Eczema

About

Eczema

Eczema (eg-zuh-MUH) is a group of very common skin problems that cause itching, inflammation, pain and redness. Also known as atopic dermatitis, symptoms range from mild to severe. The cause is unknown, and it cannot be cured. It can be treated successfully by avoiding the irritant that causes it. Eczema can be triggered by chemicals or substances in your environment, or by stress. Family history of the disease is also a cause. Skin inflammation from an over-reactive immune system causes eczema’s worst symptoms. 

What is eczema?

Eczema is a skin problem that causes itching, pain, burning, tenderness, skin rash and eruptions that are prone to infection. The itching and rash can develop anywhere on the body.

Eczema can happen to anyone or any age, but usually begins in infancy or childhood. Most childhood eczema goes away as the child grows up, but can continue into adulthood. Adults can develop it without having it as a child. Eczema is more common in people who have a family history of the disease, and have allergies and/or asthma.

Causes

What causes eczema?

Most eczema patients have an over-reactive immune system. When your immune system is triggered by something irritating -- from inside or outside your body -- it produces swelling, redness, pain and burning (inflammation). The inflammation causes relentless itching, and can weaken the outer layer of skin. Skin becomes less effective at protecting you from irritants and things you’re allergic to (allergens). Most eczema is caused by dry skin, an over-reactive immune system, or contact with a trigger (allergen) in your surroundings. 

It can also be caused by a gene mutation (change) that’s responsible for creating a protein (filaggrin) that helps maintain a protective top layer of skin. Without the filaggrin layer, skin can become very dry, allowing germs to enter the skin, and infections to develop.

What can trigger eczema?

There’s no one eczema trigger for everyone, because it affects people differently. Some of the most common triggers for eczema include:

  • Skin that’s so dry that it becomes scaly, rough or tight
  • Irritating substances including soaps and detergents, shampoo or body wash, make-up, fragrances, disinfectants and household cleansers, juice from foods, metals, tobacco smoke, latex, paint, certain fabrics, antibacterials, and poison ivy, oak or sumac 
  • Stress
  • Raising your body temperature or sweating
  • Temperature changes or a sudden drop in humidity
  • Synthetic fabrics or wool
  • Food allergies
  • Animal dander
  • Upper respiratory infections

Are there different types of eczema?

There are many types and each type has its own symptoms and triggers. 

  • Atopic dermatitis is a chronic condition requiring symptom management. This is the most common type, and many people also have asthma and hay fever. An itchy rash often develops in elbow and knee creases, and skin can change color or get thicker. Bumps may appear that leak clear fluid if scratched. In babies, the rash often develops on their scalp and cheeks.
  • Contact dermatitis is caused by a reaction to something you’ve touched. If it’s caused by an allergic reaction your immune system causes the symptoms: itchy, red bumps that burn or sting (hives); fluid-filled blisters that ooze and crust over; and thickening, scaly skin over time. 
  • Dyshidrotic eczema causes small, fluid-filled blisters on fingers, hands, toes and feet that can itch or hurt. Your skin may crack or flake. This type of eczema can be caused by frequently having hands and feet in water or long-term dampness. Allergies to nickel, cobalt and chromium salt as well as stress are also causes. 
  • Hand eczema is usually caused by working with chemicals that irritate hands, such as hair stylists, cleaners or healthcare workers. Hands become dry, itchy and red, often forming cracks or blisters.
  • Neurodermatitis causes thick, scaly and itchy patches on arms, legs, neck, scalp, hands, feet or genitals. Stress is thought to be a trigger. It often develops in people who also have psoriasis or another type of eczema.
  • Nummular eczema causes round, very itchy spots that can be triggered by insect bites, allergic reaction to chemicals or metals, or by very dry skin. It’s more common in people who also have another type of eczema. 
  • Seborrheic dermatitis occurs in areas where hair grows. Skin produces oil, and sebum is secreted. Skin becomes scaly, dry, red, with a rash and dandruff. It can be caused by a reaction to yeast in your skin. It’s also called seborrhea, cradle cap or sebopsoriasis. 
  • Stasis dermatitis occurs when fluid leaks out of weakened veins, causing itchy, red and painful skin. It can happen in people with blood circulation problems in their lower legs. Valves in your leg veins can malfunction, allowing blood to pool in lower legs, swelling and open sores. Varicose veins can develop, causing very dry, itchy skin over the affected veins. 
  • Eczema herpeticum is a serious infection caused by the herpes simplex 1 virus (oral herpes) that causes cold sores on the mouth. Sores can develop on other body parts, and cover large areas of skin, especially the face and neck. Skin develops clusters of small, itchy, painful blisters that are black, red or purple, oozing pus if cracked open. Patients may be sick with high fever, chills and swollen lymph nodes. It is very contagious, spreading by skin-to-skin contact. It’s more common in people with atopic dermatitis or other inflammatory skin diseases. It can take two weeks after contact with herpes simplex 1 virus for symptoms to develop. 

Who’s at risk for eczema?

You may be more likely to develop eczema if you have asthma and hay fever. Or, if you have eczema, you’re more likely to develop asthma and hay fever. Most cases develop in infancy or childhood, and go away with age.

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up

Symptoms

What are eczema’s symptoms?

Everyone has different reactions or symptoms to eczema. The different types of eczema cause different symptoms. You can have more than one type of eczema at the same time, and it can develop in different places on your body. However, everyone has itchy skin that can range from mild to so severe that itching causes skin to bleed.

Symptoms can come all at once, or you may just have a few symptoms. When symptoms return it is called a flare. Other symptoms include:

  • Dry and sensitive skin
  • Inflamed skin that can be red or warm to the touch
  • Red, itchy rash, commonly on arms and behind the knees, that can ooze and crust over 
  • Discolored skin
  • Rough, scaly patches of skin
  • Swelling 
  • Skin infections can cause redness, warm to the touch, pus-filled bumps, cold sores or fever blisters

Diagnosis

How is eczema diagnosed?

Your doctor or dermatologist can diagnose eczema by looking at it. You may have a patch test to see what substances cause a skin reaction. A culture may be taken from infected areas. To help you and your dermatologist identify your triggers, it’s very helpful to make a list of what you eat and drink, skin and household cleaning products you use, your activities, what causes you stress, and if you have family members with eczema. You should begin to see connections between substances and eczema flares. Be sure to share this journal with your doctor.

Is eczema related to other skin problems?

Yes, people who have eczema have a greater chance of having one or more related health conditions including:

  • Asthma
  • Hay fever
  • Food allergies
  • Skin infections from bacteria or viruses, especially staph, herpes, boils, impetigo, cellulitis
  • Mental health issues including depression, anxiety, fatigue, difficulty concentrating, sleeping problems, weight changes, and suicidal thoughts
  • Heart disease and high blood pressure
  • Stroke

Treatment

What are treatment options for eczema?

The most important thing you can do is learn what your triggers are and strictly avoid them. 

Your doctor can help you find a combination of lifestyle changes, medications and therapies that can help you manage and reduce your symptoms.

  • Medications may include antihistamines and steroid creams/ointments to relieve itching and scaling, oral corticosteroids for severe cases, or antibiotics for infection. Immunosuppressants may be prescribed to calm your immune system and prevent flares. 
  • Phototherapy uses ultraviolet light to help prevent immune system responses, and prevent skin infections. Most people need a series of phototherapy treatments.
  • Lifestyle adjustments can include finding regular ways to reduce stress; taking shorter showers with cooler water; using moisturizing lotion daily; cold compresses to relieve itching; soaking in a lukewarm, baking soda bath. Never scrub your skin, and dry it by patting gently. 
  • Protect skin by wearing gloves when handling chemicals. Wear loose-fitting clothing made with natural fibers like cotton.
  • Other methods that some patients find helpful are acupuncture, or using plant oils like primrose, coconut, sunflower or borage. Always check with your doctor before using any alternative treatment.

References

National Eczema Association. (N.d.) What is Eczema? Retrieved 9-7-21, {https://nationaleczema.org/eczema/}
Healthline. (Aug. 2020). What Are the 7 Different Types of Eczema? Retrieved 9-8-21, {https://www.healthline.com/health/types-of-eczema#treatment}
Mayo Clinic. (June 2020). Atopic Dermatitis (Eczema). Retrieved 9-8-21, {https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

Meet our doctors

TM2U Curve inverted

Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up