Eczema – what it looks like, causes, treatments and self-care tips

2nd December, 2022 • 15 min read

Atopic eczema is a common skin condition which causes dry, red, itchy skin. In fact, it’s the most common inflammatory skin condition in the world.

The word eczema comes from the Greek word ‘to boil’ – used to describe the itchy, red, dry skin linked with eczema, so this is a condition that’s been around since ancient times.

Dr. Ann Nainan of Healthily says: “If you have dry cracked skin, it can be very sore, which makes doing your usual tasks like housework hard, and if your rash is visible it can make you anxious about your appearance. Although there’s no cure, there are many effective treatments and self-care tips you can try at home, so make sure you treat it as soon as possible.”

What is atopic eczema?

The word ‘atopic’ is used to describe a group of conditions caused by allergies, such as eczema, asthma and hay fever. These conditions are linked together by an overactive immune system. You’re more likely to get atopic eczema if you or your family members have one of these atopic conditions, as they often occur alongside each other.

As a child, you may remember days when you were constantly itching and had a red, dry, irritated rash. This is because atopic eczema is most common in children, but as you get older you can often outgrow the condition. There are different types of eczema and the type you have will affect how it looks, where it occurs and the best treatment for it.

Atopic eczema affects

more women than men
, with recent studies showing that around 4% more women are affected – it’s often triggered by hormonal changes. Women also seem more likely to get more severe eczema.

The constant itching can lead to sleepless nights and difficulty concentrating, as well as impacting your emotions. Young people in particular can feel self-conscious about their dry skin and scars.

But there are many treatments you can use to ease your symptoms, including self-care, treatments you can buy from the pharmacy and prescriptions from a doctor.

Read more about

self-care for eczema
.

What does eczema look like?

Common symptoms of atopic eczema include:

  • dry, itchy, inflamed and irritated skin
  • moist, crusted, ooze skin and blistering, if more severe
  • bleeding and cracked skin

How it looks and the parts that are affected might vary depending on the color of your skin. With eczema on black skin or darker skin tones, it might be harder to see and look brown, purple or gray. If you have a lighter skin color, eczema usually looks redder.

How your eczema looks and feels will often depend on the parts of the body it's affecting. If it's on areas of your body exposed to more triggers, like your hands or face, you might notice more symptoms. Scratching, especially at night, can make it difficult to sleep, make your skin bleed and cause infection.

If your eczema gets worse over time it might become thicker (referred to as lichenification). This is more likely to happen if you have darker skin.

What does eczema feel like?

People with eczema can feel very self-conscious about their appearance, as well as find daily life more difficult.

Alice was worried people thought she had lice or scabies and was “dirty”. She said “the itchiness can be frustrating” and trying not to scratch can feel like “a battle of willpower.”

Molly struggled with both the impact of her eczema and the scars: “There was one year when my eczema was really bad and then it scarred that summer, and I was as insecure about the scars as I was when the eczema was visible.”

Watch videos from healthtalk.org about

young people talking about the emotional impact of eczema
.

Who is most likely to get atopic eczema?

You may notice patterns as to when your eczema flares up, which may be linked to your lifestyle and diet. It's important to note these down as this will help you work out your triggers, so you know what to avoid.

You might have wondered “is eczema genetic.” The answer is yes, you’re more likely to get dry skin and have a higher risk of developing atopic eczema because of your genes – research has shown about 70% of people with atopic eczema have family members with the condition.

Atopic eczema causes and risk factors

There’s no single known cause for atopic eczema, and it's not completely understood. It's thought to be linked to a complex range of factors including:

  • genetics – research shows that almost 50% of atopic eczema is likely to be caused by a mutation of a gene called filaggrin. Other genes are also thought to play a role, including those involved in your immune system
  • the environment – contact with soaps, detergents or other chemicals can trigger eczema, as can allergens in our environments, such as animal dander or even bugs like bacteria
  • your immune system – if you have eczema, your immune system often has an overactive response to allergens or inflammation

This combination means your vital skin barrier is more vulnerable and unable to retain moisture or prevent irritants, allergies and skin bugs from entering your skin. So your skin tends to feel more dry and itchy, is more likely to get inflamed and is more susceptible to allergens.

What causes an atopic eczema flare-up?

A flare-up is when your eczema gets worse. You’ll usually have periods when it’s better, too. Sometimes, it can flare up as often as 2 or 3 times a month.

How long the flare lasts will depend on lots of factors like how severe it is, where it is and how quickly you start treatment.

Triggers for a flare-up can include:

  • irritants that you come into contact with – such as soaps, detergents and shampoo
  • your clothes – especially if they’re made from materials that trigger it like wool and synthetic fabrics
  • allergens – there might be something you’re allergic to which could flare up your eczema such as latex, house dust mites, pet dander, pollen, or more rarely certain foods such as cows milk or eggs
  • the weather – especially
    cold and dry weather in winter
  • being unwell – having a
    cold
    , for example
  • skin infections with bacteria or viruses
  • having dry skin
  • stress – try our tips for
    how to relieve stress

The severity of your eczema can affect how it feels and looks. But if you treat eczema early, before it becomes severe, it’s usually much easier to manage.

Once your eczema has improved, you could still be left with darker or lighter skin for a time, which is often more obvious in darker skinned people. This is usually a result of inflammation, but the skin will usually return to its normal color over time.

Eczema and women

There are eczema causes that are specific to women and often, hormones can be involved. Women may find that their symptoms are worse before a period or related to pregnancy, for example.

Carol Kim, 28, had atopic eczema most of her life and could usually manage it with steroid cream. But following the birth of her child she said “the skin all over her face was flaking, itching and painful” and her pregnancy eczema meant she couldn't sleep or complete her daily activities.

Whilst some people experience a worsening of their eczema during pregnancy, others actually find it improves. But after the baby’s born, all the hand washing and cleaning that comes with nappy changes can also cause eczema to flare. Be sure to get any new itching in pregnancy checked out by a doctor, in case there’s another cause.

Where does eczema appear?

You can have eczema anywhere on your body. You might notice it more commonly in areas such as your hands, especially your fingers, the inside of your elbows, wrists, the backs of your knees, the face and the scalp.
You may have mild eczema, with small patches of dry skin. In more severe cases, you can also develop a rash that covers large parts of your skin and is really itchy.

It’s also possible to get breast eczema or nipple eczema. In some cases, nipple eczema can appear independently, but it’s more likely if you have a history of eczema. If you have a flare-up of nipple eczema it’s often itchy and painful, especially if you’re breastfeeding.

See a doctor if you get nipple eczema, particularly if it’s only on one side – in rare cases, it can be a sign of a rare type of breast cancer called

Paget's disease of the nipple
.

Vulvar eczema

Female genital eczema can be very uncomfortable. Let’s be honest – anything affecting your genitals can feel very uncomfortable, but things can be even worse with eczema, because of the itching and soreness.

There are a range of conditions that can affect your genital area, so it's always better to speak to your doctor, who can diagnose genital eczema, if that’s the cause. It's always worth considering an STI screen as well, especially if you've recently had unprotected sex.

If you have eczema, the irritation can be caused by sweating, the clothes you wear, and the friction as it rubs. Any skin care products used around the area can also trigger flare-ups, such as personal deodorants, feminine wipes and shower gels.

It's always best to stick to washing with just simple water and a soap substitute if you have eczema, to stop your skin from getting too dry.

Read more

healthy vagina tips
.

Atopic eczema vs psoriasis

It's not always easy to tell them apart, especially in children.

Psoriasis tends to cause well-defined, thick, red scaly patches in areas like your outer elbows or fronts of the knees, but it can also be on other areas of your body. Whereas eczema tends to be in the creases of your joints, such as your knees and your elbows.

The conditions also have different complications – in psoriasis, you can get nail changes and related joint problems called psoriasis arthritis. Eczema tends to cause intense itching, whereas psoriasis tends to be milder itching.

A doctor can usually tell the difference by asking you about your symptoms and seeing where it is on your body.

Is atopic eczema contagious?

The simple answer is no. Atopic eczema isn’t infectious and cannot be passed on, even through skin contact. But if you have an eczema flare-up, it's good to avoid close skin contact with someone with an active cold sore, as this could lead to complications.

What are the different types of eczema?

Aside from atopic eczema, other types include:

  • discoid eczema
    – which often appears in circular oval patches on the skin. This type is more common in black Caribbean, black African, or Asian skin tones
  • allergic
    contact dermatitis
    – which happens after your body comes into contact with something, which triggers an allergic response
  • irritant contact dermatitis – this happens when you’re frequently exposed to a weak irritant such as hand soap, perfume or detergent. Having atopic eczema increases your risk of this
  • varicose eczema
    – a type of eczema that often affects the skin over and around
    varicose veins
    on your legs
  • seborrheic eczema – a type of eczema linked with a yeast infection that causes red scaly patches to develop on the sides of your nose, eyebrows, ears and scalp
  • dyshidrotic eczema – a type of eczema which causes tiny blisters on the palms of your hands and soles of the feet
  • nummular eczema – a type of eczema which looks like coin-shaped lesions on your arms and legs. Use moisturizers every day to help prevent the skin from getting dry and your eczema from getting worse
  • pompholyx – a type of itchy hand eczema with lots of small blisters

Pharmacy help for eczema

A pharmacist can recommend over-the-counter steroid creams like hydrocortisone and emollients (medical moisturizers), which can control symptoms.

If a treatment is not helping, it’s better to see a doctor, who will be able to increase the doses and strength of medication, if needed, or talk to you about an alternative diagnosis.

In some cases, your pharmacist may suggest treatments if they think you have a mild infection. These could include antiseptic or anti-fungal creams. They will also advise you to see a doctor if they are worried, or if the treatments don’t help.

When to see a doctor

As eczema can affect your daily life, it's important to see a doctor if it’s disrupting your routine and lifestyle. It's also important to see a doctor if your eczema is getting worse, or you’re getting complications, and if self-care hasn’t helped.

Some of the complications develop quickly, and some develop over a longer period, like thickened skin. In some cases, your atopic eczema might be infected and you’ll need to see a doctor.

Common symptoms of infections to watch out for, are if your skin:

  • is oozing or leaking fluid
  • is yellow, crusting or spots are appearing
  • looks more swollen, sore, red and warmer than usual
  • has new fluid-filled blisters, which are open and are leaving small open sores
  • has a fast-spreading rash
  • is very painful and the eczema is getting worse

If you have a severe infection you might start to feel hot and shivery and very unwell. If you think you have a severe infection, such as cellulitis or sepsis, go to the emergency department immediately, or call an ambulance.

If your eczema is affecting your self-confidence, you might consider getting psychological support, including counseling. The

National Eczema Society
can also be a great place to get help and support.

How eczema is diagnosed

There are lots of different causes of a rash, so to get diagnosed with eczema (atopic), the doctor will usually ask questions and look at any rashes you have.

They will also ask about your symptoms, the impact this is having on you and other conditions which could be linked, like asthma, hay fever and your family history. This will help to identify any triggers or patterns.

Common criteria for an eczema diagnosis includes:

  • irritated, itchy skin – especially around your skin creases, like the inside of your elbows or behind your knees
  • skin irritation in the same places
  • dry skin over the past 12 months
  • having had eczema as a child
  • having other atopic conditions, such as asthma or hay fever, or a close family member with one of these conditions

You may be advised by your doctor to keep a food diary if you’ve noticed any food triggers. In some cases, you may be referred to a specialist like a dermatologist, who can do further tests, if needed, like allergy tests to identify more triggers.

What treatments are there for eczema?

The best eczema management usually involves a combination of lifestyle changes, as well as medications.

Moisturizers

Moisturizers, known as emollients, are the most important part of the treatment process for eczema. They should be applied frequently and used instead of soap in the shower.

There are lots of different emollients available to buy and they vary in how they feel, how they look and how greasy they are. Usually, the best one to use is the greasiest one you can, but it’s also really important to find one you like. Sometimes a doctor or pharmacist may recommend an emollient with an antiseptic if you are getting a lot of infections.

Remember to take care when near any open flames and avoid cigarette smoking, as emollients contain oils that can easily catch fire.

Medication

If your atopic eczema is severe your doctor may prescribe:

  • steroid creams and tablets – these reduce the itching and redness when your eczema is active and inflamed. Your doctor may prescribe stronger types than can be bought over the counter if your eczema is severe, such as steroid tablets which can be used for around 5 to 7 days to help bring flare-ups under control, and help manage your symptoms. Although steroids for eczema can be essential in controlling your symptoms, they may also have side effects, especially when used for long periods of time. Read more about steroid medications
  • antihistamines – in some cases these can be helpful to reduce itching, particularly at night
  • antibiotics or antivirals – if you develop a complication from atopic eczema, such as an infection, your doctor may prescribe medication to treat this

Specialist treatments

You may need to see a specialist dermatologist if your symptoms are not under control with regular treatments, if you need to keep coming back for treatment, or if you’re using steroid creams very often.

Specialist treatments include:

  • creams and ointments – these will suppress your immune system and are called ‘topical calcineurin inhibitors,’ such as tacrolimus. They may also be called immunomodulators
  • immunosuppressant treatments – these can help reduce your immune response, such as methotrexate and azathioprine
  • ultraviolet light – this is also called phototherapy
  • medicated bandages and wet wraps – these are helpful and soothing as they provide a physical barrier to scratching, while offering treatment at the same time

Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.