By Mojibola OrefujaDid you know that eczema is actually a broad term that includes multiple skin conditions? One of the most common types under this umbrella is atopic dermatitis, which affects millions of people worldwide. It usually starts in childhood and, unfortunately, cannot be cured. Instead, it’s a long-term condition that people manage throughout their lives (1).
According to the NICE website, the word “eczema” comes from a Greek term meaning “to boil.” This description perfectly captures the symptoms of eczema—dry, itchy, red skin that can sometimes become blistered, weepy, or crusted (2). Because of these similar characteristics, the term eczema is used to describe a range of skin conditions.
Eczema is not just a minor skin irritation; it can significantly impact a person’s quality of life. It can lead to sleep disturbances due to persistent itching, social anxiety from visible rashes, and even psychological distress. Many people with eczema struggle with self-confidence, especially during flare-ups. This makes understanding and managing the condition even more crucial.
These are the 7 main types of Eczema:
Types of Eczema
There are seven main types of eczema, each with different causes and treatments, though many share common symptoms (3). The key differences lie in how they develop and how they are managed. Let’s break them down:
- Atopic Dermatitis – The most common form, often linked to an overactive immune response to certain triggers. These aren’t quite allergies, but rather sensitivities that lead to long-term skin inflammation. It is a chronic condition that tends to come and go in cycles, with periods of worsening symptoms (flare-ups) followed by times of relative calm.
- Contact Dermatitis – This type occurs when the skin directly touches an irritant or allergen, such as certain chemicals, fragrances, or metals. Unlike atopic dermatitis, it only happens when there is direct contact with the trigger. Contact dermatitis is often seen in people who work in occupations that require frequent exposure to cleaning products, solvents, or latex gloves.
- Dyshidrotic Eczema – This form mainly affects fingers, toes, palms, and soles of the feet, causing small, itchy blisters (4). The triggers are similar to those of atopic dermatitis, but its specific location makes it unique. These blisters can be painful and may even interfere with daily tasks such as writing, typing, or walking.
- Neurodermatitis – A particularly challenging form of eczema, neurodermatitis starts with an intensely itchy patch of skin. Scratching makes it worse, creating a vicious cycle that leads to thick, leathery patches of skin. It commonly appears on the neck, wrists, forearms, and groin (5). This condition can be particularly difficult to manage because the itch is often triggered by stress or anxiety.
- Nummular Eczema (Discoid Eczema) – This type appears as round, coin-shaped patches of dry, itchy skin. It often worsens in winter or after an insect bite or skin injury (6). The exact cause is unknown, but it is believed to be related to skin barrier dysfunction.
- Seborrheic Dermatitis – Primarily affecting oil-rich areas of the skin, this form is common in infants and is also known as cradle cap. It causes greasy, inflamed skin with white or yellowish scales. In adults, it often appears on the scalp, face, and upper chest.
- Stasis Dermatitis – This form results from poor circulation, often in the legs, leading to blood pooling and skin inflammation. It is commonly seen in older adults and those with varicose veins.
While other forms of eczema exist, these are the most common. Since atopic dermatitis is the type most people refer to when they say “eczema,” we’ll focus on this moving forward.
Risk Factors and Triggers
Like asthma, atopic dermatitis doesn’t have a single known cause. Instead, multiple factors, including genetics, contribute to its development. Studies have shown a strong hereditary link—if a parent or sibling has atopic dermatitis, your chances of having it increase significantly. Even a family history of related conditions like asthma or hay fever increases the likelihood (6).
Aside from genetics, several triggers can worsen eczema (2):
- Soaps and detergents
- Animal fur
- Dust mites
- Extreme temperatures
- Rough fabrics
- Pollen
- Stress
Triggers vary from person to person, so identifying what worsens your eczema is key to managing it effectively. In addition, lifestyle factors such as diet, sleep, and overall stress levels can influence flare-ups. Keeping a journal of what you eat, what products you use, and your daily activities can help you identify patterns in your symptoms.
Signs and Symptoms
Regardless of the type, most forms of eczema share common symptoms:
- Itchy skin
- Red, dry patches
- Thickened, scaly skin
The location of these patches often depends on age (7):
- Infants: Face, scalp, and joint creases.
- Children: Elbows, knees, neck, and ankles.
- Teenagers & Adults: Any area of the body.
Some people experience mild eczema, while others have widespread, severe patches. Conditions like neurodermatitis may only affect a few areas, while atopic dermatitis can be more extensive.
Diagnosis
There’s no single test for diagnosing eczema; instead, doctors rely on clinical evaluation. A symptom diary can help track flare-ups and identify triggers, including changes in skincare products, diet, or environment. In some cases, a referral to a dermatologist is necessary to rule out other conditions.
Severity Levels
Once diagnosed, the next step is determining the severity of the eczema (8):
- Clear – Normal skin, no signs of eczema.
- Mild – Occasional dry skin and itching, minimal redness.
- Moderate – Frequent itching and redness, but no thickened skin.
- Severe – Widespread dry skin, intense itching, bleeding, oozing, or cracking.
Eczema can also become infected with bacteria or viruses, leading to weeping, crusting, or painful spots.
Treatment Approaches
When treating Eczema, like Asthma, we follow a stepped approach. With regards to Eczema, this means treating according to the severity of the condition. For example, mild eczema would be treated with the mild approach while severe/infected eczema who be treated as such.
- Mild Eczema Treatment (9) –
- Emollients – these are moisturizing creams, ointments, lotions or washes which can be used on dry skin to make it more hydrated.
- Mild steroid cream – only used for red skin areas. The treatment of choice here is usually Hydrocortisone 1%
- Education about Eczema is also given in this step of treatment
- Moderate Eczema Treatment (10) –
- Immediate referral to Dermatologists – if you appear to have moderate eczema, your GP should refer you urgently to the skin doctors as you are at risk of getting a viral infection of your eczema called Eczema Herpeticum.
- Emollients – these are a mainstay of eczema treatment so these will always be suggested in eczema treatment.
- Moderate steroid cream – options for this are either Betamethasone Valerate OR Clobetasone Butyrate. These should NOT be used on the face as this is a sensitive area of skin.
- For itch that is overwhelming, you may also be given antihistamines.
- Severe Eczema Treatment (11) –
- As above, with the addition of a possible oral steroid as well to help with severe flare-ups of Eczema.
Living with eczema can be challenging, but understanding its different forms, triggers, and treatments makes managing the condition much easier. While there is no cure, proactive care—such as avoiding triggers, using emollients, and seeking appropriate medical treatment—can significantly reduce symptoms and improve quality of life. Eczema affects people differently, with some experiencing mild flare-ups and others facing more severe, chronic symptoms. By recognizing the signs early and using a tailored treatment plan, individuals can minimize discomfort and prevent complications like infections. Ultimately, raising awareness and educating people about eczema helps reduce stigma and ensures that those affected can access the support they need.
References:
- National Eczema Association. What is Eczema? [Internet]. Available from: https://nationaleczema.org/eczema
- National Institute for Health and Care Excellence (NICE). Eczema – Overview [Internet]. Available from: https://www.nice.org.uk/guidance
- American Academy of Dermatology Association. Types of Eczema [Internet]. Available from: https://www.aad.org/public/diseases/eczema/types
- Mayo Clinic. Dyshidrotic Eczema – Symptoms and Causes [Internet]. Available from: https://www.mayoclinic.org/diseases-conditions/dyshidrosis
- WebMD. Neurodermatitis: Causes, Symptoms, and Treatments [Internet]. Available from: https://www.webmd.com/skin-problems-and-treatments/neurodermatitis
- Genetics Home Reference. Atopic Dermatitis and Genetics [Internet]. Available from: https://ghr.nlm.nih.gov/condition/atopic-dermatitis
- National Eczema Society. Eczema in Different Age Groups [Internet]. Available from: https://eczema.org/information-and-advice
- British Association of Dermatologists. Assessing Eczema Severity [Internet]. Available from: https://www.bad.org.uk/eczema
- NHS. Treatment for Eczema [Internet]. Available from: https://www.nhs.uk/conditions/atopic-eczema/treatment
- American Academy of Allergy, Asthma & Immunology. Eczema and Allergy Management [Internet]. Available from: https://www.aaaai.org/conditions-and-treatments/eczema
- World Allergy Organization. Severe Eczema and Systemic Treatments [Internet]. Available from: https://www.worldallergy.org/eczema-management
- Centers for Disease Control and Prevention (CDC). Eczema Herpeticum – A Serious Skin Infection [Internet]. Available from: https://www.cdc.gov/eczema-herpeticum