When you think of eczema, itchy, red, dry, scaly, or thickened skin may come to mind.
While that’s true for those with medium to darker skin tones, it may not be as obvious and can appear brown, purple, and ashen. Those with brown and Black skin also more commonly develop small bumps on the torso, arms, and legs.
This skin condition is common in children, but adults can get it too. In fact, according to the National Eczema Association, 10 percent of the population will develop the condition during their lifetime.
Anyone can be affected by eczema. The rate of prevalence among some races and ethnicities are:
- 11 percent of white people
- 10 percent of Black people
- 13 percent of Asian or Pacific Islander people
- 13 percent of Native American people
Eczema is sometimes called atopic dermatitis, which is the most common form. “Atopic” refers to an allergy. People with eczema often have allergies or asthma along with itchy, red, or hyperpigmented skin.
Eczema comes in a few other forms, too. Each eczema type has its own set of symptoms and triggers.
There are also some common symptoms for all types of eczema:
- dry, scaly skin
- itching, which may be intense
Atopic dermatitis is the most common form of eczema. It usually starts in childhood, and often gets milder or goes away by adulthood.
Atopic dermatitis is part of what healthcare professionals call the atopic triad. “Triad” means three. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions.
In atopic dermatitis:
- The rash often forms in the creases of your elbows or knees.
- The skin in areas where the rash appears may turn lighter or darker or get thicker.
- Small bumps may appear and leak fluid if you scratch them.
- Babies will often get the rash on their scalp and cheeks.
- Your skin can get infected if you scratch it.
Atopic dermatitis happens when your skin’s natural barrier against the elements is weakened. This means your skin is less able to protect you from irritants and allergens.
Atopic dermatitis is likely caused by a combination of factors, such as:
- dry skin
- an immune system problem
- triggers in the environment
If you have red, irritated skin, thick scaly region that’s caused by a reaction to substances you touch, you may have contact dermatitis.
It comes in two types: Allergic contact dermatitis is an immune system reaction to an irritant, like latex or metal. Irritant contact dermatitis starts when a chemical or other substance irritates your skin.
In contact dermatitis:
- You skin itches, turns red, is hyperpigmented or pink, magenta, burns, and stings.
- Itchy bumps called hives may appear on your skin.
- Fluid-filled blisters can form that may ooze and crust over.
- Over time, the skin may thicken and feel scaly or leathery.
Contact dermatitis happens when you touch a substance that irritates your skin or causes an allergic reaction. The most common causes are:
- poison ivy and other poisonous plants
- skin care products, including makeup
- soaps and perfumes
- tobacco smoke
Dyshidrotic eczema causes small blisters to form on your hands and feet. It’s more common in women than men.
In dyshidrotic eczema:
- Fluid-filled blisters form on your fingers, toes, palms, and the soles of your feet.
- These blisters may itch or hurt.
- Your skin can scale, crack, and flake.
Dyshidrotic eczema can be caused by:
- damp hands and feet
- exposure to substances, such as nickel, cobalt, or chromium salt
- smoking tobacco products
Seborrheic dermatitis causes scaly, oily patches of skin that produce dandruff-like flakes. These patches often appear where there are more sebaceous (oil-producing) glands on the body. This includes the hairline, scalp, upper back, nose, and groin.
If this type of dermatitis develops in infants, it is commonly called cradle cap, and it does not reappear later. In teens and adults, however, seborrheic dermatitis will most likely be an ongoing skin issue.
In seborrheic dermatitis:
- Patches of flaky white or yellow scales develop on top of oily skin, such as on your scalp, hairline, upper back, mid-chest, armpits, under breasts, or near the groin.
- The patches may produce flaking skin. This is more common on the face and scalp.
- In people with dark brown or Black skin, the patches may be darker than their skin, but in people with white skin, the patches can be lighter.
For adults and teens with this type of dermatitis, symptoms may come and go. They may also disappear for a while, typically in summer, but return when the season changes and the air is cold and dry again.
Seborrheic dermatitis develops through a combination of environmental and genetic factors.
First, a trigger, such as stress or illness, sets off an inflammatory reaction in the skin. This causes the oil-producing glands in the body to kick into overdrive and create too much Malassezia yeast. This is an organism that lives on the skin’s surface.
When yeast grows too rapidly, the immune system reacts and causes a series of skin changes. This leads to the development of the patches of skin common with seborrheic dermatitis.
Other triggers include:
- hormonal changes
- harsh detergents or chemicals
- cold, dry weather
- certain medical conditions, like Parkinson’s disease, psoriasis, HIV, and acne
- medicines, including interferon and lithium
Neurodermatitis is similar to atopic dermatitis. It causes thick, scaly patches to appear on your skin.
- Thick, scaly patches form on your arms, legs, back of your neck, scalp, bottoms of your feet, backs of your hands, or genitals.
- The patches can be very itchy, especially when you’re relaxed or asleep.
- The patches can bleed and get infected if you scratch them.
Neurodermatitis usually starts in people who have other types of eczema or psoriasis. Doctors don’t know exactly what causes it, but stress can be a trigger.
This type of eczema causes round, coin-shaped spots to form on your skin. The word “nummular” means coin in Latin.
Nummular eczema looks very different from other types of eczema, and it can itch a lot.
In nummular eczema:
- Round, coin-shaped spots form on your skin.
- The spots may itch or become scaly.
Nummular eczema can be triggered by a reaction to an insect bite or an allergic reaction to metals or chemicals. Dry skin can also cause it.
You’re more likely to get this form if you have another type of eczema, such as atopic dermatitis.
Stasis dermatitis happens when fluid leaks out of weakened veins into your skin.
This fluid causes:
- redness in lighter skin tones
- brown, purple, gray or ashen color in darker skin tones
In stasis dermatitis:
- The lower part of your legs may swell, especially during the day when you’ve been walking.
- Your legs may ache or feel heavy.
- You’ll likely also have varicose veins, which are thick, ropey damaged veins in your legs.
- The skin over those varicose veins will be dry and itchy.
- You may develop open sores on your lower legs and on the tops of your feet.
Stasis dermatitis happens in people who have blood flow problems in their lower legs. If the valves that normally push blood up through your legs toward your heart malfunction, blood can pool in your legs.
Your legs can swell up and varicose veins can form.
Eczema that only affects your hands is called hand eczema. You may get this type if you work a job, like hairdressing or cleaning, where you regularly use chemicals that irritate the skin.
In hand eczema:
- Your hands get red, hyperpigmented, itchy, and dry.
- They may form cracks or blisters.
Hand eczema is triggered by exposure to chemicals. People are more likely to get this form if they work in jobs that expose them to irritants, such as:
- laundry or dry cleaning
See your doctor if the itching, redness, hyperpigmentation, dryness, and scaliness you’re experiencing doesn’t go away, or if it interferes with your life.
A dermatologist can diagnose and treat eczema, but other healthcare professionals may also be able to provide guidance.
To help your doctor understand your condition, consider keeping a diary to identify your eczema triggers. Write down:
- what you eat and drink
- what skin products, chemicals, soaps, makeup, and detergents you use
- what activities you do, such as taking a walk outside in the woods or swimming in a chlorinated pool
- how long you spend in the bath or shower and the temperature of the water
- when you’re under stress
You should begin to notice connections between your activities and your eczema flare-ups. Bring this journal to your doctor to help them pinpoint your triggers.
An allergy specialist can also do a patch test. This test places small amounts of irritating substances on patches that are applied to your skin. The patches stay on your skin for 20 to 30 minutes to see if you have a reaction.
This test can help your doctor tell which substances trigger your eczema, so you can avoid them.
Eczema often comes and goes. When it appears, you might need to try different medicines and other treatments to get rid of the rash.
- Antihistamines such as diphenhydramine (Benadryl) can control the itch.
- Corticosteroid cream or ointment can reduce the itch. For a more severe reaction, you can take oral steroids, like prednisone (Rayos) to control swelling.
- Calcineurin inhibitors, such as tacrolimus (Protopic) and pimecrolimus (Elidel), reduce the immune response that causes itchy skin.
- Antibiotics treat skin infections.
- Light therapy exposes your skin to ultraviolet light to heal your rash.
- Cool compresses applied before you rub on corticosteroid cream can help the medicine sink into your skin more easily.
- Lotions or baths with colloidal oatmeal can relieve itching.
If an allergic reaction results in a flare-up of your eczema, you’ll want to avoid the substance that triggers it.
Here are a few ways to prevent eczema flare-ups and manage symptoms:
- Apply cool compresses to your skin, or take a colloidal oatmeal or baking soda bath to relieve the itch.
- Moisturize your skin daily with a rich, oil-based cream or ointment to form a protective barrier against the elements. Apply the cream right after you get out of the shower or bath to seal in moisture.
- After you bathe, gently pat your skin with a soft towel. Never rub.
- Avoid scratching. You could cause an infection.
- Use fragrance-free detergents, cleansers, makeup, and other skin care products.
- Wear gloves and protective clothing whenever you handle chemicals.
- Wear loose-fitting clothes made from soft fibers, like cotton.
Most eczema comes and goes over time. Atopic dermatitis is usually worst in childhood and improves with age. Other forms of eczema may stay with you throughout your life, although you can take measures to reduce your symptoms.