. Filaggrin is a protein essential to the skin barrier, and its absence or reduction contributes to the dryness and vulnerability that underpin atopic dermatitis.
Contact Dermatitis
Contact dermatitis develops when the skin reacts to a specific substance it has come into direct contact with. There are two subtypes. Irritant contact dermatitis is the more common of the two and occurs when a substance damages the outer layer of the skin. Common culprits include detergents, soaps, cleaning products, solvents, and prolonged exposure to water. It does not require an immune response; rather, the irritant itself breaks down the skin barrier.
Allergic contact dermatitis is an immune-mediated reaction. It develops after the skin becomes sensitised to a particular allergen. Subsequent exposure triggers an inflammatory response that may not appear for 24 to 72 hours, which can make identifying the cause tricky. Common allergens include nickel (found in jewellery and belt buckles), fragrances, preservatives in cosmetics, latex, and certain plants. Patch testing, arranged through a GP or dermatologist, can help identify the specific allergen responsible.
DermNet NZ maintains a comprehensive database of contact allergens and notes that occupational contact dermatitis is one of the most common work-related skin conditions in Australia, affecting healthcare workers, hairdressers, cleaners, and those in the construction industry.
Seborrhoeic Dermatitis
Seborrhoeic dermatitis is a chronic inflammatory condition that affects areas of the body with a high density of sebaceous (oil-producing) glands. The scalp, face (particularly around the eyebrows, nose, and ears), and upper chest are the most common sites. On the scalp, it often presents as persistent dandruff with greasy, yellowish scales. On the face and body, it can appear as red, flaky patches with a slightly oily texture.
The condition is associated with an overgrowth of Malassezia yeast, a fungus that naturally lives on human skin. The immune system's inflammatory response to this yeast is thought to drive the symptoms. Seborrhoeic dermatitis tends to wax and wane, with flare-ups often linked to stress, fatigue, cold weather, or changes in hormonal balance.
Healthdirect Australia notes that seborrhoeic dermatitis is common across all age groups, with peaks in infancy (where it is known as cradle cap) and in adulthood, particularly between the ages of 30 and 60.
The symptoms of dermatitis vary by type and severity, but there are common patterns that most people recognise: persistent itch, dry or flaking skin, redness or discolouration, and patches of thickened or cracked skin. In more severe cases, the skin may weep, crust, or bleed, particularly if it has been scratched extensively.
A few specific scenarios warrant prompt attention from a GP:
- Signs of infection. Eczema-affected skin is more susceptible to bacterial infection. If the skin becomes increasingly red, warm, swollen, or painful, or if there is yellow or green discharge, crusting, or pus, medical review is important. Infected eczema may require antibiotics in addition to the usual management.
- Sleep disruption. When itch is severe enough to regularly disturb sleep, it affects energy, mood, and the body's ability to heal. This is a threshold that many people tolerate for too long before seeking help. A GP can adjust the treatment plan to bring the itch under better control.
- Spread or worsening. If eczema is spreading to new areas of the body, or if existing patches are not responding to the current treatment, a review is warranted. The treatment that worked initially may need to be stepped up, or the diagnosis may need to be reconsidered.
- Impact on daily life. If dermatitis is affecting work, relationships, self-confidence, or mental health, that is reason enough to speak with a GP. Skin conditions carry a psychological burden that is well documented in the medical literature. A study published in the British Journal of Dermatology found that adults with moderate-to-severe atopic dermatitis reported significantly higher rates of anxiety and depression compared with the general population.
- Uncertainty about the diagnosis. Not every itchy rash is eczema. Psoriasis, fungal infections, scabies, and other conditions can mimic dermatitis. A GP can assess the presentation, take a history, and either confirm the diagnosis or arrange further investigation.
The general principle is straightforward: if the skin is not settling with the current approach, or if it is affecting quality of life, a GP consultation is a practical and worthwhile step.
Eczema treatment follows a well-established framework that GPs in Australia use daily. The approach is stepwise, meaning it starts with the foundations and adds targeted treatments based on severity.
Emollients: The Foundation
Emollients are the single most important element of eczema management. These are moisturising creams, ointments, and lotions designed to repair and protect the skin barrier. They do not treat inflammation directly. Instead, they address the underlying dryness and barrier dysfunction that make the skin vulnerable to flare-ups.
The RACGP's guidelines for managing atopic dermatitis emphasise that regular emollient use should continue even when the skin appears clear. For many patients, applying a thick, fragrance-free emollient twice daily is the single intervention that makes the biggest difference to flare frequency.
Ointment-based formulations generally provide better barrier protection than lighter lotions, though patient preference plays a role in adherence. A GP can help navigate the options, many of which are available over the counter at a reasonable cost.
Topical Corticosteroids
When the skin is actively inflamed, topical corticosteroids are the first-line anti-inflammatory treatment. They work by reducing the immune-mediated inflammation that causes redness, swelling, and itch. Topical steroids come in a range of potencies, from mild (such as hydrocortisone 1%, available over the counter) to potent and very potent formulations available only on prescription.
A GP selects the appropriate potency based on the severity of the flare, the location on the body, and the patient's age. Used correctly, topical corticosteroids are safe and effective. Steroid phobia is common and well documented. While prolonged, unsupervised use of potent steroids can cause skin thinning, short courses applied as directed by a GP carry a low risk profile.
The Australasian College of Dermatologists provides patient information reinforcing that under-treatment due to steroid anxiety is a more common problem than over-treatment.
Topical Calcineurin Inhibitors
For areas where long-term steroid use is less desirable, such as the face and eyelids, topical calcineurin inhibitors (tacrolimus and pimecrolimus) offer an alternative. These non-steroidal medications suppress the local immune response and do not carry the risk of skin thinning. They are available on prescription and are often used as part of a proactive maintenance strategy.
Wet Wraps and Other Adjuncts
For moderate-to-severe flares, wet wrap therapy can be highly effective. This technique involves applying emollient and a layer of diluted topical steroid, then covering the area with a damp layer of bandaging followed by a dry layer. The Royal Children's Hospital Melbourne provides detailed guidance on wet wrap technique.
Antihistamines are sometimes used to help manage itch, though their role in eczema is debated. Sedating antihistamines taken at night may help patients sleep when itch is severe. A GP can advise on whether antihistamines are appropriate.
When to Consider Specialist Referral
For eczema that does not respond adequately to the measures above, a GP may refer to a dermatologist. Specialist options include phototherapy, systemic immunosuppressant medications, and newer biologic therapies such as dupilumab. These treatments are generally reserved for moderate-to-severe cases, but the referral process starts with the GP.
Living with eczema means learning to manage a condition that does not follow a straight line. There will be good stretches and difficult ones. The goal of long-term management is not to eliminate every flare. It is to reduce their frequency, limit their severity, and build a plan that makes the condition feel less unpredictable.
Identify and minimise triggers. Common triggers include dry or cold weather, exposure to harsh soaps or detergents, wool and synthetic fabrics against the skin, house dust mites, stress, and certain foods (though elimination diets should only be pursued under medical guidance). Keeping a simple diary of flare-ups and potential triggers can help identify patterns over time.
Maintain the skin barrier daily. Consistent, twice-daily application of a suitable moisturiser is the single most effective long-term strategy. Bath and shower routines matter too: lukewarm water, short bathing times, soap-free wash products, and applying emollient within minutes of drying off.
Use proactive treatment when directed. For people with frequently relapsing eczema, GPs may recommend applying a low-potency topical steroid or calcineurin inhibitor to previously affected areas two to three times per week, even when the skin looks clear. This proactive approach, supported by evidence published in the Journal of the European Academy of Dermatology and Venereology, can significantly reduce flare-up frequency.
Address the psychological impact. Chronic skin conditions affect mental health. The visibility of eczema, the constant itch, the sleep disruption, and the unpredictability of flares can contribute to anxiety, frustration, and low mood. Speaking with a GP about the emotional toll is a practical step toward comprehensive care.
Build continuity with a GP. Eczema management improves with a clinician who knows the patient's history. When a GP understands which treatments have been tried, what has worked, what has not, and how the condition has evolved, each consultation builds on the last rather than starting from scratch.
Need eczema treatment?
Eczema and dermatitis are well suited to online GP consultations. A GP can assess the skin through high-quality video, review photographs that the patient has taken during a flare, discuss symptom history, and prescribe treatment, all without the patient needing to travel to a clinic or sit in a waiting room.
For people in regional and rural Australia, where dermatology wait times can stretch to months and GP availability is limited, online access to a knowledgeable GP can make a meaningful difference. For time-poor parents managing a child's eczema alongside work and school routines, the ability to speak with a doctor during an evening or weekend appointment removes a significant barrier.
Abby Health is an online-first clinic offering GP consultations seven days a week, 365 days a year, through a care network of over 300 clinicians. Consultations can be bulk billed for eligible patients, and electronic prescriptions are sent directly to the patient's preferred pharmacy.
What matters most for eczema management is continuity. Abby Health's model is designed around the idea that patients should be able to see the same GP over time. The clinic's 71 per cent rebook rate reflects this: three in four patients choose to return to the same doctor. For a condition like eczema, where treatment is refined over months and years, that continuity has real clinical value.
Abby AI, the clinic's medical AI, supports each consultation by surfacing relevant patient history, previous prescriptions, and clinical notes so the GP arrives informed. It does not diagnose or prescribe. It ensures the clinician has the full picture.
An online eczema consultation typically covers:
- Assessment of the current skin presentation (via video and/or uploaded photos)
- Review of treatment history and what has been tried
- Discussion of triggers and lifestyle factors
- Prescriptions for topical treatments, emollients, or other medications as clinically appropriate
- A plan for follow-up, including when to return and what to watch for
If specialist referral is needed, the GP can arrange this and provide the necessary documentation, including referral letters for dermatologists and supporting information for access to PBS-subsidised biologic therapies.
Is eczema the same as dermatitis?
Eczema is a type of dermatitis. The term dermatitis broadly means inflammation of the skin and includes several conditions. In everyday language, "eczema" usually refers to atopic dermatitis, the most common form.
Is eczema contagious?
No. Eczema is an inflammatory condition, not an infection. It cannot be passed from one person to another through touch or close contact.
Can eczema be cured?
There is currently no cure for atopic dermatitis. However, with appropriate treatment and management, symptoms can often be well controlled, and many children with eczema find that the condition improves significantly as they grow older.
Are topical steroids safe to use?
When used as directed by a GP, topical corticosteroids are considered safe and are the first-line treatment for eczema flares. Side effects are uncommon with short-term, appropriate-strength use. Under-treatment due to steroid anxiety is a recognised clinical problem.
Can a GP treat eczema, or do I need a dermatologist?
Most eczema is managed effectively by GPs. If the condition is severe, not responding to standard treatment, or requires specialist therapies such as biologics, a GP can arrange a referral to a dermatologist.
Can I get an eczema prescription through an online consultation?
Yes. A GP can assess the skin via video consultation and prescribe appropriate treatments, including emollients, topical corticosteroids, and other medications. Electronic prescriptions are sent directly to the patient's preferred pharmacy.
Does Abby Health bulk bill for eczema consultations?
Consultations through Abby Health can be bulk billed for eligible patients. Eligibility depends on individual circumstances, and the clinic's team can advise during the booking process.
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