Dr. John Van Wagoner Eczema Specialist

Understanding Eczema


Understanding Your Atopic Eczema

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Atopic dermatitis (also known as AD) is the most common type of eczema. In fact, 17.8 million Americans have AD – which often appears as a red, itchy rash normally on the cheeks, arms and legs.

Atopic dermatitis can exists with two other allergic conditions: asthma and hay fever (allergic rhinitis). People who have asthma and/or hay fever or who have family members who do, are more likely to develop AD.

AD typically begins in childhood, usually in the first six months of a baby’s life. Even though it’s the most common form of eczema, it’s also the most severe and long-lasting. When you or your child have AD, it may improve at times, but at others it may get worse or flare up. Often, AD disappears as a child grows older, though some children will continue to experience atopic dermatitis into adulthood.

How did I develop atopic dermatitis?

We don’t know the exact cause of atopic dermatitis. Researchers do know that a combination of genetics and environmental factors are involved. When something from outside the body triggers the immune system, the skin cells don’t behave like they should, causing the skin to flare up.

We also know that AD runs in families, but we don’t know the exact way it is passed from parents to children. If one parent has AD, asthma, or hay fever, there’s about a 50% chance that their child will have at least one of these diseases. If both parents have one or more of these conditions, the chances are much greater that their child will, too.

An estimated 10% of all people worldwide are affected by atopic dermatitis at some point in their life. The condition seems to be more common in urban areas and developed countries and affects men and women of all races equally. Either way, AD is not contagious. You or your child cannot “catch” it from another person, or give it to someone else.

What’s the difference between eczema and atopic dermatitis?

Atopic dermatitis is considered a more severe type of eczema. People with AD may experience a number of different sensitivities for the rest of their lives:

  • Dry skin that becomes easily irritated
  • Occupational skin diseases like hand dermatitis
  • Skin infections like “staph” and herpes and molluscum contagiousum
  • Eye problems like eyelid dermatitis or cataracts

There are other types of eczema that cause itching and redness, but some will also cause your skin to blister, “weep,” or peel. It’s important to understand which of the seven types of eczema you or your child may have, so that you can better treat and manage it. The only way to be sure that you or your child has this condition is to be seen by your eczema specialist.

What are some other types of Eczema?

Eczema is very common. In fact, over 30 million Americans have some form of eczema — a condition that causes the skin to be red, itchy, dry and scaly.

Eczema  generally appears in the first six months to five years of a child’s life. Babies usually develop it on their face (especially the cheeks and chin), but it can appear anywhere on the body (like the folds of the elbows, and/or knees) and symptoms may be different from one child to the next.

More often than not, symptoms go away as a child grows older, though some children will continue to experience eczema symptoms into adulthood. Adults can also develop eczema, even if they never had symptoms as a child. Either way, you should know that eczema is not contagious. You cannot “catch” it from another person, or give it to someone else.

7 Different Types of Eczema You Should Know About

  1. Atopic dermatitis
  2. Contact dermatitis
  3. Dyshidrotic eczema
  4. Hand eczema
  5. Neurodermatitis
  6. Nummular eczema
  7. Stasis dermatitis

#1 – Atopic Dermatitis

Atopic dermatitis is a type of eczema that is chronic and inflammatory. Though the exact cause of AD is unknown, it happens when the immune system goes into overdrive. AD usually begins in childhood, often in the first six months of life. When you or your child have AD, it might improve at times or it may get worse (when you may experience what’s called a “flare up”).

AD is part of what’s called the atopic triad, which includes two other allergic conditions (asthma and hay fever, which is also known as allergic rhinitis). Researchers believe that people who come from families with a history of AD, asthma and/ or hay fever are more likely to develop atopic dermatitis themselves.

Some common symptoms of AD:

  • Dry, scaly skin
  • Redness (erythema)
  • Itching
  • Cracks behind the ears
  • A rash on the cheeks, arms and legs
  • Open, crusted or “weepy” sores (usually during flare-ups)

#2 – Contact Dermatitis

Contact dermatitis happens when the skin touches irritating substances or allergens. These make the skin inflamed, causing it to burn, itch and become red. There are two kinds of contact dermatitis: irritant and allergic. Contact dermatitis usually appears on the hands, or parts of the body that touched the irritant/allergen.

The  most common irritants include:

  • Solvents
  • Industrial chemicals
  • Detergents
  • Fumes
  • Tobacco smoke
  • Paints
  • Bleach
  • Wool
  • Acidic Foods
  • Astringents
  • Skin care products that contain alcohol (but not cetyl alcohol)
  • Some soaps and fragrances
  • Allergens (usually animal dander or pollens)

Symptoms of contact dermatitis include:

  • Redness and rash
  • Burning or swelling
  • Blisters that may weep or crust over

#3 – Dyshidrotic Eczema

Dyshidrotic eczema is a condition that produces small, itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. Stress, allergies (such as hay fever), moist hands and feet, or exposure to nickel (in metal-plated jewelry), cobalt (found in metal-plated objects, and in pigments used in paints and enamels), or chromium salts (used in the manufacturing of cement, mortar, leather, paints, and anti-corrosives) may be “triggers” of dyshidrotic eczema. This type of eczema is twice as common in women as it is in men.

Symptoms of dyshidrotic eczema include:

  • Small fluid-filled blisters (vesicles) on the fingers, hands, and feet
  • Itching
  • Redness
  • Flaking
  • Scaly, cracked skin
  • Pain

#4 – Hand Eczema

Hand eczema (also known as hand dermatitis) is very common – up to 10% of the population has this type of eczema. It is the result of both internal and external factors including genetics and contact with allergens or irritating substances like chemicals.

Some symptoms of hand eczema:

  • Redness
  • Itching
  • Pain
  • Dryness, to the point of peeling and flaking
  • Cracks in the skin
  • Blisters

#5 – Neurodermatitis

Neurodermatitis is also known as lichen simplex chronicus. It is an itchy skin disease that is similar to atopic dermatitis. People with neurodermatitis tend to get thick, scaly patches on their skin as a result of too much rubbing and scratching of the area.

Some symptoms of neurodermatitis:

  • Thick, scaly patches on the nape of the neck, scalp, shoulders, on the bottoms of feet, on ankles, wrists and the backs of the hands
  • Itching
  • Discolored skin

#6 – Nummular Eczema

Nummular eczema, also known as discoid eczema and nummular dermatitis, is a common type of eczema that can occur at any age. It looks very different than the usual eczema and can be much more difficult to treat. People with nummular eczema develop coin-shaped spots on their skin, which may be very itchy. It is thought to be “triggered” by things such as insect bites, irritants to the skin, or dry skin in the winter.

Some symptoms of nummular eczema include:

  • Round, coin-shaped spots
  • Itching
  • Dry, scaly skin
  • Wet, open sores

#7 – Stasis Dermatitis

Stasis dermatitis is sometimes called venous stasis dermatitis because it usually happens when there is a problem with blood flow in the veins and pressure develops (usually in the lower legs). This pressure can cause fluid to leak out of the veins and into the skin, resulting in stasis dermatitis.

Symptoms of stasis dermatitis include:

  • Swelling around the ankles
  • Redness
  • Scaling
  • Itching
  • Pain
  • Oozing
  • Open areas (cracking or larger ulcers)
  • Infection

What does Atopic Dermatitis look like?

Unlike other kinds of eczema, atopic dermatitis does not usually go away in a few days or weeks. It might get better or worse but the AD symptoms typically return.

AD is very itchy. You or your child’s skin can become damaged from repeated scratching or rubbing. AD normally appears on the cheeks, arms and legs, but can be anywhere on the body.

Symptoms of Atopic Dermatitis include:

  • Dry, scaly skin
  • Redness
  • Itching
  • Cracks behind the ears
  • A rash on the cheeks, arms and/or legs
  • Open, crusted or “weepy” sores (usually during flare-ups)
  • Extensive atopic dermatitis (AD), where the skin becomes very dry and scaly.
  • Atopic dermatitis (AD) in the folds of the legs, coupled with a “staph” bacterial infection.
  • Atopic dermatitis (AD) in the folds of the elbows and knees.
  • People with AD may develop thickened (“lichenified”) skin from repeated scratching.

Are there things that can make my atopic dermatitis worse?

The key to staying healthy while living with atopic dermatitis is to manage your symptoms. That’s why it’s good to know about the everyday triggers in your surroundings that might make your AD flare up.

Some of the most common atopic dermatitis triggers:

  • Dry skin — which can easily become brittle, scaly, rough, and tight
  • Irritants — everyday products or substances (hand and dish soap, laundry detergent, shampoo, bubble bath and body wash, or surface cleaners and disinfectants) that can cause your skin to burn and itch, or become dry and red
  • Stress — emotional stress can cause a person’s AD to flare up and get worse
  • Hot/cold temps and sweating — can lead to itchy skin or “prickly heat” symptoms from the heat and/or sweating and very dry skin can develop during the cold winter months
  • Infection — from bacteria and viruses that live in your environment (like “staph,” herpes, or certain types of fungi)
  • Allergens — everyday elements in the environment like seasonal pollen, dust mites, pet dander and mold
  • Hormones — flare ups may happen, especially in women, when certain hormones in the body increase or decrease

How can I control my atopic dermatitis?

There are a number of things you can do to manage your atopic dermatitis. The most important thing is to be consistent with your skin care. Setting up a daily routine is important for you or your child so that you are able to live more comfortably with AD.

Some things you can do to help control your atopic dermatitis:

  • Establish a daily skincare routine just like you would for other activities such as brushing your teeth. Be sure not to miss treatments and adapt your routine to address any changes in your AD.
  • Recognize stressful situations and events and learn to avoid or cope with them by using techniques for stress management. You may do this on your own, or with the help of your doctor or psychologist.
  • Be mindful of scratching and rubbing and limit contact with materials or substances that may irritate your skin. Dress in soft, breathable clothing and avoid itchy fabrics like wool that can irritate your skin.

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