Eczema

Eczema, also called dermatitis, is a group of conditions that make the skin red, inflamed, itchy, and sometimes blistered or scaly. The most common form is atopic dermatitis, which often begins in childhood and can return later in life. Other types include contact dermatitis, nummular eczema, dyshidrotic eczema, and seborrheic dermatitis.

Common symptoms
Symptoms may include persistent or intense itching, red or brownish-gray patches — often on the hands, feet, ankles, wrists, neck, upper chest, eyelids, or the bends of elbows and knees — dry or sensitive skin that can crack or peel, small raised bumps that may leak fluid and crust over when scratched, and thickened, scaly skin from frequent rubbing or scratching.

What causes eczema?
Eczema develops from a mix of genetic, immune, and environmental factors. People with atopic eczema often have family members with eczema, asthma, or hay fever. The condition is linked to a weakened skin barrier, which allows moisture to escape and irritants to enter, triggering inflammation. Triggers vary by person and can include soaps, fragrances, allergens, heat, sweating, stress, and certain fabrics.

Risk factors
Risk may be higher with a personal or family history of atopic conditions, early childhood onset, dry skin or frequent use of harsh soaps, exposure to environmental irritants or allergens such as nickel or fragrances, and certain occupations involving wet work or chemicals.

How is eczema diagnosed?
Clinicians usually diagnose eczema by examining the skin and discussing symptoms and history. They may ask about when symptoms started, frequency, family history, and possible triggers. Patch testing, skin scraping, or a dermatologist referral may be recommended if the diagnosis is unclear or standard treatments aren’t effective.

Goals of management
While most types of eczema have no single cure, proper care can control symptoms, prevent flare-ups, restore the skin barrier, and treat complications like infections. With the right skin care and guidance from a healthcare practitioner, itching can be reduced, the appearance of skin improved, and flare-ups minimized.

When to see a clinician
See a clinician if symptoms are severe, widespread, or not improving with over-the-counter moisturizers; if there are signs of infection such as pain, warmth, yellow crusting, spreading redness, or fever; if eczema affects sleep, daily activities, or mental health; or if the diagnosis is uncertain or standard treatments aren’t working. Working with your practitioner, you can create a simple, consistent care plan that improves comfort and long-term skin health.

Is eczema contagious?
No. Eczema cannot be spread from person to person by touch.

What can trigger an eczema flare?
Triggers vary but often include harsh soaps or detergents, fragrances, cold or dry weather, heat, sweating, certain fabrics like wool or synthetics, stress, and allergens such as dust mites, pet dander, or pollen. Identifying and avoiding personal triggers can help reduce flares.

How can I care for my skin at home?
Use gentle, fragrance-free cleansers and moisturizers. Apply a thick moisturizer at least twice daily, especially after bathing. Take short, lukewarm showers or baths, pat skin dry gently, use mild laundry detergent, keep nails short, and consider cotton gloves at night if scratching interferes with sleep.

Are topical steroids safe? How should they be used?
Topical corticosteroids reduce inflammation and itching and are generally safe when used as directed by TidalHealth clinicians. Following instructions for strength, amount, and frequency helps minimize side effects. Our team can develop a safe, effective plan if long-term use is needed.

What if topical treatments are not helping?
For moderate to severe or hard-to-treat eczema, options include topical calcineurin inhibitors, phototherapy, oral medications to calm the immune system, or biologic therapies like dupilumab. TidalHealth specialists can help find the best approach.

Can changes in diet help with eczema?
Only a small number of people have eczema triggered by specific foods. Dietary changes should be guided by a clinician or dietitian to ensure nutrition isn’t compromised. Infants with possible food-related eczema should be properly evaluated and tested.

When should I worry about infection?
Contact your clinician if you notice pain, spreading redness, yellow crusting, pus, new blisters, or fever. Eczema can lead to bacterial or viral infections that may require specific treatment.

How can eczema be managed in children?
Children benefit from regular moisturizing, gentle bathing, avoiding triggers, and prompt treatment of flares. Pediatricians and dermatologists can help with medication dosing and answer questions about growth or side effects.

Can eczema be cured?
There is no guaranteed cure for most types of eczema, but many people experience long periods with few or no symptoms when following an individualized care plan. Ongoing self-care and regular check-ins with your healthcare team can improve comfort and quality of life.

When should I see a specialist?
Consider visiting a dermatologist if eczema is severe, covers a large area, disrupts daily life or sleep, isn’t improving with basic treatments, or may require advanced therapies.