Common Types of Eczema

Atopic Dermatitis (Atopic Eczema):

By far the most common type. It often runs in families with allergies or asthma. Kids with atopic dermatitis have sensitive, dry skin that gets itchy and inflamed due to a weak skin. This guide mainly focuses on atopic dermatitis.

Contact Dermatitis:

Skin irritation or allergy caused by direct contact with a trigger substance. Examples include irritant contact dermatitis (like a rash from harsh soaps or saliva drool) and allergic contact dermatitis (like a rash from nickel in jewelry or certain detergents). Avoiding the trigger and using medications to calm the skin can help.

Nummular Eczema:

Also called discoid eczema, it causes coin-shaped patches of red, itchy, dry skin. This form is less common in young kids (usually appears in later childhood or teen years). It may be confused with ringworm or other rashes, so a doctor should evaluate round eczema patches.

Dyshidrotic Eczema:

Tiny itchy blisters on the hands or feet. This type is less uncommon. It can flare with sweating or stress. The biggest mistake I see is when dyshidrotic (or hand eczema in general) isn’t treated hard enough. It generally requires strong steroids (to get under control) and good maintenance care.

Each type of eczema has its own triggers and treatment nuances, but they all cause an impaired skin barrier and inflammation. Atopic dermatitis is the focus for most children with eczema.

Causes and Triggers of Adult Eczema

Eczema arises from a complex interplay of factors. In atopic dermatitis, a combination of genetic predisposition, a weakened skin barrier, an overactive immune response, and environmental triggers all contribute to the disease. Key factors include:

• Skin Barrier Defects: Many people with eczema have a genetic variant (e.g. filaggrin gene mutation) that impairs the skin’s ability to retain moisture and keep out irritants/allergens. The skin’s outer layer lacks sufficient filaggrin and ceramides, leading to dryness and tiny cracks. This allows allergens, microbes, and irritants to penetrate, triggering inflammation. A deficient barrier also means the skin loses water easily, causing chronic dryness.

   

• Immune System Overactivity: Eczema skin has an exaggerated T helper-2 (Th2) immune response, causing inflammation. Normally, the immune system protects against harm, but in eczema it reacts to benign triggers as if they were threats, releasing chemicals that cause itching and redness. This inflammation further disrupts the skin barrier and perpetuates a vicious cycle of itch-scratch-damage.

   

• Environmental and Allergic Triggers: Everyday factors can flare eczema. Common triggers include irritants (harsh soaps, detergents, fragrances, wool fabrics), allergens (dust mites, pollen, pet dander, certain foods), weather extremes (low humidity dry air or high heat and sweating), and stress. Hot, dry climates and excessive sun/UV exposure can increase skin pH and further disrupt the skin lipids, worsening eczema. Infections (like Staph aureus bacteria on the skin) are also common in eczema and can trigger or worsen flares. Identifying your personal triggers (for example, soap or a seasonal pollen) is crucial so you can avoid or minimize them.

   

• Other Factors: Hormonal changes (such as during pregnancy or menstrual cycles) can influence eczema. Additionally, many adults with atopic eczema have a personal or family history of other atopic conditions like asthma or hay fever. While food allergies are a frequent trigger in children’s eczema, they are a less common cause of adult flare-ups (except in some cases, like severe eczema linked to food sensitivities).

   

Symptoms and Impact

Eczema in adults tends to cause intense itching and skin lesions that can vary from red, inflamed patches to dry, scaly, or thickened areas. Common locations include the folds of the arms and legs, hands, neck, and face, although eczema can appear anywhere. Scratching can be irresistible but leads to a “itch-scratch cycle,” where scratching causes more skin damage and inflammation, leading to more itching. Over time, chronic scratching can cause thick, leathery skin patches (we call this “lichenification”). Eczema can significantly impact quality of life – the persistent itch can disturb sleep, and visible rashes may cause self-consciousness or stress. Effective management aims to relieve itching, heal the skin, and break this cycle.

Daily Skin Care: The Foundation of Eczema Management

Managing eczema starts with consistent gentle skin care and lifestyle adjustments. Proper skin care can restore the skin’s barrier and often dramatically reduce flare-ups. Key components include:

• Moisturizing (Emollient Therapy): Regular moisturizing is perhaps the single most important step for eczema care. Applying a thick, bland moisturizer at least twice daily helps lock in moisture and protect the skin barrier. Studies show that twice-daily application of moisturizers improves skin hydration, reduces eczema symptoms and flares, and can even lessen the need for medicated creams. Choose cream or ointment-based moisturizers (they are thicker and more protective than lotions) that are fragrance-free and dye-free. Look for products labeled “for sensitive skin” or “eczema friendly.” Right after bathing, pat the skin lightly and apply moisturizer while the skin is still damp to seal in hydration. Consistent moisturizing relieves dryness and itch and provides a protective layer against irritants.

   

• Gentle Cleansing and Bathing: Bathing can hydrate the skin if done properly. Take short, lukewarm (not hot) baths or showers (about 5–10 minutes). Use mild, soap-free cleansers that are fragrance-free – harsh soaps strip natural oils and can trigger flares. Avoid scrubbing the skin with washcloths or loofahs. After bathing, gently pat (don’t rub) the skin dry and immediately apply moisturizer (within 3 minutes) to damp skin. This routine helps “seal” water into the skin. Bath additives like colloidal oatmeal or bath oil can soothe and prevent drying during baths. I am a big fan of bleach baths – which we routinely use in children and also recommended by the royal children’s hospital in Melbourne. (https://www.rch.org.au/uploadedFiles/Main/Content/derm/Eczema%20bath.pdf ******** use our link) . If you don’t like the idea of bleach for maintenance skin care, you can always just skip that and use all the other ingredients! They really moisturise the skin.

   

• Fragrance-Free Everything: Fragrances are a common trigger for eczema flares. Use fragrance-free and dye-free products across the board – this includes soaps, moisturizers, deodorants, laundry detergents, etc. (Be wary of products labeled “unscented” – they might still contain masking fragrances; look specifically for “fragrance free” labels.) Also avoid products with botanical or essential oils unless you know you tolerate them; even natural fragrances (like lavender or tea tree oil) can provoke allergic reactions in eczema-prone skin.

   

• Avoid Irritants in Daily Life: Wear soft, breathable fabrics – cotton and bamboo are good; avoid wool or rough fabrics directly on skin. Tagless clothing or removing tags can prevent scratching. Use gentle, fragrance-free laundry detergents and avoid fabric softeners (they often have fragrances). Rinse clothes well to remove detergent residue. When doing housework, use vinyl or nitrile gloves (with a cotton glove liner for comfort) to protect your hands from harsh cleaners or prolonged water exposure, as those can irritate and dry out the skin.

   

• Climate and Environment: Cold dry air can worsen dryness – consider using a humidifier in winter to keep indoor humidity moderate. Heat and sweating can also trigger itching; try to keep cool and wear moisture-wicking layers. After heavy sweating (exercise or heat), rinse off and moisturize. Protect your skin from extreme cold and wind with appropriate clothing and moisturizers. Sunlight in moderation can be helpful for some eczema, but sunburn will aggravate eczema, so use a mineral sunscreen (zinc/titanium based, which are usually better tolerated by sensitive skin) on exposed areas when needed.

   

• Identify and Avoid Personal Triggers: Keep a diary to note when flares occur and potential contacts or activities that preceded them (new skincare products, contact with an irritant, high stress day, a certain food, etc.). Common allergens that can cause contact dermatitis superimposed on eczema include nickel (in jewelry or buckles), certain cosmetics or hair dyes, and preservatives in topical products. If flares are frequent or severe, sometimes I recommend allergy testing (patch testing) to see if you have specific contact allergies triggering your eczema. Stress management is also important – stress can provoke flare-ups in many people, likely via hormonal and immune system effects. Relaxation techniques, exercise, or counseling can be useful to keep stress in check and thus reduce stress-induced flares.

   

By diligently following a gentle skin care regimen and avoiding triggers, many patients find their eczema significantly easier to control. Good daily care strengthens the skin’s barrier – which directly addresses one of the root causes of eczema.

Cosmeceuticals and Eczema: What Helps vs. What Hurts

“Cosmeceuticals” refers to cosmetic products with active ingredients purported to benefit the skin (such as anti-aging serums, specialty creams, etc.). In eczema, some cosmeceutical ingredients can be helpful, while others may aggravate sensitive skin:

• Beneficial Ingredients: Many modern moisturizers for eczema contain added ingredients beyond basic hydration, aimed at repairing the skin barrier and reducing inflammation. For example, products with ceramides (skin lipids) help replenish the missing fats in eczema skin and have been shown to improve barrier function and even reduce the need for steroid creams. Colloidal oatmeal is another proven ingredient – it has anti-inflammatory and barrier-protective properties. Daily use of a colloidal oatmeal lotion or cream can soothe itch and redness; it even showed significant improvement in clinical eczema scores in studies, performing non-inferior to a prescription barrier cream in mild eczema. Natural moisturizing factors (NMFs) like glycerin, urea, and amino acids are often added to eczema emollients – these ingredients attract and hold water in the skin. Urea, for instance, in low concentrations (5–10%) is a powerful humectant that improves hydration (though higher concentrations can be irritating to some). Essential fatty acids from plant oils (like sunflower seed oil, which is high in linoleic acid) can aid the skin’s lipid barrier. Niacinamide (vitamin B3) is another cosmeceutical additive found in some eczema creams; it can reduce inflammation and improve the skin’s production of ceramides, thus strengthening the barrier. Endocannabinoid compounds (like PEA, palmitoylethanolamide) and licorice root extract (glycyrrhetinic acid) are newer additions that have shown anti-itch and anti-inflammatory effects in eczema creams. Many of these specialized “dermocosmetic” or “barrier repair” creams are available over-the-counter. They can be used alongside or between prescription treatments – in some studies, a ceramide-dominant lipid cream used alone was as effective as a mild steroid or calcineurin inhibitor in maintaining eczema control for mild cases. Overall, cosmeceutical products that focus on restoring skin lipids, maintaining moisture, and calming inflammation can be very helpful in eczema care.

   

• Potential Irritants: On the flip side, certain skincare or cosmetic ingredients can worsen eczema. We already noted fragrance as a major no-go – it’s a top cause of allergic reactions in sensitive skin. Alcohol-based lotions or astringents can dry and sting the skin. Avoid “anti-aging” products that contain harsh actives like retinoids (retinol) or exfoliating acids (AHA/BHA) on eczema-prone areas; while these ingredients have benefits for normal skin, they are usually too irritating for compromised eczema skin and can trigger redness and peeling. Similarly, be cautious with vitamin C serums or any product that causes a burning sensation – what is mild irritation on normal skin could provoke an eczema flare on yours. Preservatives in cosmetics (like MI/MCI – methylisothiazolinone, a common preservative in wipes and some creams) are a frequent cause of contact dermatitis on top of eczema. If your eczema is not improving, consider that something you’re applying might be an irritant or allergen. I actually often recommend sticking to simple products with short ingredient lists during flare-ups. When introducing any new skincare or cosmetic item, do a patch test first: apply a small amount on the inner arm for a week to see if it causes any reaction before using it more broadly.

   

In summary, choose moisturizers and skincare products that support the skin’s barrier (ceramides, oatmeal, glycerin, etc.) and steer clear of products with potential irritants (fragrances, harsh actives). If unsure about a product, ask me!

Medical Treatments: From Topical Therapies to Systemic Medications

While good skin care is the cornerstone of eczema management, many adults with moderate or severe eczema will need medicines to control inflammation and itching, especially during flares. Treatment is typically customized based on severity and patient preference. Here is an overview of treatments:

Topical Medications

• Topical Corticosteroids: These are the first-line prescription treatment for eczema flares. Corticosteroid creams/ointments (such as hydrocortisone, triamcinolone, betamethasone, etc.) reduce inflammation and itching quickly. They come in different strengths; for sensitive areas like the face or folds, low-potency steroids are used (I actually almost always use Elidel on the face instead of steroids – next paragraph), while thicker skin (hands, feet) generally need higher potency. Steroids are very effective for short-term use to calm flares. However, they are not intended for daily long-term use unless specifically told to by your doctor due to the potential for side effects like skin thinning, discoloration, and, with extensive use, possible systemic absorption. Use them as directed – typically applied once or twice daily on active eczema patches until improvement, then tapered off. It’s often helpful to follow the “reactive” approach: use steroids during flares, and as the skin clears, switch to maintenance with moisturizers or non-steroid agents. This minimizes steroid exposure while keeping eczema controlled.

   

• Calcineurin Inhibitors : These are non-steroid anti-inflammatory creams, namely tacrolimus ointment and pimecrolimus cream (Elidel). They work by dampening the local immune reaction in the skin (by blocking calcineurin, an enzyme in T-cells which are part of the immune system). TCIs are especially useful for delicate areas (face, eyelids, neck, groin) or for long-term maintenance, where steroids might cause side effects. They do not cause skin thinning. Tacrolimus is available in 0.03% (often for children or sensitive areas) and 0.1% (for adults) strengths. Some patients feel a temporary warming or tingling/burning upon application, but this usually subsides. This is harmless if you feel it. About 10% of my patients can’t tolerate the feeling and cease the medicine for this reason. They are a key steroid-sparing option.

   

• Topical PDE4 Inhibitor: Crisaborole ointment is another non-steroidal option for mild-to-moderate eczema. It blocks an enzyme (phosphodiesterase-4) involved in inflammation. It’s approved for ages 3 months and up. Crisaborole can sting upon application, especially on open or raw skin, but it can help reduce itch and inflammation with regular use.

   

• Others: In cases of localized stubborn thickened eczema,sometimes I try topical coal tar preparations (that we normally use as a second line treatment in Psoriasis) can be helpful, although tar can be messy and has an odor. Topical antibiotics (like fusidic acid or mupirocin) may be prescribed if there is localized infection (e.g., oozing or crusted patches) – sometimes combined with steroids in one ointment. Antiseptic sprays or washes (eg. chlorhexidine wash) can reduce bacterial load on the skin for those who get frequent infections.

   

Phototherapy and Other Light Treatments

Light therapy can be a beneficial treatment for widespread or stubborn eczema, especially when topical treatments are insufficient. Traditional phototherapy uses controlled doses of ultraviolet (UV) light delivered in a medical setting, but newer technologies include various non-UV lights and lasers. Here are the main light-based therapies:

• Narrowband UVB Phototherapy: This is a time-tested treatment for moderate to severe eczema. In phototherapy, you stand in a cabin (like a light booth) that emits narrowband ultraviolet B light (311 nm) to exposed skin. UVB has an immune-suppressing effect in the skin, reducing inflammation and itch. It’s typically done 2–3 times per week for several weeks. Over time, patients often see fewer flares and more controlled eczema. It’s particularly useful for individuals who either don’t respond to or want to minimize systemic medications. Drawbacks: You must travel to the phototherapy center multiple times a week, and there can be mild side effects like temporary redness or sunburn if the dose is too high. Long-term UVB therapy (over many months/years) can contribute to photoaging and very slightly increased skin cancer risk, so I’m not a massive fan.

   

• LED Light Therapy (Low-Level Light Therapy): LED devices use non-UV light (visible light or near-infrared) to modulate skin cell activity – often called photobiomodulation. LED therapy for skin is painless and does not carry the risks of UV. Different colors of light penetrate to different depths and have various effects. For instance, blue light (around 415 nm) can kill certain bacteria and has mild anti-inflammatory effects, red light (633 nm) and near-infrared (~830 nm) go deeper and can reduce inflammation and promote skin healing.

 A small study found that blue-light LED used 3 times a week for 4 weeks led to some improvement in mild-to-moderate eczema with no adverse events (https://pmc.ncbi.nlm.nih.gov/articles/PMC6329412/ ). And anecdotal reports suggest red or near-infrared LED (often used in skincare clinics for anti-aging) may help calm eczema-prone skin by strengthening the barrier and reducing redness. Devices like MediLUX (a medical-grade LED system) offer multiple wavelengths – e.g. blue, green, yellow, red, infrared – that can be tailored to skin concerns. MediLUX and similar devices are used in some dermatology or medi-spa clinics to reduce inflammation, redness, and promote healing of inflamed skin conditions including psoriasis and eczema. The blue light targets bacteria and inflammation, green and yellow lights are said to reduce redness and assist healing, red light boosts circulation and repair, and near-infrared supports deeper tissue repair.

If you’d like to consider LED therapy as an adjunct to your current therapy Book now (***** link when you to go book you are asked if we have treated you with LED for eczema before if they say yes they just go to a page with booking one off vs booking a package if they havent they book 20 min appt with dr chris followed by 20 minute dermal clinician appointment

• Lasers and Other Light Devices: Beyond UV phototherapy and LEDs, dermatologists have experimented with various laser treatments for eczema – especially for localized, treatment-resistant areas or to address specific complications of eczema (like thickened skin or redness). Examples include:
  

   

  • Nd:YAG Laser (1064 nm): High-powered Nd:YAG lasers (like those in some multi-wavelength laser platforms, e.g. Fotona Dynamis) have primarily been used for hair removal, vascular lesions, and collagen stimulation (Laser Genesis). Interestingly, there are case reports showing improvement of severe, refractory eczema with a 1064-nm laser. It should be realised though that this is not a common treatment and all other standard options should be tried first. In one report, two patients with long-standing atopic dermatitis received a series of treatments with a high-peak power 1064 nm Nd:YAG laser and had significant improvement in their eczema symptoms (*** 1. LaBrasca, Mistica, et al. Successful Treatment of Refractory Atopic Dermatitis With the Use of High-Peak Power 1064 Nm Nd:YAG Laser Therapy. The American Journal of Cosmetic Surgery, vol. 38, no. 3, Sept. 2021, pp. 143–149, doi:10.1177/0748806821989885. ) . The laser was delivered in a non-ablative, gentle mode (similar to how “Laser Genesis” works by gently heating the dermis). This suggests it reduced skin inflammation or perhaps altered the immune response in the skin. While this is not yet a common therapy, it indicates that advanced laser systems like the Fotona Dynamis Pro (which includes an Nd:YAG laser) could be utilized in specialized cases to help calm eczema in patients not responding to other treatments. More research is needed, but it’s promising that even lasers traditionally used for cosmetic indications might have therapeutic benefits for eczema when used appropriately.

     

  • Fractional Lasers (e.g. Fractional CO₂ or Er:YAG): These lasers create microscopic channels in the skin and are typically used for scars and rejuvenation. In eczema, fractional lasers have been explored as a way to enhance topical drug delivery and to break up thickened, lichenified plaques. A recent study (2023) on chronic hand eczema showed that combining fractional laser sessions with a topical steroid (halometasone) produced better results than the steroid alone. In the trial, 62% of patients who received the laser + cream achieved treatment success by 12 weeks, compared to 28% who used the cream without laser. The laser’s microchannels likely helped the medication penetrate deeper and also stimulated skin remodeling. Importantly, the combination group also had a much lower relapse rate (only ~11% relapsed within 24 weeks, vs 50% in the cream-only group) (***https://link.springer.com/article/10.1007/s13555-023-00944-w)  Side effects were minimal, mainly some transient skin pigmentation in a few patients. This is cutting-edge therapy but it suggests that fractional laser “assisted” drug delivery in rare cases might be a tool for chronic, thick eczema that doesn’t respond to standard treatments.

     

If you’d like to consider laser therapy as an adjunct to your current therapy Book now (***** they book 20 min appt with dr chris followed by 20 minute dermal clinician appointment

Systemic Treatments (Oral and Injectable Medications)

For adults with moderate-to-severe eczema that is widespread or not controlled by topical treatments and phototherapy, systemic medications are often recommended. These work from the inside to modulate the immune system and reduce inflammation body-wide:

• Oral Antihistamines: While not treating the eczema inflammation directly, sedating antihistamines (like diphenhydramine, hydroxyzine, or doxepin) can help at night to reduce itching and aid sleep. Non-sedating daily antihistamines (cetirizine, loratadine) might help those who have allergic triggers, but they generally have limited impact on eczema itch. They are safe to use for symptomatic relief of itch in combination with other therapies.

   

• Short-term Oral Corticosteroids: A short course of oral steroids (like prednisone) can dramatically clear a bad eczema flare. However, oral steroids are used sparingly and only as a last resort for acute flares, because eczema often rebounds when they are stopped and long-term steroid use has significant side effects (weight gain, high blood pressure, diabetes, bone thinning to name a few). If used, I generally prescribe a tapered course (e.g. over 2–3 weeks) to bring a severe flare under control, while transitioning the patient to safer long-term therapies.

   

• Traditional Immunosuppressants: These are oral medications that dampen the immune system’s activity. They have been used for decades in severe eczema:

   

  • Cyclosporine: a fast-acting immunosuppressant that can greatly improve eczema within a few weeks. It’s usually a short-term option (3–6 months) due to side effects (can affect kidneys and blood pressure).

     

  • Methotrexate: a weekly low-dose pill that can help chronic eczema by anti-inflammatory effects. It’s slower onset but many patients tolerate it well long-term with proper monitoring.

     

  • Azathioprine and Mycophenolate: other immunosuppressants used in some cases of refractory eczema. They require blood test monitoring.
    These medications can be very effective at reducing eczema severity, but they suppress the immune system broadly, so there are risks like increased infections or organ-specific side effects. Doctors will monitor blood counts, liver/kidney function, etc. While on these, it’s important to avoid live vaccines and practice good infection avoidance (especially with cyclosporine, which is strongest).

     

• Biologic Therapies: The biggest breakthrough in recent years for eczema has been the advent of biologic drugs – targeted antibody therapies that block specific immune signals. The first and most well-known for atopic dermatitis is Dupilumab (Dupixent). Dupilumab is an injectable monoclonal antibody that blocks the receptors for interleukin-4 and interleukin-13, two key cytokines in the Th2 immune pathway that drives eczema. By inhibiting this pathway, Dupilumab dramatically reduces eczema inflammation and itch in many patients, leading to clearer skin and improved quality of life. It’s given as a subcutaneous injection (like an insulin shot) every 2 weeks (after an initial loading dose) and can be used long-term. Biologics are usually reserved for the most serious cases when all other treatments fail.

   

Regardless of the systemic therapy, ongoing skin care and topical treatments usually continue as adjuncts. The goal with systemic meds is to get the disease under control, then possibly step down to milder maintenance if possible. All systemic treatments require medical supervision. The good news is that with these options, even the most severe eczema can often be brought under control, vastly improving patients’ comfort and life.

Living with Eczema: Outlook and Additional Tips

With the array of treatments available today, most adults with eczema can achieve good control of their skin – meaning fewer flares, milder symptoms, and a better quality of life. Eczema tends to be a chronic condition with ups and downs, but patient education and consistent management are key to minimizing its impact. Here are some final tips and points to remember:

• Follow a Maintenance Plan: Even when your skin is clear or improving, continue with the maintenance regimen I recommendd (this usually includes daily moisturizing and possibly intermittent use of prescription topicals on trouble spots). Eczema has a tendency to flare when treatment is completely stopped. Think of it like asthma – you keep using preventive measures even when breathing is okay, to prevent attacks. Regular use of emollients and avoidance of triggers is an ongoing necessity.

   

• Manage Itch Proactively: Don’t wait until you’ve scratched your skin raw. Use anti-itch measures at the earliest sign of itching. Cool compresses, moisturizers, or anti-itch lotions containing ingredients like pramoxine or menthol can provide relief. At night, keep your bedroom cool, and consider cotton gloves if you scratch in your sleep. Keeping nails trimmed and smooth will lessen damage if you do scratch. Sometimes behavioral techniques or occupational therapy can help habitual scratching. Remember, stopping the itch-scratch cycle is crucial to healing.

   

• Monitor for Infection: Because the skin barrier is compromised, people with eczema are prone to skin infections (bacterial, viral, fungal). If you notice signs of infection – increasing redness, warmth, yellowish crusting or pus, or an eczema patch suddenly getting worse with pain – see your doctor. They may prescribe antibiotics or antivirals if needed.

   

• Allergies and Eczema: Many patients ask about diet or environmental allergies. In adults, food allergies are rarely a main driver of eczema (unlike some children). However, if you notice a clear pattern of certain foods flaring your skin, discuss with your doctor – testing can be done, and elimination diets should be supervised to ensure proper nutrition. Airborne allergens like dust and pollen can be triggers, so using mite-proof bedding covers, a HEPA air filter, and keeping a clean, dust-free home may help if those are factors for you. Some of my patients with atopic dermatitis benefit from seeing an allergist for evaluation, especially if they have other allergies or asthma.

   

Emotional and Social Support: Don’t overlook the mental health aspect of eczema. Chronic itch and visible rashes can cause anxiety, depression, or social withdrawal. Stress in turn can worsen eczema. It’s important to communicate with your doctor about how you’re coping.