Let's Talk About Eczema Signs and Symptoms
Knowing what to look for with this challenging condition can help you (and your skin) breathe a sigh of sweet relief.by Jennifer Tzeses Health Writer
If eczema had a Facebook relationship status, it would read: “It’s complicated.” The thing is, eczema is not a one-symptom-fits-all kind of condition. Just as the same shade of lipstick or foundation can look different on different people, the symptoms of eczema can show up differently on you, versus how they show up on your best friend, your mom, or your neighbor. Not to mention, they may not always appear on the same parts of your body every time (they’re sneaky like that). However, there are some general signs and symptoms to look for that will help you figure out if you have eczema—and if so, what your next steps need to be.
Our Pro Panel
We went to some of the nation's top experts in eczema to bring you the most up-to-date information about symptoms possible.
Bruce A. Brod, M.D., FAAD
Clinical Professor of Dermatology
University of Pennsylvania Perelman School of Medicine
Mary L. Stevenson, M.D.
Assistant Professor of Dermatology
Ronald O. Perelman Department of Dermatology at NYU Langone Medical Center
New York City
Alina G. Bridges, D.O.
Associate Professor of Dermatology and Laboratory Medicine and Pathology
Yes, eczema can often look like other conditions including poison ivy, an allergic reaction, psoriasis, and ringworm. This is why it’s important to see your doctor if you notice any symptoms, including dry, cracked skin, red or violet-colored sores, open sores that leak fluid, or itchy skin.
Yup, it is possible to have more than one type of eczema at the same time (come one, come all). While they all will likely itch and cause redness, symptoms can vary, and you might require multiple kinds of treatments depending on the types of eczema you have.
According to the American Academy of Dermatology, about 50% of people who get AD during childhood go on to have a milder form of AD as an adult.
Unfortunately, eczema can’t be cured, but for some people, flareups can clear for a while, even for several years. The right treatments and daily skin care can help relieve itching and other symptoms and prevent new outbreaks.
What Exactly Is Eczema, Again?
It’s red, it’s itchy, it’s inflamed—it can’t leap tall buildings in a single bound, but it can make you uncomfortable faster than the speed of light. No, it’s not an angry superhero, it’s eczema.
A common, chronic (non-contagious) skin condition, eczema affects over 30 million people in the U.S.
It doesn’t discriminate: It can strike everyone from the tiniest tot to a centenarian. It is a bit ageist, however, in how and where its symptoms show up on infants versus older kids and adults.
And it’s tricky: There are seven different types and each one comes with its own collection of symptoms. While doctors don’t know exactly what causes it—though genetics are a main suspect—they do know how to identify and manage triggers, such as environmental changes, common household products, and stress.
There is no cure for eczema (yet), but there are many ways to ease symptoms and fight flareups. Here’s all the intel you’ll need to stay one step ahead of the condition.
The Telltale Signs of Eczema
Since your brand of eczema probably won’t look exactly like anyone else’s (consider it a custom-made condition), your symptoms may include one, several, or all these hallmarks:
Dry, sensitive, or very itchy skin
Red-to-brown or gray patches
Inflamed, swollen skin
Small, raised bumps that ooze or crust especially when scratched
Rough, leathery, thickened, or scaly skin
Where these pesky patches appear can depend on age.
In babies, the eczema rash can manifest on the cheeks, scalp, knees, or elbows. Kids typically get eczema rashes in the folds of the skin—behind the knees, in the crook of the arm, folds of the neck, creases at the wrists and ankles and on the tops of the thighs. Adults can develop eczema on the skin around the eyes, on the hands and feet, and the front of the legs.
While these are the most common areas for the rash to appear among various age groups, eczema is still an equal opportunist (thank you very much!) and can sometimes crop up anywhere at any age.
How Severe Is My Eczema?
Eczema symptoms can be mild or persistent to the point of interfering with daily life. In fact, one in nine of people with eczema have missed one to two days of work because of their symptoms, and more than 2% missed three or more days per year.
Knowing how your eczema ranks in terms of severity can help determine your path of treatment going forward. Here’s a handy guide to keep in mind:
Mild: Generally distinguished by some areas of dry skin, itching (sometimes) with or without small patches of redness, and little impact on everyday activities, sleep, and overall wellbeing.
Moderate: Characterized by areas of dry skin, frequent itching, redness, oozing, skin thickening, some disturbed sleep, and a moderate impact on everyday activities and overall wellbeing.
Severe: Usually defined by widespread dry skin, persistent itching, redness, extensive skin thickening, bleeding, oozing, cracking, a change of pigmentation, and a severe limitation of everyday activities and overall functioning with nightly sleep loss.
Knowing Your Type
Okay, so you’ve just read about the general signs of eczema to watch out for. Now, meet the seven different types of the disease. Variety is the spice of life, right?
Each type of eczema comes with its own set of symptoms (we can hear the collective gasp), but don’t freak out: Eczema is incredibly common. According to the National Eczema Association, more than 30 million Americans have some form of it. To break it all down for you, here are the seven types:
The most common (and severe) form of eczema is called atopic dermatitis (AD). According to the American Academy of Dermatology, 90% of people who have AD develop it before age five. Though the condition is commonly associated with kids (about 13% of all children in the U.S. have it), it can occur at any age.
A recent study from the Perelman School of Medicine at the University of Pennsylvania found that as many as 16.5 million adults in America suffer from atopic dermatitis. And of these cases, 6.6 million would be classified as moderate to severe, leading to a decrease in quality of life. The symptoms vary slightly depending on your age, but no matter what, those with AD will likely experience:
Dry and scaly skin (in infants, this may bubble up over time)
Rash that looks like goosebumps and may turn thick and leathery over time
Here's a closer look at how symptoms vary based on the age:
Infants: Most commonly, it appears in the first six months to a year of a child’s life. In infants, the itchy rash usually forms on the scalp and face, particularly on the cheeks.
Kids: Kids between two years old and puberty typically get AD, most commonly in the creases of the elbows or knees, but also on the neck, wrists, ankles, or the crease between the buttocks and legs.
Adults: Adults who get AD will find it most often appears in the creases of the elbows or knees, the nape of neck, or on the face and around the eye area.
Just as its name indicates, contact dermatitis is an itchy rash that’s caused by either irritant (nonallergic) contact with a substance or an allergic reaction to it.
The symptoms of contact dermatitis may include:
itching, cracked, scaly skin
bumps and blisters that can ooze and crust
Irritant contact dermatitis, the most common type of contact dermatitis, is usually an immediate skin reaction that occurs when a substance or the environment damages your skin's outer protective layer.
Maybe you came into contact with a harsh bleach or detergent, washed your hands one too many times, or experienced a drastic temperature change—these can all be culprits. In one study, researchers found that irritant contact dermatitis is the most common occupational skin disease, with wet work (think: hairdressing, nursing, and cleaning) and exposure to solvents causing the most symptoms.
In the case of allergic contact dermatitis, when you come into contact with an allergen, it produces an immune reaction that can take 48 to 96 hours to develop.
Sometimes, your skin can become sensitized to an allergen. This means that while you may not have a reaction right away, your immune system will remember the allergen, and then, when you come in contact with it again, your body will react at the site of contact.
Some of the most common substances that can produce allergic contact dermatitis include:
metals such as nickel (earrings are a big offender)
formaldehyde, which can be found in household disinfectants, adhesives, and in some personal care products
Characterized by dry, itchy skin, and small, sometimes painful deep-set blisters on the hands and feet, dyshidrotic eczema is known to flare up in response to stress, high temperatures, skin that’s wet for an extended period of time, and even more so during the spring when allergy season strikes. It generally takes about two to three weeks for the blisters to clear and skin can be red, dry, and cracked in its wake.
Neurodermatitis, otherwise known as lichen simplex chronicus, is one of the most irritating forms of eczema. The condition manifests as an intense itchy patch of skin that can be dry, thick, scaly, leathery, or appear reddish, brownish, yellowish, gray or purple.
The extra annoying thing about neurodermatitis is it tends to itch most when you’re trying to relax or sleep.
And once you start scratching, you activate the itch-scratch cycle, which can cause open sores and bleeding or worse, an infection indicated by crusty sores, discharge, and/or pus-filled bumps.
While it can occur anywhere on the body, it’s commonly found on the:
Back of the neck
It can also appear in the anal and genital areas as well as on the face. According to the Cleveland Clinic, women between 30-50 years of age are at highest risk of this condition (though sorry, guys, men can get it, too).
Hand eczema most commonly affects people in professions such as cleaning, mechanical jobs, catering, hairdressing, and healthcare, who work with their hands and come into contact with chemicals and irritants.
It can be painful, and symptoms include:
Peeling and flaking
Hand eczema is different from contact dermatitis in that it only appears on hands; CD can appear all over the body. It’s estimated that hand eczema affects about 10% of the population.
Nummular eczema is marked by coin-shaped, scaly, red, pink, or brown sores on the arms, legs, torso, or hands that may ooze or crust.
It tends to crop up after a skin injury, such as a burn, scrape, scratch, or an insect bite.
The cause is largely unknown, though triggers include sensitivities to metals, such as nickel, and chemicals like formaldehyde, as well as topical medications such as neomycin. Risks for developing nummular eczema are increased if you:
live in a cold, dry climate
have very dry skin
have another type of eczema
have swelling in the legs or poor blood flow
The condition is more common in men, who usually experience their first outbreak between 55 and 65 years of age. Women who have it tend to get it at a younger age, between 15 and 25 years old.
Stasis dermatitis, also known as gravitational dermatitis or venous eczema, is caused by poor circulation and blood flow.
It most commonly appears in the lower legs, because the lower leg veins have valves that circulate blood on a one-way route. As we age, these veins can weaken and have problems sending blood back to the heart and pressure can build up causing fluid to leak from the veins into the skin.
Swollen ankles are usually the first sign of stasis dermatitis, followed by:
dry, cracked skin
red or violet-colored sores
open sores that may leak fluid and scab
itchy skin, leg aches, as well as shiny skin
The condition generally affects people over 50 and women are more likely to get it than men because they have higher progesterone levels.
Increased risks for developing stasis dermatitis include:
High blood pressure
Congestive heart failure
Blood clots in leg veins
Of course, there are many reasons for itchy or scaly skin, and just because you have one (or more) of the symptoms here doesn’t guarantee that you have eczema, so see your doctor for an official diagnosis. The good news is that if you do have this condition, there are a ton of great and effective treatments out there for you.
Managing Atopic Dermatitis: “Treatment of Atopic Dermatitis.” UpToDate. uptodate.com/contents/treatment-of-atopic-dermatitis-eczema
All About Stasis Dermatitis: American Journal of Clinical Dermatology. (2017). “Stasis Dermatitis: Pathophysiology, Evaluation, and Management.” ncbi.nlm.nih.gov/pubmed/28063094
Atopic Dermatitis: Mayo Clinic. “Symptoms & Causes.” mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273
Children and Atopic Dermatitis: American Academy of Dermatology. “Atopic Dermatitis: Overview.” aad.org/atopic-dermatitis
Eczema in Babies, Children, and Adults: National Jewish Health. “Eczema Symptoms.” nationaljewish.org/conditions/eczema-atopic-dermatitis/eczema-symptoms
Atopic Dermatitis, Contact Dermatitis, Nummular Dermatitis: NYU Langone Health. “Types of Eczema & Dermatitis.” nyulangone.org/conditions/eczema-dermatitis/types
Comparison of 6 Types of Eczema: National Eczema Association. “An Overview of the Different Types of Eczema.” nationaleczema.org/eczema/types-of-eczema/
Symptoms and Causes of Neurodermatitis: Cleveland Clinic. “Neurodermatitis.” my.clevelandclinic.org/health/diseases/17989-neurodermatitis
Diagnosis, Treatment, and Management: American Academy of Allergy Asthma & Immunology. “Eczema Overview.” aaaai.org/conditions-and-treatments/library/allergy-library/eczema-atopic-dermatitis