Eczema: Symptoms, Types, Causes and Treatment

Eczema is a common and often misunderstood group of skin conditions that affect people of all ages. Characterized by inflamed, itchy, and sometimes painful skin, eczema can have a significant impact on daily life and well-being. In this comprehensive guide, we'll explore what eczema looks and feels like, the various types, what causes it, and how it can be effectively managed.

Symptoms of Eczema

Eczema is known for its ability to cause discomfort and visible changes to the skin. Understanding its symptoms is the first step toward better management and improved quality of life.

Symptom	Description	Impact	Source(s)
Itch	Persistent, often intense	Sleep disturbance, distress	2 3 8
Redness	Inflamed, erythematous skin	Visible irritation	2 8
Dryness	Excessive scaling or rough patches	Cracking, soreness	2 3 8
Pain	Soreness, stinging, or burning	Reduced comfort	3
Oozing	Weeping or fluid leakage	Risk of infection	3
Cracks	Fissures in the skin	Bleeding, increased risk	3 8
Sleep Loss	Difficulty sleeping due to symptoms	Fatigue, mood changes	2 3 4

Table 1: Key Symptoms of Eczema

Understanding Eczema Symptoms

Eczema is most commonly associated with itching, which is not only uncomfortable but can also lead to a cycle of scratching and worsening skin damage. In fact, itch is considered the core symptom across all studies and patient reports 2 3 8. The severity of itch often increases with age and the duration of the disease, and it is frequently accompanied by redness and inflamed skin.

Other notable symptoms include:

• Dryness and Scaling: A hallmark of eczema, particularly in chronic cases, is dry, flaky skin. This can lead to painful cracks, making everyday movements uncomfortable 2 3 8.
• Pain and Soreness: Many patients describe their skin as feeling sore, hot, or even burning, especially during flare-ups 3.
• Oozing and Bleeding: In more severe cases, the skin may ooze clear fluid or even bleed, especially if scratched excessively. These symptoms increase the risk of secondary infections 3 8.
• Sleep Disturbance: The relentless itch and discomfort can result in significant sleep loss, affecting mood, concentration, and overall quality of life 2 3 4.

It’s important to note that the severity and combination of symptoms can vary widely between individuals and across different types of eczema.

Types of Eczema

Eczema is not a single disease but an umbrella term for several distinct skin conditions, each with unique features and triggers. Recognizing the different types helps in tailoring treatment and management strategies.

Type	Key Features	Typical Age	Source(s)
Atopic Dermatitis	Chronic, itchy, relapsing, often starts in childhood, associated with allergies	Infancy/childhood	1 6 9 15
Contact Dermatitis	Localized rash from irritants/allergens; can be irritant or allergic	All ages	10 13
Nummular Eczema	Round, coin-shaped lesions, intense itch	Adults	7 10
Asteatotic Eczema	Dry, cracked skin, usually on legs, worse in winter	Elderly	8 10
Dyshidrotic Eczema	Small, itchy blisters on hands/feet	Adults	10
Hand Eczema	Involves hands, can be chronic	Adults	10
Eczema Herpeticum	Widespread herpes infection atop eczema	Children/Adults	14

Table 2: Common Types of Eczema

Atopic Dermatitis (AD)

The most prevalent form, especially in children, atopic dermatitis is characterized by chronic, relapsing inflammation, intense itch, and a strong association with personal or family history of allergies, asthma, or hay fever 1 6 9 15. It often starts before age five and may persist or recur in adulthood.

Contact Dermatitis

This type is triggered by direct skin exposure to substances that irritate (irritant contact dermatitis) or provoke an allergic response (allergic contact dermatitis). Allergic contact dermatitis is a T cell-mediated delayed hypersensitivity reaction, requiring prior sensitization to the allergen 10 13.

Nummular (Discoid) Eczema

Nummular eczema presents as round or oval, itchy, scaly patches, often mistaken for fungal infections or psoriasis. It is now considered a variant of atopic dermatitis, sharing immune and molecular features 7 10.

Asteatotic Eczema

Also called "eczema craquelé," this type features dry, cracked, and sometimes fissured skin, commonly affecting the elderly during colder months 8 10.

Dyshidrotic Eczema

This form is characterized by tiny, intensely itchy blisters on the sides of the fingers, palms, and soles. It can be chronic or recurrent 10.

Hand Eczema

Hand eczema is common among adults, especially those exposed to frequent hand washing or irritants in the workplace. It can take several forms, from mild dryness to severe blistering and cracking 10.

Eczema Herpeticum

A rare but serious complication, eczema herpeticum occurs when herpes simplex virus infects eczematous skin, causing widespread, painful blisters and fever. It requires urgent medical attention 14.

Causes of Eczema

Eczema arises from a complex interplay of genetic, environmental, and immunological factors. Understanding these causes helps guide both prevention and treatment.

Factor	Role in Eczema	Example/Mechanism	Source(s)
Genetics	Inherited susceptibility	Family history of allergies	6 15
Skin Barrier	Defective barrier increases risk	Filaggrin mutation, dryness	12 14 15
Immune System	Overactive/inappropriate response	Th2/Th17 pathways, T cell-mediated inflammation	7 11 15
Environment	Triggers/exacerbates flares	Irritants, allergens, microbes	10 12 13 15
Microbiome	Dysbiosis drives inflammation	Staphylococcus aureus colonization	12 14
Diet	Food allergies in some cases	Especially in children	5 15
Stress	Can worsen symptoms	Psychosomatic impact	16 17 18

Table 3: Contributing Causes of Eczema

Genetics and Family History

Eczema frequently runs in families, especially those with atopic diseases like asthma or hay fever. A genetic predisposition affects not only immune responses but also skin barrier integrity—mutations in the filaggrin gene are a well-known risk factor 6 15.

Skin Barrier Dysfunction

Healthy skin acts as a barrier against irritants, allergens, and microbes. In eczema, this barrier is weakened—due to genetic factors or environmental damage—leading to increased water loss and vulnerability to irritants and pathogens 12 14 15.

Immune System Dysregulation

Eczema, particularly atopic dermatitis, involves an overactive immune response, especially along the Th2 (and sometimes Th17) pathway. This leads to chronic inflammation, itching, and skin changes. T cell-mediated processes, such as Fas-induced keratinocyte apoptosis, play a central role in skin damage 7 11 15.

Environmental Triggers

Many external factors can trigger or worsen eczema, including:

• Soaps, detergents, and chemicals
• Allergens (such as dust mites, pollen, pet dander)
• Microbial agents (bacteria, viruses, fungi)
• Changes in temperature and humidity 10 12 13 15

Contact with certain substances can provoke allergic or irritant contact dermatitis, while others may simply exacerbate underlying atopic dermatitis.

Microbiome and Infections

Disturbances in the skin’s microbial community (dysbiosis), particularly overgrowth of Staphylococcus aureus, can drive inflammation and worsen eczema. S. aureus colonization is nearly universal in patients with atopic dermatitis and increases susceptibility to secondary infections, including eczema herpeticum 12 14.

Dietary Factors

In children, food allergies can contribute to eczema symptoms, especially in those with extensive skin involvement. However, elimination diets should only be undertaken if a food allergy is confirmed 5 15.

Stress

Psychological stress is known to exacerbate eczema flares, possibly through effects on immune function and skin barrier integrity 16 17 18.

Treatment of Eczema

While there is no permanent cure for eczema, a wide array of treatments can help manage symptoms, reduce flares, and improve quality of life. Therapy is individualized, taking into account the type and severity of eczema, patient age, and personal triggers.

Approach	Example/Therapy	Purpose	Source(s)
Moisturizers	Emollients, creams, ointments	Hydrate, restore barrier	16 17 18 19
Topical Steroids	Hydrocortisone, betamethasone	Reduce inflammation	16 17 18 10
Calcineurin Inhibitors	Tacrolimus, pimecrolimus	Anti-inflammatory, steroid-sparing	16 17 18 10
Systemic Therapy	Cyclosporine, methotrexate, biologics	For severe/refractory cases	16 17 18 15
Antimicrobials	Antibiotics, antivirals, antifungals	Treat infection/superinfection	16 17 18 12 14
Phototherapy	UVB, UVA1	Modulate immune response	16 17 18
Allergen Immunotherapy	Aeroallergen desensitization	Selected cases	16 17
Education & Psychosocial	Eczema school, counseling	Improve management, reduce stress	16 17
Complementary	Chinese herbal medicine, dietary change	Adjunct, variable evidence	20

Table 4: Overview of Eczema Treatments

Basic Therapy: Moisturizers and Skin Care

The cornerstone of eczema management is regular use of moisturizers (emollients), which restore and protect the skin barrier 16 17 18 19. These should be applied liberally, even during periods without active inflammation. While studies show that moisturizers can reduce flares and decrease the need for corticosteroids, no single product is consistently superior; patient preference and tolerability are important 19.

Topical Anti-inflammatory Therapy

Topical corticosteroids are the mainstay for controlling inflammation during flares. Potency is chosen according to severity and body location. Topical calcineurin inhibitors (such as tacrolimus and pimecrolimus) are steroid-sparing alternatives, especially for sensitive areas like the face or long-term use 16 17 18 10.

Systemic Treatments

For severe or refractory cases, systemic immunosuppressive medications (e.g., cyclosporine, methotrexate, azathioprine) may be employed. Newer biologic agents, such as dupilumab (targeting the IL-4/IL-13 pathway), offer promising results for moderate-to-severe disease 15 16 17.

Managing Infection and Microbial Colonization

Superinfection with bacteria (especially S. aureus), viruses (herpes simplex leading to eczema herpeticum), or fungi can worsen eczema and require targeted antimicrobial therapy 12 14 16 17 18. Maintaining skin hygiene and prompt treatment of infections are essential.

Phototherapy

Light therapy (UVB 311 nm or UVA1) can help reduce inflammation and itching in chronic eczema, particularly when topical treatments are inadequate 16 17 18.

Allergen Immunotherapy and Diet

In selected cases, immunotherapy to specific aeroallergens can be helpful. Dietary restrictions should only be considered if a true food allergy is diagnosed, as unnecessary elimination can be harmful 5 16 17 18.

Education and Psychosocial Interventions

Educational programs ("eczema schools"), stress management, and psychosomatic counseling can empower patients and families to manage eczema more effectively and improve outcomes 16 17.

Complementary and Alternative Treatments

Some patients seek complementary therapies, such as Chinese herbal medicine or dietary supplements. Evidence for these approaches is limited and mixed, and they should not replace standard treatments 20.

Conclusion

Eczema is a multifaceted condition that can have a profound impact on physical comfort, appearance, and quality of life. Through understanding its symptoms, types, underlying causes, and available treatments, individuals and caregivers can make informed choices for effective management.

Key Takeaways:

• Eczema symptoms include itch, redness, dryness, pain, oozing, and sleep disturbance, with itch as the dominant and most distressing feature.
• Types of eczema encompass atopic dermatitis, contact dermatitis, nummular eczema, asteatotic eczema, dyshidrotic eczema, hand eczema, and eczema herpeticum, each with distinctive characteristics.
• Causes of eczema are multifactorial, involving genetics, skin barrier dysfunction, immune dysregulation, environmental triggers, microbial imbalances, diet, and stress.
• Treatment strategies emphasize moisturizers, topical and systemic anti-inflammatories, infection control, phototherapy, education, and, in some cases, complementary therapies.

By recognizing the diversity and complexity of eczema, those affected can better advocate for themselves and work collaboratively with healthcare providers for optimal care.