When people talk about eczema, more often than not, they are talking about atopic eczema, which is a very common skin disorder. However, the term eczema is also used to refer generally to a group of skin diseases that share common symptoms such as skin inflammation, irritation, redness, and itching. These diseases may also cause sores or minute papules to develop that may weep or ooze and crust over, and/or cause scaling, hyperpigmentation, and lichenification.
Up to 20 percent of American infants and 3 percent of children and adults suffer from some type of eczema. However, kids and babies tend to grow out of the condition by age 10. Though it is generally not an allergic reaction to internal or environmental elements, it is closely connected to allergic conditions such as hay fever, food allergies, and asthma. It usually is not life-threatening and can be controlled with proper treatment.
Types of Eczema
Although atopic eczema is probably the most common type people have, there are actually several kinds of eczema (also called dermatitis).
- Atopic Dermatitis
Atopic dermatitis, known colloquially as atopic eczema or just eczema, is a skin disease that mostly strikes in childhood–though anyone of any age can develop it. Children under the age of one frequently get this skin disease, but they eventually grow out of it. People who have asthma, hay fever, a family history of eczema, food allergies, or defects in the skin barrier are more likely to get this skin disease than people who aren’t affected by those things.
People with this condition form patches of red, dry, irritated skin that may itch on various parts of the body including the face, around mouth, hands, feet, back of the knees, and the skin inside the elbow. The affected skin may also crack, form scales, and develop blisters that ooze. Even when a person is not experiencing an outbreak, the skin may be unbearably dry and itchy, leading the child or adult to scratch.
The condition is chronic and is usually triggered by internal and environmental elements such as irritation from rough fabrics such as wool, use of perfumed soaps and lotions, food allergies, household chemicals, exposure to hot or cold air, other skin infections, and allergens such as pet dander and dust mites.
There currently is no cure for eczema, and treatment typically consists of abating symptoms by keeping the skin moisturized, using medication such as steroid creams and ointments to reduce inflammation, and/or controlling flare ups through the use of immunosuppresants.
- Contact Dermatitis
Contact dermatitis is a reaction to an allergen, a toxic substance, or other irritant in the environment. It’s one of the most common work-related skin disorders because contact with irritants is typically frequent in this setting.
There are two types of contact dermatitis: irritant dermatitis and allergic dermatitis. Irritant dermatitis is the most common kind of eczema in this category and occurs when a person comes in contact with a substance or item that aggravates the skin such as bleach and pepper spray or has long-term contract with something that’s not normally irritating. For instance, people can develop irritant dermatitis from frequent hand washing.
People often get contact dermatitis on their hands and face, but it can form anywhere the irritant touches the skin including around the mouth and on the lips. Reactions range from mild dryness to severe inflammation resembling a burn that may be painful, ulcerated and filled with fluid. Nurses, cooks, hairdressers, maids, construction workers, metal workers, and cleaners have the highest risk of developing this type of eczema.
The second type of contact dermatitis is allergic eczema. This is a reaction to an allergen such as nickel, cosmetics, latex, or poison ivy, and a person can develop symptoms even after coming in contact with minute quantities of the substance.
The reaction could be the result of a natural allergy or it could develop from repeated contact with a particular substance. In either case, the body’s defense mechanism treats the substance as a foreign matter and produces a mild to severe reaction depending on the seriousness of the allergy. The skin may break out in a rash and become dry, cracked or split, red, itchy, and develop weeping and fluid-filled sores.
Treatment for either of these conditions typically involves reducing contact with the irritant or allergen, moisturizing the skin, and using steroid medications to control inflammation.
- Dyshidrotic Dermatitis
Also known as dyshidrosis, dyshirotic dermatitis is characterized by the appearance of small blisters on the hands and feet. The condition may be acute or chronic, but the onset is typically announced by sudden severe itching on the fingers, palms, and/or soles of the feet. After a short period of time, the blisters develop and then fade into scaly patches of skin after several weeks. Cracks may also form in the hands or fingers due to dry skin.
It is thought that sweating may be the cause of this condition, but this connection has not been proven. Like atopic dermatitis, outbreaks may be triggered by internal or environmental elements such as contact with allergens, stress, and changes in the weather.
Treatment options typically include placing cold, moist compresses on the affected area to reduce itching and swelling, oral or topical steroids, or phototherapy combined with Psoralen.
This type of eczema is caused by irritated nerve endings in the skin. It is a cyclical condition that normally starts when something irritates the skin. Commonly, it is caused by the person habitually scratching a particularly area. However, the cycle can also be induced by clothing or other items rubbing or scratching the affected area.
This causes itching which, in turn, leads the person to scratch more and so on and so forth. Eventually, the skin begins to thicken into brown, leathery patches that may become wrinkled. Typically, the rash tends to stay in one place, but it can advance to other areas on the body such as the back, neck, genitals, head, wrists, ankles, inside or behind the ear, and inside the elbow or knee.
Anyone can get neurodermatitis, but it is common in children. The skin may become infected, leading to other health problems. Treatment typically consists of topical steroid medications to reduce itching. If it affects the scalp, the oral medication Prednisone may be prescribed.
- Nummular Dermatitis
Nummular dermatitis is called such because it causes coin-shaped or oval sores to form on the skin. It is also known as discoid eczema. The cause of this type eczema is unknown, but it primarily affects men and typically develops in them around their mid-fifties (about aged 55 to 65). Women who are affected by nummular dermatitis generally get it as young adults.
The sores often form on the legs, back of the hand, forearms, lower back, or hips. Outbreaks are triggered by exposure to air that’s cold and dry, chemicals such as formaldehyde, abrasions, insect bites, or metals such ad nickel. The patches last anywhere from a couple of weeks to several months before healing.
Treatment involves keeping the skin moisturized, using steroid medications, avoiding injuries to the skin such as scratches, and using antibiotics to fight any infections that may develop.
- Seborrheic Dermatitis
Known colloquially as dandruff, seborrheic dermatitis causes skin to flake and fall off. The flakes may combine with the natural oils in the skin, giving it a waxy appearance. It is unknown exactly what causes this type of eczema, but there are two theories. One idea is that a yeast called pityrosporum ovale, an organism that is found naturally on the body, may be connected to the development of seborrheic dermatitis. However, it’s not known if it’s a direct cause of the disease or just a contributing factor.
A second theory is that the dandruff may be the result of an overgrowth and rapid shedding of skin cells.
While this type of eczema is found most often in the scalp, it forms in a number of places on the body including the sides of the nose, neck, inside and behind the ears, chest, back, armpits, under breast, around the genitals including the penis and scrotum, and between the buttocks. It often suddenly develops in babies between the age of two weeks and six months and will usually form on the scalp (called cradle cap), in the nappy area, behind the knees and inside the elbows, on the face, ears, and neck.
The condition usually spontaneously resolves in infants. However, it can recur at regular intervals in adults. Depending on the location, treatment may involve using shampoos that contain salicyclc acid, selenium, coal tar or similar anti-itch substances. Topical antifungal lotions and steroid treatments may also be prescribed to eliminate symptoms.
- Stasis Dermatitis
People who develop varicose veins, a condition where blood pools in the veins, can get this type of eczema. It can also occur in people who have poor circulation, previously had phlebitis or cellulitis, or currently have a blood clot in their legs. Oftentimes, these conditions cause—or are caused by—weakened vein walls. The weakened walls allow blood and fluid to escape to the surrounding space causing edema in the ankles and legs. Eventually reddish-brown spots appear in the area followed by warmth and itchiness. Small blisters may also form.
If the problem is left untreated, the skin may become dry, red, flaky, and change color. The blisters may ooze or weep, and the skin may become crusty or crack.
Since the skin in areas where varicose veins have formed is typically weak and fragile, it’s remarkably easy for ulcers to form. Because of poor circulation that increases healing times, the sore may worsen and become a large hole called a varicose ulcer. At any time, the sore may become infected and eczema may form around the ulcer.
Treatment for this condition usually involves the use of steroid creams and ointments, moist compresses, antibiotics, and elevating the legs at regular intervals.
- Asteatotic Eczema
This type of eczema primarily affects people over the age of 60. It is characterized by skin that takes on a shiny paved appearance where pink or red grooves or fissures populate the affected area. It usually first shows up on the shins, but may also form on the upper arms, lower back, and thighs. It causes intense soreness and itching.
Like most other types of eczema, the underlying cause is unknown. However, a decrease in natural skin oils, bathing in hot water, low humidity, and other things that contribute to dry skin have been linked to this disease. A person who already has dry and rough skin may also be at a higher risk of getting asteatotic eczema.
The symptoms of eczema will vary depending on the type, and the severity will differ from person to person. In general, eczema will make the skin itch, and this will often be the first symptom you experience. Afterwards, a rash may form and the skin will become very dry, thick, or scaly. The affected area on light-skinned people may turn red or brown, while people with dark skin may experience skin lightening or hyperpigmentation in the area.
Sometimes bumps will form in the affected areas. The skin may crack, ooze or weep, and crust over. If a person continues to scratch or rub the area, the skin may develop a thick layer of plaque.
Nummular eczema is often confused with fungal infections because of its circular appearance. The bumps caused by dyshirotic dermatitis may take on a bubbly appearance when they first form and become moist when scratched. Eczema that forms on the eyelids will make them look red and puffy and the skin will itch.
The symptoms may also differ depending on the age of the person. In infants, atopic dermatitis may suddenly appear around two to three months of age. A rash may form on the face and scalp that causes the skin to become dry, itchy and scaly. The baby may rub against things to alleviate the itching, which increases the risk of him or her getting an infection. The infant may also have difficulty sleeping.
Atopic dermatitis typically appears in children starting when they are two years old. Symptoms may include a rash that appears on the neck, wrists, ankles, in the creases of the knees and elbows, on the legs, or between the butt cheeks. The rash may look bumpy, the skin may lighten or darken and turn leathery from frequent scratching, and there may be constant itching.
Adults who had atopic dermatitis as children but cast it off as they grew older typically have very dry and easily irritated skin, eye problems, and get eczema on their hands.
Over time, the skin may become extremely dry and form cracks. These cracks may weep or ooze fluid and crust over. However, they may also become infected. Signs of infection include:
- A worsening of eczema symptoms
- Swelling and soreness of the skin
- General malaise or feeling of being unwell
- Oozing fluid from the affected skin
- Yellow crust or yellow-white spots forming on the skin or appearing in the eczema
If you think your or your child’s eczema has become infected, it’s essential that you contact a doctor as soon as possible to prevent medical complications.
The cause of eczema is unknown. However, it may be caused by one or a combination of things including genetics, environment, allergies, stress, skin damage, and maternal age at a child’s birth.
Can Eczema Spread
Eczema is not contagious. Therefore, you cannot get it from someone who has it or spread it to others.
Another common question is “Is eczema hereditary?” The answer is, you have a greater risk of getting eczema if one or both of your parents and/or your siblings have it. You may also be at risk of getting eczema if you have a family history of allergies or similar skin disorders that cause defects in the skin barrier.