What is eczema?
Eczema, a form of dermatitis, is the most common inflammatory skin disorder. It causes itching, redness, swelling and scaling of the skin. These symptoms are due to an allergic or inflammatory reaction in the skin. The appearance, severity, symptoms and triggers vary among individuals.
More than 31 million Americans live with some sort of eczema. The most common form of eczema is atopic dermatitis. It accounts for most cases of eczema, affecting nearly 10 million children and more than 16 million adults in the United States. Because atopic dermatitis often develops in the first six months of life, people may call it baby eczema.
Common sites for infant atopic dermatitis include scalp, ears, cheeks, elbows or knees. In older children and adults, it often affects areas with creases. This includes the back of the neck, upper eyelids, elbows, wrists, hands, back of the knees, and ankles.
In most cases, atopic dermatitis comes and goes in flares. Usually, the flares lessen and the condition resolves in adulthood. Sometimes, it remains a chronic condition.
Atopic—or atopy—is a term that describes a genetic tendency to develop allergic diseases. People with atopic conditions have an overactive immune response to allergens. So, atopic dermatitis is an allergic condition that occurs when skin is more sensitive to certain substances than normal. It is not contagious.
There is currently no cure for eczema, but eczema can be controlled with regular medical care and a good treatment plan. Some types of eczema can be prevented by avoiding stress, irritants, and things that cause allergic reactions.
Eczema is generally not a serious condition, but there is a potential for complications, such as a secondary bacterial or fungal infection of the eczema rash. Seek prompt medical care if you have symptoms of eczema. Early diagnosis and treatment can help reduce your risk of complications.
What are the different types of eczema?
Atopic dermatitis is the most common type of eczema. The other types of eczema include:
- Asteatotic eczema: This type of eczema causes fine cracks in the skin. It usually affects older people in low-humidity environments.
- Contact dermatitis: This form is the result of contact with irritants or allergens and is fairly common. It often affects the hands only, so people may refer to it as hand eczema. Irritants include detergents, solvents, or even plain water that gets trapped under jewelry or gloves. Allergens include latex, metals and plants, such as poison ivy.
- Dyshidrotic eczema: Pompholyx, palmoplantar eczema, vesicular eczema, and foot-and-hand eczema are other names for this form. It causes tiny blisters on the hands and feet that are intensely itchy. Common triggers include personal care products, metals, and hot weather.
- Lichen simplex chronicus: Repeated scratching or rubbing of an area causes this form of eczema.
- Neurodermatitis: This type of eczema usually occurs as one or two intensely itchy patches. The most common sites are the arms, legs, and back of the neck. It is most likely an overreaction of nerves to some sort of stimulus.
- Nummular eczema: This form gets its name from the Latin word for coin. It occurs as round or oval-shaped patches that itch and can ooze. It often develops after a skin injury or trauma, such as bites, burns and abrasions.
- Seborrheic dermatitis: The rash from this form tends to be greasy rather than dry because it affects oily areas. This includes the scalp, hairline, and around the nose. It is commonly known as cradle cap in infants and dandruff in adults.
- Stasis dermatitis: Gravitational eczema, varicose eczema, and venous eczema are other names for this form. It is the result of swelling and poor blood flow in the lower legs due to venous insufficiency.
What are the symptoms of eczema?
Symptoms of eczema can differ in severity, frequency and duration among individuals and with different types of eczema. For atopic dermatitis, symptoms frequently begin in infancy, reoccur during childhood, and disappear during adulthood. Flare-ups, however, can be unpredictable throughout your lifetime.
An early-stage eczema rash often starts in the first six months of life. It typically appears on a baby’s cheeks, face and scalp. As infants begin to crawl, eczema frequently occurs on the elbows and knees. In toddlers and older children, it can affect the skin creases. The rash may also appear bumpy.
Skin areas affected by eczema can exhibit a variety of characteristics including:
- Darkening of the area of skin affected by eczema (hyperpigmentation)
- Inflammation (swelling, irritation and warmth)
- Small red bumps
- Thickening of the affected skin due to frequent scratching
Scratching eczema generally does not relieve the itching and can lead to increased inflammation, more intense itching, and harder scratching.
Symptoms that might indicate a serious condition
In some cases, scratching can lead to potentially serious complications, such as a secondary bacterial or fungal infection and cellulitis. Seek prompt medical care if you have any of these symptoms:
- High fever (higher than 101°F)
- Increase or change in the type of drainage from the blisters
- Open sores or lesions
- Redness, swelling and warmth of the skin surrounding the eczema rash
What are the stages of eczema?
Chronologically, the three stages of eczema are infantile (baby eczema), childhood and adult. According to how the skin looks under a microscope, the three stages of eczema are acute, subacute and chronic:
- Acute eczema: skin redness, swelling and itchiness due to inflammation and fluid accumulation within the top layer of skin (epidermis)
- Subacute eczema: skin thickening, scaling and crusting, as well skin redness, swelling and itching of acute eczema
- Chronic eczema: thickened and possibly discolored skin from repeated cycles of scratching and rubbing
What causes eczema?
Eczema occurs when skin is more sensitive to certain substances than normal. For most types of eczema, the exact cause is not known. But in general, eczema is linked to allergies and an abnormal immune system response.
There is evidence some people who develop eczema may have an abnormal skin barrier. This is based on genetic analysis and a mutation in the gene for filaggrin, a protein component of the protective barrier on the top layer of the skin. A weak skin barrier can lose moisture causing dry, itchy skin and make skin more prone to infections.
Certain triggers can cause an eczema flare-up in people with sensitive skin. Common triggers include:
- Abrupt changes in temperature (from hot to cold or the reverse)
- Allergens, such as plants or animal dander
- Chemicals, such as acids, solvents and dyes
- Food preservatives
- Fragrances and perfumes
- Latex and rubber
- Nickel, a metal often used in the manufacture of jewelry
- Poison ivy, poison oak, and poison sumac
- Soaps and detergents
- Some medications
- Upper respiratory infection
- Wool-containing fabric
What are the risk factors for eczema?
A number of factors increase the risk of developing eczema. Not all people who are at risk for eczema will develop the condition. Risk factors include:
- Individual allergen sensitivity
- Personal or family history of allergies
- Personal or family history of asthma
Reducing your risk of eczema outbreaks
It may be possible to prevent eczema outbreaks. You can lower your risk of outbreaks by:
- Avoiding exposure to any known allergen or irritant that triggers a skin reaction
- Avoiding situations in which your skin will be exposed to wet or hot conditions for long periods of time
- Seeking regular medical care and following your treatment plan for allergies and other skin conditions
What are some conditions related to eczema?
People who have atopic dermatitis usually have a personal or family history of conditions on the “atopic march.” This includes eczema, food allergies, hay fever, and asthma. Doctors call it a march because the conditions often, but not always, progress from one to another.
Due to a weakened skin barrier, people with eczema are also more prone than other people to skin infections, including staph bacterial and herpes viral infections.
How is eczema treated?
Eczema is a chronic condition with no known cure. However, it is possible to control eczema symptoms and lead an active, comfortable life. Your doctor will individualize a treatment plan specifically for you. It will take into account your medical history, the type and severity of your eczema, your specific triggers, and other factors.
A combination approach including lifestyle changes, medications, UV phototherapy, and other treatments as appropriate is the most effective way to control eczema and prevent flare-ups.
Medications used to treat eczema
In moderate to severe cases of eczema, doctors may prescribe medications including:
- Antibiotics or antifungal drugs, which treat secondary bacterial or fungal infections
- Antihistamines, which reduce itching
- Corticosteroid cream, which reduces inflammation
- Injectable biologic therapy, dupilumab (Dupixent) that inhibits inflammation
What lifestyle changes and eczema coping tips are effective?
Lifestyle changes and coping tips for treating eczema include:
- Avoiding alcohol and caffeine
- Avoiding hot tubs, steam baths, saunas, and chlorinated swimming pools
- Avoiding scratchy clothes
- Drinking plenty of fluids
- Getting skin patch testing, in which small amounts of common allergens are applied methodically to the skin to determine what substances are triggering the allergic response that leads to the eczema
- Minimizing skin dryness by using lotion specifically designed for sensitive skin
- Preventing flare-ups by avoiding exposure to the specific allergen or allergens that induce the condition
- Using a cool mist vaporizer or home humidifier
- Using a perfume-free moisturizer
- Using an oatmeal-based soap, such as Aveeno, to help relieve itching and inflammation
- Using ice bags or cool wet compresses to help relieve itching and inflammation
- Using mild soaps and not over-washing or harshly scrubbing skin
What are the potential complications of eczema?
When left untreated, eczema can develop into an escalating cycle of itching, scratching and inflammation. In some cases, the excessive scratching can introduce bacteria or fungus into the layers of the skin, resulting in infections that can be serious in some people. Complications include:
- Bacterial or fungal infection of the skin
- Cellulitis (an infection of the skin and surrounding tissues caused by a growing bacterial or fungal infection)
- Open sores and lesions
- Permanent change in skin texture or scarring
- Permanent skin discoloration