Eczema: Causes, symptoms, coping strategies, treatment

Eczema, a word often misunderstood, is more than a skin condition. It affects millions worldwide and can significantly impact their quality of life. 

This article aims to shed light on eczema, offering a comprehensive view of this pervasive condition. We will delve into the heart of what eczema truly is, its different types, and the common myths surrounding it. 

We’ll cover everything you need to know about eczema, from potential causes and triggers to the diagnostic processes. 

Equipped with this knowledge, we aim to empower those living with eczema and foster a more profound understanding in those who wish to learn more.

What is eczema?

Eczema, medically called ‘atopic dermatitis,’ is a chronic, inflammatory skin condition characterized by itchy, red, and flaky skin [1]. It’s more than skin-deep, often indicating an overactive response by the body’s immune system to an irritant.

It is a condition that affects both children and adults. It is not just a visual issue, but can also have significant emotional and psychological impacts. 

Types of eczema

Eczema takes on various forms, each with unique characteristics, triggers, and symptoms. Here are the most common types [2]:

1. Atopic dermatitis

This is the most common form of eczema, typically starting in childhood. It’s characterized by red, itchy patches often on the elbows, knees, and cheeks. Atopic dermatitis is closely tied to other allergic conditions, like asthma and hay fever.

2. Contact dermatitis

This type results from direct contact with certain substances. It’s further divided into irritant contact dermatitis, caused by skin-damaging substances like detergents, and allergic contact dermatitis, resulting from an allergic reaction from nickel and certain perfumes.

3. Dyshidrotic eczema

Exclusive to hands and feet, dyshidrotic eczema presents as small, itchy blisters. It’s more common in women and often linked to seasonal allergies.

4. Nummular eczema

Unlike other types, nummular eczema causes distinct, coin-shaped spots to appear on the skin. It’s more common in men and often linked to very dry skin or contact with environmental allergens or irritants.

5. Seborrheic dermatitis

This type primarily affects areas with oil-producing glands like the scalp and face, causing scaly patches, red skin, and stubborn dandruff. It’s commonly linked to yeast that lives on our skin or certain medical conditions.

6. Stasis dermatitis

Also known as venous eczema, it’s linked to poor circulation, primarily affecting the lower legs. Symptoms include swelling, varicose veins, itching, and discoloration. 

Common myths and misconceptions about eczema
Photograph: vvoennyy/Envato

Common myths and misconceptions about eczema

Since eczema is often a misunderstood condition, it also often leads to a multitude of myths and misconceptions. Dispelling these can help people understand the condition better and provide appropriate support for those living with eczema.

1. Eczema is contagious 

This is one of the most persistent myths and is entirely false. Eczema is a response from the immune system and cannot be passed from person to person [3]. 

2. Eczema is caused by poor hygiene 

Another common misconception is linking eczema to poor hygiene. This is not true; in fact, excessive cleaning can dry out the skin and exacerbate the condition. Eczema arises from a combination of genetic and environmental factors, not from cleanliness. 

3. Eczema is just a skin problem 

Many people believe that eczema is purely a cosmetic issue. In reality, the condition runs much deeper. Chronic itchiness can severely affect sleep and quality of life, and the visible symptoms can also lead to mental health issues like anxiety and depression. 

4. Eczema is a single disease 

It’s important to note that eczema is an umbrella term for a group of conditions. There are several types of eczema, each with unique symptoms and triggers. Understanding this can foster empathy and promote personalized treatment. 

5. Eczema can be cured 

There’s currently no cure for eczema [4]. However, with the right treatment and lifestyle modifications, the symptoms can be managed effectively, and individuals with the condition can lead a healthy, normal life. 

Causes and triggers of eczema

Eczema results from a complex web of factors rather than a single cause. It is generally agreed that eczema arises from interplays between genetic predispositions and environmental elements.

Potential causes of eczema 

1. Genetics

Certain genes can predispose an individual to eczema. For example, mutations in the gene that creates filaggrin – a protein that helps our bodies maintain a healthy protective skin barrier – have been linked to a higher risk of developing eczema [5].

If the skin barrier isn’t functioning correctly, it allows moisture to escape and lets in more allergens and irritants.

2. Immune system dysfunction

Some research suggests that an overactive immune system can play a part in causing eczema [6]. When the immune system responds too aggressively to an irritant or allergen, it can result in inflammation, leading to the red, itchy patches characteristic of eczema. 

3. Skin microbiome imbalance

Our skin is home to billions of microorganisms, known collectively as the skin microbiome. This microbiome plays a crucial role in maintaining skin health. When the balance of these microorganisms is disrupted, for example, by an overgrowth of certain bacteria like Staphylococcus aureus, it can lead to skin conditions like eczema [7].

Eczema triggers 

Triggers of eczema are incredibly varied, reflecting the diversity of the condition itself. These triggers are often everyday substances or occurrences that can spark flare-ups in people with eczema. Let’s delve into some of the most common: 

1. Irritants

Everyday products like soaps, detergents, shampoos, disinfectants, and even certain natural substances can irritate the skin and lead to an eczema flare-up. This is often due to these products stripping the skin of its natural oils, leading to dryness and itching.

2. Allergens

Substances that can cause an allergic reaction, such as dust mites, pet dander, pollens, mold, and certain foods, can also trigger eczema symptoms. The body’s immune response to these allergens can result in inflammation and skin irritation.

3. Climate and environment

Extreme weather conditions, particularly dry and cold weather, can trigger eczema by drying out the skin. Similarly, environments where the skin is frequently wet, then dry, like frequent hand-washing or sweating and drying off, can also lead to eczema flare-ups. 

4. Stress

While not an external substance or physical factor, emotional stress is a well-known trigger for eczema. The exact link still needs to be fully understood, but it’s thought that stress can lead to inflammation and disruption of the skin’s barrier.

5. Hormones

Another eczema trigger is hormonal changes in the body, such as those that occur during menstruation or pregnancy, can trigger eczema symptoms in some people. 

It’s important to note that triggers can be highly individual – what triggers a flare-up in one person might not affect another at all. Therefore, part of managing eczema involves learning to identify and avoid your triggers. 

What are the symptoms of eczema?

While the symptoms of eczema can vary greatly between individuals and the specific types of the condition, there are several common signs that often indicate its presence. Let’s explore these in detail:

1. Itchy skin

This is the most common and often the first symptom of eczema. The itch can be mild to severe and is typically worse at night. Persistent scratching in response to this itch can actually worsen the condition, a cycle known as the “itch-scratch cycle.”

2. Dry, sensitive skin

Skin affected by eczema is often dry and sensitive due to a compromised skin barrier which allows moisture to escape and irritants to enter. 

3. Red to brownish-gray patches

These may appear anywhere but are most commonly found on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp.

4. Small, raised bumps

These may leak fluid and crust over if scratched.

5. Swollen, sore, and inflamed skin

Scratching the itchy skin can lead to increased inflammation, which can cause the skin to become swollen and sore.

6. Cracked skin

In severe cases or when eczema is not well-managed, the skin may become so dry and inflamed that it cracks, especially in areas of flexion such as the crook of the elbow or the back of the knee.

Not all these symptoms must be present for a diagnosis of eczema, and the intensity of these symptoms can vary widely from person to person. However, if you notice these signs, consult a healthcare professional for a proper assessment.

How do eczema symptoms vary between individuals?

Eczema’s varied and individual nature is one of its defining characteristics. Even within the same type of eczema, symptoms can differ greatly from one person to another. Let’s explore the factors that contribute to this variation:

  • Age: Age can influence how eczema presents itself. Infants, for example, often develop eczema on their cheeks, forehead, or scalp, whereas adults are more likely to have eczema on their hands and feet, or in the creases of their elbows or knees.
  • The severity of the condition: The severity of an individual’s eczema can greatly affect symptom presentation. Some people have only mild itching and rash, while others experience severe, constant itchiness and extensive inflammation that can cover large body areas.
  • Co-existing conditions: Having another skin condition in conjunction with eczema can also alter symptom presentation. For example, someone with both eczema and psoriasis may exhibit symptoms that are a blend of the two conditions.
  • Personal and environmental factors: Elements like stress levels, lifestyle habits (like smoking or alcohol consumption), and exposure to environmental triggers can all influence the intensity and type of symptoms experienced.
How do eczema symptoms vary between individuals?
Photograph: vadymvdrobot/Envato

How to prevent eczema?

While eczema can’t be entirely prevented due to its genetic component, there are measures one can take to minimize the frequency and severity of flare-ups. 

Below are some practical strategies that could help keep eczema under control: 

1. Moisturize consistently

Applying moisturizer is one of the most effective ways to prevent eczema flare-ups. A good moisturizer can help restore the skin’s barrier function, preventing dryness and reducing susceptibility to irritants. The best time to apply is after a bath or shower, when the skin is still damp, to lock in moisture. 

2. Mind your diet

Certain foods can trigger eczema flare-ups in some people. Common culprits include dairy products, eggs, nuts, and wheat. If you notice a correlation between certain foods and the worsening of your symptoms, try to avoid those foods. However, it’s essential to consult a healthcare professional before making significant dietary changes.

3. Maintain a healthy lifestyle

Regular exercise, good sleep hygiene, and stress management can all play a role in preventing eczema flare-ups. These activities help boost the immune system and reduce inflammation. 

4. Choose clothing carefully

Wearing soft, breathable fabrics like cotton can prevent skin irritation. On the other hand, fabrics like wool or synthetic materials can be irritating to the skin and should be avoided.

5. Avoid sudden temperature changes

Sudden changes in temperature or humidity can trigger eczema flare-ups. Try to avoid going from a very cold to a very hot environment too quickly, and vice versa.

6. Stay hydrated

Drinking plenty of water throughout the day helps maintain the skin’s natural moisture and promotes overall health. 

7. Avoid irritants and allergens

This can include a wide range of substances, from soaps and detergents to perfumes and certain fabrics. Use hypoallergenic and fragrance-free products.

While common allergens like dust mites, pet dander, pollen, and certain foods may trigger eczema flare-ups. Regular cleaning, using dust mite-proof bed covers, and avoiding known food allergens can help.

8. Manage stress

High-stress levels can exacerbate eczema. Mindfulness techniques, yoga, regular exercise, and ensuring sufficient sleep can help manage stress levels.

9. Maintain good hygiene

Skin infections can cause eczema to flare up. Maintaining good hygiene and treating any skin infections promptly can help avoid this trigger.

Each of these strategies contributes to an overall environment that can help prevent or lessen the severity of eczema flare-ups. However, each individual is unique, and a strategy that works for one person may not work for another.

How is eczema diagnosed?

The diagnosis of eczema involves a comprehensive assessment of a person’s symptoms and medical history. In some cases, additional tests may be conducted to confirm the diagnosis and rule out other conditions. 

Here’s a closer look at the process:

Medical history

The healthcare provider will begin by taking a comprehensive medical history. They’ll ask about the duration, frequency, and pattern of symptoms, any known triggers, the patient’s personal or family history of allergic conditions, and how the condition affects the patient’s quality of life.

Physical examination

The healthcare provider will examine your skin, paying close attention to any areas of redness, dryness, or inflammation.

They’ll also assess the distribution of these symptoms, as eczema often follows characteristic patterns – for instance, it often appears in the creases of the elbows or knees in children, and on the hands in adults.

Symptom comparison

Eczema symptoms can be similar to those of other skin conditions, like psoriasis or contact dermatitis. The healthcare provider will compare your symptoms against the typical symptoms of these other conditions to help narrow down the diagnosis.

Additional testing

In some cases, further tests may be needed to confirm the diagnosis of eczema or rule out other conditions. Here are some commonly used diagnostic tests and procedures in diagnosing eczema: 

  • Skin patch testing: This test is used to identify specific allergens that may be causing or contributing to eczema. Small amounts of potential allergens are applied to the skin using adhesive patches, which are then monitored for signs of a reaction. 
  • Skin prick testing: This is another form of allergy testing. In this test, the skin is lightly pricked with a small device coated with a potential allergen. If the patient is allergic to the substance, a red, itchy bump will appear. 
  • Blood tests: Blood tests can be useful in diagnosing eczema by identifying an overactive immune response, which is common in people with eczema. These tests can also rule out other conditions that may cause similar symptoms. 
  • Skin biopsy: In some cases, a small sample of skin may be taken and examined under a microscope. This can help confirm the diagnosis and rule out other skin diseases. 

Diagnosing eczema can sometimes be a complex process due to its similarity to other skin conditions. However, a careful and detailed examination by a healthcare professional can often lead to a correct diagnosis and subsequent appropriate treatment.

How to cope with eczema

1. Adjust daily habits and lifestyle

  • Develop a daily skincare routine that includes daily moisturizers, lukewarm showers and avoiding triggers to prevent flare-ups. 
  • Keep a food diary to identify triggers. 
  • Prevent scratching by keeping nails short, and consider wearing cotton gloves at night to avoid scratching during sleep.
  • Maintain a cool and humid environment to prevent skin from drying out.

2. Manage stress levels

  • Practicing yoga, meditation, and deep breathing can help reduce stress and promote relaxation.
  • Engage in regular physical activity to reduce stress, improve mood, and promote better sleep
  • Ensure you’re getting enough quality sleep each night.
  • Connect with friends, family, or support groups who understand what you’re going through. You’re not alone, and sharing your experiences can minimize stress.
manage stress levels
Photograph: DragonImages/Envato

3. Face psychological impact positively

  • Don’t hesitate to seek help from a mental health professional if you’re feeling depressed or overwhelmed. Therapies like cognitive-behavioral therapy can be very effective.
  • Join a support group that understands what you’re going through can provide a sense of community and shared understanding.
  • Take time for yourself to do things you enjoy. This can help distract from the discomfort and stress of living with eczema.

What are the complications of eczema?

Eczema can sometimes lead to complications, both physical and mental [8]. It’s crucial to be aware of these potential problems to manage them effectively.

Physical complications

1. Skin infections

The intense itching associated with eczema can lead to scratching, which in turn can break the skin and make it more susceptible to infections. Bacterial infections (such as impetigo and cellulitis), viral infections (like herpes simplex virus), and fungal infections can all occur.

Signs of a skin infection include increased redness, pain, pus, or a yellow crust on the skin. If you suspect a skin infection, it’s important to seek medical attention promptly.

2. Eye problems

Eczema can also affect the area around the eyes, leading to conditions like blepharitis (inflammation of the eyelids), conjunctivitis (inflammation of the lining of the eyes), and keratoconjunctivitis (a serious condition that can affect vision).

If you experience symptoms like redness, itching, pain, or changes in vision, consult an eye specialist. 

3. Eczema herpeticum

This is a severe and potentially life-threatening condition that occurs when the herpes virus infects large areas of the skin in people with eczema. Symptoms can include painful blisters, fever, and feeling unwell. If you suspect eczema herpeticum, you should seek urgent medical attention. 

While these complications can be serious, knowing the risks and symptoms can help you catch them early and get appropriate treatment. Keep your eczema under control to reduce the risk of these complications.

Mental complications

Eczema isn’t just skin deep; it can also impact mental health, making it a truly holistic condition. Here’s how chronic eczema can affect mental well-being: 

1. Anxiety and depression

Chronic illnesses like eczema can significantly contribute to developing anxiety and depression. Dealing with itching, pain, sleep disturbances, and the condition’s visibility can lead to anxiety.

The long-term nature of eczema and its impact on quality of life and self-esteem can also lead to depression. If you’re feeling persistently sad, anxious, or lacking in energy, don’t hesitate to seek help. 

2. Stress

There’s a reciprocal relationship between stress and eczema; not only can stress trigger eczema flare-ups, but dealing with eczema can itself be a source of stress. Techniques like mindfulness, relaxation exercises, and cognitive behavioral therapy can be beneficial in managing stress.

3. Social phobia and isolation

People with visible eczema might feel self-conscious or embarrassed about their appearance, leading to social withdrawal or avoidance behaviors.

It’s important to remember that everyone has challenges, and support from friends, family, and professionals can make a big difference. 

4. Sleep disorders

The itching and discomfort associated with eczema can lead to significant sleep disturbances, which can ripple effects on mood and overall mental health.

Mental health is a crucial aspect of living with eczema, and it’s as important to address these issues as it is to treat skin symptoms. 

What are the treatment options for eczema?

Eczema can often be managed with the right treatment plan. This plan typically involves a combination of lifestyle changes, over-the-counter products, prescription medications, and in some cases, alternative therapies.

Medical treatments

Medical treatments for eczema vary widely based on the severity and type of eczema, as well as individual patient factors. These are some of the most common medical treatments:

  • Topical treatments: These are medications that you apply to your skin. They include corticosteroid creams or ointments, which reduce inflammation and itching, and calcineurin inhibitors, which also reduce inflammation but are generally used when other treatments aren’t effective or suitable. 

Emollients (moisturizers) are also a crucial part of topical treatment, helping to keep the skin hydrated and protect it from irritants.

  • Light therapy: This treatment, also known as phototherapy, involves exposing the skin to controlled amounts of natural or artificial light. It can be an effective treatment for moderate to severe eczema that’s not responding to topical treatments. 

However, it’s less commonly used because it’s time-consuming and has potential side effects, including premature skin aging and an increased risk of skin cancer with long-term use.

  • Systemic medications: These are drugs that work throughout your body, not just on your skin. They’re usually used for severe eczema or when topical treatments and light therapy haven’t worked. 

Systemic medications for eczema include corticosteroids (in pill or injection form), immunosuppressant drugs like cyclosporine, methotrexate, and mycophenolate mofetil, and a newer class of drugs called biologics, like dupilumab, that target specific parts of the immune system.

Complementary and alternative therapies

Alongside traditional medical treatments, some people with eczema find relief from complementary and alternative therapies.

  • Herbal treatments: Various herbal remedies have been suggested for eczema, including evening primrose oil, borage oil, and Chinese herbal medicine. While some people report benefits, the evidence for these treatments is limited and they can have side effects. If you’re considering herbal treatments, use them under the supervision of a healthcare provider or a specialist in herbal medicine.
  • Probiotics: These are beneficial bacteria that are thought to help restore a healthy balance to the gut microbiome, which might in turn help manage eczema, especially in children. The evidence for probiotics is mixed, with some studies showing benefits and others not. They’re generally safe to use but should be discussed with a healthcare provider, especially for people with weakened immune systems.
  • Acupuncture: This traditional Chinese medicine technique involves inserting fine needles into specific points on the body. Some people with eczema find it helps reduce itching and improve sleep. However, the evidence is limited, and it should be carried out by a certified practitioner to ensure safety. 

New and emerging treatments and research 

Research into eczema are ongoing, with new treatments and strategies continually being developed. Here are a few of the promising areas of research: 

  • Biologics: These are a new class of drugs that target specific parts of the immune system to reduce inflammation. Dupilumab is the first biologic approved for treating moderate to severe eczema, but several others are being studied in clinical trials [9].
  • Topical JAK inhibitors: Janus kinase (JAK) inhibitors are a new type of medication that can be applied topically for treating mild to moderate eczema. They work by blocking a pathway that contributes to inflammation [10]. Several topical JAK inhibitors are currently being investigated in clinical trials.
  • Microbiome research: There’s growing interest in the role of the skin and gut microbiome in eczema. Some research suggests that people with eczema have a different microbiome than those without the condition, which could be manipulated to manage eczema [11].

Gene therapy: Since eczema often runs in families, researchers are looking into the genetic basis of the disease and how gene therapy might be used to treat it. This field is in its early stages, but it holds promise for the future [12].

Closing thoughts

Living with eczema may sometimes feel like an uphill battle, but remember, you’re not alone. From healthcare providers to support groups, there are many resources available to help. Stay proactive in your care, communicate openly with your healthcare provider, and don’t be afraid to seek support when you need it. 

What works for one person might not work for another, so it’s crucial to find what works best for you. Whether it’s a medical treatment, a lifestyle change, or a combination of both, every step toward managing your eczema is a step toward improving your quality of life.

With new treatments on the horizon, the future holds the promise of better, more personalized ways to manage this condition.

FAQs

Is eczema a disease?

Yes, eczema is a disease. It’s a long-term or chronic, inflammatory skin condition that causes the skin to become itchy, red, dry and cracked, and it is commonly associated with other allergic conditions like asthma and hay fever.

What foods cause eczema?

While food doesn’t directly cause eczema, certain foods can trigger flare-ups in some individuals. Common food triggers can include dairy products, eggs, nuts, seeds, soy products, wheat, and food preservatives or additives.

How do you stop eczema from spreading?

To prevent eczema from spreading, it’s crucial to consistently moisturize your skin, avoid known triggers, and resist the urge to scratch affected areas. Additionally, following your prescribed treatment plan, including topical creams or other medications, can control inflammation and minimize its spread.

[1] https://nationaleczema.org/eczema/ 
[2] https://www.aad.org/public/diseases/eczema/types 
[3] https://www.medicalnewstoday.com/articles/is-eczema-contagious 
[4] https://www.dermatologynwhouston.com/5-common-myths-about-eczema/ 
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957505/
[6] https://nationaleczema.org/blog/beyond-the-eczema-rash/
[7] https://pubmed.ncbi.nlm.nih.gov/34838450/
[8] https://www.nhs.uk/conditions/atopic-eczema/complications/
[9] https://eczema.org/information-and-advice/treatments-for-eczema/dupilumab/
[10] https://www.everydayhealth.com/eczema/consumers-guide-to-severe-eczema-and-jak-inhibitors/
[11] https://www.pierrefabreeczemafoundation.org/en/support/useful-advices/microbiome-and-eczema
[12] https://www.news-medical.net/health/Eczema-Research.aspx

Photograph: antoninavlasova/Envato
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