Eczema

What is eczema?

‘Eczema’ refers to a group of skin conditions that cause dry, irritated skin. There are several different types of eczema, including contact dermatitis - a type of skin irritation resulting from contact with a particular substance. 

How eczema occurs

Eczema is caused by the immune system sending inflammatory signals to the skin. This can cause rashes, itchiness, and other eczema symptoms. In the case of contact dermatitis, the immune system is triggered by contact with an irritating substance. 

Can eczema kill you?

Eczema is not a fatal disease; however, it can have a significant impact on quality of life.

What can cause eczema?

Eczema is caused by a range of different stimuli depending upon the type of eczema. It is a good idea to identify what triggers your eczema, so you can avoid it as possible. Cold, damp or dry weather can trigger eczema.

Allergens which can trigger eczema include:

• Soaps, detergents, shampoos, and other cleaning products
• Dust mites
• Pet hair
• Pollen 
• Mold

Can you have eczema without allergies?

Eczema often occurs as a consequence of an allergic reaction. This is called contact dermatitis. In addition, atopic dermatitis is more common in people who have allergies, such as a pollen allergy. Therefore, eczema and allergies often come together, but you do not need to have any allergies to have eczema. 

Eczema symptoms

Different types of eczema can look very different from each other. There are seven types of eczema. The symptoms of each are outlined below:

Contact dermatitis

• Red rash
• Itching
• Dry or cracked skin
• Bumps or blisters
• Swelling
• Tenderness
• Burning

Atopic dermatitis

• Itching
• Dry or cracked skin
• Fluid-filled bumps or blisters
• Thickened, scaly skin
• Red or brownish-grey patches of skin - often on the feet, ankles, knees, hands, wrists, elbows, neck, upper chest or eyelids.

Neurodermatitis

• Itching
• Leathery, scaly skin
• Raised or rough patches of skin
• Red or darker-colored skin patches

Dyshidrotic eczema

• Small fluid-filled blisters that may appear individually or in clusters
• Pain and itching

Nummular eczema

• Circular patches of pink or red dry skin
• Small blisters
• Itching

Seborrheic dermatitis

• Dandruff
• Patches of greasy skin which is also flaky or scaly in appearance
• Itching
• Redness

Stasis dermatitis

• Itching
• Swelling
• Dry, flaky or scaly skin
• Pain
• Skin discoloration - may be red, brown, purple, or grey depending on skin color
   

Are eczema patches raised?

Depending on the type of eczema you experience, the affected skin patches may be raised or flat. Contact dermatitis, atopic dermatitis, dyshidrotic eczema, and nummular eczema are particularly likely to have raised patches. 

Can eczema spread?

The area of skin affected by eczema can become larger. Eczema is not contagious and cannot be spread to other areas of the body through skin-to-skin contact. 

Can eczema cause hives?

Hives are red, itchy, raised areas of skin. Some types of eczema, including atopic dermatitis and contact dermatitis, can present with hives. 

Can eczema cause swelling?

Some types of eczema do lead to swelling of the skin. However, swelling can also be a symptom of infection, so it is a good idea to watch out for other symptoms of infection, such as:

• Swollen, hot, inflamed skin
• Pus (often yellow or greenish) leaking from the affected area
• Crusts and scabs  
• Fever
• Feeling unwell

Areas of skin affected by eczema are more prone to infection as the skin is damaged. Scratching your skin increases the chance of infection, as it causes further damage, providing an opportunity for microbes to enter the body. Therefore, it is important to avoid scratching eczema-affected areas. If you notice any symptoms of infection, you should speak to your doctor. 
 

Can eczema hurt?

Eczema doesn’t always hurt, but it can be painful for some people, particularly if the eczema is severe. If your eczema causes you significant pain, you may want to speak to your doctor, as they may be able to offer you stronger treatment. 

Can eczema cause fever?

Eczema does not cause a fever. However, eczema-affected areas can be susceptible to infection. Infections may cause a fever and the following symptoms:

• Yellow crusting of affected areas
• Oozing fluid/pus
• Swelling of the affected area
• Shivering 
• Fever

If you have any of the above symptoms, you should seek medical attention as soon as possible.
 

Why eczema is itchy

Eczema is an inflammatory reaction. During an inflammatory reaction, blood flow to the affected area increases causing redness and itching. 

Can eczema cause hair loss?

Seborrheic dermatitis often affects the scalp but does not directly cause hair loss. However, it can be itchy, and excessive scratching can damage the hair follicles and lead to hair loss.

Will eczema leave scars?

Eczema can leave scars. This is not always preventable, but you should try to avoid scratching, or picking at scabs to reduce the chances of permanent scarring. 

Will eczema scars go away?

Depending on the severity of the scars, they may go away over time. Steroids and laser therapy may help you to get rid of eczema scars that do not heal naturally. 
 

How is eczema diagnosed?

Eczema is usually diagnosed through an examination of the affected area and your medical history. Tests are not usually required, although skin samples may be taken to confirm a diagnosis or rule out other conditions. 

Which type of eczema do I have?

There are several different types of eczema. To determine which type of eczema you have, you should speak to your doctor or a dermatologist. The different types of eczema have different characteristics. The following table may help you identify which type of eczema you have, but you should always seek medical advice for diagnosis and treatment. 

Eczema and psoriasis

Eczema and psoriasis can be very similar in appearance, and it can be hard to tell them apart. Psoriasis tends to affect the outside of the elbows, the knees or the scalp. Eczema can affect these areas, but in atopic dermatitis - the most common form of eczema - the flexural surfaces are more commonly affected. Flexural surfaces would include the inside of the elbow and the back of the knees.  Psoriasis may also appear more well circumscribed, having a clear border, whereas eczema can appear more diffuse.

Psoriasis and eczema have similar but slightly different symptoms. Eczema can cause intense itchiness, whereas psoriasis tends to cause more mild itching sensations. In addition, psoriasis may also occur with other symptoms such as pitted (dented) nails. 
 

Eczema and stress

Eczema can be triggered by stress. When you feel stressed, the brain releases various chemicals that affect the immune system and inflammatory responses. These changes can trigger your eczema. 

Eczema and allergies

Atopic eczema is more common in people with allergies and often develops alongside conditions such as hayfever. Contact dermatitis is a type of eczema related to an allergic reaction where contact with an irritating substance leads to inflammation of the skin. 

Are eczema and acne related?

Acne and eczema are different conditions with different causes.  Seborrheic dermatitis usually occurs on the scalp, but can resemble acne when it occurs on the face.

Are eczema and dermatitis the same thing?

The term ‘dermatitis’ refers to an inflammation of the skin. Several types of eczema are also types of dermatitis, but not all dermatitis qualifies as eczema.  

Are eczema and yeast infections related?

People with eczema are often more vulnerable to yeast infections. Healthy skin is its own barrier against yeast infections. In people with eczema, the skin is damaged, making a yeast infection more likely.

Are eczema and atopic dermatitis the same?

Atopic dermatitis is a type of eczema characterized by itchy, dry, cracked skin. The cause of atopic dermatitis is unknown, but it is more common in people with allergies.

Are eczema and arthritis related?

People who have eczema have an increased risk of developing other inflammatory conditions such as rheumatoid arthritis. 

Are eczema and asthma related?

Eczema and asthma are related, with approximately 50-70% of children with atopic dermatitis (a type of eczema) developing asthma. It is thought that a protein known as TSLP may be responsible. TSLP is produced in damaged skin and is known to cause asthma symptoms.

Will eczema go away on its own?

Most people need to use some treatment to get rid of eczema during a flare-up, but there is no known eczema cure. Eczema usually recurs once you have had it; however, some people do grow out of eczema as they get older. 

How is eczema treated?

The first-line treatment for mild eczema is emollient creams. Emollients are moisturizing creams that help the skin repair itself. Following this, a steroid cream can be tried. Steroid creams contain corticosteroids and come in a range of different strengths. Your doctor will prescribe a strength that is appropriate for the severity of your eczema. If the steroid cream you have been prescribed does not adequately treat your eczema, your doctor will prescribe you a more intense cream. Corticosteroids are also available in ointments, lotions, and shampoos if an alternative preparation is required (e.g. a shampoo would be most appropriate for seborrheic eczema affecting the scalp).
 

Can eczema be cured?

There is no cure for eczema, but there are several treatments available, including emollients and steroid creams. Some people do grow out of eczema as they get older, so you may find that your eczema goes away over time.  

How eczema resolves

An Eczema flare will generally resolve if the area is shielded from further irritation. Emollients work by preventing the skin from drying out, and steroid creams help to reduce the swelling and redness during a flare-up. 

What to do when eczema starts

When you first start experiencing eczema symptoms, you should make an appointment with your doctor or dermatologist. Depending upon the type of eczema and the severity of your condition, they will probably prescribe you emollients and steroid creams. It is also a good idea to identify any possible eczema triggers such as allergens or stress. 

What to do when eczema flares up

When eczema flares up, you should use the treatment you have been prescribed, usually both emollients and steroid creams. If you do not have any medication left, you should order more or request a new prescription. You should try to avoid scratching the affected area to reduce the chances of infection.

What to do when eczema is healing

You should continue with treatment as your eczema heals and for a few days after the symptoms have resolved. As your eczema is healing, it can be tempting to scratch or pick at your skin. You should avoid doing this as much as possible, because this interferes with the healing process and can lead to scarring and infection. 

What to do when eczema starts to peel

Some types of eczema can cause the skin to peel. This can be mild, like the peeling after sunburn, or more severe revealing raw skin underneath. It is important that you continue with your eczema treatment as prescribed, but if you feel your eczema has worsened, you may want to discuss this with your doctor. 

What to do when eczema becomes infected

Eczema is vulnerable to infection, especially if the skin is broken. Symptoms of infection include:
a yellow crust over the affected area, liquid coming from the wound, swelling, inflammation, fever and chills. If you experience any of these symptoms, you should seek medical attention as soon as possible. Depending upon the type and severity of infection, you may be prescribed antibiotics or even admitted to the hospital. 

What to do when eczema won't go away

Not all treatments are effective. Sometimes, it can take a while to find the treatment that works best for you. If your eczema symptoms don’t subside within two weeks of treatment, you should return to your doctor, as there may be stronger treatments that they can prescribe. 

What to do when eczema turns into blisters

Several types of eczema can produce blisters. This includes dyshidrotic eczema, nummular eczema, atopic dermatitis, and contact dermatitis. However, the blisters can appear differently in each type of eczema: 

• Dyshidrotic eczema produces a type of blister known as a vesicle. These are small fluid-filled blisters, less than 1cm in diameter. In dyshidrotic eczema, the vesicles may be individual or clustered together. 
• Nummular eczema is characterized by round patches of reddened skin. In some people, these patches can be covered in small blisters. 
• Atopic dermatitis blisters tend to be small but may join together to create larger blisters. 
• Contact dermatitis blisters can vary in size but could be quite large if the reaction is severe. 

If you experience eczema blisters, you should avoid anything that may break the skin. This includes itching, scratching, rubbing, bursting, or piercing the blister. Breaking the skin increases the healing time and increases the chance of infection and scarring. 
 

Which eczema cream is best?

The best eczema cream for you depends upon the type of eczema you experience and how severe it is. Your doctor will always try to prescribe the weakest effective treatment for your condition. This is because steroid creams can produce side effects, and the stronger the medication, the greater risk of side effects. It can take a while to find the best treatment for your eczema, so if you find that your treatment is not having an effect after 2-3 weeks, you should speak to your doctor.  They may be able to prescribe something more effective. 

How to treat eczema without steroids

If you only have mild eczema, it may be treated with emollient creams. If emollients are not effective, steroid creams are the best option. A doctor will always help you weigh up the risks and benefits of a treatment before prescribing. 

Eczema and diet

Some food allergies can trigger a flare-up of eczema, but they do not cause the condition itself. The following allergies or intolerances are associated with eczema: 

• Lactose
• Eggs
• Soy products
• Gluten
• Nuts
• Fish & shellfish

It may be a good idea to avoid some of these foods if you notice an association between them and your eczema flare-ups. 
There is limited evidence to suggest that certain foods can help to reduce eczema flare-ups, but the following foods may help to reduce flare-ups of eczema:

• Fish high in omega-3, such as haddock and salmon
• Foods high in quercetin, such as apples, blueberries, broccoli and spinach
• Foods containing probiotics, such as sourdough, kefir, and soft cheese.