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 the 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 making it hard to focus on school or work.
The inflammation often reddens light colored skin noticeably, which may be harder to see on darker skin. But sometimes, it causes gray, purple, or dark brown coloration.
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 shows that 40% of patients rated their eczema as severe, whereas 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 body regions:
- Head and neck
- 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 intensity of symptoms. For intensity, it rates certain symptoms on a scale from 0 to 3. These include:
- Scratch marks
- Skin thickening
It also asks about subjective effects such as 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 common 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 older than 40 years, 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 risk 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.
How Is More Severe Eczema Treated?
Topical treatments. Your doctor may prescribe over-the-counter ointments or creams to put directly on your skin, such as corticosteroids. If your eczema is mild to moderate, your doctor may prescribe crisaborole (Eucrisa). It works by blocking substances in your body that cause inflammation.
You need to use these medications exactly as your doctor asks you to. Overuse may have side effects and cause your skin to thin. In some cases, your doctor may give you stronger creams such as pimecrolimus (Elidel) or tacrolimus (Protopic) to reduce inflammation, itching, and the need to use steroids.
Oral prescription drugs. If the severe eczema leaves you with open sores that may cause infection, your doctor may give you oral antibiotics for a short time to fight off bacteria that may get in through the broken skin barrier.
If the inflammation is too much, you may have to take an oral corticosteroid such as prednisone. It’s a very strong drug that can’t be taken for a long time and may have serious side effects. Take it exactly as your doctor tells you to.
Phototherapy. If topical treatments don’t work for you, your doctor may suggest phototherapy. Your skin is exposed to a controlled amount of natural sunlight for a certain amount of time. You may also be exposed to other forms of light such as artificial ultraviolet A and narrow-band ultraviolet B. You may do this therapy with or without the use of drugs.
Phototherapy increases your risk for skin cancer and may cause your skin to age early. Ask your doctor if this the right treatment for you.
If none of these treatments work for you, the FDA has approved a new drug for moderate to severe eczema called dupilumab (Dupixent). Your doctor will have to prescribe it. You take it in the form of a shot that you can give yourself at home.
If the itching and scaly dry patches affect your sense of self-image or mental health, talk to a therapist or counselor. If the itching disrupts your sleep or gets to be a habit, you can try relaxation techniques or behavior modification.