Eczema: Your GoodRx Guide

Causes

Eczema is a rash caused by inflammation in the skin. The exact reason for the inflammation is not entirely clear and depends on the type of eczema you have. There are likely many factors that lead to eczema, including genetics, immune function, triggers, and family history.

Some people with eczema have a genetic mutation in filaggrin. This protein helps to keep the skin barrier intact and the skin moisturized. If you don’t make enough filaggrin, it may make your skin more prone to inflammation. 

Your immune system also plays a role in eczema. There are certain immune system cells that can be overactive in eczema — leading to more inflammation.  

There are many different triggers for the rash in eczema. These triggers may vary depending on the type of eczema you have. Common eczema triggers include:

• Pet dander

• Dust mites

• Soaps and detergents

• Perfumes

• Excessive sweat and overheating

• Clothing

• Dry skin

• Stress

• Illness

• Extreme weather changes

Eczema can happen in anyone, but it tends to peak in childhood. And it’s very common. In fact, over 30 million people in the U.S. are living with some form of eczema. 

People with eczema often have other inflammatory conditions like seasonal allergies, food allergies, or asthma. And they’re more likely to experience depression or anxiety. Someone is also more likely to have eczema if they have a family history of either of these conditions. 

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Symptoms

The most common symptom of eczema is an itchy rash that may come and go. The itching can be so severe that it disrupts your sleep or impairs your quality of life. The rash may have red bumps or red, dry patches of skin. Sometimes the rash may look like blisters or cracked skin that oozes or bleeds. 

But it doesn’t look the same in everyone. The rash of eczema can vary widely depending on your age, skin tone, and the type of eczema you have. 

The places eczema usually shows up on the body can change with age.  

In infants and toddlers, eczema often appears on the:

• Scalp (cradle cap)

• Cheeks

• Outer surface of the elbow

• Knees

• Torso (less common)

In older children and adults, eczema often shows up in body folds and creases. You can see the rash in areas like the:

• Back of the neck

• Eyelids

• Hands

• Feet

• Elbow fold

• Back of the knees

In darker skin tones, eczema may not appear red at all. The inflammation may cause the skin to look darker, gray, or purple. If you have concerns about eczema and have darker skin, try to find a medical provider who is familiar with how eczema looks on pigmented skin. 

In severe eczema, intense scratching can lead to a skin infection. This can cause open sores, pus, crusting, and red streaking on the skin.

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Diagnosis

Your provider can usually make the diagnosis of eczema using your history of symptoms and a physical exam. But there are times when the rash of eczema may look like other skin conditions. 

Sometimes eczema looks like:

• Psoriasis

• Ringworm

• Scabies

• Urticaria (hives)

• Folliculitis

If your healthcare provider is not sure about the diagnosis, they may recommend further skin testing.

A skin biopsy can help figure out what’s happening in your skin. With this test, your provider removes a very small sample of skin. Then a specialist closely examines the sample under a microscope to see if the inflammation looks like eczema.

You may also have a patch test. This is helpful to see if an allergic reaction to something you’re putting on your skin is causing your rash. 

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Medications

Many types of medications work well for eczema. The choice of medication is generally based on whether your eczema is mild or moderate to severe. 

Treatment for mild eczema is usually topical (applied to the skin). And you can often use over-the-counter (OTC) medications to relieve symptoms. Some topical treatments are useful to treat skin dryness, and others work to reduce inflammation. 

If you have mild eczema, your provider may recommend treatment with:

• OTC emollients (moisturizers): such as Aquaphor or Vaseline

• Topical steroids: such as hydrocortisone or triamcinolone

• PDE4 inhibitors: such as Eucrisa (crisaborole)

• Calcineurin inhibitors: such as pimecrolimus or tacrolimus

Moderate to severe eczema may require systemic treatment. This may come in the form of oral medication or injections. These medications include:

• Systemic steroids: such as prednisone

• Immunosuppressants: such as methotrexate and cyclosporine

• JAK inhibitors: such as Rinvoq (upadacitinib) and Cibinqo (abrocitinib)

• Immune modulators: such as Dupixent (dupilumab) and Adbry (tralokinumab)

Light therapy may also help improve hard-to-treat eczema. Ultraviolet (UVB) light therapy is the most common type for eczema, and it’s an effective treatment. But it may take a couple of months of regular UVB therapy to see results.

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Treatments

In addition to medication, there are other lifestyle changes and home remedies that may help your eczema. Here are a few strategies that can help reduce eczema flare-ups:

• Moisturize often. Moisturize at least twice a day, and apply it while your skin is still wet from bathing.

• Use a humidifier. This can also help add moisture to your skin. This is especially important when your environment is dry.

• Avoid irritants. Resist the urge to use harsh soaps, strong fragrances, or skin scrubs. All of these can irritate the skin.

• Try wet wraps. Wrapping the skin in moist cloths overnight after applying moisturizer can soothe the skin. It can also help keep moisture in the skin. 

• Learn your triggers. Once you identify your triggers, do your best to avoid them to limit your eczema flares. Triggers may include certain foods, chemicals, or allergens.