Eczema: Types, Symptoms, and Causes

Eczema affects an estimated 10 to 15 million people in India, making it one of the most common chronic skin conditions in the country. Despite its widespread occurrence, many individuals struggle to understand what triggers their flare-ups or even to identify which type of eczema they have.
Whether you're experiencing your first outbreak or have been managing eczema for years, understanding the specifics of your condition is the first step toward finding relief and maintaining healthy skin.

What Is Eczema?

Eczema, also known as dermatitis, is a group of inflammatory skin conditions that cause irritation, redness, and itching. The term "eczema" comes from the Greek word "ekzein," which means "to boil out," reflecting the inflamed appearance of affected skin.
This chronic condition occurs when the skin's protective barrier becomes compromised, allowing moisture to escape and irritants to enter. The result is dry, sensitive skin that's prone to inflammation and infection. While eczema can develop at any age, it most commonly appears during childhood, with many cases beginning before age five.

Types of Eczema

Understanding the different types of eczema is crucial for proper diagnosis and treatment. Each type has distinct characteristics, triggers, and treatment approaches.

Atopic Dermatitis

Atopic dermatitis is the most common form of eczema, affecting approximately 16.5 million adults in the United States. This chronic condition typically begins in early childhood and may persist into adulthood.

Key characteristics include:

• Intense itching that often worsens at night
• Red, inflamed patches that may ooze or crust over
• Dry, scaly skin between flare-ups
• Common locations: face, neck, elbows, knees, and ankles

Contact Dermatitis

Contact dermatitis occurs when skin comes into direct contact with an irritating substance or allergen. This type of eczema can affect anyone, regardless of age or previous skin sensitivity.

Two main subtypes exist:

• Irritant contact dermatitis: Caused by direct skin damage from harsh substances
• Allergic contact dermatitis: Results from an immune system reaction to specific allergens

Dyshidrotic Eczema

Dyshidrotic eczema primarily affects the hands and feet, causing small, fluid-filled blisters to form on the palms, fingers, and soles. This type tends to be more common in adults and can be particularly challenging to manage due to the location of symptoms.

Distinctive features include:

• Small, deep-set blisters that may be intensely itchy
• Blisters that eventually dry out and peel
• Seasonal patterns, often worsening in spring and summer
• Potential connection to stress and exposure to certain metals

Nummular Eczema

Nummular eczema, also called discoid eczema, creates distinctive coin-shaped patches of irritated skin. These round lesions can appear anywhere on the body but are most common on the legs, arms, and torso.

Characteristic signs include:

• Well-defined, circular patches of inflamed skin
• Patches that may be red, brown, or pink
• Potential for bacterial infection if severely scratched
• More common in adults over 55 and those with very dry skin

Seborrheic Dermatitis

Seborrheic dermatitis affects areas of the body with high concentrations of oil glands, particularly the scalp, face, and upper chest. This type is closely related to the presence of naturally occurring yeast on the skin.

Notable features include:

• Greasy, yellowish scales or flakes
• Red, inflamed skin beneath the scales
• Common areas: scalp, eyebrows, sides of nose, and behind ears
• May worsen during periods of stress or illness

Stasis Dermatitis

Stasis dermatitis develops in the lower legs due to poor blood circulation, typically affecting older adults or those with circulation problems. This condition often accompanies varicose veins or other vascular issues.

Key indicators include:

• Swelling in the lower legs and ankles
• Red, itchy skin that may become thick and leathery over time
• Open sores or ulcers in severe cases
• Skin discoloration, often appearing brownish

Common Symptoms of Eczema

While symptoms vary depending on the type of eczema and individual factors, several common signs appear across all forms of the condition. Recognizing these symptoms early can help you seek appropriate treatment and prevent complications.

Primary Symptoms

The hallmark symptoms of eczema include:

• Intense itching: Often the first and most bothersome symptom
• Red, inflamed skin: May appear darker on individuals with darker skin tones
• Dry, rough patches: Skin feels tight and may crack
• Swelling: Particularly noticeable during active flare-ups
• Oozing or crusting: Occurs when scratching leads to skin breakdown

Secondary Symptoms

Continued scratching and inflammation can lead to additional complications:

• Thickened skin: Results from chronic scratching and rubbing
• Darkened skin: Post-inflammatory hyperpigmentation
• Bacterial infections: Open scratches provide entry points for bacteria
• Sleep disruption: Nighttime itching interferes with rest
• Emotional impact: Visible symptoms may affect self-esteem and social interactions

Causes of Eczema

Eczema develops from a complex interaction of genetic, environmental, and immune system factors. While the exact cause remains unclear, research has identified several contributing elements that increase the risk of developing this condition.

Genetic Factors

Family history plays a significant role in eczema development. If one parent has eczema, asthma, or allergies, their child has approximately a 25% chance of developing eczema. When both parents are affected, this risk increases to about 60%.

Specific genetic variations affect:

• Skin barrier function
• Immune system responses
• Production of natural moisturizing factors
• Inflammatory pathways

Environmental Triggers

Various environmental factors can trigger eczema flare-ups or contribute to the initial development of the condition:

Common irritants include:

• Harsh soaps and detergents
• Fragrances and preservatives in skincare products
• Wool and synthetic fabrics
• Extreme temperatures and humidity changes
• Cigarette smoke and air pollution

Allergens that may trigger reactions:

• Dust mites and pet dander
• Pollen from trees, grasses, and weeds
• Certain foods (particularly in children)
• Mold spores

Immune System Dysfunction

Eczema involves an overactive immune response that creates inflammation even when no real threat exists. This immune dysfunction manifests in several ways:

• Increased production of inflammatory substances
• Heightened sensitivity to normally harmless substances
• Impaired ability to fight off skin infections
• Disrupted balance of beneficial skin bacteria

Skin Barrier Defects

People with eczema often have a compromised skin barrier that cannot effectively retain moisture or keep irritants out. This barrier dysfunction results from:

• Reduced production of ceramides (natural fats that seal in moisture)
• Genetic mutations affecting structural proteins like filaggrin
• Imbalanced pH levels on the skin's surface
• Altered skin microbiome composition

Conclusion

Understanding your specific type of eczema, recognizing your symptoms, and identifying your personal triggers forms the foundation of effective management. Keep a detailed journal documenting when flare-ups occur, what products you use, environmental factors, stress levels, and dietary changes.
Work closely with a dermatologist or healthcare provider who can help you develop a personalized treatment plan. This may include prescription medications, specific skincare routines, lifestyle modifications, and strategies for avoiding your identified triggers.