If you experience chronic dry, itchy and red skin, you may be one of the millions of Americans with eczema. The National Eczema Association reports that an estimated 10% of the world population experience eczema at some point in their lives, and more than 16.5 million American adults have atopic dermatitis, the most common form of eczema.
Eczema, a general term for skin conditions that involve dry, itchy and red skin, can affect people of all ages, though it often begins in early infancy.
“It can be lifelong, but many people outgrow it with time,” says Dr. Michael Blaiss, clinical professor of pediatrics at Medical College of Georgia in Augusta, Georgia and former executive director of the American College of Allergy, Asthma and Immunology.
[READ: A Patient’s Guide to Skin Diseases.]
Types of Eczema
The word “eczema” can be used when talking about many skin conditions, but it is most commonly referring to atopic dermatitis. However, there are many different types of eczema, including the following:
— Atopic dermatitis. The most common form of eczema, atopic dermatitis appears as itchy, red and dry patches along the skin. It may occur on its own, but it can also be a sign of another problem, such as an allergic reaction.
— Contact dermatitis. This type of eczema is a direct allergic reaction that occurs when the skin comes into contact with an irritant. Although its symptoms, such as redness and itching, might resemble those of atopic dermatitis, the key difference is that it is caused by physical contact with an allergen.
— Dyshidrotic eczema. Dyshidrotic eczema is a condition that is characterized by the appearance of small, itchy blisters, primarily affecting the hands, soles of feet and fingers.
— Discoid eczema. This form of eczema is identified by its distinct coin or disc-shaped patches of red, itchy and dry skin. These lesions are most common on legs, arms and trunk.
— Seborrheic dermatitis. Seborrheic dermatitis refers to flaky, itchy patches on the skin, usually on the scalp — referred to as dandruff. It can also occur on the face, ears and chest.
— Varicose eczema. This is a form of eczema that predominately affects the lower legs of older adults, particularly those with varicose veins. It typically occurs due to low blood circulation, leading to swelling, redness, itching and discoloration.
— Asteatotic eczema. Typically affecting people age 60 and older, asteatotic eczema is excessively dry, cracked and scaly skin. It is associated with natural aging processes on the skin, but can be worsened by cold, dry weather.
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Symptoms of Eczema
“Eczema is more than just dry skin. Flares erupt unpredictably: dry, scaly, irritated spots on the face or hands, or inside the crease of the elbow or knee,” says Dr. Purvi Parikh, an allergist and immunologist with Allergy & Asthma Network.
Eczema most prominently appears as red, itchy patches on the skin. However, it can appear in a variety of ways and can range from mild to severe. The patches may blister and ooze, and over time, the patches can grow thick and raised, making them look similar to a psoriasis plaque in some severe cases.
These symptoms can also show up differently based on age. Blaiss says that infants with eczema often have red, itchy cheeks, while in children until puberty, the rash tends to appear in elbow and knee creases, wrists, ankles and neck. Adults can receive the rash in any of these areas.
Some of the most common symptoms of eczema include:
— Dry, itchy skin. Itching may become more pronounced at night.
— Red or brownish-gray patches on the skin. These patches tend to collect on the hands and wrists, feet and ankles, chest and neck, eyelids and inside folds of skin, such as inside the bend of the elbow or knees. This hyperpigmentation is likely to develop as a result of excess scratching.
— Small raised bumps. These bumps may leak a clearish fluid and crust over if they’ve been scratched.
— Thick, cracked or scaly skin. Over time, eczema patches can build up and become thicker or scaly.
— Swollen or raw and broken skin. These symptoms typically arise when you’ve scratched the area.
In addition to skin symptoms, atopic dermatitis can also trigger other ailments, sleep disturbance and mental health effects, says Dr. Kanwaljit K. Brar, pediatric allergy specialist at New York University Langone Health and associate professor at NYU School of Medicine. If you wake up scratching often, that can cause you to lose sleep, and the presence of skin lesions can have mental health effects. These feelings can lead to anxiety,depression, loneliness and social isolation.
[READ: How Seasonal Allergies Can Impact Mental Health]
Causes of Eczema
Although the exact cause of atopic dermatitis isn’t known, it’s believed that certain environmental and/or genetic triggers cause the immune system to over-react and produce inflammation. This then develops into the red, itchy patches we know as atopic dermatitis. The exact reason some people develop atopic dermatitis and others don’t isn’t entirely clear. In some people, environmental triggers are likely to blame. In others, the cause may be something intrinsic in the body and their own genetic makeup that sets off the reaction.
People who have asthma, hay fever or both or who have a family history of these problems are more likely to develop atopic dermatitis. This cluster of asthma, allergies and eczema is sometimes referred to as the “atopic triad” because they so often occur together, Brar says. Children of parents with atopic dermatitis, asthma or hay fever have about a 50% chance of also developing one or more of these conditions, the NEA notes.
“Some studies suggest there is a defect in the top layer of the skin that leads to an abnormal immune response and results in the condition,” Blaiss says. In this defect, people are born with altered filaggrin, a skin protein that helps the body maintain the skin layer, allowing moisture to leave and bacteria and other irritants to enter.
People who are prone to atopic dermatitis may experience periods of worsening symptoms, called flare-ups. These may be triggered by a variety of things, such as:
— Weather. Cold, dry air can make skin drier, which leads to more inflammation. Hot weather or extreme changes in temperature can also be a trigger that dries, causes sweating or leads to inflammation in the skin.
— Irritants. Many of the personal products we use, such as soaps and perfumes, can be drying on the skin and worsen symptoms of atopic dermatitis. “While they are not allergens, some soaps, detergents, fragrances and wool or synthetic clothing can significantly irritate sensitive skin,” says Parikh.
— Dust mites and contact with animals. Pet dander and dust mites are common allergens, and for some people, coming into contact with these items can trigger a skin response.
— Skin infections. Infection by certain tiny animals, such as scabies, can worsen atopic dermatitis. Other bacterial or viral infections can also cause flare-ups.
— Fabrics. Wool and some synthetic fabric can be irritating to some peoples’ skin and trigger atopic dermatitis.
— Food allergies. A study found that food allergies trigger 20% to 30% of cases of moderate-severe atopic dermatitis. Which foods specifically trigger a flare-up can vary from person to person, but milk, eggs and soy are common culprits.
— Stress. Stress hormones increase inflammation throughout the body, and this can result in worse symptoms of atopic dermatitis.
— Hormones. Especially among women, hormonal fluctuations can also trigger flares.
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Treatments for Eczema
The first step to addressing eczema is making changes to daily life that could help improve it.
“When a patient comes to me with eczema, we first focus on clearing up the skin with a daily bathing and moisturizing routine, which can help strengthen the skin against irritation and infection,” says Parikh.
Bathe in lukewarm water, dry skin gently and then apply an ointment or moisturizing cream.
“Moisturizers seal the water on your skin to prevent evaporation so that the water can be absorbed and make your skin softer,” Blaiss says.
However, recurring or more severe cases of eczema also require the right treatment plan. There are a range of medical options for people dealing with atopic dermatitis and other forms of eczema, including:
— Topical corticosteroid creams or ointments. These creams contain powerful anti-inflammatories that help reduce redness and inflammation in the skin. Blaiss says that, for mild cases, these creams should be enough to control the rash.
— Topical immunomodulators. These topical medications, also sometimes called topical calcineurin inhibitors (or TCIs), can help calm cases of atopic dermatitis that have been less responsive to conventional treatments. It functions by helping suppress the reaction of your immune system.
— Immunosuppressant drugs. These medications are reserved for the most severe cases of atopic dermatitis. These medications inhibit the production of certain immune system components, such as T-cells or cytokines, to help quell the body’s immune response. Use of these treatments should be monitored by a physician.
— Biologic drugs. Also sometimes called interleukin inhibitors, these powerful medications work to stop the overreaction of the immune system. This is another treatment used when atopic dermatitis does not respond to other options.
— Phototherapy. Controlled exposure to ultraviolet B light can help to suppress overactive immune cells, clearing up reactions from eczema and helping to reduce itchiness.
— Antihistamines. Because allergies may be involved in some cases of atopic dermatitis, antihistamines may be useful in helping tamp down your immune system’s response to those allergens.
— Antibiotics and antivirals. Because infection can sometimes cause atopic dermatitis, agents that kill the bacteria or virus that’s causing the issue may be issued by a doctor in extreme situations.
[SEE: Best Eczema Creams and Treatments]
Lifestyle changes to help eczema
For many people, atopic dermatitis is a lifelong condition that you’ll have to learn to control. In addition to medications, there are some lifestyle changes you can make to reduce symptoms and prevent flare-ups, including the following:
— Control triggers. Learn what makes your atopic dermatitis worse and seek to eliminate or control exposure to these triggers. For example, if you know milk makes it worse, avoid consuming dairy products. If stress is a culprit, try adding meditation or other relaxation techniques to your day to help reduce stress. Remove any allergens from your home and work environment that you’ve identified as possible triggers.
— Avoid fragrances and chemicals. Air fresheners, perfumes, scented candles and other fragrant products may also irritate some people with atopic dermatitis. If your clothing is dry cleaned, air it out for a day or two before you wear it to allow any remaining chemicals on the fabric to dissipate.
— Choose your moisturizer carefully. If wool is a trigger and your lotion contains lanolin, that can pose a problem because lanolin is a waxy substance derived from wool. Also look for lotions that don’t contain fragrances, but that promise to keep more moisture in the skin. There are many OTC creams that are labeled as being helpful for eczema.
— Don’t smoke. In addition to being generally terrible for your health, smoking can also trigger atopic dermatitis flares. “Cigarette smoke can also irritate skin, the same way it irritates lungs and eyes,” Parikh says.
— Avoid excess sun. Being out in the sun can make you hot and sweaty, which may trigger symptoms. Seek shade when outdoors, and look for sunscreens that don’t contain a bunch of chemicals that could further irritate your skin.
— Make a routine. Because atopic dermatitis is often related to very dry skin, bathing regularly and following a consistent moisturizing regimen can help reduce symptoms. Keeping the skin clean can reduce the chances of infection, which can also trigger flare-ups. Avoid really hot water when washing or bathing, as that can worsen symptoms too.
— Follow doctor’s orders. If you’re under a doctor’s care to manage your atopic dermatitis, be sure to use the medications you’ve been prescribed as they are intended.
— Don’t scratch. As difficult as it can be to stop yourself from scratching, it’s important to try. “Though it’s extremely difficult to avoid scratching, do the best you can, as broken skin is easily infected, and scratching will start the cycle all over again,” Parikh says. Wearing gloves at night can help prevent you from scratching when you don’t mean to and may be a good option for helping kids stop scratching. Bamboo and cotton are good fabrics, as they tend to be soft and non-irritating. Applying a cool washcloth to an itchy area can also relieve a strong itch.
When to see a doctor for eczema
When your skin becomes red, itchy and inflamed, especially if the symptoms are so extreme they are impacting daily life, you should visit a health care provider to determine what the problem is and what’s causing it. It is also recommended to see a doctor if it becomes unmanageable with OTC medications and home remedies.
“There are a wide variety of medications now available — from medium to high potency — that allergists can prescribe for dealing with the symptoms of eczema,” Blaiss says.
Brar says that a good dermatologist or pediatrician can typically make a diagnosis of atopic dermatitis simply by examining a patient visually. “I wish people knew that eczema is not simply a skin problem. It’s a systemic disease and can be quite debilitating and emotionally taxing,” Brar says.
It is also important to monitor eczema development in infants, as it can increase likelihood of allergies.
“Infants with eczema should be evaluated for peanut allergy, as they’re at a high risk for its development. Board-certified allergists are skilled in the evaluation, treatment and, if needed, allergy testing for children and adults with eczema,” Blaiss says.
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A Patient?s Guide to Atopic Dermatitis (Eczema) originally appeared on usnews.com
Update 08/04/25: This guide was published at an earlier date and has been updated with new information.
