Expert Answers To Common Questions About Eczema

Eczema is a common and treatable condition that is often the subject of questions regarding the scientific mechanisms that cause it, the various factors that can trigger it, and the available treatment options for effective management.

To help with understanding the condition better, our experts have provided detailed answers based on the latest scientific research to some of the most common questions about eczema in this article, including what triggers the condition, which eczema treatments are worth considering, and more.

The basics of eczema

What is eczema?

Eczema is a condition that can cause the skin to become inflamed, leading to dryness, cracks and itchiness. The most common type of eczema is atopic dermatitis, characterised by systemic inflammation on the skin all over the body which results in patches of dry skin that can appear red and dark brown. Other types of eczema^[1] include:

• Contact dermatitis - a type of eczema caused by allergens such as environmental triggers
• Dyshidrotic eczema - a more severe type of eczema that can cause a burning sensation and the appearance of rashes and blisters
• Neurodermatitis (discoid eczema) - a type of eczema that affects a small patch of skin in a specific area of the body, making it itchy and scaly
• Nummular eczema - a type of eczema that causes small lesions to appear all over the body, especially on the arms and legs
• Seborrheic dermatitis - the scientific name for eczema affecting the scalp
• Stasis dermatitis - a type of eczema that appears as skin discolouration on the legs and resembles the symptoms of varicose veins

What causes eczema?

The exact cause of eczema is still being researched and depends on the type of eczema experienced. Atopic dermatitis is thought to be a hereditary condition that is caused by an overreaction of the immune system in response to irritants. On the other hand, contact dermatitis is non-hereditary, and is thought to be caused by direct skin contact with an irritant or allergen, including but not limited to certain soaps, fragrances and fabrics.

There is also research to suggest that eczema symptoms may be caused by a malfunction in the skin barrier, causing an excessive amount of moisture to leave the skin while also allowing germs to penetrate the skin barrier.

What does eczema look like?

Eczema typically appears as patches of dry, inflamed and cracked skin on the affected areas of the body.^[2] These patches typically look red for those with lighter skin tones, and dark brown for those with darker skin tones. Individuals with dyshidrotic eczema may also see blisters on their skin.

What does eczema feel like?

The skin on the areas of the body affected by eczema typically feels itchy, dry, and in some cases, swollen. If the skin in these areas is scratched, the inflammation can worsen, causing the itchiness, dryness and swelling to intensify.

Why does eczema itch?

According to research,^[3] eczema itches because of the interaction of inflammatory mediators in the body and nerve endings in the skin. When inflammatory mediators such as prostaglandins are released into the bloodstream, they can activate nerve endings in the skin affected by eczema. This causes specialised nerve fibres known as unmyelinated C-fibres to transmit itch signals to the spinal cord and subsequently to the brain.

This mechanism compels the affected individual to scratch the affected area to disrupt the itch signal transmission and create a concurrent sensation on the skin that temporarily relieves the itch.

Is eczema contagious?

No, there is no scientific evidence to suggest that eczema is contagious.

How does eczema spread?

Eczema can spread if the affected area of the body is scratched. Scratching the skin can cause further irritation and the inflammation to spread to a bigger surface area of the skin.

What is the difference between eczema and psoriasis?

Eczema and psoriasis differ in terms of their causes and symptoms. Eczema is thought to be caused by genetic factors and/or the inability of the barrier of the skin to regulate moisture and defend against bacterial penetration. Psoriasis can also be caused by genetic factors, however, it is also caused by the overproduction of skin cells and/or the immune system accidentally attacking healthy cells.^[4]

In terms of the symptoms, psoriasis causes plaques to appear on the skin due to an overproduction of skin cells. This mechanism causes new skin cells to be pushed to the surface of the skin quicker than the skin cells on the surface of the skin mature and shed. In contrast, skin affected by eczema appears inflamed, discoloured and dry, however, it does not resemble plaques.

Recommended reading: Eczema Ultimate Guide

Common eczema triggers

What causes eczema to flare up?

Eczema flare-ups can be caused by allergens and irritants such as soaps and detergents that can strip away the natural oils from the skin, weakening the skin’s barrier and causing dryness.^[5]

Stress can also cause an eczema flare-up because of the release of hormones like cortisol and adrenaline into the bloodstream, triggering inflammatory responses on the skin that can cause the skin to itch and result in further inflammation if scratched.^[6]

How long does an eczema flare-up last?

Eczema flare-ups can last anywhere from a few days to a few weeks depending on factors such as the severity of the symptoms and the treatment administered.

What makes eczema worse?

Eczema can worsen if the affected areas are scratched as this can increase how much of the skin in the affected area is inflamed. Eczema can also worsen due to weather changes (such as a drop in air humidity), exposure to irritants and allergens like certain foods, and an increase in stress levels.

What foods cause eczema?

Foods are not known to directly cause eczema, however, some foods can trigger a flare-up. Foods to avoid if you have eczema include those that contain specific types of proteins which may cause the immune system to overreact when they are eaten.

Foods that contain such proteins include but are not limited to cow’s milk, soy, wheat and peanuts. Fish and shellfish can also trigger an inflammatory response in the body, increasing the risk of experiencing an eczema flare-up.

The effects of eczema on different parts of the body

What does eczema look like on the face?

Eczema can appear as red or brown patches of inflamed skin on the face. The affected areas may appear and feel scaly or crusty, and if the eczema patches are infected with bacteria or viruses, there may be blisters and oozing.

What causes eczema around the eyes?

Eczema around the eyes can be caused by allergens and irritants that may get transferred to the eyes as a result of rubbing them. It can also be caused by a genetic predisposition to the condition, skin barrier dysfunction around the eyes, or an immune response.

What causes scalp eczema?

Scalp eczema can be caused by the same factors as those that cause eczema on other parts of the body. Some individuals may also experience seborrheic eczema on the scalp due to the overgrowth of Malassezia^[7] - a yeast present in the hair follicles that can cause itchy bumps to appear, prompting scratching and inflammation of the scalp skin.

What causes eczema in the ears?

Eczema around the ears can be caused by the same factors as eczema on other parts of the body. This can include exposure to allergens/irritants that may get transferred to the ears from the hands following contact. Eczema on the ears can also be caused by skin barrier dysfunction, a genetic predisposition to the condition, or an immune response.

What causes eczema on the hands?

Hand eczema can result from contact with irritants or allergens, including harsh chemicals found in hand soaps. Additionally, the chemicals in laundry and dishwashing detergents may act as triggers if the hands are exposed to them. Exposure to specific metals, like nickel, can also cause eczema on the hands.^[8]

What does eczema look like on the legs?

Eczema on the legs typically resembles red or brown scaly patches that tend to be more prevalent in the areas of the legs where the skin folds such as behind the knees. If the legs are dry and the affected areas are scratched, the patches may appear white (due to the skin being scratched off) or leak fluid if there are blisters.

What causes eczema on the feet?

Eczema on the feet can be caused by the same factors as eczema on other parts of the body, including genetic factors or exposure to allergens/irritants such as soaps used to clean the feet. Additionally, a compromised skin barrier can cause eczema on the feet by allowing bacteria from socks and shoes to penetrate the skin more easily.

Recommended reading: From acne to eczema: How to look after your skin

Eczema treatment and management

What is the best treatment for eczema?

The best treatment for eczema can vary depending on the type of eczema experienced, the severity of the symptoms, and which part of the body is affected:

• Hydrocortisone 1% Cream - this eczema treatment can be used to treat irritant or contact allergic dermatitis affecting any part of the body other than the face, the anogenital area, or any part of the body where the skin is broken. Hydrocortisone 1% cream must not be used by any individual who is allergic to hydrocortisone, chlorocresol or cetostearyl alcohol.
• Dermol 500 - this antimicrobial emollient is formulated to provide quick relief from dry and itchy skin caused by eczema on all parts of the body. It can be used as a substitute for soap and/or as a moisturiser. Dermol 500 should not be used by individuals who have previously had a reaction to it or on cracked or broken skin.
• Eumovate Eczema & Dermatitis Cream 0.05% - this is a short-term topical cream containing clobetasone butyrate - a corticosteroid that stops the skin from reacting to triggers that can cause eczema flare-ups. It can be applied to any part of the body other than the face, groin, genital areas or between the toes, and is suitable for individuals seeking a way to quickly control patches of red/brown, inflamed skin caused by eczema.
• E45 Eczema Repair Cream - this cream is formulated to help repair the skin barrier for 24 hours following application and is suitable for use on any part of the body.
• E45 Itch Relief Cream - this eczema cream contains urea (a natural moisturiser) and lauramacrogols - an active ingredient that can help soothe itching caused by eczema. It can be used to treat eczema on any part of the body.
• E45 Moisturising Cream - this is a general skincare cream that can soothe dry, chapped skin caused by eczema. It differs from the itch relief variant in that it is primarily formulated to hydrate dry skin.
• E45 Emollient Bath Oil - this treatment is a mineral oil that can be mixed into a warm bath to help treat dry and itchy skin caused by eczema on all parts of the body.
• Doublebase 500g - this is a topical gel that can treat dry or chapped skin caused by eczema. It is only suitable for individuals who are not allergic/hypersensitive to liquid paraffin or isopropyl myristate.

What moisturiser is good for eczema?

Dermol 500, E45 moisturising cream, E45 moisturising lotion and Aveeno Skin Relief Lotion are all excellent moisturisers to relieve dry and itchy skin caused by eczema. Aveeno Dermexa Balm is also a suitable alternative; while it is not a moisturiser, it can restore the skin’s natural barrier, reducing dryness and helping to soothe itchy skin.

What cream is good for eczema?

There are several good creams for eczema, including Hydrocortisone 1% Cream (for any area of the body other than the face, the anogenital area, or where the skin is broken), Dermol 500 and Eumovate Eczema and Dermatitis Cream. Other eczema creams worth considering include E45 Eczema Repair Cream, E45 Itch Relief Cream, E45 Moisturising Cream and Aveeno Skin Relief Lotion.

What vitamins are good for eczema?

Vitamin D, Vitamin E and Omega-3 Fatty Acids can contribute to improving eczema symptoms. Vitamin D is thought to help regulate immune responses and reduce inflammation, while Vitamin E is thought to contribute to overall skin health. Omega-3 Fatty Acids, on the other hand, may have anti-inflammatory properties that might potentially help individuals with eczema reduce the risk of flare-ups. With that said, research on the extent to which vitamins contribute to improving eczema symptoms is still ongoing.

What food is good for eczema?

Foods that contain a high concentration of Omega-3 Fatty Acids such as salmon, walnuts and flaxseeds are thought to be good for eczema because Omega-3 Fatty Acids can affect cell membranes, reducing the production of inflammatory markets such as cytokines in the body. This can reduce the expression of inflammatory genes among those with eczema, preventing skin inflammation.

How often should I shower with eczema?

Individuals with eczema are recommended to try and shower no more than once per day as showering can strip away the skin’s natural oils (especially if the water is hot). It is also advisable for individuals with eczema to apply a moisturiser immediately after showering to keep the skin hydrated.

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