What Are the Signs and Symptoms of Severe Eczema?

by Judi Ebbert, PhD, MPH, RN Health Writer

Chronic eczema affects about 30 million people in the United States — or more than the entire population of Texas. About half of all eczema sufferers have severe signs and symptoms that can compromise quality of life. According to a team of experts, eczema poses a burden equal in magnitude to that endured by people with psoriasis. The negative impact of eczema is so significant that finding more effective treatment is a public health priority.

Eczema skin on neck.

Is there more than one type of eczema?

There are eight types of eczema, but atopic dermatitis (AD) is by far the most common. AD tends to be chronic, inflammatory and severe. The cause of AD, unfortunately, is unknown. While there’s no cure, it can be managed effectively.

Woman shopping for laundry detergent.

What causes eczema?

The exact cause of eczema is not known, but several factors increase risk. Having relatives with eczema increases risk because the disorder can run in families. While not precisely understood, the immune system of people with eczema is believed to have a flaw. Stress, environmental exposure to strong soaps and detergents, and extreme temperatures may trigger an episode or flare-up.

Man with eczema behind his ear.

What are the signs and symptoms of eczema?

Symptoms are the sensations you feel, like intense itching. Signs are visual — the appearance of the rash, which may be red, scaly, and blistered (or might include open, crusty sores). There may even be scarring and thickening of skin from constant scratching.

Lighting a match.

What are eczema “flare-ups”?

A flare-up is increased intensity, like adding fuel to a fire. An eczema flare-up means signs and symptoms get worse by intensifying, spreading, and even interfering with sleep and other activities. A flare-up may mean an attack lasts longer or happens more often than usual, or the medicine that once worked brings no relief.

Man with severe eczema on lower leg.

When is eczema considered “severe”?

Signs of severe eczema are redness with skin breaks from scratching, oozing blisters, scarring, and thickening of the skin. Symptoms of severe eczema are unbearable itching. Symptoms that interfere with sleep and normal activities indicate severe eczema. If signs and symptoms continue or worsen no matter what you do, eczema is severe.

Doctor talking to a patient.

What should you do for severe eczema?

Talk with your primary care physician or a dermatologist. Failure to respond to treatment may indicate the need to change a dose, combine another therapy, or try another remedy. Don’t hesitate to tell your doctor if a treatment isn’t working for you — there are multiple therapies for the management of eczema.

Rocks balanced near the ocean.

What else can you do to get relief?

Pay attention to triggers and avoid them. Use mild soaps without added fragrance. After bathing, apply an emollient that contains petroleum jelly to seal in moisture. Take lukewarm baths or showers, and wear loose-fitting clothes. Instead of scratching use a cold compress or numbing medication. If you’re a nighttime scratcher, wear gloves to minimize skin irritation. Reduce stress by breathing deeply and picturing or visiting your favorite place. Meditation and yoga also reduce stress.

Woman speaking in a support group.

Seek support from those who understand

Did you know that the National Eczema Association (NEA) hosts a network of eczema support groups in many states? In the era of cyberconnectivity, distance is no barrier, making it easy to converse with people who understand the challenges of severe eczema. NEA also encourages tip sharing that may benefit you and others. See their Scratch Pad link.

Friends hugging from behind.

How does support help?

Social support creates a network of people with something in common. The bond of experience can improve your ability to cope and build confidence. By sharing information, people learn useful strategies to improve their condition. Friendships emerge, and talking with friends can reduce stress. Learning about new strategies can improve quality of life.

Closeup of female hands applying moisturizer.

Final tips - DOs

  • Bathe in lukewarm water.
  • Moisturize often, using an emollient after bathing with mild, fragrance-free soap.
  • Wear loose cotton clothes.
  • Use cold compresses and medication to relieve itching.
  • Take medication as directed, and consult the doctor if it stops working.
Scratching arm.

And DON'Ts

  • Don’t bathe in hot water.
  • Don’t neglect moisturizing, especially after bathing.
  • Don’t wear tight synthetic fabrics and wool.
  • Don’t scratch, it will only increase severity.
  • Don’t skip medication or fail to consult a doctor during a severe flare-up.
Judi Ebbert, PhD, MPH, RN
Meet Our Writer
Judi Ebbert, PhD, MPH, RN

Judi Ebbert earned her PhD at the University of South Florida’s College of Public Health. She has worked at three NCI-designated comprehensive cancer centers and is a writer/editor at Moffitt Cancer Center. Judi has great interest in chronic disease prevention and treatment, and is an advocate for equitable access to care and optimal quality of life for all people. She loves swimming, her dogs and cats, great food, art, humor, and cinematic thrillers. She’s on Twitter @judithebbert.