Eczema

Irritated, itchy, dry skin is something that all of us experience from time to time. But for some people, it’s more than feeling like every ounce of moisture has been sucked out of your skin—it’s actually eczema, a condition that affects more than 31 million people in the U.S (with 9.6 million of those being children), according to the National Eczema Association.

Eczema, also referred to broadly as atopic dermatitis, is a condition that often starts as itching or irritation and then progresses to inflammation and a subsequent rash. “There are many different presentations of eczema, and each can look a little bit different,” Mio Nakamura, M.D., an assistant professor of dermatology at the University of Michigan Health, tells SELF. According to the National Eczema Society, in lighter skin tones, it may look pink or red; in deeper skin tones, it may appear brown, purple, or gray. There is often some scaling and a rough texture as well.

Eczema can have effects that go beyond the skin too. According to a 2019 study published in the Annals of Allergy, Asthma, and Immunology, people with eczema report lower quality of life due to the impact their skin has on things like sleep, social interactions, and day-to-day life. In addition, untreated eczema has been linked to an increased risk of infections, other inflammatory conditions (like asthma), and depression.¹

Since eczema can have such an impact on your overall health, it’s important to know the signs and symptoms to get the proper diagnosis and treatment.

There are many different presentations of eczema, and each can look a little bit different.

Amanda K Bailey

Like most diseases, there is not one sole cause of eczema. The current hypothesis among experts is that it’s rooted in an overactive immune response reacting to a stimulus in the skin. This happens in people with either a disrupted skin microbiome (the mix of organisms that exist on the skin) or because of a physical skin barrier deficiency, or sometimes both. Genetic factors play a role in inheriting tendencies toward an overactive immune system as well as developing an abnormal physical barrier. Environmental triggers such as chemicals, climate, smoke, and allergens may then trigger a flare of eczema in people that are prone to this condition. Internal stress is also a common cause of a flare, according to the Cleveland Clinic.

Your immune system is supposed to keep your body in balance by reacting to foreign microorganisms. In people with eczema, the local and systemic immune systems are triggered by irritants and allergens on the skin that often do not trigger reactions in people without the predisposition for eczema.

Genetics also seem to play a big role in the increased risk of developing eczema. “Many people with eczema, though not all, will have at least one family member with a history of eczema, asthma, or allergies,” Kari Martin, M.D., associate professor of dermatology and child health, residency program director of dermatology, and co–medical director of dermatology clinics at the University of Missouri Health Care-Columbia, tells SELF. “If you are genetically predisposed to have eczema, there are several triggers that can cause a flare of the skin.”

“Eczema is linked to environmental allergies, food allergies, and asthma,” among other factors, adds Dr. Nakamura. “Atopic dermatitis and food allergy typically start in infancy and early childhood, while asthma often starts in late childhood and environmental allergies usually start in adolescence.”

According to Dr. Nakamura, the link between allergy-related eczema, allergic asthma, and allergies is so strong that experts actually have a name for this phenomenon: the “atopic march.”² In fact, the National Institute of Allergy and Infectious Diseases (NIAID) explains that roughly 30% of children who have eczema also have food allergies. And many of these children will continue to develop other co-occurring conditions, such as respiratory allergies and allergic asthma. Although food allergies can definitely coexist in people with eczema, there is controversy about it as a cause for eczema, especially in children, so always check in with your doctor before eliminating a type of food from a child’s diet.

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The term eczema can commonly be used to represent many forms of dermatitis, not just atopic dermatitis. Dermatitis simply means inflammation of the skin. The most common form of eczema known as atopic dermatitis most often looks like dry, inflamed patches of skin that are very itchy, Dr. Nakamura explains. Generally, this is what most people refer to when they say “eczema”—but she notes that other forms of eczema do present differently from the typical features of atopic dermatitis.

According to the American Academy of Dermatology Association (AAD), these are the other types of eczema:

• Allergic contact dermatitis is often inflamed and very itchy and develops after encountering a substance that causes an allergic reaction in the skin. A good tip for diagnosing allergic contact dermatitis is that usually the rash, which can progress to blisters (if intense enough), will be on the part of the body that is experiencing the skin exposure. This is more common in people with atopic dermatitis.
• Irritant contact dermatitis is often seen on dry, sometimes, fissured skin. This rash occurs when too much of an irritant, usually a chemical, penetrates the skin. Again, this usually occurs on the part of the body where the irritant touched the skin. This can occur in people without atopic dermatitis if the skin barrier is physically disrupted.
• Dyshidrotic eczema, also called pompholyx, is a type of eczema that presents with itchy blisters on the sides of the fingers and toes. It’s not entirely clear what causes this type of eczema, but can be set off by allergic reactions to things like nickel, or nonallergic triggers like stress.
• Hand eczema is eczema that is specifically on the hands (both palms and backs). This condition is often the result of multiple causes. Often, the hands are cracked with fissures and splits. This can be triggered by irritant or allergic contact dermatitis, or be a symptom of atopic dermatitis. Given that hand eczema can be the result of multiple causes, it can be difficult to treat.
• Nummular eczema is a type of eczema that is distinguished by slightly scaly plaques that are often not itchy. Extremely dry skin is the most common trigger.

To confuse the matter even further, because eczema shares multiple symptoms with other skin conditions, it can sometimes be hard to narrow down an eczema diagnosis—especially when the symptoms may appear similar to psoriasis, which is an autoimmune disease.

“Chronic eczema can become very thick and scaly and can start to look like psoriasis, a different skin condition that presents as very well-defined pink-to-reddened plaques with characteristically thick, silvery scales,” says Dr. Nakamura.

However, there are a few distinguishing features that can help you and your doctor identify whether new or developing symptoms are from eczema versus psoriasis, she explains. Aside from the visual differences, psoriasis is often seen on the elbows and knees, while eczema typically pops up in the crooks of these areas. In addition, psoriasis may cause mild itching, while eczema itching is usually more intense.

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