First steps to consider
- Mild eczema can be treated at home.
- Using heavy-duty moisturizers and oil-based emollient can keep skin hydrated
- Figuring out your triggers can prevent flare-ups
When you may need a provider
- Eczema is moderate to severe
- OTC products aren’t helping
Call 911 or go to the ER if you have any of the following symptoms:
- Your eczema is painful, swells, or there’s a lot of drainage or crusting of the area.
- You have severe and full-body eczema.
What is eczema?
Eczema is a chronic skin condition that causes itchy, red, inflamed skin. It’s also called atopic dermatitis or eczematous dermatitis. It is not contagious.
Eczema is very common and affects people of all ages. It is often associated with asthma and seasonal allergies.
While it can occur anywhere on the body, it typically develops on the inside of the elbows and knees, the wrists, and around the eyes. It can be uncomfortable and very itchy.
For most people who have eczema the rash will come and go throughout their life. Over time it can make skin feel rough and appear thicker or darker or lighter. During flares, it increases your risk for skin infections.
Most common symptoms
Some people think atopic dermatitis is a mild condition that rarely needs treatment. While it is true that some people have very mild disease that improves quickly with better skin care, for others atopic dermatitis is debilitating and requires systemic treatment. —Dr. Mollie MacCormack
The main symptom is itchy skin. It may be worse at night. The rash will usually act up, heal with appropriate skin care, go away, and then come back again.
Sometimes, the itching starts first. After scratching, you may notice small red bumps. These might be filled with fluid.
Sometimes the bumps might group together and look like one big plaque. You will probably have red and dry skin. If you keep scratching, clear fluid or blood might drain and the area can become crusted.
Even after the bumps go away, your skin might feel rough, thicker (lichenified), or look darker or lighter.
The itch of atopic dermatitis is often described as severe and at times nearly unbearable. It can often interfere with sleep.
- Intense itching.
- At first, the rash often consists of small red bumps, sometimes grouped together and possibly filled with fluid.
- After scratching, bumps may ooze, bleed, and scab.
- As it heals, skin may thicken, darken, develop increased skin markings and dryness.
Other symptoms you may have
Sometimes an eczema flare can become more serious.
- Superinfections occur when an open wound from an eczema flare becomes infected. It’s usually a bacterial infection. The eczema becomes more painful, the bumps become crusted over, or start to drain.
- Severe or full-body eczema can develop into a condition called erythroderma. Erythroderma can cause severe distress and dehydration. It may require hospitalization.
What makes you more likely to have eczema?
If anyone in your family—a parent or a sibling—has eczema, you’re more likely to get it. Also, if you had it before, you’re more likely to get it again.
Eczema is linked to many other health problems, including asthma and allergies that cause a runny nose, sneezing.
Dyshidrotic eczema is a form of disease that presents with intensely itchy blisters, most often on the palms/soles and edges of the fingers and toes. This form of eczema is seen most often in patients ranging in age from 20 to 40. —Dr. MacCormack
If you think you have eczema, see a dermatologist. They can help treat it and can also suggest long-term treatments and lifestyle changes to keep it from coming back again.
If your eczema is painful, swells, or there’s a lot of drainage or crusting of the area, it might be superinfected. See your doctor immediately or go to urgent care.
If you think you have severe and bodywide eczema and think you have erythroderma, go to the emergency room immediately.
Eczema in children
Eczema looks and acts the same for kids and adults. However, it often shows up in different parts of the body in different age groups.
- Less than 2 years old: Rash is most likely on cheeks and face, forehead, head, and the outside of their arms and legs.
- 2 to 12 years old: Rash most likely on inside of elbows, back of knees, wrists, ankles, hands, feet, neck, and around the eyes and mouth
- 13 years and older: Rash most likely on cheeks and face, forehead, head, and the outside of arms and legs. It's more likely to return to some of the same areas.
What is the main cause of eczema?
It is not known why some people get eczema. It seems to be caused by a combination of factors including abnormalities in skin structure, altered immune response, and maybe even abnormalities in the skin microbiome (the bacteria that normally live on the skin).
People with eczema are less likely to have “filaggrin” proteins, which usually help keep moisture in your skin. Other structural abnormalities have also been identified.
Certain irritants may cause a flare. This can include the weather, low humidity, new make-up, fabrics, or food.
Some ways to help keep it under control: maintaining good skin hydration and moisturization, avoiding known triggers such as contact allergens, and initiating medical therapy at the earliest sign of a flare. —Dr. MacCormack
There are two parts to treating eczema. First, you want to clear it up. Then you want to help keep it from happening again.
Some ways to treat active eczema:
- Topical corticosteroids (steroid) come in a variety of strengths and formulas. Ointments usually work best. Hydrocortisone can be bought over-the-counter and is not as strong as what your doctor may prescribe.
- After you put on the topical steroid, warm, wet compresses can help soothe eczema.
- Topical calcineurin inhibitors are non-steroidal creams for soothing eczema on sensitive areas, like the face.
- Taking antihistamines may make you less itchy.
- Thick moisturizing creams and ointments can help.
- Antibiotics may be prescribed if you have a superinfection.
Some ways to lower the chances of flare-ups:
- Make lifestyle changes like moisturizing daily and avoiding hot showers and baths.
- Rub on a weaker corticosteroid or topical calcineurin inhibitor several times per week where you usually get the rash, especially if you think symptoms are starting to develop.
- Antihistamines can help decrease the urge to itch.
- For more severe disease, ask your doctor about immunological therapies. These are new medications that may help with eczema.
If eczema is widespread (erythroderma), your doctor might want to treat your whole body. They include ultraviolet phototherapy and immunosuppressive drugs. Most people will never need these treatments.
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Besides using preventative medications, there are other ways to stop eczema flare-ups.
- Moisturize daily with a thick ointment or cream (instead of a lotion). Look for a formula that has ceramides in it. And apply right after showering while skin is still damp.
- Do not take hot baths or showers. They can irritate the skin.
- Consider switching to a hypoallergenic laundry detergent as people with eczema are at increased risk for developing allergic contact dermatitis.
- While the role of food allergy is unclear, if you do have a known food allergy, you should avoid that food.
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