Symptoms of Eczema (Atopic Dermatitis)

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, including skin discoloration and crusting, can also occur. Eczema symptoms can change depending, in part, on the severity and stage of the disease.

As a chronic recurring disorder, eczema requires ongoing management to treat and prevent acute flares. (The only exception is among younger children, many of whom will outgrow the condition.)

Frequent Symptoms

Eczema typically begins with an itch. When the skin is scratched, a rash erupts. The most common symptoms of eczema are:

  • A red, itchy rash
  • Dry, rough, or scaly skin
  • Small, fluid-filled blisters
  • Cracked or broken areas of skin
  • Oozing, weeping, or crusting

Eczema symptoms can wax and wane with periods of worsening symptoms (called flares) interspersed with periods of improvement (called remission).

Though doctors mainly use symptoms to diagnose the disease, they are not always definitive enough to differentiate eczema from other skin conditions such as psoriasis. The appearance of eczema can also change as the condition progresses.

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

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

Eczema Stages

Initially, an eczema rash develops as small fluid-filled bumps (vesicles) that can ooze or flake when scratched. This is called the acute stage during which the skin is usually very itchy, red, and inflamed.

As the skin begins heals, the rash will progress to the subacute stage. Here, the rash isn't as blistery but will rather appear dry, flaky, and scaly. It also tends to be less itchy.

Over time, with persistent scratching, the skin can become lichenified, meaning that it becomes thick and leathery with a hyperpigmented (darkened) appearance. Lichenification is most likely to occur during the chronic stage in which flares recur frequently and tend to get progressively worse.

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 scratch). Eczema rarely occurs in the diaper region.

In older children and adults, eczema typically involves the bend of the elbows or the back of the knees. Eczema is also common on the face, eyelids, hands, and feet, particularly in adults.

Rare Symptoms

The appearance of eczema can vary by the type involved. The most common forms, atopic dermatitis and seborrheic dermatitis (dandruff), can be aggravating but tend to be more manageable than other types.

More severe and difficult to treat is nummular eczema (also called discoid eczema), a condition characterized by itchy, coin-shaped spots that can ooze and become infected. Open lesions can sometimes lead to permanent scarring.

Nummular eczema is relatively uncommon. While atopic dermatitis affects 15% to 20% of children and 1% to 3% of adults worldwide, nummular eczema only affects only around two out of 1,000 people.

Venous eczema (also called gravitational dermatitis or stasis dermatitis) occurs when blood pressure within the veins, usually of the lower extremities, causes fluid to leak out of the skin. Infection is common, including a potentially serious type known as cellulitis. In some cases, venous eczema can lead to non-healing skin ulcers.

Dyshidrotic eczema is characterized by the formation of tiny, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. As these blisters merge, they can cause severe peeling, oozing, and cracking.

Complications

People with atopic dermatitis are prone to skin infections. This is due in part to the reduced barrier function of the skin. Cracks and scaling expose the epidermis and dermis to a wide variety of disease-causing organisms (pathogens). Scratching only makes things worse by creating breaks through which bacteria, viruses, and fungi can pass.

Atopic dermatitis is believed to be associated with reduced immune function, meaning that the body is less able to ward off pathogens.

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

Without a full complement of front-line defenders to fight infection, pathogens have an easier shot at colonization.

Bacterial Infection

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 itching, redness, and blistering of the skin.

Fungal Infections

Fungal infections, such as tinea corporis (ringworm) and tinea capitis (a scalp infection), are also 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 triggers an immune response, can leave the body less able to defend itself against relatively harmless pathogens like fungi.

Viral Infections

Viral infections are also commonly seen in people with atopic dermatitis. These tend to affect specific areas of the body, such as on the lips with herpes simplex virus (HSV) or the genitals with molluscum contagiosum. On rare occasions, it can involve the entire body, a condition referred to as eczema herpeticum.

Eczema herpeticum is especially concerning as it can lead to permanent scarring, vision damage, organ failure, and even death if it spreads to the brain, lungs, or liver.

When to See a Doctor

There are many skin conditions that cause an itchy, red rash, some of which are difficult to distinguish even among medical professionals. If you or your child develops a rash and suspect that eczema is the cause, the only way to know for sure is to visit a doctor known as a dermatologist.

If you have already been diagnosed with eczema, you should still see a doctor if your symptoms change in any way. For example:

  • Eczema is getting worse despite treatment
  • A rash is spreading or affects new areas of skin
  • Flares are more frequent or severe
  • Itching interferes with daily activities or sleep
  • There's severe cracking or oozing of the skin

You should also seek care if there are signs of a skin infection, including:

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

When to Call 911

Call 911 or seek emergency care if you experience any of the following. Symptoms like these may be a sign of cellulitis, a condition requiring five to 14 days of antibiotic therapy and, in some cases, hospitalization.

  • Hot, red, and swollen areas of skin that are rapidly expanding
  • High fever or chills
  • Nausea and vomiting
  • Increasing pain
  • Numbness on the swollen tissues
  • Blistering of the affected skin
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