What Causes Eczema and How Do You Treat It?

Eczema, also known as dermatitis, is the name for a group of skin conditions that cause an inflammatory skin reaction. Eczema can be found anywhere on the body, but is most commonly found on the hands, inside of elbows, back of the knees, face and scalp. Symptoms can begin during childhood, adolescence or adulthood and can range from mild to severe.¹

What is Eczema?

Eczema is a common condition that first appears with itching on red patches of skin. The skin becomes dry, cracked and sore and can spread to the rest of the body in some cases. Eczema can be a short reaction against one trigger, which can last for a few hours or even several days. Under rare circumstances, eczema can be chronic, increasing the risk of bacteria and fungal infection.²

Depending on the severity of your symptoms, you should reach out to a general practitioner for professional diagnosis and management.

According to the National Health Service (NHS), the exact cause of eczema is still uncertain. And although there is no cure for eczema, certain triggers can cause eczema flare ups, such as allergens or irritants.³ We advise consulting your healthcare provider on the best treatment regimen, as symptoms vary from person to person.

There are different types of eczema:

• Atopic Eczema
• Contact Dermatitis
• Eczema on Hands
• Eczema on Lower Legs
• Eczema on the Scalp

Atopic Eczema

Atopic eczema is a common form of eczema which affects up to 1 in every 5 children.⁴ Symptoms include itchy, dry, blistered and cracked red skin. It often occurs in people who have allergies such as hay fever, asthma and food allergies ("atopic" means sensitivity to allergens). It’s more common in children and often gets milder or goes away by adulthood.⁴

^{Atopic Eczema Complications}

• Bacterial skin infections can occur from cracked and broken skin caused by atopic eczema. The more you scratch your eczema and/or do not use your treatments correctly, the higher likelihood you will experience an eczema infection. Symptoms of a bacterial infection can include fluid oozing from the skin, the skin becoming swollen and sore and more.¹²
• Eczema can be infected with the herpes simplex virus, which can develop into a condition called eczema herpeticum. Symptoms of eczema herpeticum can include painful and worsening eczema, shallow open sores on skin and a generally feeling unwell.¹²

If you are suffering from any of these symptoms, contact your GP as soon as possible.

Contact Dermatitis

A type of eczema that occurs when your skin comes into contact with a substance that triggers irritation or an allergic reaction. Irritant contact dermatitis occurs after being in contact with irritants such as soaps and detergents. Contact dermatitis develops when you touch a chemical or substance that triggers an allergic reaction.⁵

Difference Between Atopic Eczema and Contact Dermatitis

While their symptoms are similar, the two types of eczema have different triggers. Cases of atopic eczema occur due to a combination of genetic and environmental factors. Contact dermatitis occurs when the skin comes into contact with something that triggers a reaction. The reaction develops within a few hours or days of contact and goes away when you avoid the irritant.⁶

Triggers: Allergies, soaps, detergents, solvents, extreme weather conditions and stress.
Symptoms: Itchy, dry, cracked and sore skin.

Eczema on Hands

Also known as hand dermatitis, it affects your hands and is often the result of regularly working with substances that irritate your skin. Symptoms start with intense itching and burning on the hands, turning the skin red, itchy, cracked and blistered.⁷

Triggers: Exposure to cleaning, hairdressing and healthcare chemicals.
Symptoms: Itching and burning, red, cracked and blistered skin.

Eczema on Lower Legs

Also known as Varicose, Venous, Gravitational or Stasis eczema, it’s a long term skin condition that affects the lower legs. As with all types of eczema, symptoms include red, itchy, cracked and blistered skin. However, the triggers are unique because they are caused by increased pressure in leg veins and are more common among people with varicose veins.

Triggers: Varicose veins and not moving for long periods.
Symptoms: Itchy, dry and swollen patches on the lower parts of your legs.

Eczema on the Scalp

Also known as Seborrhoeic eczema, it appears in areas where there are oil-producing (sebaceous) glands, such as the scalp, face and centre of the chest. It’s relatively prevalent in adults, affecting about 4% of the population.⁸ The most common symptom is dandruff, which leads to an itchy, sore and flaky scalp.

Triggers: Detergents, solvents, chemicals and soaps, stress, hormonal changes or illness.
Symptoms: Dandruff, itchy, sore and sensitive skin.

Treating Eczema at Home

In addition to seeing a doctor about treatment, there are methods you can use to ease the symptoms of eczema at home. According to the Hong Kong Medical Diary, following the below skincare advice is key to a successful treatment:⁹

Environmental Modification

• Avoid irritants such as soap, detergents, shampoo and cleansing products.
• Use adequate safety precautions such as gloves and barrier creams.
• May need to change occupation to avoid daily contact with irritants.

Emollients & Soap Substitutes

• Use fragrance-free emollients and moisturisers.
• Apply aqueous cream and emulsifying ointments.

Diet

• Maintain a well-balanced diet.
• Some research has pointed to supplementing vitamin D for eczema symptoms¹¹
• Keep a food diary for up to 2 weeks to track your daily intake as a method to determine if there is a problematic food source.

When to See a Doctor

• Where is the location of your rash and does it itch?
• When did the symptoms first begin?
• Does it come and go?
• Is there a history of eczema in your family?
• Do you have any other health conditions, such as hayfever or asthma?
• Have you recently changed your diet or lifestyle?

• Topical corticosteroids if appropriate to reduce inflammation.
• Antihistamines to relieve itching.
• Sometimes the doctor may use a new type of topical treatment called “Topical calcineurin inhibitor”, which may have fewer adverse effects than corticosteroids.
• Wet wraps and bandages to soothe symptoms and create a barrier against scratching.
• Allergy testing to determine if an allergen is causing the reaction.
• Analysis of your current medication to ensure that you are using the right products and amounts at the correct times.

Conclusion

In most cases, conditions of eczema are mild and can be treated and managed to improve quality of life. Visit your general practitioner if you are unsure what type of eczema you have or symptoms continue to worsen. The sooner you become aware of the type of eczema you have and what the triggers are, the better you will be able to manage it.

Reviewed by Dr Ray Ng (MBBS, MRCP, MRCGP, PgDipPD)

References

1. Prof. Sophia Chan. (2018). ‘LCQ4: Diagnoses and treatments for eczema patients’. The Government of Hong Kong Special Administrative Region. 28th November. Available at: <https://www.info.gov.hk/gia/general/201811/28/P2018112800675.htm> [Accessed 28 April 2021].
2. NHS. (n.d.). Atopic eczema - Complications. NHS choices. Retrieved January 7, 2022, from https://www.nhs.uk/conditions/atopic-eczema/complications/
3. National Health Service. (2019). ‘Atopic Eczema’. NHS. Available at: <https://www.nhs.uk/conditions/atopic-eczema/> [Accessed 28 April 2021]
4. British Association of Dermatologists. (2020). ‘Atopic Eczema’. The British Association of Dermatologists. July 2020. Available at: <https://www.bad.org.uk/patient-information-leaflets/atopic-eczema/?showmore=1&returnlink=https%3a%2f%2fwww.bad.org.uk%2fpatient-information-leaflets#.YI_pXrUzaUk> [Accessed 28 April 2021].
5. British Association of Dermatologists. (2021). ‘Contact Dermatitis’. The British Association of Dermatologists. April 2021. Available at: <https://www.bad.org.uk/patient-information-leaflets/contact-dermatitis> [Accessed 05 May 2021].
6. National Health Service. (2019). ‘Contact Dermatitis’. NHS. Available at: <https://www.nhs.uk/conditions/contact-dermatitis/> [Accessed 28 April 2021].
7. National Eczema Association. (2021). ‘Hand Eczema’. National Eczema. Available at: <https://nationaleczema.org/eczema/types-of-eczema/hand-eczema/> [Accessed 04 May 2021].
8. British Association of Dermatologists. (2021). ‘Seborrhoeic Dermatitis’. The British Association of Dermatologists. April 2021. Available at: <https://www.bad.org.uk/patient-information-leaflets/seborrhoeic-dermatitis/?showmore=1&returnlink=https%3a%2f%2fwww.bad.org.uk%2fpatient-information-leaflets#.YIsKN7UzaUk> [Accessed 28 April 2021].
9. Dr KK Lo. (2010). ‘Practical Approach for Eczema’. The Hong Kong Medical Diary. November 2010. Available at: <http://www.fmshk.org/database/articles/04mb1_5.pdf> [Accessed 28 April 2021].
10. National Health Service. (2019). ‘Atopic Eczema Treatment’. NHS. Available at: <https://www.nhs.uk/conditions/atopic-eczema/treatment/> [Accessed 28 April 2021].
11. Huang, C., Lara-Corrales, I. and Pope, E., 2018. Effects of Vitamin D levels and supplementation on atopic dermatitis: A systematic review. Pediatric Dermatology, 35(6), pp.754-760.
12. Alexander, H., Paller, A., Traidl‐Hoffmann, C., Beck, L., De Benedetto, A., Dhar, S., Girolomoni, G., Irvine, A., Spuls, P., Su, J., Thyssen, J., Vestergaard, C., Werfel, T., Wollenberg, A., Deleuran, M. and Flohr, C., 2019. The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group. British Journal of Dermatology, [online] 182(6), pp.1331-1342. Available at: <https://pubmed.ncbi.nlm.nih.gov/31677162/> [Accessed 1 March 2022].