Eczema

Eczema is a group of conditions that leave the skin dry, itchy, red or discolored, and inflamed. The most common type is atopic dermatitis. Atopic means linked to allergies; dermatitis means inflamed skin.

Two things go wrong. First, the skin's outer barrier is weak, so skin dries out and gets irritated easily. Second, the immune system overreacts and creates inflammation. This is why moisturizing and calming inflammation are both key.

Eczema comes and goes. Times when it gets worse are called flares. It is manageable once you learn your triggers and have a steady routine.

The main symptom is itch, and it can be intense. Other signs include dry, scaly, or rough patches and cracked skin.

The color depends on skin tone. On lighter skin, patches look red or pink. On darker skin, patches may look brown, purple, gray, or ashy, and redness can be hard to see. Where eczema appears changes with age — cheeks and scalp in babies, the bends of elbows and knees in children and adults.

• Atopic dermatitis: The most common type.
• Contact dermatitis: From touching an irritant or allergen.
• Dyshidrotic eczema: Small, deep, itchy blisters on hands and feet.
• Nummular eczema: Round, coin-shaped patches.
• Seborrheic dermatitis: Flaky, greasy patches in oily areas.

Eczema comes from a mix of genes, the immune system, and the environment.

Many people have a change in a gene called filaggrin, which helps build a strong skin barrier. A weak barrier lets in irritants and allergens. Eczema, asthma, and hay fever often run together in families. On top of that, the immune system overreacts, and dry air, harsh products, and allergens can spark a flare.

• Dry skin and dry air, especially in winter
• Harsh soaps, detergents, and fragranced products
• Heat, sweat, and temperature changes
• Stress
• Allergens like pollen, dust mites, pet dander, and some foods
• Rough fabrics like wool

Eczema is usually diagnosed by a doctor looking at your skin and asking about your history. There is no single lab test. If contact dermatitis is suspected, patch testing places small amounts of common allergens on the skin to see which cause a reaction.

Daily skin care is the foundation:

• Moisturize often with a thick, fragrance-free cream, ideally with ceramides.
• Use a gentle cleanser — mild, fragrance-free, soap-free.
• Keep water lukewarm.
• Try soak and seal — moisturize within a few minutes of bathing.
• Avoid your triggers.

This gentle approach overlaps a lot with skincare advice for rosacea.

Look for simple, gentle products for sensitive or eczema-prone skin. The most helpful moisturizers are thick, fragrance-free barrier creams and ointments with ingredients like ceramides. Pair with a mild, soap-free cleanser. Fewer ingredients and no fragrance are better.

When home care is not enough, a doctor may prescribe:

• Topical steroids to calm flares.
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus).
• Crisaborole for mild to moderate eczema.
• Dupilumab, an injectable biologic for moderate to severe eczema.
• JAK inhibitors for moderate to severe cases under supervision.

Eczema is usually treated with creams and medicines rather than procedures. For severe eczema that does not respond to other treatments, doctors may use phototherapy (controlled ultraviolet light in a clinic).

See a dermatologist if eczema is not controlled by moisturizers and OTC care; the skin looks infected (oozing, yellow crusting, pus); the itch is disrupting sleep; or flares are frequent or spreading.

• Psoriasis: Thicker patches with silvery scale.
• Contact dermatitis: A rash from an irritant or allergen.
• Rosacea: Redness and bumps on the central face, without dry scaly patches.
• Seborrheic dermatitis: Flaky, greasy patches in oily areas.
• Fungal infections: Ring-shaped, spreading rashes.