The Stages of Eczema

Eczema has three stages: acute, subacute (healing stage), and chronic. Each eczema stage has its own symptoms, though the most familiar is a red, scaly, blistered rash. Some people move from one stage to another, but they do not always do so in order.

This article will cover the three stages of eczema and the symptoms of each one, as well as common eczema treatments at each stage of healing.

How Eczema Stages Progress

Eczema (atopic dermatitis) almost always starts with red, itchy skin. The irritation can show up on any part of the body, but most often breaks out around the eyes or on the hands, neck, elbows, knees, ankles, or feet.

Eczema does not always go through the three stages in order. For example, a rash may start during the acute stage, then move to the healing stage and chronic stages. It can also start at the subacute stage and either stay there or move back to the acute stage.

The same rash can cycle through the stages many times. An eczema rash can also start and stop at nearly any stage.

It's not clear why eczema rashes progress from one stage to another. One possibility is that the process is put in motion when a person has contact with eczema triggers. Researchers think that hormonal shifts and changes in the skin's balance of natural bacteria (microbiome) could also be involved.

Acute Stage Eczema

The acute stage of eczema is when a rash has just started. Eczema symptoms are usually intense during the first phase because there is a lot of inflammation (often called a flare-up).

Itching is typically the first sign of acute eczema. The itching often starts even before the rash shows up. That’s one way that eczema is different from other common rashes. 

The acute stage of eczema can cause:

• Bumps
• Extreme redness
• Fluid-filled blisters (vesicles) that may ooze
• Intense itching
• Pain
• Swelling
• Tenderness
  

Acute Stage Eczema Treatments

There are various treatment options for acute eczema, including:

• Over-the-counter (OTC) hydrocortisone cream or antihistamine to suppress the immune system response.
• Cool, wet compresses to help soothe symptoms.
• Prescription topical steroids to reduce inflammation
• Oral steroids if the rash is severe or widespread
• Antibiotics for an infected rash
  

Subacute (Healing) Stage Eczema

The subacute stage of eczema is the most common stage. Acute eczema rashes may move into a new phase as they heal. However, healing eczema rashes can flare up again if they’re not treated. In this case, eczema goes into the subacute stage. When it's in this stage, healing eczema may even bounce back into the acute phase.

The subacute stage is in the “middle" of the progression, but eczema can also start at this stage. Long-lasting subacute rashes can also become chronic.

During the subacute stage, eczema can cause:

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

There is still inflammation of the skin in the subacute stage. Some eczema symptoms are less severe in the subacute stage than they were in the acute stage—especially itching. However, symptoms like burning and stinging are usually more intense during the subacute stage.

The rash will also be dry during the healing stage rather than blistered and oozing like it was during the acute stage.

Subacute (Healing) Stage Eczema Treatments

Here are a few strategies you can try to manage symptoms of healing or the subacute stage of eczema: 

• Moisturizers to relieve skin that is dry and flaky
• Coal tar products and antihistamines to reduce itching and inflammation
• Short-term use of topical calcineurin inhibitors and topical steroids if needed
  

Chronic Stage Eczema

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

Chronic eczema is not just determined by a timeframe—it has its own set of symptoms that are 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 (excoriations)
• Itching
• Thickened, leathery-looking skin or lichenification (lichen simplex chronicus)

Eczema symptoms in the chronic stage can be severe. Just like during the acute stage, the urge to itch can be overwhelming. However, many symptoms during the chronic stage are actually caused and made worse by repeated scratching.

Chronic Stage Eczema Treatments

Treatments for chronic stage eczema are similar to those used during the healing stage and include:

• Stronger topical steroids to control symptoms (these can be more effective when they’re covered with a barrier, such as plastic wrap)
• Moisturizers for soothing skin

If you haven’t already, you may want to talk to your provider about newer prescription treatments like biologics that have been approved to treat moderate-to-severe eczema. You can also ask about trying treatments like phototherapy for chronic eczema.

Summary

It helps to know what you can expect during the three stages of eczema: acute, subacute (healing), and chronic. While providers call the stages a "progression," the stages of eczema do not always proceed one right after another. 

In fact, many cases of eczema start in the subacute stage and stay there. Eczema in the healing stage can also work backward, especially when it’s not being treated. Over time, eczema flares can start lasting longer and become chronic. 

The uncertainty of having eczema is why understanding the symptoms of each stage will be helpful when you talk to your provider to make a 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.