Causes, Signs, and Access to Care

Eczema is a group of seven skin conditions in which areas of skin become itchy, dry, and inflamed. Atomic dermatitis is the most common type of eczema.

People with eczema may develop scaly patches of skin, a blister-like rash, oozing, or swelling. Scratching or rubbing the affected area may make it worse.

Most of the time, a person develops eczema as a young child, typically by the age of 5. However, people can develop eczema at older ages as well.

It’s still unknown what exactly causes eczema. Various genetic, environmental, and immune factors likely play a role.

What is known is that people with eczema have changes in the skin barrier that reduce the amount of moisture that can be retained, leading to very dry skin. This makes the skin more susceptible to react to various triggers, such as:

• dry air
• cold temperatures
• hormonal changes, such as during the menstrual cycle and pregnancy
• stress
• food allergies, such as allergies to peanuts, eggs, or seafood
• exposure to known allergens, such as pollen, mold, pet dander, dust mites, chemicals, and fragrances
• certain types of skin care products
• scented soaps or detergents
• clothing materials like wool or synthetic fabrics

Eczema is characterized by patches of skin that are dry and itchy. When scratched or rubbed, the affected area will appear scaly, look inflamed, and feel warm to the touch.

Although eczema can affect any part of the body, some areas are more common, such as the:

• hands or feet
• insides of the elbows
• backs of the knees
• wrists or ankles
• eyelids
• creases between the buttocks and legs
• cheeks or scalp (in infants)

Skin inflammation can also appear differently depending on skin tone. For example, in lighter skin tones, eczema may appear pink or red. In darker skin tones, it may look:

• ashen gray
• purple
• dark brown
• lighter, dry areas

It’s also possible for people with eczema to experience flare-ups. This is a period of time in which eczema symptoms become more severe. In some people, flare-ups can occur as often as two or three times per month.

Eczema symptoms can significantly impact a person’s quality of life. For example, itching can disrupt your daily activities or sleep. People with eczema may have other conditions, too, such as asthma and allergies.

Additionally, scratching or picking at inflamed areas can lead to complications like:

A dermatologist typically diagnoses eczema. This type of doctor specializes in diagnosing and treating health conditions that affect the skin.

Your dermatologist will start by examining your skin and getting your medical history. During this time, they’ll ask about things like:

• when your symptoms started and how often they occur
• where on your body symptoms occur (particularly if you have clear skin during your visit)
• how the rash feels, such as whether it itches or hurts
• whether certain things make your symptoms better or worse
• if you have a family history of conditions like eczema, allergies, or asthma
• any other underlying health conditions you may have
• what types of medications or supplements you’re taking

Many times, your dermatologist can diagnose eczema using your medical history and doing a skin exam. In some cases, they will want to collect a skin biopsy as a part of the diagnostic process.

To collect the biopsy, your dermatologist will numb an area of the skin using localized anesthesia to reduce discomfort and pain. They’ll then use a small, sharp tool to remove a small sample of skin that will then be examined under a microscope. The skin biopsy is often sent to a person who specializes in skin pathology called a dermatopathologist.

There’s no current cure for eczema, but it can be managed. Several eczema treatment options can help reduce symptoms and improve quality of life. Treatment recommendations are similar across racial and ethnic groups.

Generally, treatment options for eczema can be broken down into lifestyle changes and medications.

Lifestyle changes

There are many things you can do at home to help prevent or ease eczema symptoms:

• Frequently apply a fragrance-free moisturizer to your skin, especially after bathing. Ointments or creams may be better if you have atopic dermatitis.
• Reduce bathing time to 5 to 10 minutes. Only use gentle, unscented cleanser no more than once daily.
• Gently pat skin to dry it; do not rub skin.
• Avoid your known eczema triggers whenever possible, such as certain foods, soaps, or fabrics.
• Avoid tight-fitting clothing that can irritate skin.
• Do not pick or scratch at inflamed patches of skin, as this may lead to pigmentation changes, skin thickening, or an infection.
• Use an over-the-counter (OTC) corticosteroid cream, such as hydrocortisone, to reduce itching and swelling.
• Try taking OTC antihistamines, which may help alleviate itching.
• Take a bleach bath under the direction of your dermatologist.
• Avoid herbal products, as these may irritate an eczema flare-up.

Medications

If OTC products aren’t effective at easing your eczema symptoms, your dermatologist may prescribe a topical anti-inflammatory medication. Some examples include:

• a prescription corticosteroid cream
• a calcineurin inhibitor, such as pimecrolimus cream (Elidel) or tacrolimus ointment (Protopic)
• crisaborole ointment (Eucrisa)

In some cases, your dermatologist may prescribe oral corticosteroids. Due to their potential side effects, oral corticosteroids are typically only taken for a short time. An example of when they may be used is during a severe eczema flare-up.

Some people with eczema may need a systemic medication that suppresses the immune system, such as:

• JAK inhibitors, like abrocitinib (Cibinqo)
• cyclosporine
• methotrexate
• mycophenolate (Cellcept)
• azathioprine
• biologics

Skin infections can be common in people with eczema, typically from scratching or picking at the affected area. If you develop a skin infection, your dermatologist can prescribe antibiotics to treat it.

While not a medication, phototherapy may also be used for eczema. In phototherapy, your skin is exposed to a controlled amount of ultraviolet light (UV) light two to three times per week. Phototherapy can help reduce itching and inflammation.

Two big risk factors for eczema are a family history of eczema and environmental exposures.

Atopic dermatitis, the most common type of eczema, is associated with a hyperactive immune system. It’s often accompanied by asthma and allergies.

Eczema often develops in people who have a personal history of other atopic conditions. Additionally, if you have a close relative, such as a parent or sibling, with an atopic condition, you may also have an increased risk as well.

Environmental exposures may also play a role in eczema risk. For example, if you’re already predisposed toward eczema, coming into frequent contact with one or more eczema triggers could cause the condition to develop.

Other environmental exposures that may trigger eczema include:

• tobacco smoke
• pollution
• fragrance in many skin care products and laundry detergents
• wool clothing

Although further studies are needed, some research has found that the factors influencing eczema risk may vary based on race or ethnicity. A 2016 study found that:

• eczema was less common in Hispanic children than in white children
• the impact of parental history of atopic conditions or eczema was greater in Hispanic children than in white children
• certain environmental exposures affected these two groups differently, suggesting differences in the mechanism behind eczema development. Specifically, exposure to mold or mildew increased the risk of eczema in:
  • white children with a parental history of atopic conditions
  • Hispanic children without a parental history of atopic conditions

It’s possible that eczema may improve over time in some children. However, it’s also possible for the condition to persist into adolescence and adulthood.

Studies describing the effectiveness of eczema treatments in various racial and ethnic groups are also still limited. A 2012 review of 645 clinical trials for eczema found that only 59.5% of the trials included information about race or ethnicity.

When this information was included, Hispanic people were only 2% of the participant population for the reviewed trials.

Additionally, few trials (10.3%) have commented on race or ethnicity while discussing and interpreting their results.

Although there’s currently no cure for eczema, seeking treatment can go a long way in reducing symptoms and improving quality of life. That’s why it’s very important to find a dermatologist if you suspect that you have eczema.

While eczema is less common in Hispanic people, it can also be more severe or persistent in this group.

Additionally, some research has found that Hispanic children are more likely to seek care or miss school due to eczema.

Eczema treatment is the same across racial and ethnic groups. It generally involves lifestyle changes and medications.

Because treatment can improve symptoms and quality of life, be sure to talk with a dermatologist if you think you have eczema.