The Facts About Eczema

As many as 31 million Americans, including an estimated 10 percent to 20 percent of infants, are affected by some form of eczema. However, most of these childhood cases significantly improve as the individuals grow older, with many outgrowing the condition.

Eczema can start at any age—from newborn to adulthood—and symptoms range in severity. It is a noncontagious, inflammatory dermatological condition, with itchiness proving the most prominent symptom. Other symptoms include dryness, rashes, blisters, scaly areas and infections. 

The condition is grouped under what is called the "atopic march," which involves a domino effect of diagnoses: Eczema makes its debut during infancy, food allergies come soon after and are followed by hay fever, known as allergic rhinitis, and finally, there's asthma. 

All of these afflictions are tied to inflammation.

There are several types of eczema, but the most common is atopic dermatitis, otherwise known as atopic eczema. 

Throughout the population, there are different causes, but the primary exacerbator is a genetic variation affecting the skin's durability, which consequently lessens its protection against harmful agents. When the skin barrier is weakened and/or depleted, the immune system—geared toward fighting off bodily threats—attempts to compensate by targeting impacted areas. This response is what causes the inflammation and skin ailments seen with atopic dermatitis such as the inability to retain moisture and ward off external threats.

There are seven types of eczema: 

• Atopic dermatitis
• Contact dermatitis
• Dyshidrotic eczema
• Neurodermatitis
• Nummular eczema
• Seborrheic dermatitis
• Stasis dermatitis 

Each type of eczema has its own triggers and symptomologies, but they do share commonalities such as redness, itching, dry/scaly skin and patches that are darker than others, known as hyperpigmentation. 

Many forms of eczema are triggered by direct contact with an irritant, but that isn't always the case. For example, stasis dermatitis occurs because liquids seep out of weak veins into the dermis, and seborrheic eczema often starts with stress that consequently impacts the sebaceous glands in hair follicles.

Doctors can usually make a diagnosis by simply observing your skin and asking about symptoms. Flare-up frequency, location, comorbidities, family history and triggers are covered during your first appointment. They will also likely bring up the atopic march—a medical term used to explain the natural history of atopic manifestations—to further pinpoint the exact type and stage of eczema. 

If things aren't so clear, doctors can perform skin and blood tests to narrow the cause of dermatological issues.

Eczema is caused by both environmental and genetic factors. People with a family history of allergic conditions, specifically the atopic march, are at an elevated risk of eczema development. Research has suggested a link between eczema and filaggrin, a protein in the skin designed for moisture maintenance, which, if deficient, can lead to dry skin, a typical eczema symptom.

Stress and exposure to certain environmental substances can also bring on an eczematic flare-up. Many of these substances are encountered in daily life: personal care products, cleaning supplies and various textiles and materials, for instance.

There is a broad spectrum of eczema symptomology. The disease manifests uniquely in strength and location, and complications are often mistaken for psoriasis, another skin-irritating condition. The inflamed areas of skin become itchy, sensitive, swollen, dry, discolored, crusted, and/or texturally disturbed; essentially, they're rough, leathery or scaly. In some cases, the areas ooze, weeping a clear or straw-colored liquid.

Eczema can appear anywhere but is particularly common in creases of the skin where friction is strongest. Flare-ups last from days to weeks, depending on type and severity. Sometimes the itchiness is so severe, people scratch until they bleed, known as the "itch-scratch cycle."

Though it is tricky to find an exact origin, researchers know eczema is caused by a conjoined effort between genetic predispositions and environmental conditions, which is the classic "nature and nurture" combination that causes the vast majority of health problems.

When the body's immune system detects an outside threat, it sends cells designed to neutralize it. However, the system is not without fault. Sometimes it perceives harmless stimuli as dangerous, which unnecessarily sends it into overdrive. If you have a predisposition for eczema and encounter any of the common triggers, its symptoms can manifest quickly.

Though it is tricky to find an exact origin, researchers know eczema is caused by a conjoined effort between genetic predispositions and environmental conditions, which is the classic "nature and nurture" combination that causes the vast majority of health problems.

When the body's immune system detects an outside threat, it sends cells designed to neutralize it. However, the system is not without fault. Sometimes it perceives harmless stimuli as dangerous, which unnecessarily sends it into overdrive. If you have a predisposition for eczema and encounter any of the common triggers, its symptoms can manifest quickly.

There isn't an area of the body not impacted by hormones and their fluctuations, including skin. Research suggests stress hormones and sex hormones have the biggest impact on dermatological inflammation, the kind you get with eczema. Stress produces the hormones adrenaline and cortisol, and they increase inflammation in the entire body.

The male sex androgen hormone—testosterone—tends to suppress eczematic reactions around the time of puberty. Female sex hormones—estrogen and progesterone—have the opposite effect because they cause increased excitability of skin barrier cells, though there are exceptions.

Women undergo serious hormonal fluctuations during both pregnancy and menstruation, and this variance is known to exacerbate eczema and atopic dermatitis symptoms. The hormones with the greatest impact are estrogen and progesterone, which increase during pregnancy and vary during menstruation. During gestation, the inconsistency in levels reduces the skin's protection against water depletion, potentially causing itchy, dry or peeling skin. However, some women have the opposite experience. 

Menstruation has also been linked to an increase in dermatological ailments. This is mainly due to a drop in estrogen and progesterone, which subsequently reduces elasticity and hydration, making skin vulnerable to eczema triggers.

Dermatitis and eczema can appear anywhere on the skin, and female and male genitalia are no exception. 

Males can develop penile eczema, while women get vulvar dermatitis. These afflictions present the same itchy, red skin as eczema/dermatitis on the rest of the body, only they are localized to the genitals.

A possible contributing factor to penile eczema is being uncircumcised because the crevices in the foreskin trap heat and moisture, which leads to itchiness or redness that can stretch as far as the scrotum. Vulvar dermatitis has similar origins because of the folds of skin around the vaginal opening.

Eczema can create barriers to dating. Physical attraction is a strong factor in the selection of a partner. Some skin conditions can lead to self-consciousness and an unwillingness to enter the dating world.

If you have eczema and are preparing to date, your most important strategy is to accept yourself as you are.

Current investigations into eczema are focused on several topics. 

Scientists are on the lookout for genes besides filaggrin (the FLG gene) that are connected to eczema. In 2021 alone, researchers discovered a whopping 118 other genes that affect both eczema and psoriasis, another common skin condition. Determining problematic genes will be pivotal for symptom management in the future.

Another advancement is the introduction of dupilumab (brand name Dupixent), a monoclonal antibody drug. This drug is administered as an injection that attacks eczema beneath the surface to repress inflammation. Other similar drugs are still in development, but the results appear positive.

Depending on your demographics and symptoms, treatment for eczema is varied. Your doctor can prescribe topical corticosteroid creams and moisturizers to soothe the skin and ease discomfort, but you can also take over-the-counter antihistamines. Alternative remedies, such as cryotherapy, acupuncture, medical-grade honey and bleach baths, have eased some people's symptoms, although you should discuss any such treatments with your healthcare provider first.

If you have contact dermatitis, it is pivotal to avoid known allergic triggers or allergens. For more advanced cases, immunosuppressants, injections and phototherapies have shown some positive rates of success.

No matter how severe the symptoms are or what type you have, eczema is an incurable, chronic condition that should be taken seriously. It's important to identify your specific triggers and work closely with a general practitioner and/or dermatologist to find the right course of treatment.

What causes eczema?

Eczema is caused by both genetic and environmental components. Poor skin barrier function is a prime risk factor because it allows for easier irritation. When the immune system response is activated, it sends cells to protect the body. But with eczema, it mistakes a harmless stimulus as a threat.

How do I get rid of eczema?

Topical corticosteroid creams and moisturizers can be prescribed by your doctor to soothe skin and ease discomfort, but you can also take over-the-counter antihistamines. Homeopathic remedies have shown moderate rates of success, but should be used only with the express approval of your doctor. Avoid allergens if you have contact-based eczema. Extreme cases may necessitate immunosuppressants, injections or phototherapy.

What is the most common symptom of eczema?

The most common symptom of eczema is itchy skin. The affected area can be red, sensitive, swollen, dry, discolored, crusted and/or texturally disturbed; that is, it's rough, leathery or scaly. In some cases, fluid may ooze from the area, and frequent rough scratching can lead to bleeding, ulcers and infections.