What Is Eczema?

Eczema is a group of chronic skin conditions that can cause inflammation, irritation, and swelling of your skin. Dermatitis, which means inflammation of the skin, is often used as a synonym for eczema, though not all types of dermatitis are considered eczema.

There are many types of eczema, each with its own set of causes, symptoms, diagnoses, and treatments. While these differ from each other, something they have in common is that they are usually chronic, long-term conditions with recurring symptoms.

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Types of Eczema

Each type of eczema can affect the skin differently, from how the skin is damaged to what areas of the body are affected.

The different types of eczema include:

Atopic Dermatitis 

The most common type of eczema is atopic dermatitis, which causes inflamed, itchy rashes on the skin. In the United States, about 3 in 10 people have atopic dermatitis—primarily children and teenagers. This type of eczema affects about 7% of adults.

Contact Dermatitis

Contact eczema, or contact dermatitis, occurs when the skin comes in contact with a substance in your environment, such as an irritant or allergen. Contact dermatitis is extremely common, affecting up to 1 in 5 people at some point in life. It can occur for a long period of time, especially if the irritant or allergen is difficult to avoid, or can be circumstantial, such as a reaction to a cosmetic.

Seborrheic Dermatitis

Seborrheic dermatitis (SD), also known as seborrheic eczema, can cause skin inflammation and itchy “scales.” It most commonly occurs in areas of the body with many sebaceous (oil-producing) glands, such as your scalp, eyebrows, and cheeks. Areas where your skin folds may also be affected, such as the armpits, groin, or under the breasts. SD is less common than some other types of eczema, affecting 3-10 out of every 100 people.

There are several types of SD, which can affect infants, teenagers, and adults. In other cases, SD symptoms can accompany Parkinson’s disease, other brain disorders, or HIV.

Dyshidrotic Eczema 

Dyshidrotic eczema causes fluid-filled blisters called vesicles on the palms of your hands and soles of your feet. It is most common in adults ages 20 to 40.

This type of eczema was first called dyshidrosis, meaning difficulty sweating. Although the term “dyshidrotic eczema” is still used today, it is not medically accurate—as the disease is not caused by abnormal sweat glands. Other terms for dyshidrotic eczema include pompholyx, recurrent vesicular palmoplantar dermatitis, or acute palmoplantar dermatitis.

Nummular Eczema 

Nummular eczema causes itchy raised bumps called plaques, most often on the arms and legs. 

This condition is also called nummular dermatitis, discoid eczema, or microbial eczema. It usually develops between ages 50-65 in males and ages 15-25 in females. Its overall prevalence is still a broad estimation—ranging from 0.1% to 9.1% of the population.

Stasis Dermatitis 

Stasis dermatitis causes rashes, dryness, plaques, crusting, and blisters on the skin of the lower leg, ankle, or foot—parts of the body that are already swollen from poor blood flow. Stasis dermatitis, or venous dermatitis, is most common in people with poor blood circulation in their leg veins (called chronic venous insufficiency)—which most often affects older adults. It can also occur situationally, such as after a bad leg injury, a blood clot in your leg, or surgery.

About 15 to 20 million people over age 50 live with stasis dermatitis.

Asteatotic Eczema 

Asteatotic eczema causes itchy, scaly, dry lesions and cracked skin (known as fissures). It’s also known as xerosis (dry skin) or eczema craquelé (cracked eczema). It is the most common type of eczema in adults older than 60—affecting over 70% of older adults—but can occur in younger adults, too. It most commonly occurs during the winter months, likely due to reduced humidity caused by indoor heating.

Neurodermatitis 

Neurodermatitis consists of dry, itchy patches that can turn into scaly, thick, or raised plaques that are often itchy. Also known as lichen simplex chronicus, chronic neurodermatitis typically affects adults ages 30 to 50. 

This type of eczema worsens with scratching, the very symptom it causes. This can create a vicious cycle of scratching, followed by flares, followed by scratching, and so on. Frequent itching of the affected area can lead to irritation and infection.

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What Is Eczema?

Eczema Symptoms

Symptoms of eczema can vary from person to person depending on the type.  Most eczema types tend to cause dry skin, itchy lesions, and rashes. Different types of eczema usually have signs of scaling, oozing, or crusting of the skin.

Rashes can vary based on skin tone. People with darker skin may have rashes that appear ashen, gray, brown, or purple; whereas people with lighter skin may notice red or pink rashes.

Commonly, people with eczema experience:

• Dry skin
• Severe itching, especially at night
• Small, fluid-filled bumps that may leak and crust over after scratching
• Thickened, cracked, or scaly skin
• Raw, sensitive, swollen skin due to scratching

Causes and Risk Factors

While it's widely accepted that inflammation of the skin leads to eczema, experts don't fully understand what causes each type of eczema. The most well-known eczema risk factor is having a personal or family history of asthma or allergies, two conditions that commonly cooccur with eczema. A family history of eczema itself is also a risk factor. Living in a city or dry climate may also increase your odds of developing eczema.

Certain environmental factors, such as exposure to allergens or irritants, can trigger or worsen symptoms. Environmental triggers for eczema vary from person to person and depend on the type of eczema. Common triggers include:

• Dry air, extreme heat, or cold
• Soaps, shampoo, or other personal care items
• Laundry detergents or fabric softeners
• Certain fabrics, such as wool or polyester
• Candle fragrances
• Metals found in jewelry or utensils
• Chemicals found in cleaning products
• Natural liquids from fruits, vegetables, and meats
• Stress (which can trigger skin inflammation)

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Diagnosis

If you suspect you have eczema or another skin condition, it’s best to see medical care to ensure you have the right diagnosis. Your primary care provider can usually make a diagnosis, but they may refer you to a dermatologist or dermatology nurse (medical professionals who specialize in skin conditions) as well.

Eczema can usually be diagnosed based on the appearance of your skin lesions and where they are located on your body. Usually, your healthcare provider will need to rule out other types of eczema and other skin conditions, such as psoriasis (an autoimmune skin disorder), fungal skin infections (like tinea), or mite infestations (like scabies). 

In some cases, your doctor might perform allergy tests to confirm your diagnosis. Patch testing is a standard allergy test, especially for atopic and contact eczema. A provider will stick an allergen-containing patch on your skin for 48 hours to see if you have a reaction, followed by repeated tests to confirm the results.

For other types of eczema—like nummular eczema, asteatotic dermatitis, and neurodermatitis—your doctor may perform a skin biopsy to rule out other conditions with similar symptoms. A skin biopsy is a minimally invasive procedure in which a dermatologist numbs an area of affected skin and takes a small sample. Then, a dermatopathologist—a doctor who specializes in diagnosing skin diseases—examines the sample under a microscope to determine what is causing the skin lesion.

When diagnosing stasis dermatitis, which has an underlying cause of poor blood flow, additional tests can be used to examine the blood circulation in both your veins and arteries.

Treatments

There is no cure for eczema at this time. With some people, eczema clears up on its own. If you had eczema as a child, you may not have it as an adult. For others, eczema is a life-long condition that requires consistent management of symptoms. While there isn’t a cure, there are many treatment options to help you manage and reduce symptoms. Your treatment plan may vary depending on the type of eczema you have, your age, and your specific symptoms. 

The following are some treatments that are common across various types of eczema. 

Moisturizers

Reducing skin dryness can help with eczema management. This involves moisturizing regularly—usually twice a day or more. Moisturizers often come as ointments, creams, or lotions. Ointments contain the most moisture but can also be greasy, so you may prefer creams or lotions.

Look for moisturizers that contain petroleum jelly and avoid ones that contain preservatives (like parabens) and artificial fragrances, which can be potential allergens or irritants. Skin barrier repair creams, which contain natural skin oils like ceramides, can help protect your skin’s outermost layer.

Medication for Inflammation and Itchiness

There are various prescription and over-the-counter medication options for reducing flare-ups and skin inflammation. It is possible that medications may impact your skin barrier or your immune system, so make sure to discuss the potential side effects with your healthcare provider. Medication options include:

• Topical corticosteroids: These are often the first line of defense when it comes to treating eczema. There are several types of these drugs, which can come as ointments, lotions, or foams. 
• Antihistamines at night: For itchy skin that keeps you up at night—which can often happen with atopic or nummular eczema—your provider may recommend taking oral antihistamines (a common allergy treatment) before bed. 
• Phototherapy: Phototherapy exposes your skin to a controlled dose of UV radiation to help promote vitamin D production in your skin. This may be recommended for severe cases of nummular dermatitis, atopic eczema, or neurodermatitis that hasn’t improved after trying other treatments, like prescription topicals. 
• Immunosuppressants: Immunosuppressants, such as calcineurin inhibitors or systemic corticosteroids, may be prescribed if you have moderate to severe symptoms. This medication helps reduce the overactive immune responses that trigger skin inflammation.
• Immunomodulators: This is another type of drug that suppresses your immune response, but they are more selective than immunosuppressants. Immunomodulators target specific portions of the immune system instead of the immune system as a whole.

Treatments for Infections

Eczema can cause your skin barrier to be more susceptible to skin infections. If your skin lesions do become infected, your healthcare provider can prescribe appropriate antibiotic treatments, which may include creams or lotions applied to the skin.

If you have seborrheic dermatitis, a doctor can prescribe topical antifungals and antimicrobial shampoos. These can help treat infections on your scalp and reduce flaking.

Prevention

There are several ways to prevent worsening eczema symptoms. You can start by avoiding allergens or irritants that can trigger your skin to flare up. A healthcare provider can help test for allergens to help identify potential triggers. You can also keep track of common ingredients in personal care products to determine what may be causing your skin to react.

At times, it may not be possible to avoid an eczema trigger, such as cold temperatures or air pollution. But limit the time you spend in environments that could make your symptoms worse. Try wearing clothing that isn’t too tight or made of potential irritants (like wool). If sweat is a trigger for your condition, reduce the amount of time that sweat remains on your skin, such as by taking a shower or wiping it off.

To prevent skin dryness, protect your skin barrier with the regular use of moisturizers. A humidifier might help ease the discomfort that can occur in dry indoor rooms. Avoid taking long hot showers and instead, opt for shorter ones with lukewarm water.

Also, use soaps and shampoos with ingredients that are suitable for eczema-prone skin, and make sure to wash any cleansers off completely. You can look for personal care products with the National Eczema Association Seal of Acceptance™, meaning the NEA has determined they are “suitable for the care of eczema or sensitive skin” and don’t contain common irritants of eczema. However, you should still be careful of how your skin reacts to any product. It’s best to stop using a product if it makes your eczema worse. Talk to your healthcare provider about recommended products for eczema.

Living With Eczema

Having eczema can affect your daily life. Physically, there’s the chronic itch and other symptoms, which can disrupt your day as well as your ability to get a good night’s sleep. What’s more, eczema might also affect your social interactions and your emotional and mental health, especially if your symptoms affect your appearance.

Studies have found that atopic eczema can increase your risk for anxiety and depression. One 2021 review study also found that some people with atopic or contact dermatitis believe that their condition negatively affects their emotional well-being, from feeling agitated to being socially stigmatized.

If you have eczema, it’s important to take care of your mental health as stress can trigger eczema and worsen existing itchiness and skin inflammation. There are steps you can take to reduce your daily stress such as setting aside time to relax or through stretching, breathing exercises, or meditating. Caring for your overall health can also help reduce stress—this includes staying connected with loved ones, exercising regularly, and eating a nutritious diet.