Eczema Symptoms, Causes, Triggers and More

• Eczema is a condition that causes flare-ups of inflamed and itchy skin
• This condition develops as a result of genetic, environmental and lifestyle factors
• There are several different types of eczema, with atopic dermatitis being the most common
• Eczema triggers are many, and include dry air, stress and chemical irritants

Eczema affects about 31 million Americans of all ages, according to the National Eczema Association. During an eczema flare-up, patches of skin become dry and inflamed, and small bacteria-filled blisters can form, raising the risk of skin infections. 

A flare-up can last several days or weeks followed by a symptom-free period. Eczemic symptoms and severity will vary among individuals; no one person is the same.

Eczema is a hereditary condition, but it can also be caused by environment or lifestyle triggers such as ordinary household cleaners or stress. While there is no cure for eczema, there are effective strategies that can reduce the frequency of flare-ups, including medications that can relieve symptoms and accelerate healing.

What Is Eczema and What Are the Symptoms?

Eczema is an umbrella term for a group of similar conditions that affect the skin barrier, the top layer of skin. The skin barrier, when in a healthy state, helps retain moisture and defend against infections and injuries.

Among the most common symptoms of eczema are:

• Discolored skin – red patches for people with light skin tones and gray for darker skin
• Dry skin
• Fluid-filled bumps that can break and crust over
• Itchy skin that ranges from mild to intense
• Rough or scaly patches of skin

While eczema patches can develop anywhere on the body, certain areas are more common depending on age. In infancy, eczema usually appears on the face, hands and feet. Older children tend to get rashes in the crook of the elbow or behind a knee. Teens and adults also have flare-ups inside the elbows and knees, but also on the forearms, ankles and around the eyes.

Eczema is sometimes confused with other skin diseases, such as psoriasis, an autoimmune condition that also produces patchy areas of scaly, dry skin called plaques. Plaques that form with psoriasis are thicker than with eczema, and eczema can produce rash bumps filled with staph bacteria, unlike psoriasis. Lastly, eczema is generally much itchier than psoriasis.

Eczema usually first appears during infancy. While some children outgrow this condition, flare-ups are chronic for others. And for some people, eczema occurs for the first time in adulthood.

Types of eczema

The National Eczema Association reports that there are seven different types of eczema, with the most common being atopic dermatitis, sometimes referred to as atopic eczema.

Type	Symptoms
Atopic dermatitis	Itchy rashes, usually in the skin folds, but in infants it often appears on the face
Contact dermatitis	Skin discoloration, swelling, itching and blistering where the skin made contact with an allergen or irritant
Dyshidrotic eczema	Itchy, fluid-filled blisters, usually on the hands and fingers
Neurodermatitis	Itchy patches of skin that become leathery, typically appearing on the forearms, legs, neck or around the anus
Nummular eczema	Raised, circular red patches that are very itchy; more common in older adults
Seborrheic dermatitis	Patches of scaly, red skin, usually on the scalp; a common cause of dandruff
Stasis dermatitis	Inflamed, itchy skin and sores, usually developing on the lower legs as a result of various vascular diseases

What Causes Eczema? 

Eczema develops as a result of hereditary, environmental and lifestyle factors. These factors weaken the skin barrier and allow environmental allergens to penetrate the skin, resulting in inflammation. 

Scientists are still trying to solve the puzzle of why eczema runs in families, but some clues have emerged. In particular, a mutation of the gene that encodes filaggrin—a protein that plays a major role in maintaining a healthy skin barrier—is strongly associated with the development of eczema.

What causes eczema in babies? 

Eczema typically appears during the first year of life. Research suggests eczema is largely an inherited condition, with gene variations responsible for eczema passed down from one or both of a child’s parents. Several gene variants, including those involving the CARD11 and FLG gene, have been identified as risk factors for eczema. 

A study of expectant mothers with atopic dermatitis, hay fever, asthma or food allergies found that taking probiotics during pregnancy and while breastfeeding reduced the risk of eczema in their infants. This suggests that changing levels of certain bacteria in a child’s microbiome can lower the risk of developing eczema.

Certain food allergies could play a role, especially young children, but testing to determine if eczema flare-ups are directly related to specific foods isn’t always conclusive.  

Is eczema contagious?

Unlike a bacterial infection, such as strep throat, or a viral infection like the flu, eczema is not contagious.  

What Triggers Cause Eczema Flare Ups?

While eczema flare-ups can’t be predicted, in many cases they are preceded by changes in the weather, your stress level, or chemicals or allergens in your surroundings. If you know your triggers, you may be able to avoid them or limit your exposure, and this can in turn reduce flare-ups.

Genetic triggers

Genetic triggers include variations in some genes that affect skin health and the body’s immune system. For example, variations of a gene called KIF3A can weaken the skin barrier and cause an unhealthy amount of water loss from the skin. This can lead to flare-ups of atopic dermatitis.

A family history of asthma and hay fever also increases the odds of developing eczema. More than half of people with atopic dermatitis also have hay fever and/or asthma. Researchers have identified 132 genes involved with both these conditions.

Environmental triggers

Environmental triggers can be difficult to identify as there are so many, including irritants and pathogens, the temperature and air pollutants. Identifying the culprit requires careful consideration of elements inside and outside the home.

Some common triggers include:

• Fabrics such as wool and polyester
• Metals such as nickel
• Cigarette smoke· 
• Detergents
• Dry air
• Household cleaners
• Personal hygiene products and antiseptic wipes that include chemicals 

Lifestyle triggers

Your emotional and physical health contribute to how well or poorly eczema symptoms are managed. Generally, behaviors that trigger inflammation in the body also put you at risk for eczema flare-ups. Among the common lifestyle triggers for eczema are:

• Emotional stress
• Obesity
• Smoking
• Unprotected sun exposure

Is it possible to prevent eczema?

While there is no specific cure for eczema, there are strategies to reduce the onset of symptoms.

Follow a good skin care routine that includes regular moisturizing. Opt for short showers using warm, not hot, water. Choose gentle cleansers and shampoos and pat yourself dry to avoid irritating your skin.

The other key strategy is to identify triggers and steer clear of them as much as possible. If you notice that certain foods or contact with certain fabrics or products precede flare-ups, make an effort to avoid them. This may also mean taking steps such as staying indoors in extremely hot weather or managing stress through meditation or other relaxation techniques.

When to see a dermatologist

If you experience repeated flare-ups—even minor ones—you should see a doctor who can help prevent or reduce the frequency of these episodes. You should also make an appointment if your skin becomes very irritated, red or swollen, as you may have a skin infection.

Your dermatologist is likely to prescribe topical corticosteroids as the first-line treatment for eczema. These anti-inflammatory lotions and ointments may also be effective in preventing future flare-ups. Antihistamines can be included in your treatment to relieve itching. The use of phototherapy and immunosuppressant drugs should be considered if eczema doesn’t respond to standard treatments.

If you have minor episodes of dry, itchy skin, you may be able to treat them effectively with over-the-counter hydrocortisone or quality moisturizers. However, you should see a dermatologist if you are unable to control your symptoms or if these symptoms worsen.

Takeaway

Eczema is a result of genetic, environmental and lifestyle factors. It is a common skin condition that results in patches of dry, itchy skin; these symptoms may be mild to severe. While there is no cure available, symptoms can be effectively treated with commercial or professional oral and topical ointments and creams. As preventative measures, avoid identified triggers and follow an established skin care regimen to reduce and possibly eliminate eczema flare-ups.