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Red and blotchy or itchy skin can be tricky to diagnose. There are so many things that can cause irritation or inflammation of the skin. Recognizing what type of reaction you’re having is the first step in finding relief.

Eczema and hives are both common skin reactions. Both are a type of allergic response, but they have distinguishing features and are treated differently.

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Eczema is also known as atopic dermatitis. It’s a chronic problem that is often rooted in the immune system. Eczema is a common condition in children affecting as many as 20 percent of all children, but it can also appear for the first time in adulthood.

There are many types of eczema, and symptoms and triggering factors can vary by type. Symptoms include:

  • dryness
  • itchiness that may be worse at night
  • discolored patches on the skin
  • scaly, cracked skin
  • chronic problem with periodic flare-ups
  • raised bumps that may be filled with fluid or have crusted edges
  • rough skin patches

In people of color, eczema can appear differently. In ethnic groups with varying skin colors, redness can be difficult to see. For people with dark skin, eczema typically appears as:

  • dryness
  • skin swelling
  • flakiness
  • goosebumps or bumps around hair follicles
  • thick, raised nodules
  • dark circles around the eyes

Eczema tends to appear in certain areas of the body like the face and scalp, or extremities like the arms or legs. The condition is commonly linked to other immune disorders such as food allergies, allergic rhinitis, and asthma.

Eczema that begins in childhood may resolve in the first few years of life. But when it doesn’t, the key is controlling symptoms by avoiding known triggers. Eczema triggers vary from person to person, but may include:

  • long, hot showers or baths
  • scratching
  • sweat
  • heat
  • cold, dry weather
  • soaps, detergents, and cleaners
  • wool and synthetic fabrics
  • physical irritants (dirt, sand, smoke)
  • allergens (pollen, dander, dust)
  • stress

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Hives, or urticaria, are often associated with acute — or singular allergic reactions — but they can also be chronic. Hives appear as a raised area that’s often itchy or red. Although allergic reactions are a common culprit, they can also have physical or autoimmune triggers. These include heat, cold, vibrations, or even stress.

Autoimmune triggers are set off by antibodies to an individual allergen or condition. In some cases, it can be difficult to identify the specific triggers for chronic hives, and these cases are called chronic idiopathic urticaria.

In most cases, hives resolve within hours to days but may come and go when linked to another chronic condition. Allergy testing can help identify triggers, which is critical to preventing flare-ups of both chronic and acute hives.

Hives may be more difficult to detect in people with skin of color where pink or red tones aren’t easy to see. In skin of color, hives may appear only as raised or inflamed areas and might even be mistaken for other types of rashes.

While both eczema and hives appear with rash-like symptoms and are triggered by the immune system, there are differences between them.

Each has specific triggers, and how they react at the level of immune cells varies.

There are a few subtle signs to help you decide if your rash is eczema or hives.

  • Eczema presents most often as dry rough pink plaques on the skin or tiny blisters, known as dyshidrotic eczema, on the hands.
  • Hives typically present as wheels — or larger bumps — which are not often filled with fluid. Instead mast cells, a type of immune cell, release chemicals like serotonin and histamines. These collect under the surface of the skin to fight the allergen that triggered the reaction.
  • While hives may cause itching themselves, eczema papules often appear as the result of dry or irritated skin.
  • If you have chronic hives or eczema, your flare-ups might be linked to certain environmental conditions or triggers. Keeping a log of when the irritation occurs can help identify common threads.

There are several things you can do to help resolve, improve, or avoid eczema flare-ups. A primary goal of eczema management is to minimize triggers and keep skin moisturized. These include:

Treatment for hives will depend on what triggered the reaction in the first place. Triggers may include things like stress, temperature changes, or allergens. There are several treatment options for hives, such as:

  • avoiding irritants and other triggers
  • natural remedies to soothe and moisturize skin
  • over-the-counter or prescription antihistamines or steroids to control allergic reactions

Some people may be more prone to developing eczema than others. There may be a genetic component to eczema, and people who have family members with eczema are more prone to developing the condition themselves.

Other allergic or immune-related conditions like hay fever, food allergies, and asthma may also increase your risk of having eczema.

People who have a history of allergies or certain medical conditions may be more prone to hives than others. Outside of allergies, people with the following conditions may experience hives more frequently:

In most cases, eczema is a chronic condition. It impacts 10 to 20 percent of children and 3% of adults in the United States. Most cases of chronic eczema begin in childhood, and it’s less common for this condition to appear in adulthood without a childhood history. In some cases, eczema can resolve after childhood.

With hives, acute cases may resolve in as little as a few hours. Other times, especially in chronic cases, hives may last for weeks. Chronic hives will also come and go as exposure to triggers or certain conditions changes.

With both eczema and hives, the key to managing these conditions is to identify triggers or allergens, and find ways to avoid them or at least reduce your exposure. There are several treatments and medications that can help you manage flare-ups. Talk to your doctor about both holistic, over-the-counter, or prescription options.

Eczema and hives have similar features but are not the same rash. One thing these conditions have in common is that they may be linked to a trigger or allergen.

Identifying allergens and attempting to avoid certain triggers is key to managing both acute cases of hives and chronic hives or eczema. Talk to a doctor about how to identify and manage your triggers.