How Severe Is Your Eczema?

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

Almost everyone with eczema has dry, scaly, itchy, red skin. In more severe cases, patches of dry skin can bleed, crack,  or crust and get infected.

There are several types of eczema:

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.

There are no blood or lab tests to diagnose eczema. Your doctor will look at your skin and assess your symptoms to figure out the severity of your eczema, and decide on treatment. Each different type of eczema can range in severity from mild to severe.

Don’t be surprised if your doctor thinks your eczema is less severe than you believe it is.

One study found that 40% of patients rated their eczema as severe while just 18% of doctors gave it the same rating.

The most common tools to find the severity of eczema are the Eczema Area and Severity Index (EASI) and the Severity Scoring of Atopic Dermatitis Index (SCORAD).

The EASI looks at four body regions (head/neck, trunk, upper extremities, and lower extremities), how much of each region is affected, and the severity of the eczema.

With SCORAD, doctors try to objectively look at the severity (extent of skin involved, intensity of symptoms) of atopic dermatitis. This clinical tool gives approximate weights of 60% to intensity and 20% each to spread (extent of skin affected) and subjective signs (insomnia, depression, etc.) redness/patches on the skin, eruptions or water-filled blisters, itchiness, thick or hardened patches of skin, and dryness.

Whether your eczema is mild, moderate, or severe, treatments like medications and a skin care regimen that includes frequent moisturizing and avoiding hot baths/showers, fragrances, and irritants can ease your symptoms, prevent infections, and stop things from getting worse.

Show Sources


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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