Symptoms of Eczema (Atopic Dermatitis)

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Symptoms of eczema (atopic dermatitis) include skin dryness, sensitivity, redness, and intense itching that come together to form a rash that most often occurs behind the knees and in the creases of the elbows, although it can appear anywhere on the body. Other symptoms, such as skin darkening, scaliness, and crusting, can also occur.

Eczema symptoms can change depending, in part, on the severity of the condition and the stage it's in. Regardless, eczema is a chronic, recurrent issue that many people work to manage on an ongoing basis. (Young children, who sometimes outgrow eczema, are an exception.)

While doctors mainly use eczema symptoms to diagnose the condition, they may not always be definitive enough to separate eczema from other possibilities.

Eczema commonly occurs in early childhood but can continue or start in adulthood. Like other allergies and asthma, atopic dermatitis tends to run in families.

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 wax and wane, with periods of worsening symptoms as well as periods of relative improvement.

Eczema Stage Skin Appearance
Acute Small red bumps (vesicles); oozing or flaking
Subacute Dry, flaky, scaly
Chronic

Thickened, discolored, leathery (possible)

Initially, the rash develops as small red bumps or vesicles. These can ooze or flake with continued scratching. This is called the acute stage of the condition. The acute stage is usually very itchy, red, and inflamed.

As the flareup heals, the rash moves into the subacute stage. Here, the rash isn't blistered, but rather dry, flaky, and scaly. It usually isn't quite as itchy during this stage.

Over time, due to persistent rash and scratching, the skin can become lichenified, meaning it takes on a thickened, discolored, leathery appearance. This is more likely to happen during the chronic stage of eczema.

Common Locations

Eczema rash may appear anywhere, but certain areas 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 the areas a child is able to 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, and the hands and the feet, particularly in adults.

Complications

People with atopic dermatitis are more prone to infections of the skin, particularly those of the viral, bacterial, and fungal kind. There is compromised immunity in atopic dermatitis, meaning that the skin has less infection-fighting chemicals, giving various bacteria, especially Staphylococcus aureusan easier shot at colonizing.

This means that the disease itself causes breaks in the skin, where infection-causing microorganisms can enter.

Bacteria Colonization

Colonization and infection by Staphylococcus aureus cause various problems in people with atopic dermatitis. This bacterium not only causes skin infections such as impetigo but also produces bacterial toxins to which many people with atopic dermatitis are allergic.

These bacterial toxins can worsen eczema, but treatment with antibiotics can improve symptoms in people with bacterial colonization even if there is no obvious skin infection. People with recurrent bacterial skin colonization and/or infection can also improve their eczema symptoms with the use of bleach baths.

Fungal Infections

Fungal infections, such as tinea and yeast infections, are also more common in people with atopic dermatitis. This may be partially due to the use of topical steroids, which can suppress the immune system of the skin.

It may also be in response to the lack of special infection-fighting chemicals in the skin of people with atopic dermatitis. Treatment of fungal infections can improve the symptoms of atopic dermatitis.

Viral Infections

Viral infections are also more common in people with atopic dermatitis. These infections can be on certain areas of the skin, such as is the case with herpes infections and molluscum contagiosum. They can also involve the entire body, as seen with eczema herpeticum.

People with atopic dermatitis and severe herpes infections may require oral or intravenous antiviral medications to treat these infections.

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 for medical professionals. If you or your child develops a rash, but have never been diagnosed with eczema before, see a doctor to get a definitive diagnosis.

If you've already been diagnosed, the following are signs that you need to see your doctor again to be evaluated and, perhaps, to get a revised treatment plan:

  • Eczema is getting worse despite treatment.
  • The rash is spreading to other areas or takes up a large area of the body.
  • Flare-ups are becoming more severe.
  • Eczema is so itchy it is interfering with daily activities and sleep.
  • There is severe cracking of the skin.
  • You're no longer sure that your rash is due to eczema.

If you experience the following, see a doctor without delay, as these are possible signs of infection:

  • Increased redness
  • Swelling
  • Pain
  • Fluid or pus draining from the skin
  • Fever
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