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Eczema Overview

Eczema is a condition in which patches of skin become inflamed, itchy, cracked, and rough. Some types of eczema can also cause blisters.

Different types and stages of eczema affect 31.6 million people in the United States, which equals more than 10% of the population.

Many people use the word eczema when referring to atopic dermatitis, which is the most common type. The term atopic refers to a collection of conditions that involve the immune system, including atopic dermatitis, asthma, and hay fever. The word dermatitis refers to inflammation of the skin.

Certain foods, such as nuts and dairy, can trigger symptoms of eczema. Environmental triggers can include smoke, pollen, soaps, and fragrances. Eczema is not contagious.

About a quarter of children in the U.S. have eczema, as well as 10% of African Americans, 13% of Asian Americans and Pacific Islanders, 13% of Native Americans, and 11% of people who are white.

Some people outgrow the condition, while others will continue to have it throughout adulthood.


Types of Eczema

Following are different types of eczema:

Atopic Dermatitis

Atopic dermatitis, or atopic eczema, is the most common type of eczema. Symptoms often present in childhood and can range from mild to severe. A child is more likely to develop atopic dermatitis if one of their parents has had it.

Children with atopic dermatitis have a higher risk of food sensitivity. They are also more likely to develop asthma and hay fever. Some children may grow out of atopic dermatitis.

Atopic dermatitis tends to cause patches of dry skin that can become itchy, red, and inflamed. These patches often appear in the creases of the elbows and knees and on the face, neck, and wrists.

Scratching the patches can worsen the itching and make the skin ooze clear fluid. Over time, repeated scratching or rubbing can cause the patch of skin to thicken. This is known as lichen simplex chronicus (LSC).

Patients with atopic dermatitis usually experience flare-ups, where the eczema gets worse for a time.

Triggers of flare-ups include the following:

  • Animal hair and saliva
  • Certain fabrics, such as wool and synthetics
  • Dust mites
  • Food allergies
  • Hormonal changes, often before periods or during pregnancy
  • Irritants, such as detergents, soaps, perfumes, and fragrances
  • Low humidity, cold weather, and extreme changes in temperature
  • Skin infections, including scabies


Contact Dermatitis

Some people experience a skin reaction when they come into contact with certain substances. This is known as contact dermatitis.

Symptoms of contact dermatitis can include the following:

  • Blistering
  • Dry, red, and itchy skin that may feel as though it is burning
  • Hives, a type of rash that consists of small, red bumps

A person with atopic dermatitis has an increased risk of contact dermatitis.

Following are two types of contact dermatitis:

Irritant Contact Dermatitis

Irritant contact dermatitis can result from repeated exposure to a substance that irritates the skin, such as:

  • Acids and alkalis
  • Cement
  • Certain type of shampoos
  • Fabric softeners
  • Harsh detergents
  • Hair dyes
  • Solvents
  • Weed killers

People who regularly use or work with these substances have a higher risk of developing contact dermatitis.

Allergic Contact Dermatitis

Allergic contact dermatitis occurs when a person’s immune system reacts to a particular substance, known as an allergen.

A person might not react to an allergen the first time they come into contact with it. However, once they develop an allergy, they will usually have it for life.

Possible allergens include:

  • Certain medications, such as topical and oral antibiotics
  • Fabrics and clothing dyes
  • Glues and adhesives
  • Ingredients in some makeup, nail polishes, creams, hair dyes, and other cosmetics
  • Latex and rubber
  • Metals, such as nickel and cobalt
  • Some plants, including poison ivy, poison oak, and sumac 


Dyshidrotic Eczema

Dyshidrotic eczema, or pompholyx eczema, typically appears in adults under the age of 40 years. It usually occurs on the hands and feet and has characteristic symptoms, including intense itching and the appearance of small blisters.

In some cases, the blisters can become large and watery. The blisters may become infected too, which can lead to pain and swelling. They may also ooze pus. Blisters typically clear up within a few weeks. Following this, the skin often becomes dry and cracked, which may lead to painful skin fissures.

It is unclear what causes dyshidrotic eczema. However, it is more common in people who have:

  • Atopic dermatitis or a family history of atopic dermatitis
  • Fungal skin infections
  • Hay fever

People who work with certain chemicals or have their hands immersed in water throughout the day are also at greater risk of developing dyshidrotic eczema. Other triggers include emotional stress and changes in the weather.

Dyshidrotic eczema may be a form of contact dermatitis. People with dyshidrotic eczema also tend to experience flare-ups from time to time.

Discoid Eczema

Discoid eczema, or nummular eczema, is recognizable due to the disc-shaped patches of itchy, red, cracked, and swollen skin that it causes.

The discs typically appear on the lower legs, torso, and forearms. Sometimes, the center of the disc clears up, leaving a ring of red skin. Discoid eczema can occur in patients of any age, including children.

As with other types of eczema, the causes of discoid eczema are not fully understood. However, known triggers and risk factors include the following:

  • Atopic dermatitis
  • Bacterial skin infections
  • Cold climate
  • Certain medications
  • Dry skin
  • Insect bites
  • Poor blood flow
  • Skin injuries, such as friction or burns
  • Sensitivity to metals and formaldehyde


Varicose Eczema

Varicose eczema is also known as venous, gravitational, or stasis eczema. It is common in older adults with varicose veins.

Getting older and being less active can weaken the veins in a person’s legs. This can lead to both varicose veins and varicose eczema.

Varicose eczema typically affects the lower legs and symptoms can include:

  • Cracked skin
  • Dry, scaly skin
  • Hot, itchy spots or blisters
  • Weepy, crusty patches

The skin on the lower leg may become fragile, so it is important to avoid scratching and picking at the spots and blisters.

Asteatotic Eczema

Asteatotic eczema, also called xerotic eczema and eczema craquelé, generally only affects patients over 60 years of age. This may be due to the skin becoming drier as a person ages.

Asteatotic eczema typically occurs on the lower legs, but it can also appear on other parts of the body. Symptoms include:

  • Cracked, dry skin with a characteristic appearance that people describe as crazy paving
  • Itching and soreness
  • Pink or red cracks or grooves
  • Scaling

As with other types of eczema, the causes of asteatotic eczema are unknown, but triggers can include:

  • Dry, cold weather
  • Excessive cleaning or scrubbing of the skin
  • Hot baths
  • Rough towel drying 
  • Soaps and other detergents


Signs and Symptoms of Eczema

The symptoms of atopic dermatitis can vary depending on the patients age and the condition’s severity and can vary by each individual.

Patients with the condition will often experience periods of time when their symptoms worsen, followed by periods of time when their symptoms will improve or clear up.

General Eczema Symptoms

In most cases eczema symptoms are mild. The most common symptoms of atopic dermatitis include:

  • Dry, scaly skin
  • Itching
  • Open, crusted, or weeping sores
  • Skin flushing

Patients with severe eczema may need more intensive treatment to relieve their symptoms. Continuous rubbing and scratching can also lead to skin infections.

Eczema symptoms in People of Color

In People of Color, an eczema rash may appear gray or brown. This can make outbreaks harder to see.

However, People of Color who get eczema may also get dark or light skin patches even after eczema symptoms go away. These can last a long time. Doctors call these patches hyperpigmentation and depigmentation or hypopigmentation.

A dermatologist can evaluate these patches, which may respond to treatments like steroid creams.

Infant Eczema Symptoms

The following atopic dermatitis symptoms are common in babies under the age of 2:

  • Rashes on the scalp and cheeks
  • Bubble like rashes with leaking fluid
  • Rashes that can cause extreme itchiness, which may interfere with sleeping


Childhood Eczema Symptoms

The following atopic dermatitis symptoms are common in children aged 2 and above:

  • Bumpy rashes
  • Rashes that appear behind the creases of elbows or knees
  • skin thickening, also known as lichenification, which can then develop into a permanent itch
  • rashes that appear on the neck, wrists, ankles, and the crease between the buttocks and legs
  • Lighter or darker colored rashes

Most patients with the condition develop it before the age of 5 years. An estimated 60% of children will no longer show symptoms by adolescence.

African American and Hispanic children may have more severe eczema than children who are white.


Symptoms in Adults

The following atopic dermatitis symptoms are common in adults:

  • Rashes that are scalier than those occurring in children 
  • Very dry skin on the affected areas
  • Rashes that commonly appear in the creases of the elbows or knees or the nape of the neck
  • Permanently itchy rashes
  • Rashes that cover much of the body
  • Skin infections

Adults who developed atopic dermatitis as children but no longer experience the condition may still have dry or easily irritated skin, hand eczema, and eczema on the eyelids.

The appearance of skin affected by atopic dermatitis will depend on how much a person scratches and whether the skin is infected. Scratching and rubbing can further irritate the skin, increase inflammation, and make the itching worse.


Causes of Eczema

Researchers do not know the definitive cause of eczema, but many health professionals believe that it develops from a combination of genetic and environmental factors.

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

Some environmental factors may also bring out the symptoms of eczema.

These include the following:

  • Irritants: These include soaps, detergents, shampoos, disinfectants, 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.


Treatment of Eczema

There is currently no cure for eczema. Treatment for the condition aims to heal the affected skin and prevent flares of symptoms.

Doctors will suggest a treatment plan based on an individual’s age, symptoms, and current state of health.

For some people, eczema goes away over time. For others, however, it is a lifelong condition.

Following some of the treatment options for eczema:

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