Eczema is a chronic inflammatory skin condition that causes dry, itchy, and irritated patches of skin. It affects roughly 5.5% of American adults, with rates varying by age, from about 3.6% among younger adults to over 8% in people 75 and older. The condition isn’t contagious and tends to come and go in flare-ups throughout a person’s life.
What Happens in the Skin
Healthy skin works as a barrier, locking in moisture and keeping irritants out. In eczema, that barrier is compromised. A key player is a protein that helps the outermost layer of skin cells pack together tightly and retain water. When the body doesn’t produce enough of this protein, the skin’s outer layer forms poorly, leading to dryness and cracking. Those tiny gaps let allergens, bacteria, and irritants slip through, triggering the immune system to overreact with inflammation.
This isn’t just a surface problem. The immune response beneath the skin ramps up, releasing chemical signals that cause redness, swelling, and intense itching. Scratching damages the barrier further, which lets in more irritants, which causes more inflammation. This itch-scratch cycle is one of the most frustrating aspects of living with eczema.
What Eczema Looks and Feels Like
The hallmark symptom is persistent itching, sometimes severe enough to disrupt sleep. The skin becomes dry, rough, and inflamed, and it can crack, ooze, or develop thickened, leathery patches over time from repeated scratching. Some people develop firm, raised bumps called prurigo nodules on areas they scratch frequently.
Eczema looks different depending on skin tone. On lighter skin, flare-ups typically appear red. On darker skin, that redness is harder to see. Instead, patches tend to look darker brown, purple, or ashen grey. Swelling, warmth, scaling, and itching are more reliable signs than color alone for people with brown or Black skin. After a flare resolves, darker-skinned individuals are also more likely to notice lasting pigment changes where the affected skin looks lighter or darker than the surrounding area.
Types of Eczema
Eczema is an umbrella term for several related conditions:
- Atopic dermatitis is the most common form, often starting in childhood and linked to a family history of allergies or asthma.
- Contact dermatitis develops when the skin reacts to a specific substance, like nickel, rubber, or fragrance.
- Dyshidrotic eczema causes small, intensely itchy blisters on the hands and feet.
- Nummular eczema produces coin-shaped patches, often after a skin injury.
- Seborrheic dermatitis targets oily areas like the scalp, face, and chest.
- Neurodermatitis starts with a localized itch that becomes more intense the more you scratch it.
When people say “eczema” without specifying, they usually mean atopic dermatitis.
Common Triggers
Eczema flares are driven by a complex mix of environmental factors. Soap, detergent, and other cleansers can strip the skin’s natural oils and worsen barrier breakdown. Fragranced products are a frequent culprit: many people with eczema report increased itching from perfumed lotions or soaps, even when formal allergy testing comes back negative.
Climate matters more than most people realize. Low humidity reduces the skin’s ability to produce its protective proteins and dries the barrier out. Heat provokes sweating, which is one of the most commonly reported triggers in children. Higher rainfall has been linked to increased eczema rates in population studies, and even snowfall has been associated with worsened itching.
Other well-documented triggers include air pollution (both indoor and outdoor), hard water, cigarette smoke, dust mites, pet dander, certain foods, and emotional stress. Identifying your personal triggers is one of the most useful things you can do to manage flares, since the combination is different for everyone.
How Eczema Is Treated
Treatment follows a step-up approach based on severity. For mild cases, the foundation is consistent moisturizing and avoiding known triggers. Thick, fragrance-free moisturizers or ointments applied daily help restore the skin barrier. Creams are generally less effective than ointments because ointments seal in more moisture.
When moisturizing alone isn’t enough, topical anti-inflammatory creams are the next step. These reduce the immune overreaction in the skin and are applied directly to flare-ups. Newer topical options, including creams that target specific inflammatory pathways without using steroids, have expanded the choices for mild-to-moderate eczema.
For moderate-to-severe cases that don’t respond to topical treatments, injectable biologic medications and oral medications are available. The first biologic for eczema was approved in 2017 and works by blocking two immune signals that drive inflammation. It’s now approved for adults, adolescents, and children six and older. Several oral medications that target a different part of the immune signaling chain have since been approved for moderate-to-severe cases in teens and adults. These newer therapies have transformed outcomes for people whose eczema previously didn’t respond well to anything.
The Soak and Smear Technique
One effective method for stubborn flares involves soaking in a plain water bath for 20 minutes, then immediately applying a prescribed ointment to still-wet skin without toweling off. The long soak deeply hydrates the skin, and applying ointment right away traps that moisture in. You do this at bedtime (expect it to be messy, so use old pajamas) and repeat nightly for anywhere from four nights to two weeks, depending on how severe the flare is. Once the skin clears, you stop the soaking but continue applying moisturizer or ointment at night to maintain the barrier.
Infections and Complications
Broken, cracked skin is vulnerable to infection. Staph bacteria colonize eczema-affected skin at high rates. One study of children hospitalized with eczema found staph infections in about 30% of them. Signs of bacterial infection include increased redness, warmth, swelling, oozing, or a honey-colored crust forming over the patches.
A more serious complication is a viral skin infection caused by the herpes simplex virus. It appears as a sudden eruption of small, uniform blisters and “punched-out” sores with bloody crusts, often accompanied by fever, swollen lymph nodes, and fatigue. This tends to affect people who developed eczema before age five and who also have asthma or food allergies. It requires prompt medical treatment because, in rare cases, the virus can spread systemically and become life-threatening.
Living With Eczema Long-Term
Eczema is a chronic condition, but it’s manageable. The severity fluctuates, and many people go through long stretches with minimal symptoms between flares. Daily moisturizing, trigger avoidance, and prompt treatment of flares when they start are the pillars of long-term management. Keeping the skin hydrated is not optional; it’s the single most important daily habit for preventing flares.
Tracking your flares alongside potential triggers (new products, weather changes, stressful periods, dietary shifts) can help you identify patterns over time. The condition is highly individual, so what works for one person’s skin may not work for yours. Finding the right combination of daily care and treatment for flares often takes some trial and error, but the range of effective options is wider now than it has ever been.