What to know about eczema

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Eczema, or atopic dermatitis (AD), is an inflammatory skin condition that may cause itchy, rough patches on a person’s skin.

AD is most common in childhood. Approximately 1 in 4 children develop AD, with symptoms appearing by the age of 5 years. By adolescence, approximately 60% of people with AD will no longer show symptoms.

That said, around 2–3% of adults have AD.

Types

AD is commonly used to describe eczema because it is the most common type.

That said, there are other forms of the skin condition, including:

• Allergic contact dermatitis: This is a skin reaction that occurs following contact with a substance or allergen that the immune system recognizes as foreign.
• Dyshidrotic eczema: This refers to irritation of the skin on the palms of the hands and soles of the feet. It is characterized by small blisters.
• Neurodermatitis: This leads to scaly patches of skin on the head, forearms, wrists, and lower legs. It occurs due to a localized itch, such as from an insect bite.
• Discoid eczema: Also known as nummular eczema, this type presents itself as circular patches of irritated skin that can be crusted, scaly, and itchy.
• Stasis dermatitis: This refers to skin irritation of the lower leg. It is usually related to circulatory problems.

Symptoms of AD vary by individual and may depend on a few factors, such as a person’s age, skin tone, and the condition’s severity.

In most cases, AD symptoms are mild. However, symptoms may come and go and vary in severity.

Flare-ups refer to periods when symptoms worsen, while remissions are when symptoms improve or clear up.

The most common symptoms of AD include:

• dry, scaly patches of skin
• thickened, discolored skin
• open, crusted, or weeping sores
• skin flushing
• itching

The appearance of skin affected by AD will also depend on how much a person scratches their rashes.

For example, people with severe eczema may experience severe itching that could lead to continuous rubbing and scratching. This may cause skin infections like infected eczema.

The location, type, and severity of rashes may also vary depending on a person’s age.

Infants

Babies under the age of 2 may experience:

• rashes on the scalp and cheeks
• rashes that bubble up before leaking fluid
• rashes that cause extreme itchiness, which may interfere with sleeping

Childhood

Children from the ages of 2 to puberty may experience rashes that appear:

• behind the creases of elbows or knees
• on the neck, wrists, and ankles
• in the crease between the buttocks and legs

They may also experience:

• bumpy rashes
• rashes that can become lighter or darker
• skin thickening, also known as lichenification, which can then develop into a permanent itch

African American and Hispanic children may also have more severe eczema.

Adults

Adults may experience eczema rashes that could:

• be more scaly than those occurring in children
• appear in the creases of the elbows, knees, or nape of the neck
• cover much of the body
• be permanently itchy

People over 18 years old may also experience skin infections or very dry skin on the affected area.

Adults who developed AD as children but no longer experience the condition may still have:

• dry or easily irritated skin
• hand eczema
• eczema on the eyelids

Skin tones

An eczema rash may appear gray or brown in people with dark skin tones, which could make AD harder to see.

That said, people with darker skin tones may also get dark or light skin patches even after eczema symptoms go away. These patches are known as hyperpigmentation, depigmentation, or hypopigmentation. They may last a long time.

A dermatologist can look at these patches and develop a treatment plan, which may include steroid creams.

Learn more about eczema in People of Color.

There is no known cause of eczema. However, health professionals believe that it may develop from a combination of genetic and environmental factors.

Children are more likely to develop eczema if a parent has it or another atopic condition, such as asthma and hay fever. If both parents have an atopic condition, the risk is even higher.

Some environmental factors may also bring out the symptoms of eczema, such as:

• Irritants: These include soaps, detergents, shampoos, disinfectants, and juices from fresh fruits, meats, and vegetables.
• Allergens: Dust mites, pets, pollens, and mold can all lead to eczema. This is known as allergic eczema.
• Microbes: These include bacteria such as Staphylococcus aureus, viruses, and certain fungi.
• Hot and cold temperatures: Very hot and very cold weather, high and low humidity, and perspiration from exercise can bring out eczema.
• Foods: Dairy products, eggs, nuts and seeds, soy products, and wheat can cause eczema flares.
• Stress: This is not a direct cause of eczema, but it can make the symptoms worse.
• Hormones: Females may experience increased eczema symptoms when their hormone levels are changing, such as during pregnancy and at certain points in the menstrual cycle.

There is currently no cure for AD. However, treatments aim to heal the affected skin and prevent symptom flare-ups.

A doctor will develop a treatment plan based on a person’s:

• age
• symptoms
• current health condition

For some people, eczema may go away over time. For others, it is a lifelong condition.

Medications

Several types of medications may help treat eczema symptoms.

• Topical corticosteroid creams and ointments: These anti-inflammatory medications are applied directly to the skin to help relieve the main symptoms of eczema, such as inflammation and itchiness. They are available as over-the-counter (OTC) or prescription medications, depending on the strength needed.
• Oral medications: A doctor may prescribe systemic corticosteroids or immunosuppressants, which are available as injections or oral tablets. People should only use them for short periods of time. Also, it is important to note that the symptoms may worsen upon stopping these drugs if the person is not already taking another medication for the condition.
• Antibiotics: Doctors prescribe antibiotics if eczema occurs alongside a bacterial skin infection.
• Antihistamines: These can reduce the risk of nighttime scratching, as they tend to cause drowsiness.
• Topical calcineurin inhibitors: These medications suppress the immune system, which helps decrease inflammation and prevent flares.
• Barrier repair moisturizers: These reduce water loss and work to repair the skin.
• Phototherapy: This involves exposure to ultraviolet (UV) waves and may help treat moderate AD.

To treat moderate to severe eczema, a doctor may prescribe a combination of topical and systemic treatments, such as biologics.

Biologics block specific proteins in the immune system that trigger inflammation, which can help reduce eczema symptoms.

The Food and Drug Administration (FDA) has approved two biologics to treat eczema: dupilumab (Dupixent) and tralokinumab-ldrm (Adbry). However, they may cause side effects, which are usually mild and manageable.

Topical JAK inhibitors and topical PDE4 inhibitors have also both been approved by the FDA to help treat AD.

Even after an area of skin has healed, it is important to keep looking after it, as it may easily become irritated again.

Home care

Some home remedies may help people with eczema support their skin health and alleviate symptoms, including:

• taking lukewarm baths
• applying moisturizer within 3 minutes of bathing to “lock in” moisture
• moisturizing every day
• wearing cotton and soft fabrics
• avoiding rough, scratchy fibers and tight-fitting clothing
• using a humidifier in dry or cold weather
• using a mild soap or a nonsoap cleanser when washing
• taking extra precautions to prevent eczema flares in winter
• air drying or gently patting the skin dry with a towel, rather than rubbing the skin after bathing or taking a shower
• avoiding rapid changes in temperature and activities that cause sweating
• learning and avoiding individual eczema triggers
• keeping fingernails short to prevent scratching from breaking the skin

People can also try various natural remedies for eczema, including aloe vera, coconut oil, and apple cider vinegar.

What causes eczema to start?

The cause of eczema is unknown. However, certain triggers may cause AD symptoms to flare up.

These may include:

• certain irritants, like soaps, detergents, and shampoos
• allergens, like dust mites and mold
• very hot or very cold temperatures
• some foods
• stress

How can eczema be cured?

There is currently no cure for eczema. But, some different treatment options may help people manage their symptoms and reduce the risk of flare-ups.

These may include:

• systemic therapies
• phototherapy
• oral medications
• topical ointments
• home remedies

A person should speak with a doctor to develop the best treatment plan for them.

Eczema is an inflammatory skin condition that is more cost common in children, although adults may still develop it.

The most common type is called atopic dermatitis (AD), which may cause discomfort and vary in severity. It can present differently depending on a person’s age. In people with darker skin tones, the symptoms may be harder to see.

Although there is currently no cure, people can treat and prevent eczema flares using home remedies, moisturizers, medications, and lifestyle changes.