Eczema is the everyday name for atopic dermatitis, the most common type of eczema. It is a long-lasting condition that makes skin itchy, dry and inflamed. It affects nearly 1 in 10 Americans and up to 1 in 5 children. It often appears between 2 months and 5 years of age, but it can start at any age, including in adulthood. A parent with eczema, asthma or hay fever raises the chance of getting it. It is not contagious.
Eczema comes in flares, with calmer stretches in between. Researchers believe changes in the skin’s protective layer let moisture escape, which leads to dryness, damage and inflammation. Genes, the immune system and the environment all seem to play a part.
What it looks like and what sets it off
Itch is the main symptom, and it can be intense. On lighter skin, eczema usually shows as a red rash. On darker skin it is more likely to show as small bumps, very dry skin, and patches that look gray, violet-brown or darker than the surrounding skin. Once it heals, the area can stay darker or lighter for a while.
Where it appears changes with age. Babies often get it on the cheeks, forehead and scalp. Children get it in the creases of the elbows and knees. Adults are more likely to have it on the hands and around the eyes. Years of scratching can thicken skin until it feels leathery and itches even between flares. Poor sleep is common at every age.
Common triggers include fragranced skin products and soaps, harsh detergents, wool, hot or cold weather, very dry skin, stress and tobacco smoke. Some people never pin down a specific trigger.
When to see a dermatologist
The American Academy of Dermatology advises seeing a dermatologist as soon as signs appear, because eczema that becomes more severe is harder to treat. Other clear reasons to book:
- Itch that keeps you or your child from sleeping.
- Skin that has started to thicken or crack.
- Yellow or golden crusts, which often mean a staph infection.
- Eczema that stays poorly controlled despite treatment, or that significantly affects your quality of life.
Dome-shaped blisters with fever, tiredness or swollen glands can mean eczema herpeticum, a herpes infection of eczema skin. You should see your healthcare provider right away and not wait for a delayed scheduled appointment.
What happens at the visit
A dermatologist looks at the skin and asks about family history of eczema, asthma or hay fever, when symptoms started, and what makes them better or worse. For many people the exam and history are enough to diagnose it. Sometimes a small skin biopsy is taken to confirm the diagnosis or help choose treatment, and blood tests may be used to rule out other causes of a rash. Because eczema comes and goes, it is normal to be seen on a calm day, and more than one visit may be needed. It can help to bring photos taken during a flare.
How dermatologists treat it
Eczema cannot be cured, but it can be controlled. The goals are fewer flares, less itch, well-hydrated skin and a lower risk of infection. Treatment usually builds in layers.
- Skin care. A specific way of bathing and moisturizing, which the dermatologist explains. This is the base of every plan.
- Topical anti-inflammatory medicines. Corticosteroid creams and ointments, which relieve symptoms quickly, and several non-steroid creams, including calcineurin inhibitors.
- Light therapy. Narrow-band ultraviolet light treatment, ordered by your healthcare provider when creams and other topical treatments are not controlling eczema. Sessions usually happen 2 to 3 times a week, last only a few minutes each, and can continue for 1 to several months. Tanning beds and sunbathing are not a substitute.
- Systemic medicines. For moderate to severe eczema: biologic injections, JAK inhibitor pills, and other traditional medications that calm the immune system. Some need regular monitoring.
- Extra measures. Treating skin infections when they happen, and sometimes wet wrap therapy or diluted bleach baths, used only when a dermatologist recommends them.
Finding the right combination can take trying a few options.
Living with it day to day
Daily habits do a lot of the work. Lukewarm baths, once a day. A mild unscented soap or a non-soap cleanser. Patting the skin dry instead of rubbing, then moisturizing right away. Creams and ointments rather than thin lotions, which can sting. Soft fabrics instead of wool. A cool, steady indoor temperature. Short fingernails for children who scratch. Eczema can also wear people down, and counseling or a support network is a normal part of care when it feels overwhelming.
How to choose a dermatologist
Ask how often the practice treats eczema, and in which age group, since care for a baby and care for an adult look different. Ask whether they offer light therapy in the office and how they handle a bad flare between appointments. If you have darker skin, ask about their experience with how eczema shows on your skin tone. Check whether your insurance needs a referral from your primary care provider first.
The city list below shows dermatologists who name eczema on their own websites.