Eczema: Types, Causes, Symptoms, and Treatments

What is Eczema?

Eczema is a group of inflammatory skin conditions causing itchiness, dry skin, and rashes. It affects the skin by weakening its barrier, leading to moisture loss and vulnerability to irritants, allergens, and bacteria. 

On lighter skin, eczema appears red and inflamed; on darker skin tones, it may look brown, purple, gray, or ashen.

Unlike psoriasis, which causes well-defined, silvery scales often on the scalp, elbows, and knees, eczema can appear anywhere on the body, commonly in the creases of elbows, knees, neck, wrists, and ankles. 

According to WebMD statistics, 1 in every 10 people will experience eczema at some point in their life.

It's important to note that eczema is not contagious and cannot be spread from person to person.

There are also specific forms like papular eczema, which presents as small, raised bumps, and follicular eczema, which causes inflammation around hair follicles. 

Types of Eczema

There are several types of eczema, each with unique triggers, symptoms, and affected areas:

Atopic Dermatitis

Atopic dermatitis is the most common type of eczema and results from an overactive immune system.

According to NIAMS, the risk of developing atopic dermatitis increases if there is a family history of the condition, hay fever, or asthma. Research also shows that atopic dermatitis is more common in non-Hispanic black children and is slightly more prevalent in females than males.

It often appears on the cheeks, arms, and legs of children, but can affect any part of the body. 

On lighter skin, it looks red and inflamed, while on darker skin, it can appear brown, purple, gray, or ashen.

• Severe itching
• Dry, scaly skin
• Red or dark patches
• Oozing and crusting

Contact Dermatitis

Contact dermatitis occurs when the skin comes into direct contact with an irritant or allergen, causing inflammation. 

The National Eczema Association states that irritant contact dermatitis is common among professionals who frequently use chemicals, such as mechanics, custodians, healthcare workers, and hairstylists.

It can appear anywhere on the body but is common on the hands and face.

• Red, itchy rash
• Blisters or hives
• Swelling and burning sensation
• Dry, cracked skin

Dyshidrotic Eczema

Dyshidrotic eczema causes small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. 

The cause is not well understood, but it is often triggered by stress, moisture, and allergies.

The National Eczema Association notes that dyshidrotic eczema is most prevalent in young adults, usually between the ages of 20 and 40.

• Tiny, fluid-filled blisters
• Intense itching
• Red, cracked skin
• Painful skin cracks

Nummular Eczema

Nummular eczema, also known as discoid eczema, is characterized by coin-shaped patches of irritated skin. It can appear anywhere on the body and is often mistaken for fungal infections.

The AAD states that once someone has had nummular eczema, it can recur and often appears in the same location.

• Round, scaly patches
• Intense itching
• Oozing and crusting
• Red or darker patches

Seborrheic Dermatitis

The National Eczema Association reports that seborrheic dermatitis, also known as seborrhea, is most common in infants and adults aged 30 to 60, and more frequently affects males among adults and teens.

Seborrheic dermatitis primarily affects oily areas of the body, such as the scalp, face, and upper chest. 

It is thought to be related to a combination of factors, including genetics, yeast on the skin, and an immune response.

• Red, greasy skin covered with flaky white or yellow scales
• Itching and burning
• Dandruff on the scalp
• Rash on oily areas

Stasis Dermatitis

Stasis dermatitis, also known as gravitational dermatitis, venous eczema, or varicose eczema, occurs when there is poor circulation in the lower legs, leading to fluid buildup and skin irritation. 

According to the AAD, although the risk of venous insufficiency rises with age, it can also develop after a severe leg injury, blood clot, or surgery.

• Swollen legs and ankles
• Red or brown patches
• Itchy, scaly skin
• Open sores or ulcers

Neurodermatitis

Neurodermatitis starts with an itchy patch of skin. Scratching makes the itch worse, leading to thick, leathery patches.

An interesting fact from the AAD is that the itch often starts during a highly stressful period. Many people remember feeling stressed, depressed, or frustrated before the itching began. Some also report feeling very anxious or worried.

• Intense itching
• Thick, scaly patches
• Discolored skin
• Patches commonly appear on the neck, wrists, forearms, and lower legs

Each type of eczema presents differently and can affect various parts of the body. Recognizing these differences is crucial for proper management and treatment. 

If you are unsure about your symptoms, using an online Symptom Checker can help identify potential conditions, but always consult a healthcare professional for an accurate diagnosis and treatment plan.

Diagnosis and Tests

Diagnosing eczema involves a thorough examination by a healthcare provider, who will review your medical history and examine your skin.

Because eczema symptoms can resemble those of other skin conditions, accurate diagnosis is crucial.

To identify allergies and rule out other conditions, doctors might perform several tests:

• Allergy Tests: Skin prick tests or blood tests can identify specific allergens triggering eczema.
• Patch Tests: Small amounts of potential allergens are applied to the skin to check for reactions.
• Skin Biopsy: In some cases, a small sample of skin may be taken for laboratory analysis to confirm the diagnosis and rule out other skin conditions.

Consulting a dermatologist is important for managing eczema effectively. Dermatologists have specialized knowledge and can provide tailored treatment plans, ensuring better control over the condition and preventing complications.

Treatment Options

It's essential to follow your doctor's instructions, as treatments can vary in effectiveness from person to person. Sometimes, treatment plans need to be adjusted when medications become less effective.

This is a complete guide to eczema treatments from WebMD, detailing various methods to relieve symptoms and promote skin healing: 

Medical Treatments

1. Corticosteroid Creams, Solutions, Gels, Foams, and Ointments: These hydrocortisone steroid treatments quickly reduce itching and inflammation. Available in different strengths, they range from mild OTC options to stronger prescriptions. OTC hydrocortisone is often recommended for mild eczema, while more potent prescriptions may be needed for thicker, scaly skin. Side effects, such as skin thinning and stretch marks, are rare if used as directed.
2. PDE4 Inhibitor: A nonsteroidal anti-inflammatory is prescribed for mild to moderate eczema. Applied twice daily for patients 2 and older, it reduces inflammation and helps the skin appear more normal.
3. Barrier Repair Moisturizers: Available OTC and by prescription, these moisturizers lock in moisture, repair skin damage, and alleviate dryness, redness, and itching. Some products may contain irritating ingredients, so consult a doctor or pharmacist for recommendations.
4. Calcineurin Inhibitors: They reduce inflammation and are alternatives when OTC steroids are ineffective or problematic. 
5. Corticosteroid Pills, Liquids, or Shots: These powerful drugs are used for severe or hard-to-treat eczema but should only be taken short-term due to risks like skin damage and bone loss.
6. Systemic Immunomodulators: These drugs suppress the immune system to help moderate-to-severe eczema when other treatments fail. They reduce itching, allowing the skin to heal, but have serious side effects and should be used short-term.
7. Biologics: These medications, derived from living cells, calm the immune system and ease eczema symptoms.
8. Antibiotics: These are prescribed to treat bacterial skin infections resulting from scratching.
9. Antihistamines: Taken at night, these drugs relieve itching and help with sleep.

Phototherapy

UV light therapy treats moderate-to-severe eczema by controlling the immune system's response. It must be carefully monitored to avoid skin aging and cancer risks. Treatments can be:

• UV Light Therapy: Involves exposure to UVA, UVB, or a combination, sometimes with coal tar, conducted in a dermatologist’s office several times a week.
• PUVA Therapy: Combines psoralen medication with UVA light for those unresponsive to UV therapy alone.

Prevention Tips

Preventing eczema flare-ups involves proactive skincare and lifestyle choices, which can also help minimize eczema scars. Here are some essential tips:

Regular Moisturizing

Regular moisturizing is crucial to prevent the skin from becoming dry and irritated:

• Apply Daily: Use a thick, fragrance-free moisturizer at least twice a day. The best time to moisturize is after bathing when your skin is still damp.
• Use Appropriate Products: Choose products specifically designed for sensitive skin to avoid irritation.

Proper Bathing Practices

How you bathe can significantly impact your skin's health:

• Use Lukewarm Water: Hot water can strip your skin of natural oils, so opt for lukewarm water instead.
• Gentle Cleansers: Use mild, fragrance-free cleansers that won't irritate your skin.
• Short Baths or Showers: Limit your bathing time to avoid drying out your skin. Aim for 10-15 minutes.

Wearing Eczema-Friendly Clothing

Your choice of clothing can affect your eczema:

• Soft, Breathable Fabrics: Opt for cotton and other natural fabrics that allow your skin to breathe. Avoid wool and synthetic materials that can cause irritation.
• Wash New Clothes: Always wash new clothes before wearing them to remove any potential irritants. Use a mild, fragrance-free detergent.

Managing Stress and Emotional Well-being

Stress is a known trigger for eczema, so managing it is essential:

• Relaxation Techniques: Practice relaxation techniques such as meditation, yoga, or deep breathing exercises to reduce stress levels.
• Healthy Lifestyle: Maintain a balanced diet, get regular exercise, and ensure adequate sleep to support overall well-being.
• Seek Support: If stress or emotional issues are overwhelming, consider talking to a therapist or counselor.

By implementing these tips, you can effectively manage and prevent eczema flare-ups, leading to healthier skin and an improved quality of life.