Everything You Need to Know About Eczema, According to Derms
If you've recently developed skin irritation in the form of redness or itchiness, you may be experiencing a frustrating (but common) condition called eczema, which can lead to super dry skin—and even blisters and sores in severe cases, or if left untreated. Dermatologists explain what causes eczema, why some people are more prone to getting it than others, and how to treat and control it.
What Is Eczema?
Eczema is basically a generic term for skin dermatitis that is either allergic or irritant in nature, explains Macrene Alexiades, M.D., Ph.D., a New York-based dermatologist and founder of Macrene Actives. It causes dry, rash-like irritation that can eventually even lead to painful sores and blisters. (Related: Natural Eczema Remedies You Haven't Tried Yet)
What Does Eczema Look Like?
Clinically, it can look like inflamed red skin, dark-colored patches, scaly, rough or leathery skin or oozing crusting skin, says Marie Hayag, M.D., a New York-based dermatologist and founder of Fifth Avenue Aesthetics. "There are different types of eczema, but the most common type is atopic dermatitis or 'classic' eczema that usually presents with pink, itchy, dry, or inflamed skin," she says.
What Causes Eczema?
While the cause of eczema is not entirely known, Dr. Alexiades says that it could be due to "a genetic predisposition of breakage in the skin barrier followed by exposure to allergens or irritants"—in other words, credited to a combination of genetic, environmental, and immune triggers. Normally, the skin would shield against allergens and bacteria, but with eczema, that protective barrier dries out, leaving you open to irritants in the environment. Even exposure to everyday items—including detergent, fragrance, clothing dye, dust, pet dander, and more—could trigger eczema symptoms.
How Is Eczema Diagnosed?
If you're experiencing dry, itchy, or red skin and if you're not sure if it's eczema, know that there are areas of the body that are more prone to eczema over others. This skin condition usually crops up on faces, necks, and the insides of elbows, knees, and ankles, notes Dr. Hayag. "It is classically itchy and can be mild to severe."
Apart from the face, it's also common to see eczema on your hands. If your hands are feeling excessively dry, flaky, cracked, or itchy—and if the symptoms aren't relieved after liberally applying moisturizer—it could be a sign of eczema. Those who have their hands in water all day (frequent hand washing, anyone?) or who work closely with allergens or irritants (think: detergent), are more likely to develop eczema. (You can apply a hand cream after washing your hands or doing laundry to help prevent irritation and future flare-ups.)
Unfortunately, there isn't a specific test for diagnosing eczema. Your doctor will do a physical exam and look for telltale signs, including a rash or itchiness. He or she will most likely ask if you have a family history of allergies, since eczema can be genetic. Be sure to let your doctor know when your symptoms first began, if they come and go, what parts of your body are affected, and what seems to cause the flare-ups. Once the exam is complete, your doctor might then refer you to an allergist or dermatologist.
Who Is More Susceptible to Eczema?
If you or a loved one have recently been diagnosed with eczema, try not to worry, because it's a fairly common skin condition. "One in ten people will develop eczema at some point in their lifetime," says Dr. Hayag. What's more, youngsters are more prone to getting eczema than adults, as it occurs in 25 percent of children and in up to 3 percent of adults, she points out. (Related: 5 Skin Conditions That Get Worse with Stress—and How to Chill)
Those who have a family history of allergies are also more susceptible to eczema, especially those who exhibit the "atopic triad" (aka allergies, eczema, asthma, which tend to appear together). "People with both eczema and allergies have a change to a gene called filaggrin, which is a protein in our skin barrier that keeps the skin moist," explains Dr. Hayag. "People who don't make enough of this filaggrin lose more water from their skin, which causes the dryness and itchiness of eczema. The lack of filaggrin also makes the skin let in more allergens, bacteria and viruses," she adds.
The Difference Between Eczema and Psoriasis
What if you've recently developed a skin rash and aren't sure if it's eczema, psoriasis, or another skin condition? The key differentiating factor between eczema and psoriasis is that psoriasis is not itchy, manifests in classic areas such as the elbows, knees, and scalp, and is triggered by stress, infections, alcohol, and certain medications, says Dr. Alexiades.
While signs and symptoms of eczema can vary from person to person, it typically comes with intense itching—which can be so bothersome that it worsens when you scratch it and can keep you up at night. And sometimes, if you continue to scratch it, it can lead to bleeding, an open wound, or infection. (Related: This Is Why Your Skin Feels So Itchy Right Before You Fall Asleep)
How to Treat Eczema
If you suffer from eczema, opt for skin-care products with occlusives, humectants, and emollients, which can all help treat eczema.
- Occulisves: "Occlusives are a type of moisturizing agent that forms a protective coating on the surface on the skin," says Dr. Hayag. Occlusive ingredients to look out for are petrolatum and silicone derivatives such as dimethicone, she says.
- Humectants: "Humectants are hygroscopic (or water-attracting) moisturizers that actively pull and absorb water and hydrate the outer layer of the skin," says Dr. Hayag. Humectants, such as glycerin and hyaluronic acid, can be found in many of the skin-care products already in your arsenal.
- Emollients: Emollients are agents that help to prevent water loss, and also soften and soothe skin. Dr. Alexiades is a fan of emollient-rich ingredients, including glycerin, shea butter, cocoa butter, sunflower extracts, ceramides, and squalane.
Looking something to treat dryness, redness, or irritation on your face? Two other products that get her stamp of approval: Peter Thomas Roth Water Drench Moisturizer (Buy It, $39, amazon.com)—a face moisturizer that drastically improves hydration and leaves skin super soft—and Eau Thermale Avène Soothing Eye Contour Cream (Buy It, $27, amazon.com), which features thermal spring water, antioxidants, and vitamin E to moisturize, soothe, and relieve irritation, redness, and puffiness.
And if you want an all-over body product, opt for Biossance 100% Sugarcane Squalane (Buy It, $32, sephora.com), an oil that hydrates, soothes redness, softens skin, and helps to seal the skin barrier. (More eczema treatment options here: The Best Eczema Cream, According to Dermatologists)
When selecting skin-care products, choose moisturizers that have high oil content over water content, since this will draw more water into the skin and reduce water loss. An ointment is a far better option over a lotion, says Dr. Hayag. This is because ointments have the highest oil content of all, so they don't generally burn when they're applied to sensitive skin and are very good at sealing in moisture, she explained. "Creams are second to ointments in the amount of oil they contain and are also very good at sealing in moisture," says Dr. Hayag. And since they contain less oil, they are also less greasy to the touch, if you hate the feel of sticky skin.
As for what to avoid, those with eczema should stay away from abrasive chemical exfoliators—such as alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs)—and physical exfoliators, including scrubs and products with beads and textures, which could further irritate sensitive skin. Choose products made without sulfates, a chemical cleaning agent found in soaps, laundry detergents, shampoos, toothpastes, and more. Sulfates can strip skin of its natural oils and cause it to become even more dry, itchy and irritated, heightening eczema symptoms. And while you might love sweet-smelling beauty products, fragrance is not your friend. Fragrance can be harsh and irritating on eczema-prone skin, so be sure to opt for products with labels touting that they're "fragrance-free" or safe for sensitive skin. (Related: PHA Acids Might Be the Best Exfoliating Ingredient for Sensitive Skin)
Is Eczema Curable?
Eczema can be a frustrating skin condition, and, unfortunately, there's currently no cure. For many, eczema is a chronic condition that never fully goes away—most people with eczema learn to avoid triggers in order to keep their flare-ups at bay. And those that get eczema as children may experience improvements and milder symptoms as they get older.
The good news is that eczema can be controlled and treated using oral and topical medications, with proper skin care, avoiding triggers, and enlisting coping mechanisms (like exercising, which has been shown to decrease stress, which in turn can be helpful in managing eczema), notes Dr. Hayag. "The goals of treatment are to keep the skin moist, reduce inflammation and the risk of infection, and minimize the itch associated with the rash," she adds.
If you have dry, red, or itchy skin and suspect eczema to be the culprit, a word to the wise: Dr. Hayag suggests making an appointment with your doctor so he or she can diagnose the condition, recommend next steps in treating your issue, and help you prevent future flare-ups. (Related: Products and Tips to Deal with Itchy, Dry Skin On Your Face)