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How Severe Is Your Eczema?

Medically Reviewed by Stephanie S. Gardner, MD on June 14, 2020

Is your eczema mild, moderate, or severe? It’s not always an easy question to answer.

The seriousness of eczema symptoms can vary a great deal between people. With mild eczema, you may have nothing more than small areas of dry skin that get a bit itchy from time to time.

In more serious cases, eczema inflames skin all over your body and causes relentless itching that can be hard to ignore. These might split and bleed and lead to regular skin infections. This can make it hard to focus on school or work. 

The inflammation often reddens lighter colored skin noticeably. It may be harder to see on darker skin, but it sometimes causes gray, purple, or darker brown coloration.

How Do Doctors Assess Severity of Eczema?

There are no blood or lab tests that measure the severity of your eczema. Your doctor will ask you about your symptoms and look at your skin to assess the seriousness. Each different type of eczema can range in severity from mild to severe. It’s not the type of symptom that makes the difference but rather how widespread, persistent, and intense it is.

To complicate matters further, doctors and patients don’t always agree on the seriousness of eczema symptoms. 

One study found that 40% of patients rated their eczema as severe while just 18% of doctors gave it the same rating. That’s in part why scientists developed tools for you and your doctor to assess the severity of your eczema in a more careful way.

Two of the most common of these tools are the Eczema Area and Severity Index (EASI) and the Severity Scoring of Atopic Dermatitis Index (SCORAD).

The EASI looks at how your eczema affects four different body regions:

  • Head and neck
  • Trunk
  • Arms, hands, and other upper extremities
  • Legs, feet, and other lower extremities

It scores each region according to how much of a certain region it covers and the intensity of the symptom. You can even do the assessment yourself with an online tool or mobile app.

SCORAD takes a similar approach, assessing the amount of skin and the intensity of symptoms. For intensity, it rates certain symptoms on a scale from 0 to 3. These include:

  • Redness
  • Swelling
  • Crusting
  • Scratch marks
  • Skin thickening
  • Dryness

It also asks about subjective effects like the degree of itchiness and sleeplessness due to your eczema. SCORAD also has an online tool that you or your doctor can use to help assess the severity of your eczema.

Different types of eczema can look and feel somewhat different. That's why it helps to know the typical symptoms for your eczema. Some common types include:

Atopic dermatitis: More than half of people with eczema have this. It’s the most severe type of eczema and it lasts the longest. Symptoms often start in childhood. They include dry, itchy, and scaly skin, especially on the insides of the elbows and backs of the knees. It also causes rashes on the cheeks.

It’s common for atopic dermatitis to “flare,” causing symptoms to get more intense. Flare-ups often come with crusted sores caused by infection.

Dyshidrotic eczema: Also known as pompholyx eczema, it causes itchy water blisters on your hands and feet. It also brings a burning sensation and prickling feelings on the palms of the hands and soles of the feet.

This affects adults over 40, especially those with allergies. It’s also more common among folks who put their hands and feet in water a lot. Those who work with chromium, cobalt, or nickel have a higher chance of getting it, as well. Stress is also a trigger.

Nummular eczema: "Nummular," the Latin word for "coin," refers to the coin-shaped spots on the skin. It’s also called discoid eczema because the scaly patches look like discs. Its cause is unknown, although the spots, which can be dry and scaly or weeping (and may or may not be itchy) might be triggered by reactions to inflammation or dry skin. The lower legs, forearms, and trunk are the most commonly affected areas.

Show Sources

SOURCES:

British National Health Service: “Atopic eczema.”

My.dermatools.net

scorad.corti.li

National Eczema Association.

National Eczema Society.

Mayo Clinic: "Atopic Dermatitis/Eczema."

Cvetkowski, R. British Journal of Dermatology, 2005.

Shiohara, T. Current Problems in Dermatology, 2011.

American Academy of Allergy Asthma and Immunology: “How to Measure Clinical Signs of Atopic Dermatitis.”

University of Nottingham: “How to use EASI.”

National Institute of Allergy and Infectious Diseases: "Eczema (Atopic Dermatitis) Treatment.”

American Academy of Dermatology: “Atopic Dermatitis.”

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