Eczema is a general term for a group of dermatitis conditions that causes skin to become inflamed, itchy and red. Eczema usually starts in childhood, but it can occur at any age, and presents with occasional eczema flare-ups.
Causes of eczema, and triggers for eczema flare-ups
We don’t understand the exact cause of eczema, but we do know that people with eczema have a combination of genetic causes and environmental triggers:
- The immune system incorrectly reacts to an irritant or an allergen, causing the skin cells to develop an eczema flare-up. Faults in the filaggrin gene cause moderate to severe eczema in up to a third of people of north European and eastern Asian descent.
- Possible environmental triggers/allergens include soaps, detergents, house dust mites, pollens, animal dander and some bacteria that contain protease proteins.
- Emotional stress. Stress, including anger and frustration, is a proven trigger and can worsen symptoms.
- Foods. If you are allergic to certain foods, eating them may cause an eczema flare.
- Inhaled allergens. Some typical allergens are animal dander, house dust mites and pollen.
- Irritants. These include chemicals, soaps, detergents, fragrances, certain fabrics and smoke.
Each form of eczema, including atopic dermatitis, has slightly different triggers, symptoms and treatments, so it’s important to know which type of eczema you have.
Signs and symptoms of eczema
(and when to see your primary care provider)
The signs and symptoms vary based on the specific type of eczema, but eczema usually causes an itchy rash. The itchiness is usually mild to moderate, but in some cases it can become serious and you might develop extremely inflamed skin.
Common symptoms of eczema
According to the National Eczema Association, common symptoms include:
- Dry, sensitive skin.
- Red, inflamed skin.
- Very bad itching.
- Discolored patches of skin.
- Rough, leathery or scaly patches of skin.
- Oozing or crusting.
- Areas of swelling.
Your primary care provider can help
You might have eczema flare-ups or your symptoms could go away entirely. The only way to know for sure if you have eczema is to see your primary care provider.
You should see your provider right away if you or your child:
- Continues to experience symptoms despite trying home remedies.
- Has a skin infection—symptoms include red streaks, pus and yellow scabs.
- Is having trouble with daily activities or sleep.
Get immediate medical attention for yourself or your child if either of you has a fever and the rash looks infected.
What's the difference between eczema and psoriasis?
Both eczema and psoriasis are common skin conditions in children. When you bring your child in for a diagnosis and treatment, your primary care provider or dermatologist will be able to tell the difference between eczema and psoriasis by evaluating your child’s skin, the amount of itching and where the disease appears.
- Eczema typically appears in the crooks of the knees and the elbows.
- Psoriasis causes well-defined, thick, red, scaly patches that typically appear on the face, buttocks and scalp of children.
Children who have psoriasis tend to have mild itching; with eczema, the itching is more intense. There can be overlap between eczema and psoriasis, and in some children, it’s difficult to tell the difference.
Treatment options for eczema
Your primary care provider or dermatologist will develop the best treatment plan for your or your child’s type of eczema. Treatment begins with avoiding any known triggers.
Your treatment plan may include:
- Allergy injections. Can help some patients with eczema, especially those with asthma and hay fever (allergic rhinitis). Allergy shots are not the same as steroid injections.
- Antihistamines. Sedative antihistamines can help you sleep at night.
- Biologic medicines. Anti-inflammatory medications that have been approved for other allergic diseases such as asthma, as well as for other skin conditions like psoriasis.
- Diluted bleach baths. Bathing in one-quarter to one-half cup of bleach mixed with 40 gallons of water once to twice weekly may help improve your rash and may decrease the need for antibiotics.
- Light therapy. Phototherapy exposes your skin to controlled amounts of natural sunlight. It is typically used for people who don’t get better with topical treatments or who rapidly flare again after treatment. Other forms use artificial ultraviolet A (UVA) and narrowband ultraviolet B (UVB) either alone or with medications.
- Stress relieving therapies. Biofeedback and other techniques may help with emotional stress, improve your mood and decrease your anxiety about your eczema.
- Therapies for associated infections. If you have an associated infection, your provider may prescribe an antibiotic.
- Topical moisturizers. Dry skin tends to worsen the itching and rash, so moisturizing your skin is critical part of eczema care.
- Topical steroids. Anti-inflammatory medications that you apply to the rash areas.
- Topical anti-inflammatory medications. If topical steroids are not effective, your provider may prescribe topical immunomodulators.
- Vitamins. If you have been diagnosed with vitamin D deficiency, your provider may prescribe vitamin D supplements.
- Wet wrap therapy. Usually recommended for severe and difficult to manage eczema. In this therapy, you soak your skin in warm water for about 20 minutes and then pat it dry. Then, you place topical medications on the rash areas of the skin and cover with a moist dressing, either gauze or clothing. You then wrap the area with dry material, such as an elastic bandage, pajamas or a sock. You keep the wrap on for 2–6 hours based on your provider’s recommendation.
For most types of eczema, you can manage flare-ups by:
- Avoiding your triggers.
- Starting a daily bathing and moisturizing routine.
- Using over-the-counter (OTC) creams and ointments, and prescription medication, consistently and as prescribed.
We will help relieve your symptoms so you can get back to work or school, and your favorite activities and social occasions, without worrying about your skin.
American Academy of Dermatology Association. Eczema Resource Center (https://www.aad.org/public/diseases/eczema)
National Institute of Allergy and Infectious Diseases (NIAID). Eczema (Atopic Dermatitis) (https://www.niaid.nih.gov/diseases-conditions/eczema-atopic-dermatitis)