Eczema
Eczema, also called atopic dermatitis, is a common inflammatory skin condition that leads to dry, inflamed, and intensely itchy skin. It is a chronic disorder that tends to flare periodically and then improve, although the skin often remains sensitive even between flare-ups. This condition is not contagious, but it can significantly affect comfort, sleep, and overall quality of life. Under the care of a board-certified dermatologist such as Dr. Patricia Richey, eczema can be accurately identified and properly managed to reduce symptoms and protect long-term skin health.
Atopic dermatitis develops because the skin’s natural protective barrier does not function as it should. Healthy skin holds in moisture and shields the body from irritants, allergens, and microbes. In individuals with eczema, this barrier is weakened. Moisture escapes easily, leaving the skin dry and vulnerable. Irritants can penetrate more deeply, triggering inflammation and itching. This cycle of dryness, irritation, and scratching further damages the skin and prolongs flare-ups.
Eczema often begins in infancy or early childhood, although it can first appear in adolescence or adulthood. Many children experience improvement as they grow older, but some continue to have symptoms throughout life. The condition commonly runs in families, especially in those with a history of asthma, seasonal allergies, or hay fever. This connection reflects an overactive immune response that reacts strongly to environmental triggers.
The hallmark symptom of atopic dermatitis is itching. The itch can range from mild to severe and is often worse at night. Persistent scratching may temporarily relieve discomfort, but it damages the skin and increases inflammation. Over time, repeated scratching can cause the skin to thicken and become leathery in texture.
The affected skin typically appears dry, rough, and scaly. Redness is common in lighter skin tones, while in darker skin tones eczema may appear brown, gray, purple, or ashen. Patches can develop small, raised bumps that may ooze fluid when scratched. During more intense flare-ups, the skin may crack, crust, or become swollen and tender. Open areas increase the risk of bacterial infection, which may cause increased pain, warmth, pus, or fever.
Symptoms often come and go. Periods of worsening inflammation are known as flare-ups, while quieter phases may involve only mild dryness or irritation. Identifying and avoiding triggers plays an important role in minimizing these cycles.
Eczema often begins in infancy. In infants, it often appears on the cheeks, scalp, and outer arms and legs. In older children and adults, it more commonly affects the inner elbows, behind the knees, wrists, hands, neck, eyelids, and around the mouth. Hand eczema can be particularly disruptive because of constant exposure to soaps, water, and environmental irritants.
Atopic dermatitis does not have a single cause. Instead, it develops from a combination of genetic, immune, and environmental factors. A key factor in eczema is a weakened skin barrier. Some individuals have inherited variations in genes responsible for maintaining the skin barrier, making their skin less able to retain moisture. This structural weakness allows irritants and allergens to trigger inflammation more easily.
Environmental factors frequently provoke flare-ups. Harsh soaps, fragrances, detergents, wool fabrics, dry air, extreme temperatures, and prolonged hot showers can worsen symptoms. Seasonal changes, particularly during colder months when indoor heating reduces humidity, often increase dryness and irritation. Emotional stress can also intensify itching and inflammation, contributing to flare cycles.
Allergens such as dust mites, pet dander, pollen, and certain foods may play a role in some individuals, particularly children. However, not every person with eczema has allergies, and food is not always a trigger. Identifying individual triggers requires careful evaluation rather than assumption.
Diagnosis of atopic dermatitis is based primarily on a thorough medical history and physical examination. Dr. Richey evaluates the appearance, distribution, and pattern of the rash, as well as the history of itching and flare-ups. The chronic nature of the symptoms and family history of allergic conditions often provide additional diagnostic clues.
There is no single laboratory test that confirms eczema. In most cases, the condition can be diagnosed clinically based on characteristic features. If allergic contact dermatitis is suspected, patch testing may be recommended to determine whether specific substances are causing skin reactions. If the rash appears atypical or does not respond as expected, further evaluation may be performed to rule out other conditions such as psoriasis or fungal infections.
Early diagnosis is important because uncontrolled eczema can lead to complications. Persistent scratching increases the risk of bacterial infections and can result in long-term thickening and discoloration of the skin. Severe itching may interfere with sleep, concentration, and daily functioning. In children, chronic discomfort can affect mood and behavior.
Atopic dermatitis is a manageable condition, but it requires consistent care and an understanding of triggers. Accurate diagnosis by a board-certified dermatologist ensures that other skin disorders are ruled out and that the treatment approach addresses the underlying barrier dysfunction and inflammation. With proper evaluation and guidance, individuals with eczema can reduce flare-ups, protect their skin barrier, and improve overall skin health.
At a Glance
Dr. Patricia Richey
- Board-certified dermatologist
- Fellowship-trained and board-certified Mohs surgeon
- Harvard fellowship-trained in lasers and cosmetics
- Author of innovative dermatology research and publications
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