Understanding eczema: types, symptoms, causes and treatment

Eczema, also called dermatitis, refers to a group of dry skin conditions. It is not contagious but is common, affecting over one in five children and one in 10 adults in the UK. 

Eczema can cause considerable discomfort as your skin becomes inflamed, irritated and very itchy. This can lead to bleeding, cracked, dry, flakey and/or sore skin, which appears red in lighter skin tones and ashen, brown or purple in darker skin tones. Cracked skin can also become infected with bacteria. 

The severity of symptoms varies between individuals, ranging from small patches of itchy skin that cause mild irritation to intensely itchy skin all over the body. Severe symptoms can cause sleepless nights, which can lead to problems concentrating, stress and depression.

Both children and adults experience similar symptoms. However, there are certain types of eczema that are more common in children or in adults.  

Types of eczema

There are seven main types of eczema, and you may have more than one type at any given time.

Asteatotic eczema

This is the most common type of eczema in older people and is caused by the top layer of the skin losing too much water. This results in dry, scaly, cracked skin, which usually develops on the front of your legs but can also develop on your abdomen, arms, back and thighs.

Symptoms often worsen in the winter when the air is drier, and your skin is exposed to more indoor heating. Spending too long in the bath or shower or bathing or showering in hot water can also worsen your symptoms.

Atopic eczema

This is the most common type of eczema across all ages. Atopic refers to an increased likelihood of developing allergies due to your genes. Consequently, atopic eczema tends to run in families and is more common in individuals with asthma, allergic rhinitis and/or hay fever.

It usually develops in childhood before age one. As children get older, atopic eczema may disappear. However, it can leave your skin sensitive for the rest of your life and recur in later life.

Atopic eczema can affect any part of your body but commonly affects the creases of your joints ie the inner side of your elbows and backs of your knees, as well as your hands, especially your fingers, face and scalp.

Contact eczema

More commonly referred to as contact dermatitis, this type of eczema occurs when your body is exposed to an allergen (a substance that triggers an allergic reaction) or an irritant in the environment. Irritant contact dermatitis is much more common than allergic contact dermatitis. 

In irritant contact dermatitis, irritants directly damage or inflame your skin without triggering an allergic reaction. Irritants include household cleaning agents, detergents, soaps, body wash, pesticides and fertilisers. 

Allergic contact dermatitis occurs when, over months or years, your body develops an allergy to a specific substance. Common allergens include nickel, which is often used in jewellery, formaldehyde, which is released when certain cleaning products or cosmetics are exposed to water, and paraphenylenediamine, which is found in hair dye, henna and temporary tattoos. 

Discoid eczema

Also known as nummular eczema, this type of eczema causes itchy, oval or round lesions. The lesions start off bumpy and can later develop lumps and blisters before eventually becoming dry, flakey and scaly.

It affects both children and adults but is more common in men. You’re more likely to develop discoid eczema if you have atopic eczema or had atopic eczema as a child, have allergic contact dermatitis or have a skin infection resulting from your eczema.

Pompholyx eczema

Also known as dyshidrotic eczema, this type of eczema is more common in adults aged under 40 and in women. Around half of people with pompholyx eczema also have atopic eczema or have a family history of atopic eczema.

Pompholyx eczema usually affects the fingers, palms of your hands and soles of your feet. Patches of itchy skin develop, blisters form that leak fluid, and then the skin becomes dry, flakey and cracked. Pompholyx eczema can also cause your nail folds — the skin around your nails — to become swollen (paronychia).

Seborrhoeic dermatitis

This type of eczema can affect adults and infants. Infantile seborrhoeic dermatitis is more commonly known as cradle cap and disappears on its own at around six to 12 months of age. In adults, seborrhoeic eczema usually occurs after age 20 and is more common in men.

Seborrhoeic dermatitis occurs in areas of the body where there are lots of sebaceous glands (glands that produce oil to keep your skin lubricated). In adults, it commonly affects the ears, face, scalp and chest. It causes greasy-looking white or yellow scales, as well as dry, inflamed skin.

Varicose eczema

As the name suggests, varicose eczema is more likely if you have varicose veins. It is, therefore, more common in older people — around 70% of people aged over 70 have varicose eczema. As varicose veins most often occur in the legs, varicose eczema is also most common in this area. 

Other risk factors for varicose eczema include high blood pressure, a previous deep vein thrombosis (DVT), the skin condition cellulitis, the blood vessel condition phlebitis, being overweight and leading an inactive lifestyle.

Causes and triggers of eczema

The causes of eczema vary depending on which type of eczema you have. Eczema can be triggered by irritants or allergens. It can develop due to your genetics (ie a family history of eczema), having varicose veins or having skin that isn’t able to retain moisture well.

Periods of time where your symptoms worsen (flare-ups) can occur due to stress, extreme temperatures or when the air is too dry. In women, hormonal changes can also worsen symptoms eg before your period starts or during pregnancy.

How is eczema diagnosed?

In most cases, eczema can be diagnosed after your GP examines your skin and asks you questions about your symptoms and medical history.

This may include questions about when your symptoms started, if they are persistent or come and go, and if they worsen in certain situations, as well as if you have allergies or a family history of eczema.

When to see a doctor

If you’ve never had eczema before but are concerned that you’re showing signs of the condition, see your GP. 

If you’ve already been diagnosed with eczema, you should see your GP if your symptoms are preventing you from sleeping well at night or if they’re causing considerable discomfort even after using over-the-counter treatments. 

You should also see your GP if you develop a skin infection. Symptoms include:

• A yellow crust on your skin
• Fever
• Fluid leaking from your skin
• Swollen, sore skin
• Yellow-white spots in patches of your eczema

Is infected eczema preventable?

It isn’t always possible to prevent skin infections from developing if you have eczema. However, you can reduce your chances of infection by taking steps to prevent your skin from becoming cracked.

This involves seeking medical help if you’re struggling with your eczema, regularly moisturising your skin, trying to avoid scratching your skin and avoiding any known triggers.

Treating eczema: medical treatments

Although there are many different types of eczema, the treatments are similar and vary according to the severity of your eczema.

Treatments for mild to moderate eczema

In the first instance, the two main treatments for eczema are emollients and topical steroids. 

Emollients are non-cosmetic moisturisers that help prevent your skin from drying out and are used daily. Most are available over-the-counter and fall into two broad categories: greasy ointment emollients that are used on dry skin, and cream emollients that are used on sore and/or weeping skin. 

Topical steroids are also available on prescription to reduce the redness and swelling that occurs during flare-ups. 

Treatments for moderate to severe eczema

Paste bandages and wet wrapping can help treat moderate to severe eczema. This involves wearing medical-grade garments or bandages to soothe your skin and prevent itching and scratching.

Wet wrapping involves wrapping part of the body in a wet layer of material that is soaked in water or an emollient and then covering this with a dry layer. This helps cool, hydrate and protect your skin. Paste bandages also provide a protective barrier but contain zinc oxide to soothe and cool your skin.

If topical steroids are ineffective or you can’t tolerate them well, your doctor may recommend topical calcineurin inhibitors (TCI), such as pimecrolimus cream and tacrolimus ointment, which alter your immune system to reduce the severity of flare-ups or prevent them from occurring.

Further treatments for severe eczema

In severe cases of eczema, where all other treatments applied to your skin (topical treatments) are ineffective, your doctor may recommend:

• Immunosuppressant drugs eg azathioprine, ciclosporin and mycophenolate mofetil — these suppress your immune system to reduce inflammation
• Oral steroids — steroid tablets that are taken once a day to suppress your immune system and reduce inflammation during a flare-up; these are not prescribed for long-term use due to the side effects
• Phototherapy — specific types of UVA and UVB light are applied to reduce inflammation in your skin over the course of several weeks 

Treating eczema: lifestyle treatments

Eczema can often be unbearably itchy, so to help prevent scratching, try gently rubbing your skin instead as well as covering your skin. Keeping your nails short will help limit damage from scratching.

You should also try to avoid triggers that worsen your symptoms. Triggers vary from one person to the next and depend on what type of eczema you have. You may need to keep your home at a more constant temperature, avoid irritating detergents and personal hygiene products, and avoid wearing synthetic fabrics or wool — many people with eczema find cotton, bamboo or silk clothing more comfortable.