Eczema: Symptoms, Causes & Treatment

Eczema, also called atopic dermatitis, is a non-contagious skin condition that causes inflammation, itching, dryness, redness, and peeling. It can happen at any age, but it is more common in babies and children.

The exact cause of eczema is not completely understood, but flare-ups may be triggered by allergies, dry air, temperature changes, irritating products, stress, or certain fabrics. There are several types of eczema, including contact eczema, dyshidrotic eczema, nummular eczema, and stasis eczema.

Eczema treatment should be guided by a dermatologist and may include creams, ointments, oral medications, or phototherapy. Daily skin care, such as using fragrance-free moisturizer, gentle soaps, and loose cotton clothing, can help reduce dryness and prevent flare-ups.

Common symptoms

The main symptoms of eczema include:

• Dry skin
• Skin peeling
• Intense itching
• Skin swelling
• Redness
• Blisters on the skin, which can rupture and release fluid
• Skin wounds
• Changes in skin color in affected areas, which may become lighter or darker than usual

In chronic eczema, blisters may dry out and form crusts, and the affected skin can become thicker over time.

Symptoms in babies

In babies and young children, eczema most commonly appears on the cheeks, the outside of the elbows, and the knees. Babies with eczema may rub their skin against the bed or other objects to try to relieve the itching. Read more about baby eczema and how to manage it.

In older children, eczema often appears on the hands, feet, arms, and behind the knees.

Symptoms on darker skin tones

On darker skin tones, eczema may appear as red, brown, purple, gray, or dark red patches. The affected skin may also become thicker, and small bumps may develop.

Itching is common and can be intense. Eczema can also leave affected areas lighter or darker than usual after a flare-up.

Confirming a diagnosis

An eczema diagnosis is usually made by a dermatologist based on the symptoms, health history, and a physical exam of the skin.

The doctor may also order allergy tests to help identify possible eczema triggers.

Possible causes

The exact cause of eczema is not fully understood. However, some factors may increase the risk of developing eczema or trigger flare-ups, including:

• Family history of eczema, allergies, or asthma
• Extreme heat or cold
• Low air humidity
• Allergies to foods, dust mites, mold, pollen, dust, or pet dander
• Cleaning products, such as detergents and soaps
• Clothing, belts, jewelry, or certain fabrics, such as wool or denim
• Certain medications, such as antibiotics, phenytoin, carbamazepine, or lamotrigine
• Cosmetic products, such as makeup, perfume, shampoo, deodorant, soap, or depilatory cream
• Emotional factors, such as stress, anxiety, or depression
• Hormonal changes during the menstrual cycle or pregnancy

Eczema is a non-contagious inflammatory skin condition, which means it does not spread from person to person.

Types of eczema

Eczema can be classified into different types based on its cause, location, and symptoms. They include:

1. Atopic dermatitis

Atopic dermatitis, also called atopic eczema, is the most common type of eczema. According to the American Academy of Dermatology Association, atopic dermatitis causes itchy, dry, inflamed skin and usually begins in childhood.

It is often linked to a personal or family history of allergies, asthma, or allergic rhinitis. Symptoms are usually noted on the face and in skin folds, such as the inside of the elbows or behind the knees.

2. Contact dermatitis

Contact dermatitis happens when the skin reacts after touching an irritating substance or allergen. It most commonly affects areas that come into direct contact with the trigger, such as the hands, face, neck, or feet.

3. Nummular eczema

Nummular eczema, also called discoid eczema or nummular dermatitis, causes round or coin-shaped patches on the skin. These patches may be pink, red, brown, or darker than the surrounding skin, depending on skin tone.

This type of eczema can cause intense itching, burning, dryness, crusting, or oozing. It may be linked to dry skin, skin injuries, allergies, frequent hot showers, or stress.

4. Dyshidrotic eczema

Dyshidrotic eczema, or dyshidrosis, causes small, itchy, fluid-filled blisters on the palms of the hands, sides of the fingers, or soles of the feet. It may be triggered by allergies, sweating, moisture, contact dermatitis, or physical or emotional stress.

5. Seborrheic dermatitis

Seborrheic dermatitis is a common form of eczema that affects oily areas of the skin. According to the American Academy of Dermatology Association, it can cause a scaly rash on areas such as the scalp, face, ears, chest, or skin folds.

Other symptoms may include redness, itching, flaking, greasy scales, or dandruff-like patches. In babies, seborrheic dermatitis is often called cradle cap.

6. Neurodermatitis

Neurodermatitis is a type of eczema that develops from repeated scratching or rubbing of the skin. According to the American Academy of Dermatology Association, neurodermatitis usually begins with an itchy patch of skin, and scratching can make the itch worse.

Over time, this itch-scratch cycle can lead to thick, rough, scaly patches, often on the neck, scalp, arms, legs, ankles, anus, or genitals.

7. Stasis dermitis

Stasis dermatitis, also called stasis eczema, is usually caused by poor circulation in the legs. It happens when fluid builds up in the lower legs and irritates the skin.

Symptoms may include swelling, itching, dryness, scaling, skin darkening, crusting, or open sores on the legs or ankles. Pus, warmth, increasing pain, or spreading redness may be signs of infection and should be assessed by a doctor.

Other forms of eczema

Eczema can also affect specific areas of the body, such as the eyelids or the skin around the anus. These forms may be related to irritation, allergies, moisture, hygiene changes, friction, or other skin conditions.

Asteatotic eczema is another form of eczema that is linked to very dry skin and loss of moisture from the skin barrier. It is more common in dry environments and may be triggered by low humidity, frequent bathing, or harsh soaps.

Medication-related eczema happens when a medicine triggers an allergic or inflammatory reaction in the skin. It can cause itchy, red, swollen, or peeling patches, and a doctor should evaluate whether the medication is contributing to these symptoms.

Eczema treatment

Eczema treatment should be guided by a dermatologist and may include topical medications, oral or injectable medications, and phototherapy, depending on the severity of symptoms.

According to the American Academy of Dermatology Association, topical corticosteroids and topical calcineurin inhibitors are recommended options for treating atopic dermatitis in adults.

1. Topical medications

The dermatologist may prescribe creams or ointments containing topical corticosteroids, such as betamethasone, to reduce skin inflammation, redness, and itching.

Calcineurin inhibitors, such as tacrolimus ointment or pimecrolimus cream, may also be recommended when corticosteroids are not effective or are not the best option for the affected area.

Topical or oral antibiotics may be prescribed if there are signs of a bacterial skin infection.

2. Oral or injectable medications

In moderate to severe cases, the doctor may prescribe oral or injectable medications to help control inflammation and reduce flare-ups.

These may include immunosuppressants or injectable biologic therapy, such as dupilumab. Antihistamines may also be recommended in some cases to help reduce itching or improve sleep when itching is severe.

3. Phototherapy

Phototherapy with ultraviolet A or B radiation (UVA or UVB) may be recommended by your doctor for moderate eczema that has not improved with other treatments, as it helps to reduce skin inflammation.

Phototherapy can be used together with an oral or topical medication, psoralen, which is referred to as PUVA therapy. This consists of taking or applying psoralen in the form of an ointment on the skin, and 2 hours later exposing the area that will be treated with ultraviolet radiation.

How to prevent an eczema flare up

According to the American Academy of Pediatrics, moisturizers are a cornerstone of atopic dermatitis treatment and should be applied daily, especially after bathing while the skin is still moist.

Other daily care measures can also help prevent eczema flare-ups or keep symptoms from getting worse. These include:

• Take short showers, lasting up to 5 minutes, with warm water
• Gently pat the skin dry after bathing with a soft, clean towel
• Avoid scratching the affected skin
• Use mild, fragrance-free soaps and detergents
• Avoid perfumes or scented lotions on the skin
• Wear loose cotton clothing and avoid tight or rough fabrics
• Use a humidifier when the air is very dry or cold

• Avoid very hot environments

These measures should be followed regularly, even after symptoms have improved, as they can help prevent dry skin and new flare-ups.