The Stages of Eczema

It's one word—eczema—that can actually mean many things besides the red, scaly, blistered rash for which it's most known.

It all depends on the stage you're talking about. And eczema has three stages: acute, subacute, and chronic.

Each eczema stage has its own distinct symptoms. And they're not nearly as predictable as you might assume.

Even scientists have a lot to learn about what causes eczema and how it advances through the three stages.

This article explains the three stages of eczema and the symptoms most likely to occur during each one. It's crucial to know that while some people move from one stage to another, the stages aren't necessarily linear in nature. This article also discusses common treatment options at each stage.

The Progression of Eczema

Also known as atopic dermatitis, eczema almost always begins with red, itchy skin. It can show up anywhere, but most often breaks out around the eyes or on the hands, neck, elbows, knees, ankles, or feet.

For reasons scientists don't completely understand, eczema is more common among people who have a family history of asthma, environmental allergies, or food allergies. The good news is, about half of all people outgrow eczema as they get older.

Eczema's progression through the three stages isn't always linear. For example, a rash may start at the acute stage and then move to the subacute and chronic stages. Or, it may start at the subacute stage and either stay there or move back to the acute stage.

The same rash may cycle through the stages many times. A rash may also start and stop at nearly any stage.

It's not clear why eczema rashes progress from one stage to another. It may have something to do with someone coming into contact with certain triggers, undergoing hormonal changes, or possibly experiencing changes in the skin's microbiome, which is supposed to keep your skin healthy.

Acute Stage

The acute stage refers to an eczema rash that has just started. Itching is often the first sign of acute eczema. This happens even before the rash is apparent, which is different from many other types of rashes.

Some characteristics of the acute stage of eczema include:

• Bumps
• Extreme redness
• Fluid-filled blisters, called vesicles, which may ooze
• Intense itching
• Pain
• Swelling
• Tenderness

Eczema tends to be intense during this initial phase. It partially explains why the stage is often referred to as a flare-up.

Acute eczema can be caused by contact with allergens (like poison ivy or poison oak), an id reaction (a skin rash that develops in a distant site due to a reaction to a primary infection, typically fungal), or a worsening of atopic dermatitis.

There is some indication that Staphylococcus aureus colonies growing on the skin may contribute to disease flares in atopic dermatitis.

Subacute Stage

The subacute stage may be the "middle" stage of the progression, but eczema may begin at this stage. Here, eczema is known for:

• Cracks in the skin
• Flaky, scaly skin
• Itching, burning, and/or stinging
• Redness that may be less intense than the acute stage, but not always

Subacute symptoms are generally less severe than those in the acute stage. This is especially true of itching, which may be subdued.

Burning and stinging in the subacute stage is more intense, however. And the rash is dry rather than blistered and oozing.

Many acute eczema rashes move into the subacute phase as they heal. Subacute rashes can bounce back into the acute phase during an eczema flare, while long-lasting subacute rashes often become chronic.

Chronic Stage

The chronic stage refers to eczema flares that are longer-lasting. In general, it takes three or more months for chronic eczema symptoms to appear.

Chronic eczema isn't solely determined by a timeframe, however. It has its own set of symptoms that are quite different from the other two stages. The symptoms of chronic eczema include:

• Cracks in the skin
• Dark, dull, or discolored skin
• Deeper skin lines
• Larger areas of skin breakdown, called excoriations
• Itching
• Thickened, leathery-looking skin or lichenification (called lichen simplex chronicus)

Symptoms can be quite severe during the chronic stage. Many symptoms are caused by repeated scratching of the skin. As just like at the acute stage, the urge to itch can be intense in this stage.

Summary

It helps to know what you can expect during the three stages of eczema: acute, subacute, and chronic. Physicians call the stages a "progression," but the stages don't always proceed one right after another. In fact, many cases begin at the subacute stage—and stay there. Or they can start at the subacute stage and work backwards. The uncertainty of eczema is why understanding the symptoms of each stage can be so helpful as you consult your physician about an appropriate treatment plan.

A Word From Verywell

If you have eczema, you've probably noticed that the rash waxes and wanes as it moves throughout the three stages. Becoming familiar with the stages of eczema can help reassure you that changes in your rash are normal. Your physician can help you determine the best treatment for your rash and guide your treatment as the rash changes.