Atopic dermatitis, more commonly known as eczema, is a chronic skin condition that causes inflammation, dryness, itchiness, and bumpy skin rashes. It’s one of the most common skin disorders seen in dermatology, especially among children, though it can affect people of all ages. If you or your child are experiencing itchy skin, red patches, or flares that come and go, you’re not alone. Eczema affects over 30 million people in the U.S. Understanding your symptoms and seeking the right eczema treatment can dramatically improve your comfort and quality of life.
While eczema is not contagious, it can be uncomfortable, embarrassing, and even painful during severe flare-ups. The good news? There are several effective treatments to help manage and control your eczema symptoms. Our board-certified dermatologists are here to help you or your child find relief with a personalized treatment plan.
What Is Atopic Dermatitis?
Atopic dermatitis is the most common type of eczema. It causes the skin to become inflamed and irritated, often resulting in intense itching, dryness, and patches of red or scaly skin. These symptoms can come and go, sometimes flaring up due to external triggers like dry weather or harsh soaps, or internal factors like stress or illness.
In more severe cases, eczema can compromise the skin barrier, allowing irritants, allergens, and bacteria to enter the body more easily. This can lead to further inflammation, secondary infections, or allergic reactions.
Eczema can:
- Start early in childhood or develop in adulthood
- Flare seasonally or year-round
- Range from mild dryness to severe rashes and skin cracking
Affect quality of sleep, mental health, and daily comfort
What Causes Eczema?
The exact cause of eczema isn’t fully understood, but it’s believed to be a mix of genetics, environment, and immune system factors. People with eczema often have a weakened skin barrier, which allows moisture to escape and irritants to enter more easily.
Common Eczema Triggers Include:
- Harsh soaps, detergents, or household cleaners
- Environmental allergens (pollen, dust mites, pet dander)
- Dry weather or low humidity
- Hot showers or overheating
- Emotional stress or anxiety
- Certain fabrics like wool or synthetic materials
- Foods (especially in children) such as eggs, dairy, nuts, or wheat
Children with eczema are also more likely to develop other atopic conditions, such as asthma or hay fever, a combination often referred to as the “atopic triad.”
While some people can identify specific triggers, others never find a clear cause. Either way, the main goal of treatment is to soothe the skin, restore the skin barrier, and reduce inflammation.
What Are the Symptoms of Eczema?
Eczema symptoms vary from person to person. Some people experience only occasional mild itching and dryness, while others have persistent rashes or cracked, weeping skin.
Common Symptoms Include:
- Dry, scaly patches
- Red, inflamed skin
- Intense itching (often worse at night)
- Skin that cracks, oozes, or bleeds
- Thickened or leathery skin from repeated scratching
- Fluid-filled blisters
- Crusting or signs of skin infection
Eczema can appear anywhere, but it’s most common on:
- Elbows and knees
- Face and neck
- Hands and feet
- Wrists and ankles
- Groin or behind the knees
Scratching the rash can worsen the inflammation and even lead to infection. That’s why it’s so important to control itching and manage flare-ups early.
Types of Eczema
While atopic dermatitis is the most well-known form of eczema, there are several different types, each with its own pattern and causes.
1. Atopic Dermatitis
- Chronic, itchy inflammation that often begins in childhood
- Common on the face, neck, arms, and legs
- Frequently linked to allergies or asthma
2. Contact Dermatitis
- Caused by direct contact with irritants (like bleach or fragrances) or allergens (like nickel or poison ivy)
- Skin becomes red, itchy, and possibly blistered
3. Dyshidrotic Eczema
- Causes small, itchy blisters on the hands and feet
- Can be triggered by stress or sweat
4. Nummular Eczema
- Characterized by round, coin-shaped patches on the skin
- Often appears in dry climates
5. Seborrheic Dermatitis
- Affects oily areas like the scalp, face, and chest
- Common in infants (cradle cap) and adults with oily skin
- Genetics, immune system function, and overgrowth of yeast normally found on the skin also play a role
6. Stasis Dermatitis
- Occurs in the lower legs due to poor circulation or varicose veins that leads to swelling
- Skin may appear red, scaly, and swollen
7. Neurodermatitis
- Caused by chronic scratching due to stress or habit
- Skin becomes thick and leathery and often has a brown discoloration.
How is Eczema Treated?
There is no cure for eczema, but treatment can significantly reduce symptoms and help prevent flare-ups. The goal of eczema treatment is to restore the skin barrier, reduce inflammation, and control itching.
Treatment Options Include:
Basic Skincare (For All Cases)
- Use fragrance-free moisturizers and emollients daily
- Lotions: Water and alcohol-based; as the lightest moisturizers, lotions are the least effective at hydrating the skin, and can also sting broken skin due to the alcohol content.
- Creams: Water and oil-based creams contain less oil than ointments so they are less greasy, but also less effective at moisturizing the skin. However, creams are much more effective than lotions.
- Ointments: Oil-based; ointments contain the most oil and are the best for hydrating the skin and least likely to cause stinging on broken, inflammed skin.
- Take short, lukewarm showers (avoid hot water)
- Gently pat skin dry and apply moisturizer immediately after bathing
- Wear breathable, non-irritating fabrics like cotton
- Keep moisturizer near every sink in your home.
- Use gentle cleansers instead of harsh soaps.
Over-the-Counter Treatment Options
- Hydrocortisone creams to reduce inflammation
- Oatmeal baths for itch relief
- Antihistamines for nighttime itching
- Calamine lotion for soothing allergic dermatitis caused by allergic irritant reactions such as poison ivy or insect bites
- Pramoxine which contains lotions for reducing itching and redness
Prescription Medications
- Topical corticosteroids: anti-inflammatory medicines that reduce redness and itching
- Topical calcineurin inhibitors: non-steroidal anti-inflammatory creams such as tacrolimus or pimecrolimus that reduce itching and redness
- Oral antibiotics: treat secondary infections introduced through broken skin. Certain antibiotics also have anti-inflammatory properties that help reduce inflammation systemically.
- Oral antihistamines: treat itching and skin hyper-sensitivity
- Oral corticosteroids: short-term anti-inflammatory medications used for severe flares
- Calcipotriene: a topical synthetic vitamin D analog that decreases inflammation
- Topical phosphodiesterase-4 (PDE4) inhibitor (crisaborole (Eucrisa), roflumilast (Zoryve)): non-steroidal anti-inflammatory creams
- Topical JAK inhibitors (ruxolitinib (Opzelura)): non-steroidal medicine that shuts down inflammation
- Oral JAK inhibitors (abrocitinib (Cibinqo), upadacitinib (Rinvoq)); a relatively new option used for severe eczema that is unresponsive to other therapies
- Aryl hydrocarbon receptor (AhR) agonist (tapinarof (Vtama): non-steroidal anti-inflammatory cream that reduces inflammation
Advanced Treatment Options
- Phototherapy (light therapy): used for moderate to severe eczema
- Biologic medications: Breakthrough injectable medications that target specific pathways in the immune system such as:
- Dupilumab (Dupixent): Anti-IL4/IL13
- Tralokinumab (Adbry): Anti-IL13
- Lebrikizumab (Ebglyss): Anti-IL13
- Nemolizumab (Nemluvio): Anti-IL31
- Immunosuppressants: like mycophelonate mofetil, azathioprine, or methotrexate for severe, uncontrolled eczema
Living With Eczema
Managing eczema isn’t just about treating flare-ups, it’s also about long-term skin maintenance. Making a few adjustments to your lifestyle and daily skincare routine can reduce the frequency and intensity of symptoms.
Tips for Managing Eczema Long-Term:
- Keep fingernails short to prevent skin damage from scratching
- Use a humidifier during dry months
- Wear gloves when cleaning or doing dishes
- Avoid known triggers and allergens
- Practice stress-reducing techniques like meditation, yoga, or journaling
For children, eczema can sometimes improve or go away entirely with age. For adults, it may become a manageable part of life with the right support and treatment plan.
When to See a Dermatologist
If your skin is not responding to over-the-counter treatments, or if your eczema is interfering with your sleep, work, or emotional well-being, it’s time to seek professional care. Chronic or severe eczema often requires prescription medication, or a combination of therapies tailored to your specific needs. At Dermatology Healthcare Excellence, our board-certified dermatologist works to understand your lifestyle and goals to create a custom treatment plan to help you feel comfortable and confident in your skin.