Eczema, also known as atopic dermatitis, is an extremely common skin condition that affects people of all ages. It mainly shows as dry, itchy, angry skin that can cause pain and even significantly disrupt daily life. Despite how common it is, eczema still has no cure. For many people, the realistic goal is to manage and improve the symptoms. This article takes a deep dive into what eczema is and its different types. It also covers the causes, triggers, symptoms and the treatment options that work best.
What is Eczema?
Eczema is a chronic inflammatory skin disorder that usually appears as patches of dry, red and itchy skin. It normally develops in childhood but can start at any age. It tends to follow a relapsing-remitting course, with periods of flares and remissions. Despite affecting around 20% of children and 10% of adults worldwide, the exact cause is still unknown.
What research does show is that the condition arises from a complex interplay of genetic predisposition, immune system dysfunction and environmental triggers. Together these weaken the skin barrier, which leaves the skin more vulnerable to irritants, allergens and water loss. That barrier damage is what drives the characteristic dryness, inflammation and itching.
What Causes Eczema?
Understanding the underlying causes helps target both treatment and prevention. Eczema is complex and rarely has a single cause. The scientific consensus is that it results from a combination of the factors below.
- Genetics: A key factor is genetic predisposition. Studies have identified mutations in the filaggrin gene, which plays a crucial role in maintaining the skin’s protective barrier. People with weaker barriers are more prone to water loss, irritation and sensitivity to allergens. Eczema also runs in families and is commonly associated with asthma and hay fever, together known as the atopic triad.
- Immune system dysfunction: People with eczema often have an overactive immune response. Instead of reacting only to genuine threats, the immune system attacks harmless substances by mistake. This triggers chronic inflammation, redness and itching, and further damages the skin barrier.
- Environmental irritants and allergens: Everyday substances can trigger flare-ups by irritating the skin or causing an allergic reaction. Common irritants include harsh soaps, detergents, synthetic fabrics and air pollution. Allergens like pollen, dust mites, mould and pet dander can also set off immune reactions.
- Climate and weather: Sudden weather changes can worsen eczema. Cold, dry air strips moisture from the skin, whilst heat and humidity cause sweating that irritates it. As a result, symptoms often fluctuate with the seasons.
- Stress and emotional factors: Psychological stress is a known trigger. Stress releases hormones like cortisol that weaken the barrier and raise inflammation, which highlights the link between mental health and skin health.
- Hormonal changes: Shifts in hormone levels during puberty, pregnancy and menopause can worsen symptoms. Some women find their eczema flares before their period, and it can also change during pregnancy and menopause.
- Dietary factors: Diet alone does not cause eczema, but certain foods may act as triggers for some people. Dairy, eggs, nuts and gluten have been linked to worsening symptoms. A food diary kept under medical guidance can help identify whether diet plays a part.
What are the Different Types of Eczema?
Eczema is really an umbrella term for several inflammatory skin conditions. They share features like itching, redness and irritation, but each type has its own triggers and pattern.
- Atopic dermatitis: This is the most common and chronic form, often developing in childhood and linked to genetic predisposition. It runs in families with asthma, hay fever or allergies. It shows as dry, scaly red patches that can crack and are super itchy. These are typically on the face, neck, hands and the folds of the elbows and knees.
- Contact dermatitis: Caused by direct contact with an irritant or allergen, this type produces a localised rash. It splits into two forms. Irritant contact dermatitis comes from substances like detergents, whilst allergic contact dermatitis is triggered by allergens such as nickel, latex or fragrance. The rash appears where the skin met the trigger.
- Dyshidrotic eczema: This type mainly affects the hands and feet, causing small, very itchy, fluid-filled blisters. It is more common in warmer months and is often linked to sweating or moisture. Triggers include stress, metal allergies and humidity.
- Nummular eczema: Also known as discoid eczema, this shows as coin-shaped patches of irritated skin that can be red, dry, cracked or weepy. It is more common in adults with dry skin and tends to appear on the arms, legs and torso. Triggers include cold weather and skin injuries.
- Seborrhoeic dermatitis: This affects oily areas like the scalp, face, upper chest and back. It is linked to an excess in growth of the Malassezia yeast that naturally lives on the skin. Seborrhoeic dermatitis causes greasy yellow scales, flaking and redness. It commonly shows as dandruff on the scalp or irritation around the nose and eyebrows.
- Stasis dermatitis: Caused by poor circulation, this “venous eczema” appears on the lower legs and ankles where blood pools due to weak veins. Stasis dermatitis leads to swelling, redness, itching and brown or purple dark patches on the skin. In severe cases open sores called venous ulcers.
What are the Symptoms of Eczema?
Eczema symptoms vary with the type, severity and individual triggers. All forms share some core features, whilst certain types add their own distinct signs.
- Itching: This is the main symptom of eczema. Often severe and persistent itching and the scratching it provokes further damages the barrier and raises the risk of infection and long-term thickening. It is particularly intense in atopic, dyshidrotic and nummular eczema, where it can disrupt sleep.
- Redness and inflammation: Affected areas turn red, swollen and warm from the immune response. This is most common in atopic dermatitis, contact dermatitis and seborrhoeic dermatitis.
- Dryness and scaling: Skin appears dry, rough and flaky because a damaged barrier cannot hold moisture. This is a key feature of atopic dermatitis, nummular eczema and stasis dermatitis, where the skin may also crack.
- Blisters or weeping lesions: In some forms, fluid-filled blisters develop, burst and crust over. This is especially seen in dyshidrotic eczema on the hands and feet, and in nummular eczema where patches can turn weepy and infected.
- Thickened, leathery skin: Chronic scratching can lead to thick, leathery skin, a process called lichenification. It is common in atopic dermatitis, where prolonged irritation deepens skin lines and darkens patches in folds like the elbows and knees.
- Oily or greasy scaling: Seborrhoeic dermatitis causes greasy yellow flakes on the scalp, face and upper chest, alongside redness. Unlike other forms, this one stems from yeast overgrowth rather than dryness.
- Swelling and skin discolouration: Stasis dermatitis causes swollen legs and ankles, red-brown discolouration and, in severe cases, open venous ulcers.
How is Eczema Treated?
Managing eczema usually takes a multifaceted approach that combines skincare, lifestyle changes and medical treatment to control symptoms and prevent flares. There is no cure, but the right plan can significantly improve the skin and reduce discomfort, and care steps up by severity.
- Skincare routine: A daily hydrating routine is the foundation of eczema care. Regular moisturisers and emollients repair the barrier, prevent dryness and calm irritation. Choose fragrance-free, hypoallergenic creams or balms and cleanse with gentle products that do not strip the skin.
- Topical treatments: Prescription and over-the-counter creams reduce inflammation and itching. Corticosteroid creams control flares, whilst calcineurin inhibitors such as tacrolimus and pimecrolimus offer a steroid-free option for delicate areas like the face and eyelids. Antibacterial or antifungal creams help where infection is a problem.
- Systemic treatments: For severe eczema that does not respond to topical treatments, doctors may prescribe oral corticosteroids, immunosuppressants such as methotrexate or cyclosporine, or biologics like dupilumab. These target the immune system to reduce chronic inflammation and prevent recurrent flares.
- Phototherapy: Ultraviolet light therapy can help ongoing eczema that resists topical treatment. Narrowband UVB is the most common form and reduces inflammation and itching.
- Lifestyle: Identifying and avoiding personal triggers is central to reducing flares, whether that is irritants, allergens or extremes of temperature. Stress management techniques like meditation or yoga can help, and some people find that reducing dairy, gluten or processed foods improves their symptoms.
Eczema is a complex condition that needs a personal approach, so treatment should always be adjusted to the type and severity, triggers and your skin’s needs. To improve your chances of success, see a dermatologist early on, since they can confirm the type and build a treatment plan to keep your eczema under control.
City Skin Clinic, we an online clinic specialising in personalised prescription skincare for conditions like acne, hyperpigmentation, melasma and skin ageing. We do not treat eczema itself, which is best managed by a GP or dermatologist, but a gentle, barrier-supporting routine can sit alongside your medical treatment. To start your bespoke treatment book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
