Eczema

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Eczema is a common skin condition that’s dry, itchy, and red. Most cases can be treated with over-the-counter creams and a few skincare changes.

Also Called

Atopic dermatitis (INCLUDES: Contact dermatitis, neurodermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, stasis dermatitis)

Frequently Found On

Infant's face, cheeks and scalp; adult legs and arms

What is eczema?

Eczema can be misdiagnosed. Some people call everything ‘eczema,’ or everything ‘dry skin,’ or everything ‘dermatitis.’

—Dr. Lily Talakoub, a board-certified dermatologist at McLean Dermatology in McLean, Virginia.

Itchy, dry skin is nothing new to anyone who’s ever experienced winter, when the humidity in the air is low and dry heat is blasting inside. But if typical lotions and creams aren’t soothing those dry patches, it might be eczema.

Eczema can come in all shapes and sizes and appear in almost every area of the body, though it’s more common on legs in adults. While eczema isn’t contagious or threatening, it is itchy and uncomfortable, but the good news is that there are a few different routes to treating it and you can usually get it under control with a change in skincare routine.

So what exactly is eczema and where does it come from? Let’s dive in.

Eczema is a category of dry skin conditions centered around itchy, inflamed patches of skin. It’s especially common in babies and young children, but it can persist in teens and adults.

“Most people who have eczema have either had it since childhood, or had a bout of it in childhood,” says Dr. Lily Talakoub. “If it happens in adulthood in someone who’s never had it before, it’s usually because of something they’re doing to their skin that doesn’t react to their skin very well. That’s usually things like, they’re overwashing their skin, they’re using a soap that’s too harsh, taking too-hot showers, or not moisturizing enough.”

The most chronic type of eczema is atopic dermatitis, and this is usually what people are referring to when they say they have eczema.1 Atopic dermatitis is the type of eczema people have that begins in childhood and might carry into adulthood.

Another common type of eczema is nummular dermatitis, which are dry patches on the skin, especially the legs, during the winter. This is more common in men, but can happen to anyone.

There’s also contact dermatitis, which is caused by an irritant like perfume or laundry detergent or a cleaning supply. This can cause burning and itching sensations until the irritant is removed/washed off.

“Eczema can be misdiagnosed,” warns Dr. Talakoub. “Some people call everything ‘eczema,’ or everything ‘dry skin,’ or everything ‘dermatitis.’ But there are a lot of other external factors that can cause rashes that look like eczema that may not be eczema. Those can be allergies to fragrances, hair dyes, makeup, or skin creams. Allergens in your environment you wouldn't even know about can cause things that look like eczema.” The best way to get a proper diagnosis, and to determine which variety of eczema it may be, is to have a dermatologist check it out to confirm.


Symptoms of Eczema


The main symptom of eczema is a patch of skin that is itchy, rough, flaky, scaly, or dry. The skin might also be inflamed and red in lighter skin tones, or brown/purple in darker skin tones. It can flare up, subside, and then flare up again without notice. It’s most common on the arms, inner elbows, or lower legs, but can potentially appear all over the body.

Areas of eczema are also typically intensely itchy, with some severe cases in which there are small raised blisters that ooze fluid when scratched. (Though “it’s very rare that you have oozing pus,” notes Dr. Talakoub. “You may have bacteria in the skin, but it’s usually not oozing.”)

Illustration: The main symptom of eczema is a patch of skin that is itchy, rough, flaky, scaly, or dry.
The main symptom of eczema is a patch of skin that is itchy, rough, flaky, scaly, or dry.

Although eczema isn’t contagious, itching can further irritate the skin and make the condition worse.

If the flare-ups are so uncomfortable that they interfere with your daily life or are oozing pus (which again, is pretty rare), definitely contact a doctor. However, most mild cases can be treated with over-the-counter creams and a change in your skincare routine.

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What causes eczema?

Despite decades of research and studies, the exact cause of eczema isn’t fully understood. However, based on the evidence that exists, scientists believe eczema is triggered by an overactive immune system that responds aggressively when exposed to certain irritants.

Healthy skin can retain moisture that protects the body from irritants and allergens. But skin with eczema isn’t able to retain that moisture, which can lead to atopic dermatitis.

Dr. Lily Talakoub, a board-certified dermatologist at McLean Dermatology in McLean, Virginia, explains the genetic component of atopic dermatitis: “The immune factor of eczema is that there is a mutation in a gene called filaggrin. That’s the genetic cause. Filaggrin holds moisture in the skin. When you have that genetic defect, your skin can’t hold the moisture the same as a person who doesn't have that gene mutation.” This is why so much of eczema treatment is about moisturizing the affected area with thick and soothing creams.

When she sees patients with eczema who are kids, the cause is usually genetic and it might show up with hay fever, asthma, and allergies (which are all related to the functioning of the immune system).

When she sees adult patients who have never had eczema before, “it’s usually because of something they're doing to their skin that doesn't react to their skin very well,” says Dr. Talakoub. “Like they’re overwashing their skin, they’re using a soap that’s too harsh, they’re taking hot showers, or they’re not moisturizing it enough.”

An eczema flare-up occurs when one or more symptoms appear somewhere on the body. Common causes of a flare-up may include:

  • Chemicals in cleaners and laundry detergents
  • Synthetic fabrics, like nylon and polyester
  • Sweating
  • Temperature changes
  • Stress
  • Sudden drop in humidity
  • Food allergies2
  • Irritating clothing fibers
  • Irritating perfumes and fragrances

How do you treat eczema?

There isn’t a “cure” for eczema, which makes it sound deadly—it’s not. It just might recur here and there once you get it; maybe you get the same patch on your leg every winter. But eczema can be successfully treated and managed with a few routine changes. “Skincare is paramount,” says Dr. Lily Talakoub. “How you hydrate your skin, and how you take care of the skin, will affect how much you can control it.” But it’s important to see a dermatologist if you’re experiencing eczema for the first time; different types of eczema require different treatment.


Topical Ointments and Creams


Topical creams and body moisturizers help treat the dryness associated with eczema. “I usually tell people to use a cream, not a lotion,” says Dr. Lily Talakoub. “A cream is an oil that has a little bit of water in it. While lotion is a lot of water, with a little bit of oil in it. So, creams that are thick, that are in a tub, are better to use because they contain more oils.”

In really itchy situations, Dr. Talakoub might recommend a topical steroid cream (often labeled “anti-itch” or “itch relief” at the drugstore), or a very thick ointment-based moisturizer, “like very thick”, she says, such as Vaseline or Aquaphor. Take it a step even further, she says, by wrapping that part of the skin with plastic wrap to really keep that moisture in.

To treat an infection caused by eczema, a doctor might prescribe a topical antibiotic cream when an over-the-counter option isn’t strong enough. Usually the infection is because a patient scratched at their itchy skin, broke the skin, and bacteria got in. In very severe cases in kids with open sores, The American Academy of Pediatrics recommends a bath with about a tablespoon of bleach, two to three times a week, to keep bacteria from spreading.3


Skincare Routine Changes


In adulthood, eczema is usually flared by something you’re doing to your skin, or an external irritant (like the weather or laundry detergent), says Dr. Lily Talakoub. When she meets with eczema patients, “I start by going over what they’re doing to their skin: how they’re washing it, how often they shower, are they using hot water, lukewarm water? Are they using soaps that are too irritating, too drying, too lathering? And then, are they actually moisturizing their skin? Do they live in a dry climate? Do they have dry heat on in the house, which is drying out the air? Things like that.”

Hot water dries out the skin, so you might need to cut your luxurious morning showers short, turn the heat down, or stop taking hot baths until the skin heals a bit. Don’t even think about a hot tub.

After the shower, if moisturizing the entire body isn’t part of your routine, you need to make it one. Skin with eczema isn't able to retain water very well, so that moisture has to come from a cream, ideally a thicker cream and not a thin lotion.


Switching Soaps


In the shower, some products might need to go. The more bubbly and sudsy a soap or body wash is, the more likely it’s drying out your skin and potentially causing an eczema flare-up. Our skin has oil glands that produce oil to self-moisturize, but some soaps might be washing that oil right off. The reason a lot of adults experience eczema on their legs is because that area of the body doesn’t produce a lot of oil to begin with.

“We’ve learned that the more a soap lathers, the more it strips the skin,” she explains, “while the more hydrating a soap is, the less it strips the skin.” Think about how you wash oily dishes: The combination of hot water and soap cuts through the grease. So in the case of your skin, you want to retain that moisture, and the two things that strip our naturally-produced skin oils the most are hot water and soap.

So toss out the harsh soaps and super suds. Look for products labeled for sensitive skin, gentle cleansers, eczema-specific body washes, or oil-based body washes, and definitely avoid harsh scrubs, which can irritate the skin even worse.


Lifestyle Changes


Stress can trigger an eczema flare-up or make an existing flare-up worse. Managing stress through deep breathing exercises, meditation, exercise, or getting more sleep might help alleviate eczema-related symptoms (but should be combined with a topical cream too).4

Cold compresses or lukewarm baths can also soothe itchiness, especially in more uncomfortable instances of atopic dermatitis.

For eczema flared by the cold, dry weather or dry heat indoors, adding a few humidifiers to your environment might help replace moisture in the air.


Light Therapy


Light therapy is an uncommon treatment for eczema (it’s more common as a treatment for psoriasis). Dr. Lily Talakoub says that she turns to it only “in very, very extreme full-body cases.” She estimates less than two percent of her patients ever need it. “It would have to be pretty widespread and pretty not resistant to treatment.”

With light therapy, special machines emit targeted ultraviolet light treat areas of the body that are affected with severe eczema. Although it is not exactly known why it works, theories suggest that natural sunlight can reduce the inflammatory response in the skin. In light therapy, synthetic UVA and UVB lights are applied to the skin with the hopes of reducing skin inflammation, as well as causing a positive effect on the immune system.5


Antihistamine Medication


For eczema that’s caused by an immune response to an allergic reaction, antihistamines can help treat the itchiness. Antihistamines work by blocking histamine, which is a compound within the body that triggers an immune response.

“It depends on how extensive the eczema is,” says Dr. Lily Talakoub. “For patches on the arms and legs, antihistamines don’t help. If the eczema is all over the torso, then we prescribe an antihistamine.”

Antihistamines won’t prevent the flare-ups themselves: they will just help to relieve itching and burning sensations associated.

Most antihistamines can be purchased over-the-counter at a local drugstore. Keep in mind that many of these drugs can lead to drowsiness, so consider taking them in the evening before going to bed (or look for non-drowsy options).

Talk to your dermatologist about the best treatment plan for you; a combination of antihistamines and steroid creams and cold compresses and a new moisturizer might be what it takes for the itching to subside, but every person’s experience is different.

How do you prevent eczema?

One of the best ways to prevent an eczema flare-up is to identify and avoid the triggers that often cause it.6 That might mean swapping out laundry detergents, wearing different types of fabric, taking cooler showers, or using a non-irritating soap.

To identify your triggers, think about where your flare-ups usually occur. If it’s on the hands it might be from drying hand soap; if it’s mostly on the chest it could be caused by an irritating material in a favorite shirt; if it’s your legs, and you don’t normally lotion up that area (but should!).

Using thick creams daily can also help prevent eczema flare-ups by soothing the dry skin and helping the skin retain its moisture. The best time to apply moisturizer is when the skin is still damp from the shower (the cream will lock it in), but you might need to moisturize twice, or three times a day to manage a deep winter case.

Also, don’t scratch. As uncomfortable as it might be, scratching a patch of eczema can cause the skin to break, bleed, and cause an infection. Try anti-itch creams, topical antihistamine cream, or oral antihistamines. Follow the advice of Dr. Lily Talakoub and wrap the moisturized skin in plastic wrap to keep yourself from touching it. If the itch must be scratched, rubbing or patting might be a gentle alternative.

Citations

1A Comprehensive Review of the Treatment of Atopic Eczema by Ji Hyun Lee, Sag Wook Son, and Sang Hyun Cho. Allergy Asthma Immunol Res.
2Scientists identify unique subtype of eczema linked to food allergy by the National Institute of Allergy and Infectious Diseases.
3
Dilute bleach baths may ease eczema symptoms in children by Carla Kemp. AAP News.
4Stress: Is It A Common Eczema Trigger? by the American Academy of Dermatology.
5Phototherapy by the National Eczema Society.
6Prevention of atopic dermatitis by Hywel C. Williams, Joanne R. Chalmers, and Eric L. Simpson.

Additional References:
The nonlesional skin surface distinguishes atopic dermatitis with food allergy as a unique endotype by Donald Y. M. Leung et al. Science Translational Medicine.

Contributing Experts

Dr. Lily Talakoub, MD

Board-Certified Dermatologist

Dr. Lily Talakoub is a is a board-certified dermatologist at McLean Dermatology and CEO of Derm to Door in McLean, Virginia.

Endorsement Disclaimer: Soft Services works with experts to strengthen the information provided on Mass Index. Please note that they do not endorse our products.

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