What is Eczema?
Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It’s common in children but can occur at any age. Atopic dermatitis is long-lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever.
Chances are, you’re here to look for answers about eczema (eg-zuh-MUH) and find support.
You might have first noticed an itchy, red patch on your baby’s cheeks, chin, or chest that she or he scratched until it became even more irritated. Sound familiar? Or maybe you experienced something similar on your own neck, inner elbows, or behind your knees.
That’s probably when you made an appointment with your doctor, who looked at it, talked to you about your symptoms, asked you questions about your family history and the types of products you use on your skin and in your home. Then your doctor told you it was eczema.
Rather than a specific health condition, eczema is a reaction pattern that the skin produces in a number of diseases. It begins as red, raised tiny blisters containing a clear fluid atop red, elevated plaques. When the blisters break, the affected skin will weep and ooze. In older eczema, chronic eczema, the blisters are less prominent and the skin is thickened, elevated, and scaling. Eczema almost always is very itchy.
So what exactly is eczema? Who can get it and why? And what should you do, now that you or your child has been diagnosed?
Learning more about what kind of eczema you have and what may have triggered it, is the best starting point to treating and managing it so that your eczema doesn’t get in the way of your everyday life.
The good news is you’ve come to the right place. We’re here to help guide you — with all of the tools and support you’ll need — every step of the way.
No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps, moisturize your skin regularly, and apply medicated creams or ointments.
Signs and Symptoms
Signs and symptoms of eczema can vary widely during the early phases. Between 2 and 6 months of age (and almost always before they’re 5 years old), kids with eczema usually develop itchy, dry, red skin and small bumps on their cheeks, forehead, or scalp. The rash may spread to the arms and legs and the trunk, and red, crusted, or open lesions may appear on any area affected.
They also may have circular, slightly raised, itchy, and scaly rashes in the bends of the elbows, behind the knees, or on the backs of the wrists and ankles.
As kids get older, the rash is usually scalier than it was when the eczema first began, and the skin is extremely itchy and dry. These symptoms also tend to worsen and improve over time, with flare-ups occurring periodically.
Children often try to relieve the itching by rubbing the affected areas with a hand or anything within reach. But scratching can make the rash worse and eventually lead to thickened, brownish areas on the skin. This is why eczema is often called the “itch that rashes” rather than the “rash that itches.”
Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:
- Dry skin
- Itching, which may be severe, especially at night
- Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp
- Small, raised bumps, which may leak fluid and crust over when scratched
- Thickened, cracked, scaly skin
- Raw, sensitive, swollen skin from scratching
Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.
Types of eczema
Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. There are several types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis.
Eczema is very common. And in many cases, it’s also manageable. In fact, over 30 million Americans have some form of eczema.
Living with eczema can be an ongoing challenge. The word “eczema” is derived from a Greek word meaning “to boil over,” which is a good description for the red, inflamed, itchy patches that occur during flare-ups. Eczema can range from mild, moderate, to severe.
It’s most common for babies and children to develop eczema on their face (especially the cheeks and chin), but it can appear anywhere on the body and symptoms may be different from one child to the next. More often than not, eczema goes away as a child grows older, though some children will continue to experience eczema into adulthood.
Adults can develop eczema, too, even if they never had it as a child.
There are at least 13 distinct types of skin conditions that produce eczema. In order to develop a rational treatment plan, it is important to distinguish them. This is often not easy.
1] Atopic dermatitis
This health condition has a genetic basis and produces a common type of eczema. Atopic dermatitis tends to begin early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles.
Atopic dermatitis is the most common form of eczema. It usually starts in childhood, and often gets milder or goes away by adulthood. Atopic dermatitis is part of what doctors call the atopic triad. “Triad” means three. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions.
In atopic dermatitis:
- the rash often forms in the creases of your elbows or knees
- skin in areas where the rash appears may turn lighter or darker, or get thicker
- small bumps may appear and leak fluid if you scratch them
- babies often get the rash on their scalp and cheeks
- your skin can get infected if you scratch it
Atopic dermatitis happens when your skin’s natural barrier against the elements is weakened. This means your skin is less able to protect you against irritants and allergens. Atopic dermatitis is likely caused by a combination of factors such as:
- dry skin
- an immune system problem
- triggers in the environment
Neurodermatitis is similar to atopic dermatitis. It causes thick, scaly patches to pop up on your skin.
- thick, scaly patches form on your arms, legs, back of your neck, scalp, bottoms of your feet, backs of your hands, or genitals
- these patches can be very itchy, especially when you’re relaxed or asleep
- if you scratch the patches, they can bleed and get infected
Neurodermatitis usually starts in people who have other types of eczema or psoriasis. Doctors don’t know exactly what causes it, although stress can be a trigger.
3] Irritant dermatitis
This occurs when the skin is repeatedly exposed to excessive washing or toxic substances.
4] Allergic contact dermatitis
After repeated exposures to the same substance, an allergen, the body’s immune recognition system becomes activated at the site of the next exposure and produces a dermatitis. An example of this would be poison ivy allergy.
If you have red, irritated skin that’s caused by a reaction to substances you touch, you may have contact dermatitis. It comes in two types: Allergic contact dermatitis is an immune system reaction to an irritant like latex or metal. Irritant contact dermatitis starts when a chemical or other substance irritates your skin.
In contact dermatitis:
- your skin itches, turns red, burns, and stings
- itchy bumps called hives may pop up on your skin
- fluid-filled blisters can form that may ooze and crust over
- overtime, the skin may thicken and feel scaly or leathery
Contact dermatitis happens when you touch a substance that irritates your skin or causes an allergic reaction. The most common causes are:
- poison ivy and other poisonous plants
- skincare products, including makeup
- soaps and perfumes
- tobacco smoke
5] Stasis dermatitis
It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs.
Stasis dermatitis happens when fluid leaks out of weakened veins into your skin. This fluid causes swelling, redness, itching, and pain.
In stasis dermatitis:
- the lower part of your legs may swell up, especially during the day when you’ve been walking
- your legs may ache or feel heavy
- you’ll likely also have varicose veins, which are thick, ropey damaged veins in your legs
- the skin over those varicose veins will be dry and itchy
- you may develop open sores on your lower legs and on the tops of your feet
Stasis dermatitis happens in people who have blood flow problems in their lower legs. If the valves that normally push blood up through your legs toward your heart malfunction, blood can pool in your legs. Your legs can swell up and varicose veins can form.
6] Fungal infections
This can produce a pattern identical to many other types of eczema, but the fungus can be visualized with a scraping under the microscope or grown in culture.
It’s caused by an infestation by the human itch mite and may produce a rash very similar to other forms of eczema.
8] Dyshidrotic Eczema (Pompholyx)
This is a common but poorly understood health condition which classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles.
Dyshidrotic eczema causes small blisters to form on your hands and feet. It’s more common in women than men.
In dyshidrotic eczema:
- fluid-filled blisters form on your fingers, toes, palms, and soles of your feet
- these blisters may itch or hurt
- the skin can scale, crack, and flake
Dyshidrotic eczema can be caused by:
- damp hands and feet
- exposure to substances such as nickel, cobalt, or chromium salt
9] Lichen simplex chronicus
It produces thickened plaques of skin commonly found on the shins and neck.
10] Nummular Eczema
This is a nonspecific term for coin-shaped plaques of scaling skin most often on the lower legs of older individuals.
This type of eczema causes round, coin-shaped spots to form on your skin. The word “nummular” means coin in Latin. Nummular eczema looks very different from other types of eczema, and it can itch a lot.
In nummular eczema:
- round, coin-shaped spots form on your skin
- the spots may itch or become scaly
Nummular eczema can be triggered by a reaction to an insect bite, or by an allergic reaction to metals or chemicals. Dry skin can also cause it. You’re more likely to get this form if you have another type of eczema, such as atopic dermatitis.
11] Xerotic (dry skin) Eczema
The skin will crack and ooze if dryness becomes excessive.
12] Seborrheic dermatitis
It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, it can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.
13] Hand eczema
Eczema that only affects your hands is called hand eczema. You may get this type if you work in a job like hairdressing or cleaning, where you regularly use chemicals that irritate the skin.
In hand eczema:
- your hands get red, itchy, and dry
- they may form cracks or blisters
Hand eczema is triggered by exposure to chemicals. People who work in jobs that expose them to irritants are more likely to get this form, such as:
- laundry or dry cleaning
Diagnosing eczema can be challenging because:
- Each child has a unique combination of symptoms, which can vary in severity.
- It’s sometimes confused with other skin conditions, such as seborrheic dermatitis (better known as “cradle cap”), psoriasis (a genetic disease that causes the skin to become scaly and inflamed), and contact dermatitis (caused by direct skin contact with an irritating substance, such as a metal, medicine, or soap).
- No test is available to diagnose it definitively.
If your doctor suspects eczema, a thorough medical history is likely to be the best diagnostic tool. A personal or family history of hay fever, other allergies, or asthma is often an important clue.
Besides doing a physical examination, the doctor will likely ask about your child’s symptoms and past health, your family’s health, any medicines your child is taking, any allergies your child may have, and other issues.
The doctor will also help you identify things in your child’s environment that might be adding to the skin irritation. For example, if your child began using a new soap or lotion before the symptoms started, mention this to the doctor because something in the soap might be irritating the skin.
The doctor also might ask about any stress your child is feeling at home, school, or elsewhere because stress can lead to eczema flare-ups.
Your doctor will also probably:
- Examine the distribution and appearance of the rash.
- Ask about how long the rash has been there.
- Look for evidence of thickening of the skin from itching or rubbing (called lichenification).
The doctor will want to rule out other diseases and conditions that can cause skin inflammation. So your child might need to be seen more than once before a diagnosis is made. The doctor might recommend sending your child to a dermatologist or an allergist.
An allergist can test to see if the rash is an allergic reaction to a substance. This might involve one or more of the following:
- a blood test
- a patch test (placing a patch of suspected allergen, such as dyes or fragrances, on the skin)
- scratch/prick tests (placing suspected allergens on the skin or injecting them into the skin)
Your doctor also may ask you to eliminate certain foods (such as eggs, milk, soy, or nuts) from your child’s diet, switch detergents or soaps, or make other changes for a time to find out whether your child has a reaction to something.
Scientists believe that eczema is inherited, so there’s no way to prevent it. But because specific triggers can make it worse, flare-ups can be prevented or improved by avoiding possible triggers. These include:
- animal dander
- dry winter air with little moisture
- skin that gets too dry
- certain harsh soaps and detergents
- certain fabrics (such as wool or coarsely woven materials)
- certain skincare products, perfumes, and colognes (particularly those that contain alcohol)
- tobacco smoke
- some foods (this depends on the person, but dairy products and eggs, wheat, soy, and nuts can be common culprits)
- emotional stress
- excessive heat
Also, curbing the tendency to scratch the rash can prevent the condition from worsening and progressing to cause more severe skin damage or a secondary infection.
Helping Your Child
You can help prevent or treat eczema by keeping your child’s skin from becoming dry or itchy and avoiding known triggers that cause flare-ups. Try to follow these suggestions:
- Avoid giving your child frequent hot baths, which tend to dry the skin.
- Use warm water with mild soaps or non-soap cleansers when bathing your child.
- Avoid using scented soaps.
- Ask your doctor if it’s OK to use oatmeal soaking products in the bath to help control the itching.
- Avoid excessive scrubbing and toweling after bathing your child. Instead, gently pat your child’s skin dry.
- Avoid dressing your child in harsh or irritating clothing, such as wool or coarsely woven materials. Dress your child in soft clothes that “breathe,” such as those made from cotton.
- Apply moisturizing ointments (such as petroleum jelly), lotions, or creams to your child’s skin regularly and always within a few minutes of bathing, after a very light towel dry. Even if your child is using a corticosteroid cream prescribed by the doctor, apply moisturizers or lotions frequently (ideally, two to three times a day). But avoid alcohol-containing lotions and moisturizers, which can make skin drier. Some baby products also can contribute to dry skin.
- Apply cool compresses (such as a wet, cool washcloth) on the irritated areas of skin to ease itching.
- Keep your child’s fingernails short to minimize any skin damage caused by scratching.
- Try having your child wear comfortable, light gloves to bed if scratching at night is a problem.
- Help your child avoid becoming overheated, which can lead to flare-ups.
- Eliminate any known allergens such as certain foods, dust, or pet dander from your household. (This has been shown to help some young kids.)
- Have your child drink plenty of water, which adds moisture to the skin.
Although eczema can be annoying and uncomfortable for kids, its emotional impact can become the most significant problem later especially during the preteen and teen years, when your child will need to take responsibility for following the prevention and treatment strategies.
You can help by teaching your preteen or teen to:
- Establish a skin-care routine. Brief, lukewarm showers or baths and moisturizing regularly will help to avoid or alleviate flare-ups.
- Use only “unscented” makeup and sunscreens and facial moisturizers labeled non-comedogenic and oil-free.
- Recognize stressful situations (such as taking tests at school or sports competitions) and how to manage them (like taking deep, calming breaths, focusing on an enjoyable activity, or taking a break).
- Be aware of scratching and minimize it as much as possible.
The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever or asthma.
- Eczema is not a single health condition but a recognizable reaction pattern seen in a number of skin diseases.
- Atopic dermatitis, a common cause of eczema, is more prevalent in those with asthma and hay fever.
- Eczema signs and symptoms include tiny blisters (vesicles) that can weep and ooze, eventually producing crusted, thickened plaques of skin. It is almost always quite itchy.
- It is important to distinguish the different causes of eczema because effective treatments often differ.
- If eczema is produced by skin exposure to a specific substance, it can be helpful to avoid it.
- Keeping the skin healthy and moisturized can prevent certain kinds of eczema.
Complications of atopic dermatitis (eczema) may include:
- Asthma and hay fever. Eczema sometimes precedes these conditions. More than half of young children with atopic dermatitis develop asthma and hay fever by age 13.
- Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
- Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase the risk of infection from bacteria and viruses, including the herpes simplex virus.
- Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants.
- Allergic contact dermatitis. This condition is common in people with atopic dermatitis.
- Sleep problems. The itch-scratch cycle can cause poor sleep quality.
Topical corticosteroids, also called cortisone or steroid creams or ointments, are commonly used to treat eczema and are not the same as the steroids used by some athletes. These medicines are usually applied directly to the affected areas twice a day.
Continue to apply the corticosteroids for as long as the doctor suggests. It’s also important not to use a topical steroid prescribed for someone else. These creams and ointments vary in strength, and using the wrong strength in sensitive areas can damage the skin, especially in infants.
Nonsteroid medications are also available now in creams or ointments that can be used instead of — or in conjunction with — topical steroids.
Other prescription treatments your doctor may recommend include:
- antihistamines (to help to control itching)
- oral or topical antibiotics (to prevent or treat secondary infections, which are common in kids with eczema)
Eczema often comes and goes. When it appears, you might need to try different medicines and other treatments to get rid of the rash.
- Antihistamines such as diphenhydramine (Benadryl) can control the itch.
- Corticosteroid cream or ointment can reduce the itch. For a more severe reaction, you can take steroids like prednisone (Rayos) by mouth to control swelling.
- Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) reduce the immune response that causes red, itchy skin.
- Antibiotics treat skin infections.
- Light therapy exposes your skin to ultraviolet light to heal your rash.
- Cool compresses applied before you rub on the corticosteroid cream can help the medicine get into your skin more easily.
If an allergic reaction results in a flare-up of your eczema, you’ll want to avoid the substance that triggers it.
Some older kids with severe eczema also may be treated with ultraviolet light under the supervision of a dermatologist to help clear it up and make them more comfortable. In some cases, newer medications that change the way the skin’s immune system reacts are also prescribed.
When to Call the Doctor
See your doctor if the itching and redness you’re experiencing doesn’t go away on its own, or if it interferes with your life. A skin doctor called a dermatologist can diagnose and treat eczema.
Children and teens with eczema are prone to skin infections, especially with staph bacteria and herpes virus.
To help your doctor understand your condition, it may be helpful to keep a diary to identify your eczema triggers. Write down:
- what you eat and drink
- what skin products, chemicals, soaps, makeup, and detergents you use
- what activities you do, such as taking a walk outside in the woods or swimming in a chlorinated pool
- how long you spend in the bath or shower, and the temperature of the water
- when you’re under stress
You should begin to notice connections between your activities and your eczema flare-ups. Bring this journal to your doctor to help them pinpoint your triggers.
An allergy specialist can also do a patch test. This test places small amounts of irritating substances on patches that are applied to your skin. The patches stay on your skin for 20 to 30 minutes to see if you have a reaction. This test can help your doctor tell which substances trigger your eczema, so you can avoid them.
Call your doctor immediately if you notice any of the early signs of skin infection, which may include:
- increased fever
- redness and warmth on or around affected areas
- pus-filled bumps on or around affected areas
- areas on the skin that look like cold sores or fever blisters
Also, call your doctor if you notice a sudden change or worsening of the eczema, or if it isn’t responding to the doctor’s recommendations.
Even though eczema can be bothersome for kids and parents alike, taking some precautions and following the doctor’s orders can help to keep it under control.