Eczema, also known as atopic dermatitis, is an extremely common skin condition that affects people of all ages. It mainly presents as dry, itchy and angry skin which lead to pain and even significant disrupt daily life. Despite this, eczema still lacks a cure. So for many people, the best they can hope for is help to manage and improve the symptoms. In this article, we’re going to take a deep dive into what eczema is and its different type. We’ll also explore the causes, tiggers and symptoms of eczema as well as the most effective treatment options.
What is Eczema?
Eczema is a chronic inflammatory skin disorder that normally appears as patches of dry, red and itchy skin. Although it normally develops in childhood, eczema can occur at any age. It often follows a relapsing-remitting course. with periods of flares and remissions. Despite affecting around 20% of Children and 10% of adults worldwide, the exact cause of eczema remains unknown. However, research suggests that the condition arises from a complex interplay of genetic predisposition, immune system dysfunction and environmental triggers. All of these contribute to a weak skin barrier. This makes the skin more vulnerable to irritants, allergens and water loss. This leads to the characteristic dryness, inflammation and itching associated with eczema.
Causes of Eczema
It’s vital to understand the underlying causes of eczema as it provides a more targeted approach to treatment and prevention. Eczema is a complex condition with multiple causes. So far, the general scientific consensus is that eczema results from a combination of the below causes:
- Genetics: A key factor in eczema is genetic predisposition. Studies have identified mutations in the filaggrin gene, which is crucial for maintenance of the skin’s protective barrier. Individuals with this problem often have weaker skin barriers, making them more prone to water loss, irritation, and increased sensitivity to allergens and bacteria. Additionally, eczema frequently runs in families. Commonly, there is an association with other allergic conditions such as asthma and hay fever. These are together known as the atopic triad.
- Immune System Dysfunction: People with eczema often have an over active immune response. Instead of responding only to harmful invaders like bacteria or viruses, the immune system by mistake attacks harmless substances which trigger chronic inflammation. This immune overreaction leads to constant redness, swelling and itching. It also makes the skin more prone to infections as the inflammation disrupts the natural skin barrier.
- Environmental Irritants & Allergens: Everyday substances in the environment can trigger eczema flare-ups by irritating the skin or provoking allergic reactions. Common irritants include harsh soaps, detergents, synthetic fabrics, cigarette smoke and air pollution. Allergens such as pollen, dust mites, mould and pet dander can also cause immune reactions that lead to skin inflammation. Identifying and avoiding these triggers is essential for managing eczema effectively.
- Climate & Weather: Sudden changes in weather can aggravate eczema. Cold dry air depletes moisture from the skin which leads to increased dryness and irritation. Heat and humidity can cause excessive sweating which may further irritate sensitive skin. People with eczema often find that their symptoms fluctuate with the seasons which requires different skincare routines throughout the year.
- Stress & Emotional Factors: Psychological stress is a known eczema trigger. When the body experiences stress, it releases hormones like cortisol which can weaken the skin barrier and increase inflammation. Many eczema patients get flare-ups during stressful periods which highlights the connection between mental health and skin health.
- Hormonal Changes: Fluctuations in hormone levels, particularly during puberty, pregnancy, and menopause, can worsen eczema symptoms. For example, some women experience worsened eczema before their menstrual cycle due to changes in oestrogen and progesterone levels. Similarly, eczema may be affected by hormonal shifts during pregnancy and menopause.
- Dietary Factors: Whilst diet alone does not cause eczema, certain foods may act as triggers for some people. Dairy, eggs, nuts, gluten and processed foods have been linked to worsening symptoms in people with food sensitivities. Keeping a food diary and eliminating potential triggers under medical supervision can help identify whether dietary changes could improve eczema symptoms.
Different Types of Eczema
So eczema is actually an umbrella term for various inflammatory skin conditions. Each of these has its own triggers, symptoms and treatment approaches. Although all types of eczema share common characteristics such as itching, redness and skin irritation there are some differences:
- Atopic Dermatitis: This is most common and chronic form of eczema which often develops in childhood and is linked to genetic predisposition. It frequently runs in families with a history of asthma, hay fever or other allergies. Symptoms include dry scaly red patches that can become inflamed, cracked and intensely itchy. They often appear on the face, neck, hands and in the folds of elbows and knees. Triggers include harsh soaps, cold weather, allergens, synthetic fabrics and stress. All of these can worsen flare-ups.
- Contact Dermatitis: Caused by direct skin exposure to an irritant or allergen this type of eczema leads to a localised rash. It is split into irritant contact dermatitis (from substances like detergents or harsh chemicals) and allergic contact dermatitis (triggered by allergens such as nickel, latex or fragrances). Symptoms include red, inflamed, itchy and sometimes blistering skin which appears at the point of contact with the trigger. Common irritants include soaps, cleaning products, cosmetics, certain metals and plants like poison ivy.
- Dyshidrotic Eczema: This type of eczema primarily affects the hands and feet, causing small and very itchy fluid-filled blisters. It is more common in warmer months and is often linked to excessive sweating or excessive moisture exposure. The affected areas can become tender, scaly or cracked as the blisters heal. Triggers include stress, metal allergies (especially nickel or cobalt), humidity and seasonal allergies.
- Nummular Eczema: Also known as discoid eczema, this type presents as coin-shaped patches of irritated skin that can be red, itchy, dry, cracked or even ooze fluid. It is more common in adults with dry skin and often appears on the arms, legs, torso and back. Triggers include cold weather, skin injuries (such as cuts, burns, or insect bites) and sensitivity to environmental allergens.
- Seborrheic Dermatitis: This affects oily areas of the skin such as the scalp, face, upper chest and back.
- it is linked to an overgrowth of the Malassezia yeast which naturally lives on the skin. Seborrheic dermatitis symptoms include greasy, yellow scales, flaking, and redness. It commonly presents as dandruff on the scalp or irritation around the nose, eyebrows and ears. Triggers include stress, hormone changes, cold or dry weather and certain medical conditions like Parkinson’s disease.
- Stasis Dermatitis: Caused by poor circulation, this “venous eczema” typically presents in the lower legs and ankles, where blood pools due to weak vein function. Stasis dermatitis leads to swelling, redness, itching, and skin darkening, with brown or purplish patches developing over time. In severe cases, open sores (venous ulcers) can form. Triggers include prolonged standing, varicose veins, deep vein thrombosis (DVT) and underlying circulatory conditions.
Symptoms of Eczema
Eczema symptoms can vary widely depending on the type of eczema, severity and individual triggers. However, all forms of eczema share common features but different types present with additional distinct characteristics. Here are the most common symptoms of eczema:
- Itching: This the hallmark symptom of eczema which is often severe and persistent leading to excessive scratching. This can further damage the skin barrier, making it more susceptible to irritation, infection and long-term thickening. Itching is particularly intense in atopic dermatitis, dyshidrotic eczema and nummular eczema where it can disrupt sleep and daily activities.
- Redness & Inflammation: Affected areas become red, swollen and warm due to immune response and skin irritation. This is most common in atopic dermatitis, contact dermatitis and seborrheic dermatitis where inflammation can be triggered by allergens, irritants or yeast overgrowth.
- Dryness & Scaling: Skin often appears dry, rough and flaky due to a damaged skin barrier that cannot retain moisture effectively. This is a key feature of atopic dermatitis, nummular eczema and stasis dermatitis where the skin may also crack and feel tight.
- Blisters or Weeping Lesions: In some forms of eczema, fluid-filled blisters may develop, which can burst, ooze and crust over. This is particularly seen in dyshidrotic eczema where small, itchy blisters appear on the hands and feet and nummular eczema where round patches may become weepy and infected.
- Thickened or Leathery Skin (Lichenification): Chronic scratching can lead to thick, rough or leathery skin, a process known as lichenification. This is especially common in atopic dermatitis, where prolonged irritation leads to deeper skin lines and darker patches, particularly in skin folds like the elbows, knees and neck.
- Oily or Greasy Scaling: Seborrheic dermatitis causes greasy yellow flakes on the scalp, face and upper chest alongside by redness and irritation. Unlike other forms of eczema, this type is associated with an overgrowth of yeast rather than extreme dryness.
- Swelling & Skin Discoloration: Stasis dermatitis leads to swollen legs and ankles, red-brown skin discolouration and in severe cases even open sores (venous ulcers).
Treatment Options for Eczema
Management of eczema often requires a multifaceted approach that combines skincare, lifestyle changes and medical treatments to control symptoms and prevent flare-ups. Whilst there is no cure for eczema, the right treatment plan can significantly improve skin health and reduce pain. Here are the most effective treatment options for eczema:
- Skincare Routine: A daily hydrating skincare routine is essential for managing eczema. Regular use of moisturisers and emollients helps repair the skin barrier, prevent dryness and calm irritation. Opt for fragrance-free hypoallergenic creams or balms. Always cleanse with gentle hydrating products to avoid stripping the skin of its natural oils.
- Topical Treatments: Prescription and over-the-counter creams can help reduce inflammation and itching. Corticosteroid creams are commonly used to control flares whilst calcineurin inhibitors (such as tacrolimus or pimecrolimus) offer a steroid-free alternative, particularly for sensitive areas like the face and eyelids. For those prone to infections, antibacterial or antifungal creams may help.
- Systemic Treatments: For more severe eczema that does not respond to topical treatments, doctors may prescribe oral medications such as corticosteroids, immunosuppressants (e.g., methotrexate or cyclosporine) or biologics like dupilumab. These treatments target the immune system and reduce chronic inflammation to prevent recurrent flares.
- Phototherapy: Ultraviolet (UV) light therapy can be beneficial for individuals with ongoing eczema that doesn’t respond to topical treatments. Narrowband UVB therapy is the most common form and helps reduce inflammation, itching and symptoms overall.
- Lifestyle: Identifying and avoiding personal triggers is key to stopping flares. This includes irritants (such as harsh soaps, certain fabrics, and household chemicals), allergens (like pollen, dust mites, and pet dander) and environmental factors (such as extreme temperatures and humidity levels). Stress can also play a role in eczema, so using stress management techniques like meditation, yoga or deep breathing exercises can be helpful. Some individuals find that dietary changes, such as reducing dairy, gluten or processed foods may help manage symptoms.
Eczema is a complex condition that requires a personal approach to management. Always tailor treatment to the type and severity of eczema, your triggers and skin needs. To improve your chance of success, seek help form a dermatologist early on so they can help provide you with a custom treatment plan to keep eczema your under control.
