What Is Eczema?
Eczema is a common skin condition that causes itchiness, rashes, dry patches, and infection. It’s a type of dermatitis, which is a group of conditions that can inflame or irritate your skin. The most common type is atopic dermatitis or atopic eczema. “Atopic” means that you’re more likely to get allergic conditions such as asthma and hay fever.
Most people can manage their symptoms by getting treatment and by avoiding irritants, things that can affect your skin when you come into contact with them. Extreme itchiness is the most common symptom of eczema, and scratching that itch only makes it worse.
The periods when symptoms are at their worst are called “flare-ups.” These can last days or even weeks.
Eczema Symptoms
Eczema looks different for everyone. And your flare-ups won’t always happen in the same area.
No matter which part of your skin eczema affects, it’s almost always itchy. The itching sometimes starts before the rash. Your skin may also be:
- Red
- Dry and cracked
- Itchy
- Swollen with a rash (color varies depending on skin color)
- Bumpy (on brown or Black skin)
- Thick and leathery
- Oozing and crusting
- Raw from scratching
Eczema rash
One of the first signs of eczema is a rash that looks different on different individuals. For those with darker skin, the rash can be purple, brown, or gray. If you have a light skin tone, the rash can look pink, red, or purple.
Symptoms in infants
In infants, the itchy rash can lead to an oozing, crusting condition, mainly on the face and scalp. It can also appear on their arms, legs, back, and chest. Newborn babies can show symptoms within the first few weeks or months after birth.
Symptoms in children
Children and teens usually have a rash on the bends of their elbows, behind their knees, or on their necks, wrists, or ankles. The rash turns scaly and dry.
Symptoms in adults
The rash usually happens on your face, the backs of your knees, wrists, hands, or feet.
Your skin will probably be very dry, thick, or scaly. In fair-skinned people, these areas may appear reddish at the start and then turn brown. In darker-skinned people, eczema can affect skin pigments, making the affected area lighter or darker.
In the early stages, it might look pink, brown, or purple instead of red. In some people of color, eczema can appear as tiny bumps that look like goosebumps. The itching can be worse and skin dryness is more likely. Black individuals tend to have dark circles around their eyes.
Flare-ups can sometimes last several days or weeks.
When to see your doctor
Contact your doctor right away if you’ve been taking steps to manage your symptoms and notice any of the following:
- Signs of an infection, such as a fever, redness, warmth, pus, or blisters
- Your eczema suddenly changes or gets worse
- Treatments aren’t working
Types of Eczema
Eczema includes conditions such as:
Atopic dermatitis
This is what people usually mean when they say “eczema.” This is the most common form, and it affects more than 7% of American adults. Other allergic disorders, such as asthma and hay fever, can trigger it. It often starts in childhood.
Contact dermatitis
Nearly everyone gets this at some point in their lives. It happens when your skin comes into contact with something that causes a rash. The trigger can cause irritation or an allergic reaction. Triggers are unique to each person and vary depending on the type of contact dermatitis. Contact dermatitis has two main types:
- Irritant dermatitis is the more common kind and is more closely linked to people with atopic dermatitis. Triggers may include skin care products, soaps and detergents, jewelry made with nickel, and industrial chemicals such as solvents and cement.
- Allergic dermatitis flares when your skin comes into contact with something you’re allergic to. Common allergens include poison ivy, nickel, and other metals, fragrances, and beauty products with fragrances, rubber, latex, and the preservative thimerosal. For some people, it takes sunlight to cause a reaction.
Dyshidrotic eczema
This is a less common but more challenging form of eczema. It causes outbreaks of tiny blisters on the palms of the hands, soles of the feet, and sides of the fingers. Sweat or irritants such as metals may trigger it.
Neurodermatitis
This type of eczema tends to cause just one or two intensely itchy patches, often on the back of your neck, arm, or leg. Risk factors include having another form of eczema, such as atopic or contact dermatitis, or just very dry skin. Some mental health issues, including anxiety disorder and obsessive-compulsive disorder (OCD), can also trigger it. Those assigned female at birth (AFAB) between the ages of 30 and 50 have a higher chance of getting it than other people.
Nummular eczema
This coin-shaped eczema often appears after a skin injury such as a burn or insect bite. You’re more likely to get nummular eczema if you or your family members have atopic dermatitis, allergies, or asthma.
Seborrheic dermatitis
This happens in areas of your body with lots of oil glands. When it’s on your scalp, it’s called dandruff. It shares a common link with some other skin conditions, such as psoriasis, acne, and rosacea, as well as a variety of other diseases.
Stasis dermatitis
This type happens in people who have poor blood flow, usually in their lower legs. Unlike some other types of eczema, these plaques don’t mean you have abnormal genes. Some lifestyle habits raise the risk too, such as being overweight or not getting enough physical activity.
Eczema Causes
Experts aren’t sure what exactly causes eczema. Things that may make it more likely include:
- An immune response to something irritating
- Problems in your skin’s barrier that let moisture out and germs in
- A family history of other allergies or asthma
Is eczema contagious?
No. You can’t catch eczema from someone or pass it on to others.
Eczema risk factors
Stress and genes are among the most common risk factors for getting eczema. But there are more, including:
- Having very dry skin
- Using hair care or skin products with certain allergens
- Food allergies
- Living in cold, damp areas or swampy, hot areas
- Having someone in your family who has eczema
Your age may affect whether you get eczema or not:
- Eczema shows up most often before you turn 5. Most children will outgrow eczema.
- If you get eczema as an adult, you’re more likely to get it either in your 20s or over the age of 50.
- Atopic dermatitis is more common in children, while forms such as nummular eczema are more typical in adults.
Eczema Flare-Ups
When your immune system responds to something unusual going on inside or outside of the body, it causes inflammation. Inflammation causes the itchy, painful symptoms of eczema. Different people react to different substances, experiences, and triggers. Some people may react to more than one thing.
What causes eczema flare-ups?
There are many causes, and they’re different for each person. These may include one or more of the following:
- Genes and family history
- Overreactive immune system
- Extremely dry skin
- Stress
- Environment — pollen from different blooming plants, cold and damp or hot and humid weather
- Allergens — substances that may cause allergic reactions, such as those in certain household or grooming products, and foods
Recent studies suggest that living near factories, major roadways, or wildfires can increase the risk of developing eczema. So can exposure to household materials such as paint, plastics, and cigarette smoke or synthetic fabrics such as spandex, nylon, and polyester.
Eczema triggers
Some people have flare-ups in response to specific things, such as:
- Pollen
- Rough or coarse fabrics or clothing (such as wool)
- Feeling too hot or cold
- Household products such as soap or detergent
- Dander from animal hair or fur
- Dust mites or mold
- Infections or colds (including skin infections)
- Stress
- Heat and sweat
- Cold and dry air
- Fragrances or tobacco smoke
- Irritating chemicals
- Certain foods (including peanuts, dairy, and eggs)
Eczema flare-up prevention
A few tips can help you prevent outbreaks or keep them from getting worse:
- Moisturize your skin often.
- Avoid sudden changes in temperature or humidity.
- Try not to sweat or get too hot. Keeping cool and keeping your home comfortable can reduce itching.
- Manage stress, and take time for yourself to relax.
- Get regular exercise. It can help control stress and boost circulation.
- Avoid scratchy materials such as wool.
- Don’t use harsh soaps, detergents, or solvents.
- Pay attention to foods that might trigger symptoms, and try to avoid them.
- Use a humidifier in rooms where you spend the most time.
- If your baby is more likely to have eczema because of family history, it’s best to breastfeed them exclusively for the first 3 months of life, or longer if possible. Doctors advise continuing breast milk for at least up to 6 months (preferably 1 year) as you introduce your baby to solid food. Babies should also be protected from potential allergens such as pet hair, mites, and molds.
Eczema and mental health
There’s a strong link between eczema and emotion. While stress, anxiety, and depression don’t cause eczema, they can set off a physical reaction that includes inflammation. This can make flare-ups worse.
It works the other way as well. Having eczema can make it more likely that you’ll have issues with mental health. One study found that more than 30% of adults with eczema also have a diagnosis of depression, anxiety, or both. Kids who have the condition are two to six times more likely to also have anxiety, depression, or attention deficit hyperactivity disorder (ADHD) than those who don’t. If they have other atopic conditions such as asthma, their risk goes up.
There are many things you can do to help yourself manage your mental health when you have eczema. Meditation, spending time outside, and exercise are some things that can help you handle stress and feel calmer.
If you have symptoms of depression for 2 weeks or more, talk to your doctor right away. They may suggest that you join a support group or start therapy with a mental health professional. Signs of depression to watch for include:
- Feeling sad, empty, or hopeless
- Being unable to concentrate
- Low energy
- Loss of interest in hobbies or activities you usually enjoy
- Thoughts of suicide
Eczema Diagnosis
No one test can spot eczema. Your doctor will probably diagnose it by looking at your skin and asking a few questions.
Because many people with eczema also have allergies, your doctor may order some allergy tests to look for irritants or triggers. Children with eczema are especially likely to have allergy tests.
If your doctor diagnoses you with eczema, you might want to ask them:
- What’s the best way to add moisture to my skin? Can I use over-the-counter products, or do you need to prescribe something?
- Do I need to buy special soaps, lotions, and laundry detergent? Do fragrance-free or sensitive-skin products help?
- Are there foods that I should avoid to keep flares at bay?
- Are there fabrics that I shouldn’t wear? What fabrics should I wear?
- Do pets make symptoms worse?
- If sweating makes things worse, can I still exercise?
- What’s next if my symptoms don’t improve or I get an infection from scratching my skin?
- Does stress lead to flare-ups?
- Are long periods without symptoms common?
- Are there ways I can treat my skin to reduce my chances of another flare-up?
Psoriasis vs. eczema
It can be difficult to tell the difference between the two. Psoriasis and eczema look the same and have similar symptoms. Both can cause a rash that appears in the same places, such as the hands or scalp. Neither condition is contagious, but both types of rashes can become infected.
Psoriasis is an autoimmune disease. This means that the person’s immune system doesn’t work right, and their skin cells grow too fast. Those cells show up on top of the skin as a white, scaly patch. Risk factors can include a person’s genes (family background) or exposure to something in the environment — or both.
How can you tell them apart? Here are a few things that your dermatologist will consider when making a diagnosis:
Itchiness. Psoriasis causes milder itching and, sometimes, a burning sensation. Eczema itches so much that some individuals scratch until it bleeds.
Location. Both can show up anywhere on your body, but they tend to develop in certain areas. Psoriasis typically appears on the scalp, elbows, knees, buttocks, and face. Eczema often occurs on the back of the knees or inside of the elbows.
Age. Both can occur at any age, but eczema affects children more often.
Sun exposure. Sunshine is a treatment for psoriasis because it slows down abnormal cell growth. (Too much sun can trigger symptoms, so your dermatologist will recommend the ideal duration for sun exposure to prevent flare-ups.) People with eczema tend to be more sensitive to heat because sweating can lead to flare-ups.
Eczema Treatment
Eczema treatment aims to ease and prevent itching, which can lead to infection.
Medications
Your doctor may also prescribe creams and ointments with corticosteroids to ease inflammation. If the area becomes infected, you’ll probably need antibiotics.
Other options include tar treatments (chemicals that reduce itching), phototherapy (using ultraviolet light), and the drug cyclosporine.
The FDA has approved two medications called topical immunomodulators (TIMs) for mild to moderate eczema. Elidel cream and Protopic ointment work by changing your immune system response to prevent flare-ups. They can reduce inflammation and itching.
The FDA has warned doctors to use caution with Elidel and Protopic because of concerns over cancer risk. The two products also carry the FDA’s “black box” warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe Elidel and Protopic for only a short time after other eczema treatments have failed in adults and children older than 2 years. It should not be used in kids younger than 2 years.
A biologic drug called dupilumab (Dupixent) has FDA approval for moderate to severe eczema. Biologics block certain proteins from binding to receptors on your cells. This eases or prevents inflammation by keeping your immune system from overreacting. Tralokinumab (Adbry) is another injectable biologic drug.
Other medication options for eczema include:
- Azathioprine (Azasan)
- Methotrexate
- Mycophenolate mofetil (CellCept)
- Phosphodiesterase inhibitors (Eucrisa ointment)
- Ruxolitinib (Opzelura cream)
- Upadacitinib (Rinvoq)
Eczema cream
Some moisturizing creams are not effective in treating eczema-prone skin. Some can even cause flare-ups. To protect and moisturize your skin, look for creams that are fragrance- and dye-free. Avoid ingredients such as citrus extract and lidocaine. The best creams are the ones that feel “greasy” because they contain more oil, which keeps moisture in and irritants out.
Eczema lotion
Lotions have more water than creams. Some contain preservatives that can irritate or burn the scratchy skin. Just like creams, lotions that are free of problematic ingredients are the safest and least irritating. Look for ingredients such as oat or shea butter, aloe, glycerin, hyaluronic acid, petrolatum, vitamin E, humectants, and niacinamide. Hypoallergenic products are a good choice.
Alternative treatments
Self-hypnosis, meditation, and biofeedback therapy have all been shown to ease eczema symptoms. You may also want to see a therapist. They can help you change habits or negative thought patterns that may be adding to your skin problems.
Find out more about the best treatments for eczema.
Other alternative treatments include taking vitamin D and applying rice bran broth to the skin. Be sure to discuss these with your doctor first, as nontraditional approaches can irritate you.
Baby eczema treatment
Daily bathing with a mild cleanser and warm water is key. Be sure to rinse completely, pat your baby dry, and apply a fragrance-free moisturizing lotion or cream while the skin is still damp. Moisturize at least twice a day (test products on a small patch of skin first). Avoid itchy fabrics and extreme temperatures. To help avoid scratching, trim your baby’s nails or put on cotton mittens.
Contact your medical provider if your baby’s rash is purple, crusty, watery, or has blisters, or if your baby has both a rash and a fever.
Eczema Health Disparities
Research shows that 1 in 10 Americans will get eczema during their lifetime. But adult women are more likely to get it than men.
In the U.S., boys and girls are equally likely to have eczema, with about 11% of each gender affected. The condition is more common among non-Hispanic Black children than among children of any other race. For example, 2021 data from the CDC reports around 14% of Black kids under 17 had eczema, compared to 9% of non-Hispanic Asian children.
Among adults, multiracial and White people have the highest incidence. One reason may be that they’re more likely than people of other races to see a doctor for a diagnosis. At the same time, Black children and adults are more likely to have a more serious and persistent form of eczema. That may be due to a lack of insurance, reliable transportation, and other barriers to seeking care.
Physical differences also may explain some of the disparities. For example, researchers believe that Black people tend to have drier skin compared to Asian people. And people with eczema lose their skin moisture more quickly.
Eczema Complications
Eczema can lead to skin infections from scratching or cracking. That can break down your skin’s barrier against bacteria and other germs. Complications with eczema can include some or all of the following:
- Asthma or hay fever. Either of these can happen before or after diagnosis.
- Food allergies. These can cause hives.
- Darker or lighter skin areas. This is more common in people with a darker skin color.
- Skin infections. If you get a skin infection, it can be life-threatening. So, watch out for these and tell your doctor right away.
- Sleep problems. Eczema can cause these because of the itchiness.
Living With Eczema
Eczema can lead to many complications, but there are ways to manage your daily life and routine if you have the condition. These tips may help you avoid flare-ups and reduce costs.
Eczema diet
Since eczema is linked to allergens in food, there’s no one specific diet you should stick to if you have eczema. But it’s good to focus on anti-inflammatory foods that are less likely to lead to an allergic reaction. Foods that can often be inflammatory include:
- Red meat
- Processed meats (lunch meats, hot dogs, bacon)
- Fried foods
- Foods and drinks with added sugar
- Trans fats
- Refined carbs (white bread, pastries)
- Snack foods, such as cookies, chips, and crackers
It’s also important to keep in mind that allergies are highly individual. It may take time to learn your specific allergy triggers. Some foods, such as dairy, can cause inflammation even if you’re not allergic, and you can eat them without troublesome symptoms. In time, you can find the right diet for you, whether it’s paleo, Mediterranean, gluten-free, or something else.
It’s also important to drink plenty of water. Water helps keep your skin from drying out, which can cause flare-ups.
Eczema and exercise
Some studies show that weight loss may contribute to reduced eczema symptoms. Since sweat from physical activity and exercise can cause flare-ups, try doing low-impact workouts and strength training. In addition to moisturizing before and after exercises, be sure to:
- Stay hydrated.
- Avoid hot weather.
- Wear cotton workout gear rather than synthetic fabrics, and choose loose clothing instead of tight ones.
- Take lukewarm or cool showers after workouts.
Home remedies
Some things you can do at home that may help ease symptoms. These include:
Moisturizers. Because your skin is dry and itchy, your doctor will recommend lotions and creams to keep it moist. Creams and ointments ease inflammation and put water back in your skin to help it heal. Put them on several times a day, including right after you take a bath or shower. Petroleum jelly and mineral oil work well because they form a thick barrier over your skin.
Products with glycerin, lactic acid, and urea may also help because they help pull water into your skin. You’ll use these when your skin is damp, such as after bathing, to help hold in moisture.
Hydrocortisone creams and antihistamines. Over-the-counter products such as hydrocortisone cream and antihistamines can also help. Hydrocortisone is a steroid that helps keep redness, itching, and swelling at bay. You can buy low-strength creams and lotions at the store. If those don’t help, your doctor may prescribe something stronger.
It’s safe to put hydrocortisone on most body parts as many as four times a day for up to 7 days — as long as you’re not pregnant or breastfeeding. Keep it away from your eyes and private parts.
Some people have a severe reaction to hydrocortisone. If you have trouble breathing or swallowing or notice a skin rash after you use it, call 911.
Over-the-counter allergy meds may not work well for itchy skin caused by eczema. However, antihistamines that are known to cause drowsiness can help you sleep if you take them before bed.
Colloidal oatmeal. Add this finely ground oatmeal to a lukewarm bath. It contains starches that seal in moisture to keep your skin hydrated and help block irritants.
Wet wraps. When your eczema is flaring, soak some gauze, bandages, or pieces of soft clothing in cool water and put them on your skin. The coolness will relieve itching, and the moisture will help creams or lotions work even better. Carefully cover the area with a dry layer (such as pajamas) and leave it in place for several hours or overnight.
Talk to your doctor to find out how often you can use wet wrap therapy. If you do it too much, it can cause an infection in your skin.
Coal tar. People have been using this product for more than 2,000 years to treat eczema and other skin problems. Although it’s messy and many people don’t like the strong smell, it may help soothe your skin.
Calamine lotion. It can be put in the refrigerator and helps relieve itching quickly.
Relaxation techniques. There’s a strong link between stress and your skin. Plus, you’re likely to scratch more when your emotions are running high.
Use a humidifier. Hot, dry indoor air can worsen itching and flaking. A home humidifier will add moisture to the air inside your home.
Managing eczema
There are several things you can do to ease itchiness, which is the main symptom of eczema. You can:
- Use a cold compress at the itch site.
- Softly pat the itchy skin. Don’t scratch it.
- Take an apple cider vinegar bath.
- Make sure your clothing is soft and breathable.
- Try to avoid sitting on rough things, such as grass or carpet.
- Moisturize during the day with a product containing ceramides.
Eczema Prognosis
Because experts are unsure of the exact causes of eczema, it’s best to treat the symptoms and reduce triggers for flare-ups. Speak with your doctor or dermatologist about what the root cause of your eczema might be and how to best manage it. Treatments tend to include a mixture of medications and home remedies.
Can eczema be cured?
There is currently no cure for eczema. But with the right treatments, such as medications, ointments, over-the-counter drugs, and home remedies, you can control and manage the symptoms.
What to expect with eczema
Almost 50% of children will outgrow their eczema as they get older and reach puberty. For others, it could last a lifetime. If you have eczema, there are ways to treat it, but it may take some time to find the right treatment for you. There will be times when flare-ups only last days and other times when they last weeks. There may also be long periods when you don’t have any flare-ups. Just keep in mind that this doesn’t mean the eczema has gone away. Stay away from inflammatory foods and triggers such as stress.
You can manage your eczema by living a healthy and well-balanced lifestyle. Avoid triggers such as stress, harsh soaps, and rough or scratchy clothing. Keep your skin well-moisturized. This can help you prevent flare-ups and cut down on itchiness. If you feel your eczema is getting worse, let your doctor or dermatologist know right away.
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