The 3 Stages of Eczema

The Acute, Subacute, and Chronic Stages of This Skin Condition

Eczema is a term that's often used to describe certain skin conditions. As research progresses, scientists are learning more and more about what actually causes it and the various stages of eczema.

eczema triggers
Illustration by Jessica Olah, Verywell

This has led researchers to split eczema into two group: atopic and non-atopic. Whether or not eczema is atopic or non-atopic depends on whether certain parts of the immune system are overactive. There are a few subtle differences between the appearance of atopic and non-atopic eczema, but the two conditions generally look the same, depending on how long the rash has been present. Both types of rashes can cycle through the three different stages of eczema the longer they persist.

The three stages of eczema are the acute stage, the subacute stage, and the chronic stage. Certain treatments work better during different stages of a rash. All three stages respond well to topical steroids and antihistamines, like Benadryl and Zyrtec. If bacteria have invaded the skin during any stage, an oral antibiotic such as cephalexin or dicloxacillin is useful. Learn more, below, about each of the stages of eczema.

Acute Stage of Eczema

"Acute" refers to an eczema rash that has just started. Some characteristics of the stage of acute eczema include:

  • Blisters
  • Extreme redness
  • Intense itching
  • Pain
  • Tenderness
  • Swelling
  • Heat

An over-the-counter hydrocortisone cream or antihistamine can be used to suppress the immune system. Antibiotics can be prescribed to reduce inflammation and treat infection. Eczema tends to be very intense during this initial phase and, in some cases, steroids are used. Additionally, cold, wet compresses can help soothe symptoms.

Subacute Stage of Eczema

The subacute stage is the transitional phase between the acute and chronic stages. Eczema doesn't always spend the same amount of time in the subacute stage. Each case of eczema transitions from stage to stage differently. The eczema rash evolves and takes on these new characteristics:

  • Flaky, scaly skin
  • Less redness
  • Cracks in the skin
  • Itching, burning, and/or stinging

Symptoms are still present during the subacute stage, but they are much less intense than they are during the acute stage. Moisturizers can be used to hydrate dry, flaky skin, coal tar can be used to relieve itching, and antihistamines can be used to reduce inflammation.

Chronic Stage of Eczema

The chronic stage refers to eczema flares that last three or more months. Chronic eczema is quite different from the other two stages in the following ways:

  • Thickened, leathery-looking skin or lichenification
  • Accentuated skin lines
  • Cracks in the skin
  • Skin appears dark and dull
  • Larger areas of skin breakdown called excoriations
  • Itching

Symptoms are at their most severe during the chronic stage, thus affecting the course of treatment. If commonly used over-the-counter products cannot ease symptoms, prescription topical steroids can be used. They are often more effective when covered with a barrier, such as plastic wrap. Moisturizers are also very helpful during this stage.

Causes and Triggers 

The exact cause of eczema is unknown, but the condition is believed to be linked to certain allergens, irritants, and other environmental factors. Common triggers include:

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Article Sources

  • Causes & Triggers. (2013).
  • Habif, Thomas. "Eczema and Hand Dermatitis." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby. 41-9.