Symptoms of Eczema (Atopic Dermatitis)

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Symptoms of eczema (atopic dermatitis) include skin dryness, redness, itching, and a scaly rash. Although eczema can occur on any part of the body, it is most often seen behind the knees and in the creases of the elbows. Other symptoms, such as skin darkening, scaliness, and crusting, can also occur.

Eczema symptoms can change depending, in part, on the severity and stage of the disease. As a chronic, recurrent condition, eczema requires ongoing management to treat and prevent acute flares. (The only exception is among younger children, many of whom will outgrow it.)

While doctors mainly use symptoms to diagnose the disease, they may not always be definitive enough to differentiate eczema from skin conditions.

Frequent Symptoms

Eczema typically begins as an itch that, when scratched, erupts into a rash. The most common symptoms of eczema are:

  • Rash that is itchy and red
  • Dry, rough, or scaly skin
  • Small, fluid-filled blisters (called vesicles)
  • Cracked or fissured skin
  • Oozing, weeping, or crusting

Eczema symptoms can wax and wane, with periods of worsening symptoms (called flares) as well as periods of relative improvement (referred to as remission).

This photo contains content that some people may find graphic or disturbing.

Dermatitis eczema texture of ill human skin
Dermatitis eczema texture of ill human skin. Pan Xunbin / Getty Images 

Eczema Stages

Initially, an eczema rash develops as small red bumps or vesicles, which can ooze or flake with continued scratching. This is called the acute stage in which the skin is usually very itchy, red, and inflamed.

As the skin begins heals, the rash moves into the subacute stage. Here, the rash isn't blistered but is rather dry, flaky, and scaly. It also tends to be less itchy.

Over time, with persistent rash and scratching, the skin can become lichenified, meaning that it takes on a thickened, discolored, and leathery appearance. This is more likely to happen during the chronic stage of eczema in which the symptomatic flares recur frequently.

Rash Locations

Eczema rash can appear anywhere on the body, but certain parts are more common depending on one's age.

In infants and very young children, eczema most often involves the face, chest, and back of the scalp since these are areas where younger kids can scratch. Eczema doesn’t usually occur in the diaper region.

In older children and adults, eczema often involves the skin in the bend of the elbows and behind the knees, since these flexural areas are the most easily scratched. Eczema also commonly involves the face, eyelids, hands, and feet, particularly in adults.

Complications

People with atopic dermatitis are more prone to skin infections. This is due in large to the reduced barrier function of the skin as cracks and scaling expose it to a variety of infectious microorganisms. Scratching only makes things worse by creating breaks in the skin through which bacteria, viruses, and fungi can pass.

Atopic dermatitis is also associated with reduced immune function, meaning that the body is less able ward off local infections.

A growing body of evidence suggests that genetic defects in the innate immune system⁠—the body's first-line defense against infection⁠—contributes to the development and severity of eczema.

Without a full complement of front-line defenders to fight infection, microorganisms (especially bacterium like Staphylococcus aureus) have an easier shot at colonization.

Bacteria Colonization

Bacterial infection by Staphylococcus aureus can cause a variety of problems in people with atopic dermatitis. It may not only cause impetigo (characterized by honey-crusted sores) but produce toxins that can trigger allergy symptoms. This can further complicate eczema outbreaks, prolonging flares while intensifying the itchiness, redness, and blistering of the skin. 

Antibiotics can help improve symptoms in people with eczema even if there is no obvious skin infection. People with recurrent skin infections may also benefit from the use of bleach baths.

Fungal Infections

Fungal infections, such as tinea corporis (ringworm) and tinea capitis (a scalp infection), are more common in people with atopic dermatitis. This may be due, in part, to the use of topical steroids which suppress the immune system and allow common fungi to colonize and proliferate.

It may also be due to the lack of infection-fighting cytokines in people with atopic dermatitis. The loss of these proteins, which signal an immune response, can leave the body less able to defend itself against relatively harmless microorganisms like fungi.

Treatment with a topical antifungal can usually resolve an infection. Less commonly, an oral antifungal may be used.

Viral Infections

Viral infections are also more common in people with atopic dermatitis. These infections can be on certain areas of the body, such as on the lips with herpes simplex virus (HSV) or the genital with molluscum contagiosum, but can also involve the entire body, such as with eczema herpeticum.

Eczema herpeticum, while rare, is especially alarming since it can lead to complications such as scarring, vision loss (if it involves the eyes), and even organ failure and death if it spreads to the brain, lungs, or liver.

People with atopic dermatitis and severe viral infections may require oral or intravenous antivirals to help resolve the symptoms.

When to See a Doctor

There are many other skin conditions that cause an itchy, red rash. They can sometimes be difficult to distinguish even among medical professionals. If you or your child develops a rash and suspect that eczema is the cause, see a doctor to get a definitive diagnosis.

If you've already been diagnosed, the following are signs that the disease is changing and may require a different course of treatment:

  • The eczema is getting worse despite treatment.
  • The rash is spreading or involves other areas of skin.
  • Flares are becoming more frequent or severe.
  • The itch is interfering with daily activities and sleep.
  • There is severe cracking of the skin.
  • You are no longer sure that your rash is due to eczema.

You should also seek care if there are signs of a skin infection.

Signs of a Skin Infection

  • Increased redness and swelling
  • Continual or increased pain and tenderness
  • Hot skin temperature
  • Pus or fluid drainage from the skin
  • Fever
  • Feelings of malaise
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Article Sources

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