Papular Eczema: Symptoms, Causes, Diagnosis and Treatment

What Is Papular Eczema?

Papular eczema is a form of eczema that causes small, raised bumps on the skin.

Papular eczema is sometimes associated with atopic dermatitis, a more common type of eczema. Atopic dermatitis can have various forms, including papular eczema. However, not all people with atopic dermatitis will develop papular eczema specifically.

Also important to note that papular eczema is not contagious. The bumps and redness may look scary, but you can't spread it to others by touch.

Difference with Other Eczema Types

Papular eczema is one type of eczema, but it has some unique features:

What Are the Symptoms of Papular Eczema?

Papular eczema causes visible symptoms on the skin, often leading to discomfort. The symptoms may vary from person to person, but there are common signs to look out for.

Common Symptoms in Adults

Adults with papular eczema often experience the following symptoms:

• Small, raised bumps on the skin, which can be red and itchy.
• The bumps may appear on the arms, legs, or hands, but they can develop anywhere.
• The skin might feel rough or scaly to the touch.
• Intense itching can cause scratching, which may break the skin. Broken skin increases the risk of infection.
• Over time, the affected areas may become thickened or hardened due to repeated scratching or rubbing.

Symptoms in Children

About 65% of children with eczema show symptoms during their first year of life, and 90% develop symptoms within the first five years.

The symptoms in children are similar to those in adults. Small bumps appear on the skin, and these are often very itchy. 

In babies, the bumps are more likely to show up on the face, scalp, and elbows.

In children, the condition can sometimes cause more widespread irritation. The skin may appear dry or cracked, and scratching can lead to open sores or scabs.

Features on Different Skin Tones

Papular eczema can look different depending on your skin tone:

Causes and Risk Factors

The exact cause of eczema, including papular eczema, is not fully understood. However, it likely results from a combination of genetic and environmental factors.

Genetic Factors

Papular eczema often runs in families. If your parents or close relatives have eczema, asthma, or allergies, you’re more likely to develop it too. This is because your skin may be genetically weaker at maintaining moisture and blocking out irritants. That makes it easier for eczema to flare up.

As Dr. Jeff Yu, an assistant professor of dermatology at Massachusetts General Hospital, explains:

“There’s a very strong genetic component to this disease. When someone has eczema, there is almost always a family history of the disease.” 

Environmental Factors

Certain environmental triggers can worsen papular eczema or cause flare-ups:

Substances like dust mites, pet dander, pollen, and mold can irritate the skin. If you're allergic to these, your immune system may cause inflammation in your skin, leading to bumps.

Everyday products like soaps, shampoos, laundry detergents, and perfumes can irritate sensitive skin. Harsh chemicals in these products remove the skin’s natural oils, making it dry and easier to irritate.

For people with papular eczema, these irritants can cause flare-ups and make symptoms worse.

Cold, dry air can dry out your skin, making eczema flare-ups more likely.

Also, sweating due to sudden changes in humidity or hot weather can trigger symptoms. 

It is important to keep your skin moisturized and protected from extreme weather to help manage these flare-ups.

Immune System Response

In papular eczema, the immune system tends to overreact to harmless substances. This response causes inflammation in the skin and leads to the formation of small, itchy bumps. 

Although the immune system plays a role, papular eczema is not classified as an autoimmune disease. Autoimmune diseases occur when the immune system attacks the body’s healthy tissues. In papular eczema, the immune system responds to external triggers.

Age and Gender

Papular eczema can affect people of any age, but it is more common in children. Many kids develop eczema in infancy or early childhood. It may persist into adulthood. In some cases, symptoms can improve with age. 

Women may also be slightly more prone to eczema than men.

Race and Ethnicity

Eczema affects people of all races and ethnicities, but it appears to be more common in African Americans. Certain racial and ethnic groups may experience more severe symptoms or flare-ups.

Stress and Infections

Stress doesn’t directly cause papular eczema, but it can worsen the condition. 

When you're stressed, your body produces hormones like cortisol. This hormone can affect your immune system and make it more reactive. It can lead to more frequent or severe flare-ups. 

Additionally, infections, such as bacterial or viral infections, can irritate the skin and trigger eczema symptoms.

Diagnosis and Tests

Diagnosing papular eczema usually involves a physical examination of the skin and patch testing.

Physical Examination

During a physical exam, a dermatologist will check for signs like small, raised bumps, redness, and dryness. They will also ask about your family history of eczema, allergies, or asthma, as these conditions often run in families and can help with diagnosis.

In some cases, they may perform a skin biopsy, where a small sample of skin is taken to rule out other conditions, such as fungal infections or psoriasis.

Patch Testing

If a doctor suspects that allergens may trigger your eczema, they might recommend patch testing. This test involves applying small amounts of potential allergens to your skin. After a few days, your doctor will check for any allergic reactions. 

Patch testing helps identify specific triggers, such as certain soaps, metals, or chemicals.

Differential Diagnosis

Differentiating papular eczema from other skin conditions is crucial for accurate treatment. A careful evaluation of symptoms and comparison with other conditions can help identify the right diagnosis.

• Psoriasis: Psoriasis often causes thick, scaly patches. They are different from the small bumps of papular eczema. Psoriasis patches also have a silvery scale on top, something not seen in papular eczema.
• Folliculitis: Folliculitis causes small, raised bumps that are usually found around hair follicles. These bumps often have a pus-filled center. Papular eczema doesn't form around hair follicles and doesn’t have pus.
• Scabies: Scabies causes intense itching, small red bumps, and blisters. A key difference is that scabies has burrows made by mites, which are not found in papular eczema.
• Contact Dermatitis: Contact dermatitis can cause red, itchy bumps like papular eczema. However, these bumps appear only in areas exposed to the allergen or irritant. Also, the bumps often go away once the irritant is removed.

How Is Papular Eczema Treated?

There is no cure for papular eczema, but you can manage this condition and prevent flare-ups.

Home Remedies

Several home remedies can help soothe papular eczema and prevent flare-ups:

• Keeping your skin hydrated is one of the best ways to manage eczema. Use a gentle, fragrance-free moisturizer to lock in moisture and prevent dryness.
• Switch to gentle, fragrance-free products to reduce irritation. Harsh chemicals can strip the skin of natural oils, making eczema worse.
• Adding colloidal oatmeal to a warm bath can soothe irritated skin and reduce itching. Avoid hot water, as it can dry out your skin.
• Keep baths and showers to 10 minutes or less, and use lukewarm water. This helps prevent your skin from drying out and becoming more irritated.
• Aloe vera gel can help cool the skin and reduce inflammation, which helps with itching.
• Apply coconut oil on affected areas to help lock in moisture and soothe dry, irritated skin.
• A cold compress can help reduce itching and inflammation, especially during flare-ups.
• Choose clothing made of breathable fabrics like cotton to avoid irritating your skin.

Professional Treatment

If your symptoms are severe or don’t improve with over-the-counter treatments, a doctor may recommend prescription medications. Common professional treatments include:

• Topical Steroids: These are applied directly to the skin to reduce inflammation and itching. They help to calm the affected areas and reduce redness.
• Antihistamines: If itching is a major problem, antihistamines may reduce your body’s allergic reaction.
• Antibiotics: If your eczema becomes infected, a doctor may prescribe antibiotics to clear up the infection and prevent further complications.
• Phototherapy: For severe cases of eczema, phototherapy (light therapy) may be recommended. This involves exposing the skin to controlled amounts of natural or artificial UV light to reduce inflammation and improve symptoms.

Tips for Parents

If your child has papular eczema, these tips can help:

• Apply a gentle moisturizer several times a day, especially after bathing.
• Choose baby soaps and shampoos that are free of dyes and fragrances to reduce skin irritation.
• This helps prevent scratching, which can break the skin and lead to infections.
• Soft, cotton clothing is best to avoid friction and irritation on the skin.

How Can You Prevent Papular Eczema?

It is impossible to prevent the development of eczema, but it is possible to reduce the number of flare-ups.

Avoid Common Triggers

To prevent flare-ups, it's important to identify and avoid common triggers like allergens and irritants. 

Minimize exposure to dust mites, pet dander, pollen, and mold through regular cleaning. 

Use gentle, fragrance-free products. Avoid harsh soaps or detergents that can irritate your skin. 

Wearing soft, breathable fabrics like cotton can also help, while rough materials like wool should be avoided to reduce itching.

Protect Your Skin from Weather

In the winter, use a humidifier indoors and wear protective clothing outdoors. 

In the summer, avoid overheating and sweating, as this can also trigger symptoms. 

Always moisturize after being in the sun or cold weather.

Manage Stress

Try relaxation techniques like deep breathing, yoga, or meditation to reduce stress levels. Keeping stress under control may help prevent flare-ups.

How Does Eczema Affect Mental Health?

Papular eczema doesn’t just affect your skin; it can impact your emotional health too. The visible bumps and constant itching often lead to frustration and embarrassment, especially when flare-ups occur in noticeable areas like the face or hands.

Self-image is a major concern for many people with eczema. They may feel self-conscious about their appearance, which can affect their confidence. This can influence both personal and professional relationships, making social interactions more difficult.

Bullying is another issue, particularly for children. Kids with eczema may face bullying at school. It can lower their self-esteem and make them feel isolated. 

Adults with eczema may also experience bullying in the workplace or in social settings. 

Seeking therapy or promoting open discussions in schools and workplaces can provide support and help create a sense of belonging.

Sleep problems are common for people with eczema. The severe itching makes it hard to sleep, which affects both physical and mental health. Lack of sleep can reduce concentration and impact the quality of work and daily activities.

Eczema’s emotional toll is real. Managing both the physical and psychological aspects is key. 

Relaxation techniques, such as deep breathing, yoga, or meditation, can help reduce stress, which may lead to fewer flare-ups. 

Staying involved in hobbies or spending time with supportive friends and family can improve your mood and help you feel more in control. 

If feelings of anxiety or depression become overwhelming, seeking help from a healthcare professional or therapist can provide valuable support.