Eczema, the most common type of skin inflammation (dermatitis), refers to several conditions that share a pattern of changes in the surface of the skin. Eczema first appears as an episode of itching and redness of the skin. You also may have tiny bumps or blisters. When it develops into a long-term condition (chronic eczema), it leads to thickening skin, scaling, flaking, dryness and color changes. There are many types of eczema, depending on the cause, shape and location of the rash. Most are related to allergies or to contact with irritating substances. Some are associated with underlying medical conditions that cause fluid retention in the legs. In the United States, eczema affects approximately 10% of the population.

• Atopic eczema (atopic dermatitis). This type of eczema comes and goes repeatedly, and usually occurs in people who have a genetic (inherited) tendency to have allergies. In about 70% of cases, the person (or a family member) has allergic asthma, hay fever or food allergies. Atopic eczema appears early in life, usually in babies between 2 months and 18 months old. In babies, atopic eczema primarily affects the face, neck, ears and torso. It also appears on the tops of feet or the outside of the elbows. Atopic eczema in older children, teenagers and adults, usually involves the skin inside the creases of the inward bend of the elbow, as well as the knee, ankle or wrist joints, the hands, and upper eyelids.



• Contact dermatitis. When irritants touch the skin, they can produce two types of contact dermatitis. One is irritant contact dermatitis, which is the direct irritation of the skin. Irritant contact dermatitis can be caused by prolonged contact with irritants such as detergents, bubble bath, harsh soap, sweat, saliva or urine. The second type of contact dermatitis is allergic contact dermatitis, which is an allergic reaction in the skin. This occurs in people who have an allergy to a specific substance. Each year, some type of skin allergy affects about 70% of people in the United States. The most common allergens are poison ivy, poison oak and poison sumac. Other substances that can trigger skin allergies include some materials used to build homes and offices, cleaning products, deodorants, cosmetics and medications. Dermatitis of the earlobes can be caused by an allergy to earrings containing nickel. Chemicals in fragrances, skin cream and lotions, shampoos and shoes or clothing can cause allergic reactions.



• Hand eczema. Limited to the hands, this type of eczema can be related to atopic eczema or it can occur because of repeated hand washing or exposure to strong detergents. Occasionally, hand eczema is caused by an allergy, such as to latex.



• Nummular eczema. This eczema causes coin sized patches of irritated skin, typically on the legs, arms or chest. It usually occurs in adults. It can be related to atopic dermatitis and, less often, allergic contact dermatitis. In a few cases, it represents an allergic reaction to a fungal infection such as athlete's foot. In this case, nummular eczema still appears typically on arms, legs or chest, even if the fungal infection is elsewhere on the body.



• Asteatotic eczema. This eczema dries the skin, causing fine cracks in the skin, usually first involving the lower legs, where there are fewer oil glands. It commonly occurs in the elderly, especially during winter months spent indoors in low humidity environments.



• Stasis dermatitis. Occurring on the calves, ankles and feet of people who have poor blood circulation in the lower legs, this type of dermatitis involves leg swelling, leading to itching, fine red bumps, skin redness or darkening, and sometimes, weeping sores.



• Lichen simplex chronicus. This eczema is a reaction to repeatedly scratching or rubbing of the skin in one location. A nervous scratching habit can lead to thickened, discolored skin on the wrist, ankle, groin or back of the neck. Skin picking can lead to smaller bumps of the same type of rash called prurigo nodularis.



• Seborrheic dermatitis. Doctors consider this a type of eczema, although it creates a greasier rash than usual for eczema. This scaly dermatitis commonly appears on the scalp of infants (as cradle cap) or as dandruff in adults. Probably triggered by the skin yeast Pityrosporum ovale, it commonly affects the face or neck around the nose and at the scalp line.

Short-term symptoms of eczema include itchy skin, redness and tiny bumps or blisters. If these symptoms remain untreated, the skin can become thick, scaly and dry, with areas of hair loss and color changes. Skin affected by long-term eczema is more vulnerable to secondary infections, usually caused by bacteria.

Each type of eczema has specific characteristics and pattern of symptoms:

• Atopic eczema (atopic dermatitis). Atopic dermatitis appears as irritated, red, dry, crusted patches on the skin. If the skin becomes infected, it may develop a wet (weeping) look. Scratching the itchy patches causes more irritation and increases the risk of infection by bacteria.



• Contact dermatitis. When an irritant causes contact dermatitis, symptoms can range from a mild redness to severe skin blistering or ulceration. When triggered by an allergic reaction, contact dermatitis usually causes skin redness, fine red bumps or blisters and severe itching. When caused by plant allergies (poison ivy, poison oak, poison sumac), the reaction usually is intense, with bumps and blisters occurring in lines or streaks where the leaves of the plant brushed against the skin.



• Hand eczema. Hand eczema usually appears during the winter as patches of dry, cracked skin, with or without redness. Other forms of hand eczema generally cause itching, red bumps or blisters and scaling. Irritation often occurs under rings from soap trapped under the rings.



• Nummular eczema. Nummular eczema begins as small areas of irritation that turn into round red, crusted or scaly patches.



• Asteatotic eczema. Asteatotic eczema usually occurs on the lower legs and causes itching or stinging pain in areas of dry, cracked, reddened skin, with or without tiny bumps.



• Stasis dermatitis. Stasis dermatitis usually begins with mild redness and itching of the lower legs, which are already slightly puffy or very swollen because of poor circulation in the legs. Poor circulation usually is caused by varicose veins or poorly functioning veins, but it can be caused by leg swelling (edema) related to heart failure or kidney problems. If redness and tenderness develop suddenly, it could be caused by a secondary bacterial infection. Bacterial infections require immediate medical attention.



• Lichen simplex chronicus. This rash creates thickened, leathery skin with darkening of skin color. It is very itchy. Scratching makes the problem worse.



• Seborrheic dermatitis. Seborrheic dermatitis causes red, scaly patches with yellow, greasy crusts. These appear most commonly on the scalp as dandruff, but also can occur elsewhere on the body, including the eyebrows, eyelids, ears and skin creases near the mouth and nose. These patches can be itchy or can cause burning. The scalp lesions in infants (cradle cap) can appear yellowish and greasy and usually cause no discomfort.

Depending on your pattern of skin symptoms, your doctor will ask about your personal and family allergy history, your history of exposure to irritating chemicals and your contact with potential allergy triggers, such as poison ivy.

In many cases, your doctor can diagnose eczema by examining the skin. If your doctor suspects that allergies are involved, patch testing with various allergy causing chemicals (nickel, lanolin, fragrances, etc.) may be necessary.

Depending on the type of eczema, symptoms may go away after a week or two, or persist for years. For example, contact dermatitis caused by poison ivy usually lasts about two or three weeks, while atopic dermatitis that begin in childhood can persist into adulthood. Stasis dermatitis related to varicose veins can last for many years.

To prevent or reduce eczema flare-ups, avoid exposure to extreme temperatures, dry air, harsh soaps, perfumed products and bubble baths. Use blankets and clothing made of cotton instead of more irritating fabrics, such as wool, or stiff synthetics, such as polyester. After showering or bathing, pat dry (rather than rub) so you leave a little moisture on your skin. Then apply a moisturizing cream or lotion to trap moisture in the skin. Use a humidifier to add moisture to indoor air during the winter heating season.

To help to prevent contact dermatitis, avoid skin contact with irritating chemicals, plants, jewelry and substances that trigger skin allergies. If you have leg swelling, you can help prevent stasis dermatitis by wearing compression stockings and by elevating your legs if you sit for long periods.

Your doctor usually will review your skin care routine to make sure you are doing everything possible to prevent symptoms. If, despite these measures, your eczema is bothersome, your doctor may prescribe a corticosteroid ointment or cream for you to use on the affected area. In atopic dermatitis, mild or medium strength topical (applied to the skin) steroids generally are used, while strong steroids and oral antihistamines may be needed to treat allergic contact dermatitis. If there are signs of bacterial skin infection, oral antibiotics usually are needed.

Sometimes, in very severe cases of eczema, your doctor will prescribe a short course of oral steroids or stronger medications that decrease the activity of the immune system. However, steroids taken for prolonged periods and other drugs that suppress the immune system can have serious side effects. They must be used cautiously. In some people, treatment with ultraviolet (UV) light is another option.

Seborrhea in adults is best treated with dandruff shampoo and, occasionally, with prescription antifungal facial creams or rinses. Cradle cap in infants eventually clears up without treatment, though it can last several months. The crust usually can be loosened by applying baby oil to the scalp 30 to 60 minutes before brushing with a soft brush and then washing with baby shampoo.

When treating a contact allergy in a child, avoid topical treatments containing antihistamines (such as calamine lotion with diphenhydramine) because skin reactions can occur.

Call your doctor if you have an area of skin that is red and very itchy, or skin that is cracked, blistered or painfully dry. Ask your doctor for an urgent evaluation if you have signs of infection -- an area of skin that is painful, swollen, has yellow drainage or has streaking or spreading redness.

The prognosis varies from person to person, depending on the type of eczema and its response to treatment. For example, most contact dermatitis heals within two to three weeks, while most stasis dermatitis lasts for years. Among children affected by atopic eczema, about half still will have the problem as adults.

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National Institute of Arthritis and Musculoskeletal and Skin Diseases
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