What Is Eczema?
Eczema is a group of conditions that make your skin inflamed or irritated. The most common type is atopic dermatitis or atopic eczema. “Atopic” refers to a person’s tendency to get allergic conditions such as asthma and hay fever.
Eczema affects about 10% to 20% of infants and about 3% of adults and children in the U.S. Most children outgrow it by their 10th birthday. Some people continue to have symptoms on and off for life.
There’s no cure, but most people can manage their symptoms by getting treatment and by avoiding irritants. Eczema isn’t contagious, so you can’t spread it to another person.
Eczema looks different for everyone. And your flare-ups won’t always happen in the same area.
No matter which part of your skin is affected, eczema is almost always itchy. The itching sometimes starts before the rash. Your skin may also be:
Symptoms in infants
In infants, the itchy rash can lead to an oozing, crusting condition, mainly on the face and scalp. It can also happen on their arms, legs, back, and chest.
Symptoms in children
Children and teens usually have a rash in the bends of their elbows, behind their knees, on their neck, or on their wrists or ankles. The rash turns scaly and dry.
Symptoms in adults
The rash usually happens on your face, the backs of your knees, wrists, hands, or feet.
Your skin will probably be very dry, thick, or scaly. In fair-skinned people, these areas may start out reddish and then turn brown. In darker-skinned people, eczema can affect skin pigments, making the affected area lighter or darker.
When to see your doctor
Call your doctor if:
- You notice signs of an infection, such as fever, redness, warmth, pus, or blisters
- Your eczema suddenly changes or gets worse
- Treatments aren’t working
Types of Eczema
Eczema includes conditions such as:
Atopic dermatitis. This is what people are usually talking about when they say “eczema.” This is the most common form, and it affects more than 7% of American adults. It’s also linked to other allergic disorders, like asthma and hay fever, and often starts in childhood.
Contact dermatitis. Nearly everyone gets this at some point in their lives. It happens when your skin comes into contact with something that causes a rash. The trigger can cause irritation or an allergic reaction. Triggers are unique to each person and vary by the two types of contact dermatitis:
- Irritant dermatitis is the more common kind and is more closely linked to people with atopic dermatitis. Triggers may include skin care products, soaps and detergents, jewelry made with nickel, and industrial chemicals like solvents and cement.
- Allergic dermatitis flares when your skin comes into contact with something you’re allergic to. Common allergens include poison ivy, nickel and other metals, fragrances and beauty products with fragrances, rubber, latex, and the preservative thimerosal. For some people, it takes sunlight to provoke a reaction.
Dyshidrotic eczema. This is a less common but more challenging form of eczema. It causes outbreaks of tiny blisters on the palms of the hands, soles of the feet, and sides of the fingers. It may be triggered by sweating or irritants like metals.
Neurodermatitis. This type of eczema tends to cause just one or two intensely itchy patches, often on the nape of the neck, an arm, or a leg. Risk factors include having another form of eczema, like atopic or contact dermatitis, or just very dry skin. But it’s also linked to some mental health issues like anxiety disorder and obsessive-compulsive disorder (OCD). Women between the ages of 30 and 50 have a higher chance of getting it than other people.
Nummular eczema. This coin-shaped eczema often appears after a skin injury like a burn or insect bite. You’re more likely to get nummular eczema if you or your family members have atopic dermatitis, allergies, or asthma.
Seborrheic dermatitis. This happens in areas of your body with lots of oil glands. When it’s on your scalp, it’s called dandruff. Seborrheic dermatitis probably results from a severe reaction to a high amount of Malassezia yeast, a common organism, on the skin. It’s also linked to other skin conditions, like psoriasis, acne, and rosacea, as well as a variety of other diseases.
Stasis dermatitis. This type happens in people who have poor blood flow, usually in the lower legs. Unlike some other types of eczema, these plaques aren’t linked to faulty genes. Some lifestyle habits raise the risk too, like being overweight and not getting enough activity.
Eczema Causes and Risk Factors
Experts aren’t sure what exactly causes eczema. Things that may make it more likely include:
- An immune system response to something irritating
- Problems in your skin’s barrier that let moisture out and germs in
- A family history of other allergies or asthma
Some people have flare-ups of the itchy rash in response to things like:
- Rough or coarse fabric
- Feeling too hot or cold
- Household products like soap or detergent
- Animal dander
- Respiratory infections or colds
No one test can spot eczema. Your doctor will probably diagnose it by looking at your skin and by asking a few questions.
Because many people with eczema also have allergies, your doctor may order some allergy tests to look for irritants or triggers. Children with eczema are especially likely to have allergy tests.
If your doctor diagnoses you with eczema, you might want to ask them:
- What’s the best way to add moisture to my skin? Can I use over-the-counter products, or do you need to prescribe something?
- Do I need to buy special soaps, lotions, and laundry detergent? Do fragrance-free or sensitive-skin products help?
- Are there foods that I should avoid to keep flares at bay?
- Are there fabrics that I should avoid wearing? What about fabrics I should wear more?
- Do pets make symptoms worse?
- If sweating makes things worse, can I still exercise?
- What’s next if my symptoms don’t improve or I get an infection from scratching my skin?
- Does stress lead to flare-ups?
- Are long periods of time without symptoms common?
- Are there ways I can treat my skin to reduce my chances of another flare-up?
Is Eczema Contagious?
No. You can’t catch eczema from someone or pass it on to others. Eczema doesn’t mean that your skin is infected or that it spreads from person to person. Some people might assume that eczema may be contagious because it often tends to run in families. But eczema can arise from several factors, including your immune system, your genes, the environment, and other things that cause your skin barrier to be faulty.
Still, eczema can lead to skin infections from scratching or cracking. That can break down your skin’s barrier against bacteria and other germs.
The aim of eczema treatment is easing and preventing itching, which can lead to infection.
Some things you can do at home may help ease symptoms.
Moisturizers. Because your skin is dry and itchy, your doctor will recommend lotions and creams to keep it moist. Creams and ointments ease inflammation and put water back in your skin to help it heal. Put them on several times a day, including right after you bathe or shower. Petroleum jelly and mineral oil work well because they form a thick barrier over your skin.
Products with glycerin, lactic acid, and urea may also help because they help pull water into your skin. You’ll use these when your skin is damp, such as after bathing, to help hold in moisture.
Hydrocortisone creams and antihistamines. Over-the-counter products like hydrocortisone cream and antihistamines can also help. Hydrocortisone is a steroid that helps keep redness, itching, and swelling at bay. You can buy low-strength creams and lotions at the store. If those don’t help, your doctor may prescribe something stronger.
It’s safe to put hydrocortisone on most body parts as many as four times a day for up to 7 days, as long as you’re not pregnant or breastfeeding. Keep it away from your eyes, rectum, and genitals.
Some people have a severe reaction to hydrocortisone. If you have trouble breathing or swallowing, or notice a skin rash after you use it, call 911 or your doctor.
Over-the-counter allergy meds may not work well for itchy skin caused by eczema. But antihistamines that are known to cause drowsiness can help you sleep if you take them before bed.
Colloidal oatmeal. Add this finely ground oatmeal to a lukewarm bath.
Wet wraps. When your eczema is flaring, soak some gauze, bandages, or pieces of soft clothing in cool water and put them on your skin. The coolness will relieve itching, and the moisture will help creams or lotions work even better. Carefully cover the area with a dry layer (such as pajamas) and leave in place for several hours or overnight.
Talk to your doctor to find out how often you can use wet wrap therapy. If you do it too much, your skin may get infected.
Coal tar. Your doctor may suggest a product with coal tar. Coal tar has treated eczema and other skin problems for more than 2,000 years. Although it’s messy and many people don’t like the strong smell, it may help soothe your skin.
Calamine lotion can be put in the refrigerator and helps relieve itching quickly.
Relaxation techniques. There’s a strong link between stress and your skin. Plus, you’re prone to scratch more when your emotions are running high.
Self-hypnosis, meditation, and biofeedback therapy have all been shown to ease eczema symptoms. You may also want to see a therapist. They can help you change habits or negative thought patterns that may be adding to your skin problems.
Your doctor may also prescribe creams and ointments with corticosteroids to ease inflammation. If the area becomes infected, you’ll probably need antibiotics.
Other options include tar treatments (chemicals that reduce itching), phototherapy (using ultraviolet light), and the drug cyclosporine.
The FDA has approved two medications called topical immunomodulators (TIMs) for mild to moderate eczema. Elidel cream and Protopic ointment work by changing your immune system response to prevent flare-ups. They can reduce inflammation and itching.
The FDA has warned doctors to use caution with Elidel and Protopic because of concerns over a cancer risk. The two products also carry the FDA's "black box" warning on their packaging to alert doctors and patients to these potential risks. The warning advises doctors to prescribe Elidel and Protopic for only a short time after other eczema treatments have failed in adults and children over the age of 2. It should not be used in kids under age 2.
A biologic drug called dupilumab (Dupixent) is FDA approved for moderate to severe eczema. Biologics block certain proteins from binding to receptors on your cells. This eases or prevents inflammation by keeping your immune system from overreacting. Tralokinumab (Adbry) is another injectable biologic drug.
Other medication options for eczema include:
- Azathioprine (Azasan)
- Mycophenolate mofetil (CellCept)
- Phosphodiesterase inhibitors (Eucrisa ointment)
- Ruxolitinib (Opzelura cream)
- Upadacitinib (Rinvoq)
Eczema Flare-up Prevention
A few tips can help you prevent outbreaks or keep them from getting worse:
- Moisturize your skin often.
- Avoid sudden changes in temperature or humidity.
- Try not to sweat or get too hot. Keeping cool and keeping your home comfortable can reduce itching.
- Manage stress, and take time for yourself to relax. Get regular exercise. It can help to control stress and increase circulation.
- Avoid scratchy materials such as wool.
- Don’t use harsh soaps, detergents, or solvents.
- Pay attention to foods that might trigger symptoms and try to avoid them.
- Use a humidifier in your bedroom.
- If your baby is more likely to have eczema because of a family history, it’s best to breastfeed them exclusively for the first 3 months of life, or longer if possible. Doctors advise continuing breast milk for at least up to 6 months (preferably 1 year) as you introduce your baby to solid food. Babies should also be protected from such potential allergens as pet hair, mites, and molds.