Eczema, a pervasive skin condition affecting up to 10-20% of children and 2-10% of adults globally, is more than just a source of discomfort; it's a chronic issue that can significantly impact quality of life. Characterized by inflamed, itchy, and sometimes painful skin, eczema is often misunderstood as a singular condition. However, eczema is an umbrella term encompassing several distinct types, each with its own triggers, symptoms, and visual manifestations.
Understanding these differences allows for accurate diagnosis and effective treatment, enabling healthcare providers and patients to better manage this complex condition.
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What Is Eczema?
Eczema is a chronic dermatitis (skin inflammation) characterized by inflamed, itchy, and dry skin. While it can affect individuals of all ages, eczema is most commonly seen in children. It often starts in infancy and may persist into adulthood or reoccur later in life. (35)
Symptoms of eczema include:
- Dry skin
- Itchy skin
- Skin rash
- Bumps on the skin
- Thick patches of skin
- Flaky, scaly, or crusty skin
- Swelling
- Discoloration of the skin, varying from pink, red, purple, brown, or gray depending on skin tone
Eczema can occur anywhere on the body, but symptoms most commonly appear on the:
- Hands
- Wrists
- Elbows
- Ankles
- Knees
- Face
- Ears
- Lips (9)
The exact cause of eczema remains unknown, but it is believed to result from a combination of genetic and environmental factors. One core theory suggests that eczema is linked to a genetic mutation that affects the skin's ability to provide an effective barrier against irritants, allergens, and microbes. This skin barrier dysfunction makes the skin more susceptible to dryness and inflammation. (21, 35)
Another theory emphasizes the immune system's role, proposing that an overactive immune response to environmental triggers, such as pollen, pet dander, or certain foods, leads to the chronic inflammation seen in eczema. (21, 35)
The Different Types of Eczema
Let's dive a little deeper into each of the six subtypes of eczema.
Atopic Dermatitis
Atopic dermatitis (AD) is the most common form of eczema, affecting more than 9.6 million children and 16.5 million adults in the United States. AD is marked by red, inflamed skin that frequently affects areas such as the face, hands, and skin folds, including the elbows and knees. The inflamed skin is often intensely itchy, leading to scratching that can cause the affected areas to crack, ooze, and become prone to infection. (4)
Additionally, people affected with AD also tend to have other allergic conditions, including allergic rhinitis (hay fever) and asthma. As such, AD is often associated with measurable elevations of serum immunoglobulin E (IgE), an immune protein that plays a key role in allergic immune responses. (28)
People with AD have skin that is more sensitive to environmental factors. Exposure to these triggers can cause eczema flare-ups:
- Environmental allergens, such as pollen and pet dander
- Food allergens, including peanuts, tree nuts, eggs, soy, cow's milk, wheat, shellfish, and seafood
- Fragrances and harsh soaps or detergents
- Tobacco smoke
- Cold, dry weather
- Emotional stress
Contact Dermatitis
Contact dermatitis occurs when the skin comes into direct contact with an irritant or allergen, leading to an inflammatory reaction. This condition manifests as a red, itchy rash ranging from mild to severe. The skin may blister, crack, or become extremely dry and scaly in more intense cases. (14)
Unlike AD, contact dermatitis doesn't run in families and isn't linked to other allergic conditions. It is common in people who work with chemicals daily, such as mechanics, custodians, healthcare workers, and hairstylists. (14)
The affected area of skin will correspond directly with the site of contact with the irritant or allergen. For example, a rash under a ring may indicate an allergy to nickel. Common triggers of contact dermatitis include:
- Solvents
- Detergents
- Soaps
- Bleach
- Nickel
- Poison ivy (14)
Dyshidrotic Eczema
Dyshidrotic eczema is also called pompholyx, foot-and-hand eczema, palmoplantar eczema, and vesicular eczema. It causes small blisters on the palms of hands, soles of feet, and edges of fingers and toes that are painful and itchy. As the blisters heal, the skin becomes dry, tender, red, cracked, and prone to infection.
Dyshidrotic eczema is more common in women and people with other forms of eczema. It also tends to run in families (19).
Exposure to the following can trigger dyshidrotic eczema:
- Nickel or cobalt
- Harsh chemicals in personal care products
- Medications, especially aspirin or birth control pills
- Intravenous immunoglobulin (IVIG)
- Tobacco
- Frequently wet or sweaty hands and feet
- Stress (20, 24)
Nummular Eczema
Nummular eczema may also be called discoid eczema or nummular dermatitis. It features coin-shaped circular and scattered spots that are often oozing and itchy, commonly on the arms, legs, hands, and torso. Patches of nummular eczema are often infected with Staphylococcus aureus bacteria.
Nummular eczema is more common in males, and can be triggered by:
- Allergies
- Insect bites
- Scrapes
- Chemical burns
- Exposure to rough fabrics
- Very dry skin
- Frequent bathing with hot water
- Use of irritating soaps (36, 37)
Because nummular eczema may appear similar to other skin conditions, such as ringworm, psoriasis, or other types of eczema, dermatologists may take a skin scraping to confirm the diagnosis (36, 37).
Seborrheic Dermatitis
Seborrheic dermatitis primarily affects areas of the body rich in sebaceous (oil-producing) glands. It is commonly known as dandruff when it affects the scalp and cradle cap in infants. Research suggests that 3-10% of people will experience seborrheic dermatitis at some point during their lives.
Seborrheic dermatitis appears as patches of greasy red skin with white flakes and yellow scales or crust. It commonly presents on the scalp, face, nose, eyebrows, ears, chest, and skin creases. (44)
Common triggers and risk factors for seborrheic dermatitis include:
- An overgrowth of a yeast called Malassezia
- Stress
- Hormonal changes
- Cold and dry weather
- Neurological conditions, such as Parkinson's disease
- Weakened immune system
Stasis Dermatitis
Stasis dermatitis, also called gravitational dermatitis, venous eczema, and varicose eczema, is caused by poor circulation in the lower legs (venous insufficiency). It is relatively common, affecting 15-20 million people over age 50 in the United States.
Stasis dermatitis usually only affects the feet and lower legs. Symptoms include:
- Ankle swelling
- Itching or burning sensation
- Orange-brown speckles of skin discoloration
- Thickened, discolored skin (red, brown, purple, or gray depending on skin tone)
- Dry, cracked skin that may ooze or crust
- Heaviness or aching in the legs
- Shiny skin
- Open sores or ulcers around the ankles
Risk factors for stasis dermatitis include:
- Varicose veins
- High blood pressure
- Obesity
- Congestive heart failure
- Kidney failure
- Sedentary lifestyle
- Having a job that involves hours of sitting or standing
How to Properly Identify Your Type of Eczema
A proper diagnosis begins with consulting a qualified healthcare professional, such as a dermatologist, who can conduct a comprehensive evaluation. Dermatologists have the expertise to differentiate between eczema and other skin conditions that may present with similar symptoms. They will assess the appearance and location of the skin lesions, review the patient's medical history, and may perform tests such as skin biopsies or allergy tests to confirm the diagnosis and identify specific triggers.
Patients can play a proactive role in their diagnosis by using self-assessment techniques. Keeping a skin diary is particularly helpful. By tracking the onset, severity, and potential triggers of symptoms, patients can provide their doctors with valuable insights during their medical appointments. This detailed information can help the dermatologist identify patterns and tailor a treatment plan that addresses the specific type and triggers of the patient's eczema.
The National Eczema Association developed the EczemaWise app to help patients track their eczema symptoms and triggers. EczemaWise also features the PO-SCORAD (Patient-Oriented SCORing Atopic Dermatitis), a self-assessment tool that patients can use to evaluate the severity of their condition.
Treatment Options Based on Eczema Type
Treating eczema involves a multi-faceted approach tailored to the specific type and severity of the condition. The core principles of eczema treatment include managing inflammation, reducing symptoms, preventing flare-ups, and restoring the skin barrier. This often involves a combination of lifestyle adjustments, topical treatments, and, in some cases, systemic medications. (9)
Correctly identifying the eczema subtype is important because it helps to tailor effective treatment options that target the underlying cause. Examples of treatment options for the specific eczema types are outlined below:
Atopic Dermatitis
- Corticosteroid creams or ointments are used to reduce inflammation. Non-steroidal options like calcineurin inhibitors may be prescribed if corticosteroids fail to work. (22)
- Identify and avoid allergens, irritants, or other triggers that exacerbate symptoms (22).
- Frequently apply thick emollient creams to affected areas to maintain skin hydration, especially after bathing (22).
- Wet wrap therapy is a treatment method that involves applying a layer of topical medication and damp clothing or bandages over the affected skin, followed by a dry layer of clothing or bandages on top.
Contact Dermatitis
- Contact dermatitis rashes will resolve once the exposure to the causative irritant or allergen has been removed. Allergen testing may be recommended to help in this identification process. (23)
- Cool compresses, oatmeal baths, and topical or oral medications to reduce swelling and itching can be helpful to provide symptomatic relief (23).
Dyshidrotic Eczema
- Apply a thick emollient or cream to the affected skin to prevent excessive drying and repair the skin barrier (19).
- Soak the affected areas with Burrow solution (10% aluminum acetate) in a 1:40 dilution to dry out blisters.
- Manage stress
Nummular Eczema
- Keep the skin hydrated by bathing in lukewarm water for no more than 20 minutes daily and applying moisturizer throughout the day (25).
- Use a humidifier in your home and workplace to moisten the air (25).
- Treat Staphylococcus infection with a topical antibiotic and application of an astringent compress (37).
Seborrheic Dermatitis
- Treat fungal overgrowth with topical ketoconazole or other medicated shampoo.
- Use topical keratolytics to reduce oil production from sebaceous glands.
- To treat cradle cap, use an emollient, such as mineral or olive oil, to loosen the scales and then remove them with a cloth or infant hair brush (7).
Stasis Dermatitis
- Promote blood flow and circulation of the lower extremities by elevating the legs and wearing compression stockings (18).
- Anthocyanins are antioxidants that have been used traditionally to treat chronic venous insufficiency. Foods rich in anthocyanins include berries, grapes, and red/purple vegetables.
When to Seek Medical Attention
Signs that indicate you should see a doctor for eczema treatment include:
- Persistent or severe symptoms that do not improve with over-the-counter treatments or home remedies, stop responding to prescription medications, or disrupt daily life or sleep
- Signs of infection, such as swelling, pain, and pus
- Worsening or spreading symptoms despite following prescribed treatments
- Frequent flare-ups
- Development of new symptoms
Preventive Care Tips for All Types of Eczema
Steps to prevent eczema flares include:
- Moisturize skin regularly with skin care products that are hypoallergenic, fragrance-free, and have lipids or ceramides to improve skin barrier function (21)
- Take baths and showers with warm, not hot, water. Moisturize the skin immediately after bathing to seal moisture into the skin.
- Prevent dehydration by drinking half your body weight in ounces of water daily.
- Manage stress
- Use a humidifier during cold, dry weather
- Avoid contact with irritants and allergens
- Eat a healthy diet rich in antioxidants, essential fatty acids, and collagen – important nutrients for maintaining healthy skin.
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Key Takeaways
- Identifying your specific eczema type is important for effective management and treatment.
- Each form of eczema has unique triggers, symptoms, and treatment requirements. Understanding these differences enables a tailored approach, significantly enhancing treatment outcomes and improving your quality of life.
- By staying proactive through regular consultations with healthcare professionals, keeping detailed skin diaries, and adhering to prescribed care routines, you can better manage your eczema and lessen its impact on your daily life.
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