Symptoms of Eczema (Atopic Dermatitis)

Eczema is a chronic recurring skin disorder linked to an overactive immune system. It is also called atopic dermatitis. The condition can show up on any part of the body, but it's usually found behind the knees and in the creases of the elbows.

The main symptoms of eczema are skin dryness, redness, itching, and a scaly rash. Other symptoms of eczema include skin discoloration and crusting.

Eczema symptoms can change depending on the severity and stage of the disease. Younger children often outgrow eczema.

A person with eczema needs to manage the condition long-term to prevent acute flares of symptoms.

This article will go over the signs and symptoms of eczema. You will also learn how to prevent complications from the condition.

Frequent Symptoms

The most common forms of eczema are atopic dermatitis and seborrheic dermatitis (also called dandruff). While they do cause symptoms, these forms tend to be more manageable than other types of eczema.

Eczema usually starts 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 vary. At times, a person will have flares (worsening symptoms). They will also have remissions (times when their symptoms get better).

Healthcare providers use a person's symptoms to diagnose eczema. However, the symptoms can be similar to those of other skin disorders like psoriasis. Eczema can also look different as the condition progresses.

Eczema Stages

There are several stages of eczema. The symptoms at each stage are a little bit different and can change as the condition progresses with time.

• Acute stage: At first, an eczema rash forms small fluid-filled bumps (vesicles). These bumps can ooze or flake when scratched. During this stage, the skin is usually very itchy, red, and inflamed.
• Subacute stage: As the skin begins to heal, the rash will start to change. It won't look as blistery; instead, it will be dry, flaky, and scaly. The rash also tends to be less itchy at this stage.
• Chronic stage: Over time, scratching an eczema rash causes the skin to get thick and leathery. This is called lichenification. The skin can also develop hyperpigmentation (become dark). During this stage, flares happen frequently and tend to get worse each time.

Rash Locations

Eczema can appear anywhere on the body. However, rashes are more likely to appear on certain parts of the body depending on how old someone is.

• Infants and very young children: Eczema most often involves the face, chest, and back of the scalp because these areas are where younger kids tend to scratch. Eczema rarely occurs in the diaper region.
• Older children and adults: Eczema typically involves the bend of the elbows or the back of the knees. In adults, eczema is also common on the face, eyelids, hands, and feet.

Rare Symptoms

There are a few less common types of eczema. Each type looks different.

Less Common Types

These types can be severe and they are often harder to manage.

• Nummular eczema or discoid eczema: This type of eczema causes itchy, coin-shaped spots. The spots can ooze and become infected. Open lesions can sometimes lead to permanent scarring.
• Nummular eczema is not very common. For comparison, atopic dermatitis affects 15% to 20% of children and 1% to 3% of adults worldwide. Nummular eczema affects only around 2 out of 1,000 people.
• Venous eczema, gravitational dermatitis, or stasis dermatitis: This type of eczema happens when the blood pressure in the veins causes fluid to leak out of the skin. This usually happens in the lower limbs. Infection is common with this type of eczema. A very serious infection that can happen is cellulitis. Venous eczema can also lead to skin sores (ulcers) that do not heal.
• Dyshidrotic eczema: This type of eczema causes tiny, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. The blisters can start to move together and cause severe peeling, oozing, and cracking.

Complications

People with atopic dermatitis tend to get skin infections often. They are more likely to get infections because eczema makes it harder for the skin to be a good barrier.

Cracks and scaling expose the skin layers (epidermis and dermis) to germs. Scratching causes breaks in the skin that let bacteria, viruses, and fungi in.

Atopic dermatitis is thought to be linked to reduced immune function, which means the body is less able to fight off germs.

Research has also shown that genetic defects in the body's first-line defense against infection⁠ (innate immune system) might be related to eczema.

Bacterial Infection

Bacteria such as Staphylococcus aureus can cause infections like impetigo. It can also make toxins that can trigger allergy symptoms.

These symptoms can complicate eczema outbreaks by making flares last longer and causing worse 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.

Many people with eczema use topical steroids to treat the condition. However, these medications locally suppress the immune system, which gives common fungi a chance to take hold and spread.

The risk of fungal infections can also be related to proteins called cytokines, which can trigger an immune response that leaves the body less able to defend itself against germs.

Viral Infections

Viral infections usually affect certain body parts. For example, the herpes simplex virus (HSV) tends to appear on the lips. When it occurs in adults, molluscum contagiosum most often infects the genitals.

Rarely, an infection can occur all over the entire body. For example, eczema herpeticum can develop across a large plaque of eczema where the skin is broken, allowing the virus to spread. If left untreated it could spread across the body. Eczema herpeticum can lead to permanent scarring, vision damage, and organ failure. If it spreads to the brain, lungs, or liver, it can also lead to death.

When to Seek Medical Care

Many skin conditions cause an itchy, red rash. It can be difficult to tell an eczema rash from another kind of rash. The only way to know for sure is to see a skin expert called a dermatologist.

If you have already been diagnosed with eczema, you still need to see a provider to help manage your condition.

There are also some signs that you should always tell your provider about, such as:

• Your symptoms are getting worse even though you're being treated.
• The rash is spreading or appearing on new areas of your skin.
• Your flares are more frequent or severe.
• The itching interferes with your daily activities or sleep.
• Your skin is severely cracked or oozing.

You should also know the signs of an infection, including:

• Increased redness and swelling
• Pain and tenderness that doesn't get better or is getting worse
• Skin that feels hot
• Pus or fluid coming out of the skin
• Fever
• A general feeling of being sick (malaise)

Summary

Eczema is a chronic skin disorder. It's also called atopic dermatitis. The condition happens when there is inflammation in the skin linked to an overactive immune system.

The main symptom of eczema is a rash. The skin can be red, flaky, and itchy. It can also hurt, weep fluid, or bleed.

It's important to care for skin affected by eczema. Trying to keep the skin from getting too dry and avoiding scratching will help prevent infections and scarring.

A Word From Verywell

If you have skin symptoms and don't know what's causing them, talk to your provider. They can find out if you have eczema or another skin condition.

If you already know that you have eczema, understanding how to manage your symptoms is a key part of living with the condition. It's also important to know how to spot signs of complications.