Eczema

Eczema is a common skin condition that causes dry, itchy skin and rashes, affecting more than 31 million people in the United States alone. While there is no cure, understanding your triggers and following proper treatment can help you manage symptoms and live more comfortably.

Table of contents

• What is eczema?
• Types of eczema
• Who gets eczema?
• Symptoms of eczema
• What causes eczema?
• Common triggers
• How is eczema diagnosed?
• Treatment options
• Daily management and prevention
• Living with eczema

What is eczema?

Eczema is a skin condition that causes your skin to become dry, itchy and bumpy. This condition weakens your skin’s barrier function, which is responsible for helping your skin retain moisture and protecting your body from outside elements^[1]. Eczema is also called dermatitis, which is a group of conditions that cause skin inflammation^[1].

Eczema is not contagious, so you cannot catch it from someone else^[2]. The condition causes severe itching, redness, and scaly rashes. These symptoms can be painful and can cause changes in skin color and blisters^[3].

Eczema is a chronic condition, which means it is long-lasting. It usually comes and goes in periods called flare-ups. A flare-up is when your symptoms get worse for days or even weeks. Between flare-ups, your symptoms may get better or go away completely for a while^[2][4].

Types of eczema

There are seven different types of eczema. Each type has unique triggers that can affect your skin’s barrier function^[1][2]:

• Atopic dermatitis is the most common type of eczema, which causes inflammation, dryness and itchy skin. The most common symptom is itch, which can lead to rashes, pain and poor sleep. Often, the term eczema is used as a synonym for atopic dermatitis^[2].
• Contact dermatitis develops when your skin touches allergens, chemicals, materials, or other irritants. Symptoms vary depending on what touched your skin, but can range from reddening to blistering to a burning sensation^[2][5].
• Dyshidrotic eczema causes small, itchy blisters on the edges of the fingers, toes, palms and soles of the feet. These blisters can be painful^[2][5].
• Neurodermatitis (also called lichen simplex chronicus) develops as a result of chronic scratching which results in thickened skin that is usually itchy, dry, and darker than surrounding skin^[1][5].
• Nummular eczema produces itchy, circular patches of inflamed skin that measure 2 to 3 centimeters in diameter. It usually affects the arms and legs^[1][5].
• Seborrheic dermatitis is a chronic form of eczema that causes inflamed, scaly skin in parts of the body with a high concentration of oil glands, including the face, scalp, and chest^[1][5].

It is possible to have more than one type of eczema at the same time^[1].

Who gets eczema?

More than 31 million Americans have some form of eczema^[2]. Anyone at any age can experience eczema, from newborn babies and teens to older adults^[2]. Symptoms usually appear during childhood and last into adulthood^[1].

Infants are especially prone to eczema, and 10% to 20% will have it. However, nearly half of all infants diagnosed with eczema outgrow the condition or have significant improvement as they get older^[1]. About 60 percent of those with eczema will experience symptoms by age 1, and another 30 percent will experience symptoms by age 5^[3].

You might be more at risk of having eczema if you have a family history or a diagnosis of dermatitis, allergies, hay fever, or asthma^[1]. Children born into families that have a history of allergic diseases are at an increased risk for developing eczema^[3].

Symptoms of eczema

The most common symptom of eczema is unbearable itching^[4]. Symptoms of eczema include^[1]:

• Dry skin
• Itchy skin
• Skin rash
• Bumps on your skin
• Thick, leathery patches of skin
• Flaky, scaly or crusty skin
• Swelling

Eczema can look different on each person diagnosed with the condition. If you have a dark skin tone, an eczema rash can be purple, brown or gray. If you have a light skin tone, an eczema rash can look pink, red or purple^[1][2].

The severity of the rash depends on the stage of the condition. During an acute rash, the skin is reddish and very itchy. Blisters may form on the inflamed areas of skin. These can easily break open and then weep (leak liquid). The rash gradually gets better after the acute phase. The skin becomes dry and peels off. Over time, the affected skin may get thicker, rougher and crack^[4].

Symptoms of eczema can show up anywhere on your skin. The most common places include hands, neck, elbows, ankles, knees, feet, face (especially cheeks), and in and around ears^[1]. In babies, eczema mainly appears on the cheeks and the outer surfaces of the arms and legs. In children, teenagers and adults, it mainly affects the hollows of the knees, the elbows and the back of the neck^[4].

What causes eczema?

The exact cause of eczema remains unknown, though most types have both genetic and environmental components^[5]. Several factors are known to contribute to eczema^[1]:

Your immune system: If you have eczema, your immune system overreacts to small irritants or allergens (triggers) in your environment. When you contact a trigger, your immune system assumes that these small irritants are foreign invaders, like bacteria or viruses, that can harm your body. As a result, the triggers activate your body’s natural defense system. Your immune system’s defense is to create inflammation, which causes symptoms of eczema on your skin^[1].

Your genes: You are more likely to have eczema if there is a history of eczema or dermatitis in your family. You are also at a higher risk if there is a history of asthma, hay fever and allergies^[1]. Researchers have identified several genes associated with eczema, including one called the FLG gene. This gene inhibits the production of filaggrin, a protein that plays an important role in the growth of the outer layer of skin. Because there isn’t enough filaggrin, the balance of fats in the skin changes, causing the skin to lose moisture^[4].

Skin barrier problems: In people with eczema, the outer layer of skin doesn’t provide enough protection because it is damaged by inflammation. That allows irritants, germs and substances that trigger allergies to enter the body^[4].

Common triggers

The first signs of eczema are itchiness, dry skin and a rash. These signs indicate that you came into contact with a trigger in your environment that caused your symptoms to start or flare up^[1]. A trigger is anything that might make your eczema symptoms worse^[9].

Common triggers include^[3][9][20]:

• Skin irritants such as soap, shampoo, bubble bath, cleaning supplies, and detergents
• Allergens such as pollen, pet dander, dust mites, or foods that trigger an allergic reaction
• Harsh fabrics like wool or scratchy materials
• Stress
• Changes in the weather, especially dry weather and cold, dry winter air
• Overheating and excessive perspiration
• Skin infections
• Long, hot showers
• Sudden changes in temperature and humidity
• Exposure to chlorine in pools

It is important to keep in mind that there can be a delay between exposure to eczema triggers and your actual flare up. This can make it difficult to identify what aggravates your eczema^[20]. Triggers vary from person to person, so not all these things will affect every person with eczema. Identifying your personal triggers will help you manage your eczema^[9].

How is eczema diagnosed?

Your doctor will ask about your symptoms and what makes them worse. They will ask about your health in general and examine you. Your doctor should be able to diagnose eczema by looking at your skin and asking about your symptoms and medical history^[9][12].

You may need tests to identify allergies and rule out other skin diseases^[12]. If your doctor thinks a certain food caused your child’s rash, they may ask about potential food allergies. Your doctor may recommend patch testing on your skin. In this test, small amounts of different substances are applied to your skin and then covered. During visits over the next few days, the doctor looks at your skin for signs of a reaction. Patch testing can help diagnose specific types of allergies causing your dermatitis^[12].

Treatment options

While there is no cure for eczema, a variety of effective treatments can help you manage and prevent eczema flares^[13]. Treatment of eczema may start with regular moisturizing and other self-care habits. If these don’t help, your doctor might suggest medicated creams that control itching and help repair skin^[12].

Topical steroids: Steroid medicines that are applied to the skin are called topical steroids. They fight inflammation and are very helpful when rash is not well controlled. Topical steroids are available in many forms such as ointments, creams, lotions, gels and even tape. They are made in low to super potent strengths. Used correctly, topical steroids are safe and effective treatment for eczema^[14].

Topical Calcineurin Inhibitors (TCIs): These medicines are also applied to the skin for treatment of eczema. They also treat inflammation, but are not steroids. A common side effect is skin burning, which is often not a long-lasting problem. Examples include Protopic ointment (tacrolimus) and Elidel cream (pimecrolimus)^[14].

Topical PDE4 Inhibitors: These medicines are applied to the skin to treat inflammation, but are not steroids. This is approved for children 3 months of age and older with mild to moderate eczema. An example is Eucrisa (crisaborole)^[14].

Moisturizers and emollients: The most effective way to treat dry itchy skin is to give it the moisture it needs and help it to retain it. Moisturizers help restore the skin barrier and protect the skin from irritants and allergens by locking in moisture. Regular use of moisturizers have convincingly shown to help people manage their eczema^[18][21].

Phototherapy: This treatment uses ultraviolet light to help with severe eczema^[13][15].

Systemic medications: For moderate or severe eczema, your doctor may prescribe oral or injectable medicines. These include oral JAK inhibitors available for patients 12 years of age and older, and biologic medicines^[14][15].

Some types of eczema may require antibiotics to clear up bacterial infections. Your doctor may also suggest allergy shots or tablets if allergens trigger your condition^[10].

Daily management and prevention

Managing eczema often involves a combination of lifestyle adjustments and daily management routines to alleviate symptoms and prevent flares^[13]. Here are the top five things everyone with eczema can do daily to help manage their condition^[18]:

Bathing properly: Studies suggest that bathing once a day (or even twice a day) is actually better than less frequent bathing. Take a short, warm (not hot) bath or shower for about 5-10 minutes every day. Use a gentle cleanser (not soap) that is unscented, fragrance-free and dye-free. Avoid scrubbing your skin with a washcloth or loofah. Bathing helps replenish some of the moisture lost through the skin barrier^[18][21].

Moisturizing regularly: Moisturize at least twice a day, ideally anytime your skin feels dry. While your skin is still damp after bathing, apply moisturizer within 3 minutes to seal in the hydration. Creams and ointments work better than lotions. Be sure to choose products without fragrances or ingredients like alcohol that can dry out skin^[18][21].

Avoiding triggers: Try to avoid allergens or limit your time around them. Common allergens include eggs, dairy products, wheat, dust, mold, pet dander, and pollen. Also avoid irritants like harsh soaps, detergents, and scratchy fabrics like wool^[1][20].

Managing stress: Stress can make eczema worse, so try to find ways to relieve it, such as meditation, yoga, exercise, or making time for your favorite hobbies^[18][19].

Getting enough sleep: Eczema causes itch, which often disrupts sleep. Poor sleep has a direct and negative effect on the skin barrier and can result in worse eczema. Create a consistent bedtime routine and make sure your bedroom is cool, dark, comfortable and technology-free^[18].

Watching what you wear: It helps to wear loose-fitting clothes made out of soft, comfortable fabrics like cotton. Avoid irritating cloth like wool. Wash all new clothes before you wear them to remove any chemicals that could irritate your skin. Use a mild laundry detergent that doesn’t have fragrances or dyes^[19].

Living with eczema

Eczema can greatly affect your quality of life. The itching can be especially bad, making it difficult to concentrate and sleep well. Many people who have eczema are ashamed of the visible rash. But it can usually be managed by taking good care of your skin, using medication and avoiding things that trigger the disease^[4].

Having a skin condition like eczema can affect the way you look, how you feel about yourself, other people and the world around you^[16]. Studies show that people with eczema are more likely to experience symptoms of anxiety and depression. Understanding how your mental state affects your eczema can help you get a handle on the stress-flare cycle. It is important to create a network of support, which can include friends, family and a mental health professional, to talk with regularly^[18].

Try not to scratch or rub your skin when it itches. This will only make the problem worse. When you scratch, you can break your skin and open it up to infection. Instead, apply a cold moisturizer or a cool gel to soothe it. If you tend to scratch while you sleep, try wearing light gloves to bed^[19].

You should see your doctor if you or your child has itchy, dry skin. Contact your doctor right away if your eczema suddenly changes or gets worse, if treatments aren’t working, or if you notice signs of an infection such as a fever, redness, warmth, pus, or blisters^[8][9][10].