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Eczema\u2014whether you live with it yourself or know and love someone who does\u2014is rarely far from your orbit. In the United States, nearly 32 million people, about 10 percent of the population, have some form of eczema, according to the National Eczema Association.<\/p>\n
That\u2019s not to say eczema is the most intuitive topic to unpack. To make it easier to understand, I spoke with four board-certified dermatologists to break down what they spent years studying into a clear, easy-to-digest guide to what eczema is, what triggers it and what actually helps keep flares under control.<\/p>\n
\u201cEczema, most commonly atopic dermatitis, is a chronic inflammatory skin condition where the skin barrier doesn\u2019t function the way it should,\u201d says New York dermatologist Dendy Engelman, MD. \u201cWhen that barrier is compromised, moisture escapes and irritants, allergens and bacteria can penetrate more easily, leading to redness, itching, dryness and sometimes cracking or oozing.\u201d<\/p>\n
The hallmark symptom of eczema is \u201crecurrent itchy patches of skin,\u201d says New York dermatologist Shira Wieder, MD. While it often begins in childhood, eczema can develop at any age. \u201cThe cause of eczema is multifactorial, involving\u00a0genetic predisposition,\u00a0 immune system sensitivity and skin barrier dysfunction,\u201d adds Chicago dermatologist and dermatopathologist Morayo\u00a0Adisa, MD\u2014and it is not contagious. <\/p>\n
While many people use \u201ceczema\u201d and \u201catopic dermatitis\u201d interchangeably, the term eczema is actually an umbrella term that includes several types, Dr. Wieder explains. These include atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular dermatitis, seborrheic dermatitis, neurodermatitis and stasis dermatitis\u2014each with its own triggers and patterns.<\/p>\n
During a flare, that weakened skin barrier sets off a chain reaction. Once external triggers penetrate the skin, the immune system mounts an exaggerated inflammatory response. \u201cInflammatory cytokines are released, leading to redness, swelling and that hallmark intense itch,\u201d Dr. Engelman explains.<\/p>\n
Scratching then further damages the barrier, fueling what New York dermatologist Ariel Ostad, MD calls the \u201citch\u2013scratch cycle,\u201d which he explains \u201cfurther damages the barrier and prolongs inflammation,\u201d helping explain why eczema can be so persistent and difficult to calm once it begins.<\/p>\n
Because eczema can resemble other inflammatory skin conditions, it\u2019s often confused with psoriasis or contact dermatitis. Here\u2019s how each differs:<\/p>\n
Dr. Engelman explains that eczema \u201ctends to be very itchy and shows up as dry, inflamed, sometimes rough patches,\u201d commonly in the creases of the elbows, behind the knees, on the neck or around the eyes. Over time, repeated scratching can cause the skin to thicken.<\/p>\n
Psoriasis, by contrast, tends to form thicker, more clearly outlined plaques. \u201cThe plaques are thicker, with a silvery-white scale on top of red skin,\u201d Dr. Engelman continues. They\u2019re often found on the scalp, elbows, knees and lower back and are driven more by rapid skin-cell turnover than barrier dysfunction.<\/p>\n
Contact dermatitis usually has a clear trigger. \u201cIt appears exactly where the skin touched an irritant or allergen: new skin-care product, fragrance, detergent or even nickel jewelry,\u201d she explains. The rash may burn or sting in addition to itching, and once the trigger is removed, it often improves.<\/p>\n
\u201cLocation and symmetry, thickness and scale of the rash, intensity of itch, can help identify which is which,\u201d Dr. Engelman adds. That said, rashes can overlap in appearance, so if you\u2019re unsure, it\u2019s best to see a dermatologist for an accurate diagnosis.<\/p>\n
Because atopic dermatitis is the most common form of eczema, it\u2019s often what people mean when they refer to \u201ceczema.\u201d Its triggers are also the most widely studied.<\/p>\n
\u201cTypical triggers for atopic dermatitis include cold weather, dry air, pet dander, sweat, dust mites, pollen and even viral illnesses like the common cold,\u201d Dr. Wieder explains. \u201cWhile a consistent skin-care routine involving moisturizers and avoiding triggers like fragrances can be helpful to prevent mild flares, atopic dermatitis is a chronic recurrent disease that has flares and quiet periods. A consistent skin-care routine is often not enough.\u201d<\/p>\n
In other words, eczema-prone skin is reactive\u2014and sometimes the triggers are hiding in plain sight. While triggers vary depending on the type of eczema, many everyday exposures can aggravate multiple forms of the condition. \u201cThe most frequently missed triggers are personal care products\u2014like soaps, shampoos, conditioners and laundry detergents\u2014with fragrances, dyes or essential oils,\u201d warns Dr. Wieder.<\/p>\n
Beyond that, subtle habits can add up. Cologne, perfumes, fabric softeners and scent boosters can irritate sensitive skin. Harsh hand cleansers may weaken the skin barrier. Even long, hot showers and rough fabrics like wool can provoke itching and redness. \u201cI recommend switching out your wool sweaters (or any rough, itchy fabric) for cotton if possible,\u201d Dr. Wieder suggests.<\/p>\n
While eczema can\u2019t be cured, it can absolutely be managed. The focus is on supporting your skin barrier, calming inflammation and avoiding the things that tend to set it off.<\/p>\n
Daily moisturizing is foundational. \u201cI recommend daily use of thicker moisturizers and applying them within 90 seconds of getting out of the shower,\u201d says Dr. Wieder on what she recommends to eczema patients. \u201cIt\u2019s important to apply while skin is still damp,\u201d she adds, because it helps trap water in the skin and prevent it from drying out.<\/p>\n
Since prolonged heat exposure can weaken the skin barrier, keep showers short and use warm (not hot) water. While long, steamy showers may feel soothing in the moment, they can worsen dryness over time.<\/p>\n
Management also means choosing products strategically. Dr. Wieder suggests looking for moisturizers that contain petroleum, glycerin, colloidal oatmeal, ceramides and hyaluronic acid to help support the skin barrier. Niacinamide may also calm inflammation.<\/p>\n
On the flip side, ingredients like retinoids, fragrance, lanolin (including products that contain it, such as Aquaphor) and urea can trigger irritation during active flares, she warns.<\/p>\n
When eczema-prone skin is flaring, less is more. \u201cCleanse with a gentle, fragrance-free cleanser using lukewarm water followed immediately with application of bland moisturizer,\u201d Dr. Adisam.<\/p>\n
For moderate to severe eczema\u2014or for those experiencing frequent flares\u2014at-home care may not be sufficient. In those cases, Dr. Wieder recommends speaking with a dermatologist about maintenance therapy, or a preventative treatment plan designed to keep symptoms under control. This may include applying a topical steroid two to three times per week or incorporating a non-steroidal prescription option for longer-term management.<\/p>\n
Mild eczema that responds to generous use of over-the-counter moisturizers or 1 percent hydrocortisone can often be managed at home, she explains. If symptoms improve and flares become less frequent, a prescription may not be necessary.<\/p>\n
But if irritation persists, worsens or continues despite consistent at-home care, it\u2019s time to seek professional guidance. \u201cAnything that does not improve with over-the-counter products should seek out an appointment with a dermatologist,\u201d says Dr. Wieder. \u201cNo need to suffer\u2014we can really help.\u201d<\/p>\n
Typical eczema is itchy and inflamed, but infection adds new symptoms. Warning signs include increased pain (rather than just itching), pus, yellow or honey-colored crusting, rapidly spreading redness or fever, says New York dermatologist Ariel Ostad, MD. \u201cBecause eczema disrupts the skin barrier, patients are more prone to bacterial infections, particularly from Staphylococcus aureus,\u201d he explains. If those symptoms appear, it\u2019s important to seek care promptly.<\/p>\n
\u201cFor moderate to severe eczema that doesn\u2019t improve with topical steroids or moisturizers, we now have more advanced options,\u201d says Dr. Ostad. Prescription treatments may include stronger topical medications, non-steroidal anti-inflammatory creams and, in more persistent cases, targeted biologic injections such as Dupixent (dupilumab) or Adbry (tralokinumab), which block specific inflammatory pathways involved in atopic dermatitis.<\/p>\n
Ultimately, treatment isn\u2019t one-size-fits-all. It depends on how extensive the eczema is, how often it flares and how much it disrupts daily life. A board-certified dermatologist can help map out the next step so you\u2019re not left guessing.<\/p>\n<\/p><\/div>\n