The 3 Stages of Eczema

Eczema—the general name for various inflammatory skin conditions that cause a red, scaly, blistered rash—has three stages: acute, subacute, and chronic. Each eczema stage has its own distinct symptoms that demonstrate the progression of the condition. Unlike some other health concerns, however, the stages of eczema are not as predictable as you might assume.

As research advances, scientists are learning more and more about what actually causes eczema to advance through these stages.

Researchers have split eczema into two groups: atopic and non-atopic. Whether a case is one or the other depends on if there's overactivity of the immune system.

Both types of rashes can cycle through the three different stages of eczema the longer they persist, but there is no set timeline for doing so. This varies rash to rash and person to person.

Eczema's progression through the stages isn't always linear. For example, a rash may start at the acute stage, move to subacute, and then chronic. Or, it may start at the subacute stage and move 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 always clear why eczema rashes progress from one stage to another, but it may have to do with coming in contact with certain triggers, having hormonal changes, and possibly experiencing changes in the skin's microbiome.

Acute 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 rather different than most other types of rashes.

Some characteristics of the stage of acute eczema include:

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

Acute eczema has very distinct borders. Eczema tends to be very intense during this initial phase. The acute stage of eczema is often referred to as a flareup.

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.

Treatment Options

An over-the-counter hydrocortisone cream or antihistamine can be used to suppress the immune system. Additionally, cold, wet compresses can help soothe symptoms.

Topical steroids can be prescribed to reduce inflammation. Oral steroids may be used in cases where the rash is very severe or widespread.

While antibiotics don't clear up acute eczema, they may be prescribed if the rash is infected.

The subacute stage is the transitional phase between the acute and chronic stages. Eczema may also begin at the subacute stage.

At this stage, eczema has these characteristics:

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

Subacute symptoms are generally less severe. This is especially true of itching, which may be subdued. Burning and stinging in the subacute stage is more intense, however.

In subacute eczema, rash borders aren't as distinct. The rash is dry rather than blistered and oozing.

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

For some people, eczema begins as a subacute rash and simply stays at this stage. Eczematous rashes that commonly start and hold at the subacute stage are irritant contact dermatitis and perioral dermatitis.

Treatment Options

Moisturizers are very helpful during the subacute stage, as the skin is dry and flaky. Coal tar products and antihistamines can be used to reduce itching and inflammation.

Short-term use of topical calcineurin inhibitors and topical steroids may also be needed.

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:

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

Symptoms can be quite severe during the chronic stage, thus affecting the course of treatment. Many of the symptoms are caused by repeated scratching of the skin. As it was during the acute stage, itching is intense.

Treatment Options

Treatments are similar to those used for subacute eczema. However, stronger topical steroids may be needed to get this stage under control. They are often more effective when covered with a barrier, such as plastic wrap. Moisturizers are also very helpful during this stage.

A Word From Verywell

If you have eczema, you've likely noticed that the rash itself 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 now and guide your treatment as the rash changes.