Eczema is a widespread skin condition that creates dry, itchy, and inflamed patches on your body. It affects millions of people worldwide, from newborn babies to older adults, and while it cannot be cured, understanding its causes, symptoms, and management strategies can help you take control of your daily comfort and quality of life.

How Common is Eczema Around the World

Eczema stands as one of the most common skin conditions affecting people globally. In the United States alone, more than 31 million Americans live with some form of eczema, showing just how widespread this condition really is^[1][2]. The condition does not discriminate by location or geography, appearing in communities everywhere and touching lives across all continents.

The condition shows a particular pattern when it comes to age groups. Among infants, the numbers are striking, with roughly 10 to 20 percent developing eczema during their early months or years^[1]. This makes it an especially common concern for new parents. When looking at children broadly, studies indicate that up to 30 percent of dermatology visits involve eczema and related skin concerns^[5]. An estimated 10 percent of the overall population has some form of this inflammatory skin disorder^[5].

The good news is that many children who develop eczema in infancy will see improvements as they grow. About 60 percent of those with eczema experience their first symptoms by age one, while another 30 percent develop symptoms by age five^[3]. Research shows that nearly half of all infants diagnosed with eczema will either outgrow the condition completely or experience significant improvement as they get older^[1]. However, for those whose eczema continues into adulthood, it becomes a chronic condition requiring ongoing care and attention.

Most cases of eczema begin before the age of five, with symptoms typically appearing during childhood and potentially lasting into adulthood^[3]. While it is unusual to develop eczema after the age of 60, it can still occur and may point to other underlying medical conditions that need attention^[3].

What Causes Eczema to Develop

The exact cause of eczema remains unknown, but researchers have identified that it results from a combination of genetic and environmental factors working together^[7]. Understanding these underlying causes can help you make sense of why this condition affects some people and not others.

Your genes play a significant role in whether you develop eczema. If one or both of your parents have had eczema, you face a higher risk of developing it yourself^[8]. Scientists have identified several specific genes associated with eczema, with particular attention paid to the FLG gene^[4]. This gene controls the production of filaggrin, which is a protein that plays an essential role in building the outer protective layer of your skin. When your body doesn’t produce enough filaggrin, the balance of fats in your skin changes, leading to moisture loss and a weakened protective barrier.

Beyond genetics, your immune system (your body’s natural defense system) plays a central part in eczema development. If you have eczema, your immune system tends to overreact to small irritants or allergens (substances that trigger allergic reactions) in your environment^[1]. When you come into contact with a trigger, your immune system mistakenly treats these small irritants as dangerous invaders, similar to how it would respond to harmful bacteria or viruses. This overreaction activates your body’s defense mechanisms, creating inflammation (swelling and redness in body tissues) that shows up as the visible symptoms of eczema on your skin.

The skin itself is structured in three layers, with the outermost layer called the epidermis. Within the epidermis, the corneal layer serves as your body’s first line of defense, protecting you from germs and harmful substances in your environment^[4]. In people with eczema, this protective corneal layer becomes damaged by inflammation and doesn’t work as well as it should. This breakdown in your skin’s barrier function allows irritants, germs, and allergens to enter your body more easily, while also making it harder for your skin to hold onto moisture.

Research also suggests that the microorganisms living on your skin may play a role in eczema development^[4]. Your skin naturally hosts countless microscopic organisms that usually exist in balance, but disturbances in this balance might contribute to eczema flare-ups. Additionally, disorders of the immune system can further complicate the condition, creating a cycle where weakened skin barriers and immune responses continuously affect each other.

Who is More Likely to Develop Eczema

Certain factors increase your chances of developing eczema throughout your lifetime. Understanding these risk factors can help you recognize whether you or someone in your family might be more vulnerable to this condition.

Family history stands as one of the strongest predictors of eczema risk. If your parents, siblings, or other close family members have had eczema or dermatitis, your likelihood of developing the condition increases significantly^[1]. This genetic connection extends beyond just skin conditions to include a broader group of allergic diseases. People with a family history of asthma, hay fever, or various allergies face a higher risk of developing eczema^[1][3].

The concept of the “atopic march” describes a common pattern where certain conditions tend to develop in sequence. This progression typically begins with eczema during infancy, followed by food allergies, then allergic rhinitis (commonly known as hay fever), and finally asthma, usually appearing in that order^[3]. If you have eczema, you may be more likely to develop these other allergic conditions later in life. Similarly, if you already have allergies or asthma, your risk of experiencing eczema increases.

Children born into families with a history of allergic diseases face the highest risk^[3]. The presence of allergies to common substances like pollen, pet hair, or certain foods can signal a higher likelihood of eczema development. Even dust mite allergies can serve as a risk factor for this skin condition.

Infants represent a particularly vulnerable group, with the condition being especially common during the first year of life^[3]. However, eczema can affect anyone at any age, regardless of sex or ethnicity^[5]. The condition does not favor one gender over another, and people of all ethnic backgrounds can develop eczema, though the appearance of the rash may differ based on skin tone.

Signs and Symptoms of Eczema

The symptoms of eczema can vary significantly from person to person, and even within the same individual over time. The most prominent and distressing symptom is intense itching, which can be unbearable and often disrupts sleep and daily activities^[4]. This itching typically starts before any visible rash appears, creating discomfort even when your skin looks relatively normal.

Your skin will likely become very dry, often described as feeling tight and rough^[1][2]. As the condition progresses, you’ll notice a rash developing on affected areas. The appearance of this rash depends heavily on your skin tone. If you have light to medium skin, the rash may appear as pink or red patches with bumps and crust. For those with medium to dark skin tones, the rash can look dark brown, gray, or purple, often appearing as dry, small bumps^[2][10].

During an acute flare-up (a period when symptoms suddenly worsen), your skin becomes reddish and extremely itchy^[4]. Blisters may form on the inflamed areas, and these can easily break open, causing the skin to weep or leak fluid. This oozing, crusting condition is particularly common in infants but can occur at any age. After the acute phase, your skin gradually improves but becomes dry and begins to peel off.

Over time, if eczema persists, the affected skin may become thicker, rougher, and develop a leathery texture^[1][4]. The skin can crack, creating painful fissures that are prone to infection. You might notice flaky, scaly, or crusty patches, and the area may appear swollen. In people of color, eczema often affects skin pigmentation, making the affected areas either lighter or darker than surrounding skin^[10]. For some individuals with darker skin tones, eczema can appear as tiny bumps that resemble goosebumps.

The locations where eczema appears on your body can vary depending on your age. In babies, the condition mainly shows up on the cheeks and the outer surfaces of the arms and legs, with less common involvement of the back, tummy, and chest^[4]. In children, teenagers, and adults, eczema typically affects the hollows of the knees, the bends of the elbows, and the back of the neck^[4]. The itchy rash may also occur on the wrists, ankles, palms of the hands, and soles of the feet. While facial involvement is common in babies, it rarely affects the face in older children and adults.

People of color may experience slightly different patterns, with eczema sometimes appearing on the outsides of the knees or elbows rather than in the creases^[9]. The condition can also affect the hands, neck, feet, face, ears, lips, and even less common areas like the nipples, breasts, and genital folds.

Eczema typically comes and goes in cycles, meaning you’ll experience periods when your symptoms are worse (flare-ups) and times when they improve or disappear completely^[4]. You can have acute and less acute rashes on different parts of your body at the same time. While the skin is only rarely permanently inflamed, the unpredictable nature of flare-ups can significantly impact your quality of life, making it difficult to concentrate and affecting your sleep patterns.

Preventing Eczema Flare-ups

While you cannot prevent eczema from developing if you have a genetic predisposition, you can take meaningful steps to reduce the frequency and severity of flare-ups. Prevention focuses largely on avoiding triggers and maintaining your skin’s protective barrier.

Identifying and avoiding your personal triggers represents one of the most effective prevention strategies. Common triggers that can worsen eczema include dry weather and sudden changes in temperature or humidity^[9][20]. Cold, dry winter air can be particularly problematic, as heated indoor spaces often have low humidity that dries out your skin and increases itching. Overheating and excessive sweating can also irritate your skin and trigger symptoms.

Skin contact with irritants should be minimized whenever possible. These irritants include certain soaps, detergents, shampoos, bubble baths, and cleaning supplies with heavy fragrances^[3][20]. Exposure to perfumes and household chemicals can irritate your skin and lead to flare-ups. When choosing skincare and cleaning products, look for options that are unscented, fragrance-free, and dye-free.

The fabrics and materials that touch your skin matter significantly. Avoid scratchy fabrics like wool and opt instead for loose-fitting clothes made from soft, comfortable materials like cotton^[19][20]. Wash all new clothes before wearing them to remove chemicals like formaldehyde that could irritate your skin. Use a mild laundry detergent without fragrances or dyes, and rinse clothes twice to ensure all traces of soap are removed.

Allergens can trigger eczema symptoms even if eczema itself is not an allergic condition. Common allergens include dust mites, mold, pet dander, pollen, and certain foods like eggs, dairy products, wheat, and acidic foods such as tomatoes^[19]. Insect bites and stings can also provoke flare-ups. Try to limit your exposure to substances you’re allergic to, and consider discussing allergy testing with your doctor if you suspect specific allergens worsen your symptoms.

Stress management plays an important role in prevention. Stress can make eczema worse, so finding ways to relax becomes essential^[8][19]. Consider incorporating exercise, meditation, yoga, tai chi, or journaling into your routine. Making time for hobbies you enjoy can also help reduce stress levels. Learning breathing techniques for moments of acute stress can provide quick relief when you need it most.

Maintaining proper skin care forms the foundation of eczema prevention. Taking short, lukewarm (not hot) baths or showers once a day helps replenish moisture lost through your damaged skin barrier^[18][19]. Use a gentle cleanser instead of soap, avoid scrubbing your skin, and pat it gently dry, leaving it slightly damp. Apply moisturizer within three minutes after bathing to seal in hydration. Regular moisturizing two to three times a day, including after every hand washing, helps protect your skin barrier and prevents dryness.

Avoiding the urge to scratch is crucial, though admittedly difficult. Scratching damages your skin further, breaks the protective barrier, and opens the door to infections^[19]. When the itch becomes intense, apply a cold moisturizer or cool gel to soothe it instead of scratching. Some people find wearing light gloves to bed helps prevent unconscious scratching during sleep.

How Eczema Changes Your Skin

Understanding what happens to your skin when you have eczema can help you appreciate why certain treatments and prevention strategies work. The changes that occur in eczema are not just superficial but involve fundamental alterations in how your skin functions.

Your skin consists of three main layers: the outer layer called the epidermis, the middle layer known as the dermis, and the inner layer called the subcutis^[4]. The epidermis itself has multiple sub-layers, including the basal layer where new skin cells are born, the spinous or prickle-cell layer, and the corneal or horny layer which is the visible part of your skin. The corneal layer serves as your body’s first line of defense, protecting you from germs, irritants, and allergens while preventing moisture from escaping. This layer constantly renews itself as new cells grow from the deeper basal layer and gradually move upward.

In people with eczema, the corneal layer fails to provide adequate protection because inflammation damages it^[4]. This damaged barrier becomes “leaky,” meaning it cannot effectively keep moisture in or harmful substances out. Irritants, germs, and allergens can penetrate more easily into your body through this compromised barrier. At the same time, water evaporates more readily from your skin, leading to the characteristic dryness that makes eczema so uncomfortable.

The inflammation in eczema skin results from your immune system’s overreaction to triggers in your environment^[1]. When your immune system perceives a trigger, it releases chemicals that cause blood vessels to dilate and white blood cells to rush to the area. This immune response creates the redness, swelling, and heat you see and feel during a flare-up. The inflammation also stimulates nerve endings, producing the intense itching that characterizes eczema.

The defective skin barrier in eczema is partly due to insufficient production of filaggrin, the protein mentioned earlier^[4]. Without enough filaggrin, the balance of fats (lipids) in your skin changes, further compromising the barrier’s ability to hold moisture. This creates a vicious cycle: the damaged barrier allows irritants in, which triggers inflammation, which damages the barrier even more, which leads to more dryness and irritation, and so on.

During a flare-up, you might notice blisters forming on inflamed areas^[4]. These blisters can break open, causing the skin to weep and crust over. As the acute inflammation subsides, your skin doesn’t simply return to normal. Instead, it becomes dry and scaly, peeling as it tries to heal. With repeated flare-ups over time, the affected skin can become thickened and leathery, a process called lichenification. This thickening occurs because constant scratching and rubbing stimulate the skin to produce more cells as a protective response.

The changes in skin structure also affect its appearance. The inflammation can alter skin pigmentation, particularly noticeable in people with darker skin tones. Areas affected by eczema may become either lighter or darker than the surrounding skin, and these pigmentation changes can persist even after the inflammation has resolved.