What is eczema?

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What is eczema?

Definition  |  Causes  |  Symptoms  |  Appearance  |  Diagnosis

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Written by Dr. Ian Harrison BSc, PhD with contributions from Dr. Andrew Leech FRACGP, MBBS, BSc, DCH.

Updated on June 30, 2023

Eczema, also known as atopic dermatitis, is the most commonly diagnosed inflammatory skin disease in the world, and can affect up to 3% of adults and 20% of children1. As an inherited, chronic itchy skin condition, it usually appears in early childhood and may continue into adulthood for some people, but many cases may improve or clear up during later childhood. 

Definition

What is eczema? 

Eczema is an inflammatory skin condition that causes patches of the skin to become red, dry, scaly and itchy. Your skin, which is the body’s largest organ, is also its first line of defence to the outside world. It is made up of three main layers: the hypodermis (deepest layer), the dermis (middle layer) and the epidermis (upper layer). 

It primarily affects the upper layer of the skin, the epidermis, or the stratum corneum which forms the protective skin barrier between the inner body and the outer world2, stopping allergens and irritants from entering the body, whilst helping your skin retain moisture. When skin is affected by eczema, the skin’s barrier function is compromised, leaving the skin vulnerable to symptoms such as red and inflamed rashes inflamed, itchy dry skin, typically seen on joints, the face and hands3.

Causes

Do we know what causes eczema?

The exact cause of eczema is unknown amongst children and adults. However, there is belief that it’s caused by a mutation in the gene called filaggrin. Filaggrin is important for formation of the skin barrier, and those susceptible to eczema have only one copy of this gene, instead of two.

Research also suggests that ceramides are significantly lower in eczema skin and associated with increased moisture loss4. It is recommended that topical products with ceramides be used on eczema skin, helping to support the structural integrity of your skin barrier. 

Allergens and environmental factors have also been known to cause or exacerbate symptoms5, which may cause your immune system to fire up and go into overdrive, resulting in inflammation and itchiness on the surface of the skin.  Common triggers of eczema may include6: 

Hot temperatures and overheating your skin: Layer clothing for easy removal as required to keep the skin cool. Cotton clothing is recommended. 

Perfumed products and contact with irritants: Including detergents, soaps, and chlorinated pools. Soap-free and fragrance-free products are recommended. 

Dust and dust mites, pet fur.

Certain foods: Food allergies also involve the immune system, so it might not come as a surprise that around 30% of children with eczema and a family history of allergies will also develop a food allergy before the age of five (compared with only 10% in the general population)7. 

Watch our Science Says video to learn more with Dr. Niyati Sharma
Eczema is a skin condition where the skin becomes dry, scaly and itchy. It can start at any age but is most common in children. There can be a family history or a link to other allergy problems like hayfever, asthma and food allergies. It can be caused by a variety of triggers, the most common are environmental such as heat, soaps and detergents, grasses and wool. Sometimes we never find the cause and children eventually grow out of it.

Dr. Andrew Leech

Symptoms

What are the symptoms of eczema?

Eczema can present differently at different times and ages [refer to table 1], often depending on the severity of the eczema (mild, moderate and severe)8, and may look different for everyone.

Key symptoms of eczema include:

  • Patches of red and inflamed skin on the body such as elbows or knees
  • Dry skin 
  • Itchy skin
  • Skin rashes

Many find their symptoms intensify as their skin becomes drier and as they find themselves scratching more. Scratching leads to damaging the skin barrier and, in a vicious cycle known as the ‘itch-scratch cycle’, worsens dryness and exacerbates the itch and scratch12-13. This can further irritate the skin and lead to an eczema flare up or infection. 

Key symptoms of an eczema infection include:

  • Intense itchy skin
  • Intense inflammation and redness of the skin
  • Raised bumps
  • Fluid weeping or oozing from site
  • Thickened skin
  • Fever

What impact does eczema have on me psychologically?

In addition to all the symptoms mentioned above, eczema and the vicious ‘itch-scratch cycle’ can have severe emotional and psychological effects. Anxiety and depression are often linked with eczema, and these conditions also tend to be worse if the eczema itself is severe14. The itch-scratch cycle can also have other effects too: sleep quality can be noticeably impacted as you toss and turn trying to get comfortable at night, making it harder to function properly at work or school15. As if that isn’t bad enough, infants with eczema may experience issues with early development around touch, which could have a negative impact on their emotional and/ or physical development16.

Eczema is a condition that can be hard to live with, but it can be managed with the right approaches. If you are ever in doubt, speak to your health professional about management strategies that could work for you.

Appearance

Where can eczema symptoms appear on my body?

Symptoms are most commonly present in areas such as the joints9. In children, we typically see eczema symptoms on the face, scalp and the arms and legs, whereas symptoms usually only involve areas such as the elbow joints and behind the knees in late-childhood or adult eczema10.

Infants
 Toddlers School-age
AD is often widely distributed AD becomes more localised Inner creases of joints most often affected, particularly elbows and knees
Cheeks are usually the first area affected Outer skin of the joints (wrists, elbows, ankles, knees) are most commonly affected May also affect eyelids, earlobes, neck and scalp
Infants
 Toddlers School-age
AD is often widely distributed AD becomes more localised Inner creases of joints most often affected, particularly elbows and knees
Cheeks are usually the first area affected Outer skin of the joints (wrists, elbows, ankles, knees) are most commonly affected May also affect eyelids, earlobes, neck and scalp

Table 1 - Commonly affected areas. Eczema can look different depending on the child's age1

Diagnosis

When should I see my health care professional? 

The information included is for educational purposes only and is not intended as a substitute for medical advice. Eczema requires diagnosis by a medical practitioner. We recommend you see your medical practitioner for further information and if you are;

  • Experiencing symptoms of eczema
  • Symptoms are not responding to treatment and impacting your day to day life
  • An infection is suspected (look out for a fever, exacerbated eczema symptoms, oozing skin) 

How do I live with eczema?

A health professional such as a qualified dermatologist will help you unpack a correct management plan,  it may vary from person to person once you have identified your triggers. However at the basis of every eczema management routine, are two key strategies that may help prevent your eczema symptoms getting worse and ending in an infected flare up:  

Identifying & avoiding triggers

Just as things like dust and pollen can aggravate hay fever, some irritants are known to trigger or even worsen eczema. These aren’t the same for everyone, but often include heat, animal dander, dust, sweat, fragrances, wool clothing & carpets, soap, stress, and food allergens like egg17-19.

It’s important to be aware of these triggers and watch for any others that might be affecting you or your child. One way to do this is to use a symptom diary, where you can record when and where symptoms occur. This can make it easier to spot patterns or triggers in your or your child’s diet or environment, it's ideal to share this with your medical practitioner. 

Regular use of moisturisers

Even when the skin appears normal (not red or inflamed), people with eczema have a weakened skin barrier—the part of the skin responsible for keeping water in and irritants out6. Just like a bucket with holes in the bottom, eczema skin will lose water more quickly than normal skin and is often bordering dryness and irritation. Similarly, the incessant itch associated with eczema can be made worse by dry skin20.

To work effectively, the skin barrier needs to be hydrated all the time, so regular use of moisturisers should form the foundation of any eczema management plan. This is why all expert guidelines for eczema management recommend regular, liberal use of moisturisers 21-23.

The information included is for educational purposes only and is not intended as a substitute for medical advice. Eczema requires diagnosis by a medical practitioner. See your medical practitioner for further information. 

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References

1. Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care 2017;23(8 Suppl):S115–23.

2. Matsui T, Amagai M. Dissecting the formation, structure and barrier function of the stratum corneum. Int Immunol 2015;27(6):269–80.

3. Chung J, Simpson EL. The socioeconomics of atopic dermatitis. Ann Allergy Asthma Immunol 2019;122(4):360–6.

4. Mao-Qiang M, Feingold KR, Thornfeldt CR, Elias PM. Optimization of Physiological Lipid Mixtures for Barrier Repair. J Invest Dermatol 1996;106(5):1096–101.

5. Eczema and Dermatitis. In: Clinical Dermatology. Chichester, UK: John Wiley & Sons, Ltd; 2014. page 76–98.

6. Better Health Channel: Eczema (atopic dermatitis). [cited 15 June 2021]. Available from: www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/eczema-atopic-dermatitis#rpl-skip-link.

7. ASCIA. Eczema and Food Allergy [internet]. Australia. Soc. Clin. Immunol,. Allergy ASCIA. 2020 [Cited 2021 Jul 28]; Available from: www.allergy.org.au/patients/fast-facts/eczema-and-food-allergy. 

8. Chopra R, Vakharia PP, Sacotte R, Patel N, Immaneni S, White T, et al. Severity strata for Eczema Area and Severity Index (EASI), modified EASI, Scoring Atopic Dermatitis (SCORAD), objective SCORAD, Atopic Dermatitis Severity Index and body surface area in adolescents and adults with atopic dermatitis. Br J Dermatol 2017;177(5):1316–21.

9. Sweetman SC, editor. Eczema. In: Martindale - The Complete Drug Reference. London, Chicago: Pharmaceutical Press; 2009. page 1579. 

10. Akdis CA, Akdis M, Bieber T, Bindslev-Jensen C, Boguniewicz M, Eigenmann P, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. J Allergy Clin Immunol 2006;118(1):152–69.

11. Stanway A. Atopic dermatitis [Internet]. DermNet NZ2004 [cited 2020 Jun 23];Available from: www.dermnetnz.org/topics/atopic-dermatitis.

12. Wahlgren CF. Pathophysiology of itching in urticara and atopic dermatitis. Allergy 1992;47(2 Pt 1):65-75.

13. Rinaldi G. The Itch-Scratch Cycle: A Review of the Mechanisms. Dermatol Pract Concept 2019;9(2):90–7.

14. Thyssen JP, Hamann CR, Linneberg A, Dantoft TM, Skov L, Gislason GH, et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide. Allergy 2018;73(1):214–20.

15. Sibbald C, Drucker AM. Patient Burden of Atopic Dermatitis. Dermatol Clin 2017;35(3):303–16.

16. Koblenzer CS, Koblenzer PJ. Chronic intractable atopic eczema. Its occurrence as a physical sign of impaired parent-child relationships and psychologic developmental arrest: improvement through parent insight and education. Arch Dermatol 1988;124(11):1673–7.

17. Atopic dermatitis [Internet]. National Eczema Association [cited 2020 Sep 24]; Available from: www.nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis.

18. World Allergy Organization. Atopic dermatitis [Internet]. 2018 [cited 2021 Dec 16]; Available from: www.worldallergy.org/UserFiles/file/WAOAtopicDermatitisInfographic2018.pdf. 

19. Eczema – British Skin Foundation [Internet]. [cited 2021 Dec 16];Available from: https://knowyourskin.britishskinfoundation.org.uk/condition/eczema/.

20. Homey B, Steinhoff M, Ruzicka T, Leung DYM. Cytokines and chemokines orchestrate atopic skin inflammation. Journal of Allergy and Clinical Immunology 2006;118(1):178–89.

21. National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management [Internet]. 2007 [cited 2021 Dec 16]. Available from: www.nice.org.uk/guidance/cg57/resources/atopic-eczema-in-under-12s-diagnosis-and-management-pdf-975512529349.

22. Bourke J, Coulson, I, English, J. Guidelines for the management of contact dermatitis: an update. British Journal of Dermatology 2009;160:946–954.

23. Holden C, English J, Hoare C, Jordan A, Kownacki S, Turnbull R, et al. Advised best practice for the use of emollients in eczema and other dry skin conditions. J Dermatolog Treat 2002;13(3):103–6.

Always read the label and follow the directions for use.
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