If you’ve ever had itchy, red skin (and especially if it comes back), you might actually have something called eczema. This term is used to describe a broad group of skin disorders that cause inflammation, accompanied by varying degrees of itching and redness.
Eczema is not contagious and tends to be a long-term condition that flares-up occasionally, often due to exposure to irritants, chemicals, and allergens. Its symptoms can range in severity and—depending on the type of eczema—can last for anywhere from a few hours or days to several years.
The outlook for people with eczema varies according to the particular type of eczema involved, but in general, it can be managed with appropriate treatment.
Sometimes, eczema and dermatitis are used interchangeably. Many people, in fact, use the term ‘eczema’ to refer to ‘atopic dermatitis,’ a common form of skin inflammation—that is, a common form of eczema. Here, however, ‘eczema’ refers to a general inflammatory skin disorder.
“Atopic dermatitis is very common among children, and many do outgrow the condition as they get older,” says Sara Perkins, MD, a Yale Medicine dermatologist. “Other variants, such as contact dermatitis and seborrheic dermatitis, can be seen in both adults and children. Your dermatologist can help discern which subtype you have, and how best to manage it.”
What is eczema?
Eczema is a general term used to refer a group of inflammatory skin disorders. Most forms of eczema produce an itchy, reddened rash, though people with the condition may have dry, cracked, scaly, or areas of thickened skin. Affected areas of skin may be painful.
Eczema is among the most common skin conditions. It can occur in people of any age, sex, or ethnicity. Up to 30% of dermatology visits are for eczema and related conditions, and an estimated 10% of Americans have some form of the skin disorder.
What are some types of eczema?
There are many kinds of eczema and each has its own particular set of causes, symptoms, and treatments. Some types of eczema include:
- Atopic dermatitis. A type of eczema characterized by dry, itchy, inflamed skin. It is the most common form of eczema and most frequently occurs in children, but can develop in adults. It is associated with certain allergies and asthma.
- Contact dermatitis. This develops due to skin exposure to allergens, chemicals, materials, or other irritants. Symptoms vary depending on the allergen or irritant involved, but can range from reddening to blistering to a burning sensation.
- Dyshidrotic eczema. Also known as pompholyx, this type of eczema is characterized by tiny itchy blisters that resemble tapioca pudding on the palms, fingers, and soles of the feet. It typically occurs in young adults.
- Nummular eczema. Also called discoid dermatitis, this produces itchy, circular patches of inflamed skin that measure 2 to 3 centimeters in diameter. It usually affects the arms and legs.
- Seborrheic dermatitis. A chronic form of eczema that causes inflamed, scaly skin in parts of the body with a high concentration of sebaceous glands—glands that produce a kind of oil called sebum—including the face, scalp, and chest.
- Lichen simplex chronicus. Also called neurodermatitis, this form of eczema develops as a result of chronic scratching which results in thickened, or “lichenified,” skin that is usually itchy, dry, and darker than surrounding skin.
What causes eczema?
The causes of many types of eczema remain unknown, though most have both genetic and environmental components.
- Genetic factors. People who have a family history of atopic dermatitis, asthma, or allergic rhinitis are at increased risk for atopic dermatitis. What’s more, researchers have identified several genes associated with eczema, further suggesting a genetic component.
- Environmental factors. The following “environmental exposures” are known to trigger eczema:
- Skin contact with irritants and allergens, including certain chemicals, fabrics or materials, and plants (e.g., formaldehyde, detergents, nickel, poison ivy, among others)
- Allergies (such as seasonal or food)
- Insect bites and stings
- Cold, dry weather
What are the symptoms of eczema?
Eczema can occur in any part of the skin. It may cause the following symptoms:
- Itching, which may be intense (often accompanied by scratch marks)
- Reddened skin
- Dry skin
- Areas where skin looks cracked
- Patches of tough and thickened skin
- Scaly skin
People with eczema may be at higher risk for skin infections.
How is eczema diagnosed?
Your doctor will begin to make a diagnosis by asking you about your symptoms, when they began, and whether you have allergies or asthma. He or she will conduct a physical exam to look at your skin and assess your symptoms. In most cases, at this point your doctor will be able to make a diagnosis. Sometimes, though, your doctor will order additional diagnostic tests.
The most common diagnostic tests for eczema are patch tests and skin biopsy.
- Patch test: A physician will place one or several adhesive patches on your back. Each of these patches contains a small dose of an allergen. The patches remain in place for two days, at which point the physician examines the skin to determine which, if any, particular allergens cause skin irritation.
- Skin biopsy: In this procedure, a physician removes a small piece of skin tissue. Once collected, a pathologist will examine the tissue sample under a microscope to confirm diagnosis.
How is eczema treated?
Treatment for eczema typically involves lifestyle changes, over-the-counter moisturizers, medications, and phototherapy.
Lifestyle changes and moisturizers. Anyone with eczema should try to avoid exposure to allergens and contact with chemicals or other substances known to trigger symptoms. If a flare-up occurs, people should try to avoid scratching to prevent additional skin damage and thickening of the skin.
Over-the-counter moisturizers and hydrocortisone cream may be soothing and can help relieve itching. Bathing or showering with lukewarm, rather than hot, water will help, too.
Medications. If symptoms continue, a doctor may prescribe one or more of the following treatments:
- Antihistamines: These may be used to treat eczema symptoms caused by exposure to allergens. They may be available over-the-counter or by prescription.
- Corticosteroids: While over-the-counter hydrocortisone cream is available, sometimes higher doses of topical corticosteroids (available by prescription only) are necessary to reduce and control skin inflammation. Sometimes these medications must be taken orally, as a pill or tablet.
- Antibiotics or Antifungals: Because skin lesions caused by eczema are prone to infections, a doctor may prescribe these to eliminate infections that may accompany eczema.
- Immunosuppressive drugs: These medications reduce the body’s immune response, which lessens inflammation and other symptoms.
Phototherapy. In some cases, a doctor may recommend phototherapy, a treatment in which the skin is exposed to certain wavelengths of ultraviolet (UV) light. This can reduce skin inflammation and itching.
What is the outlook for people who have eczema?
The outlook varies according to many factors including the type of eczema involved and its severity. Some forms of the disorder are long-lasting and tend to recur even after symptoms wane. There is no treatment that can cure eczema, but among children with the disorder, in 70 to 90% of cases the condition subsides by adulthood.
People who have eczema should become familiar with and avoid substances or other factors that trigger their symptoms. With appropriate lifestyle changes and medical treatment, the symptoms of eczema can usually be kept under control.
What makes Yale Medicine unique in its treatment of eczema?
“Yale Medicine dermatologists are experts in treating inflammatory skin disease,” Dr. Perkins says. “Our treatment algorithms include both well-established and novel modalities, allowing us to tailor care to meet our patients’ needs.”