What Is Eczema? Everything to Know About the Common Chronic Skin Condition

What Is Eczema? 

Eczema has varying levels of intensity, and can appear differently on everyone. You may see Anything from crusting, oozing, and blisters, to slight redness and minor signs of sensitive skin. On the more severe side, a flare-up can even resemble an allergic reaction or skin infection.

“It’s a broad term and refers to chronic inflammatory skin conditions characterized by itchy skin, red eczematous lesions on the skin, and often by dry skin,” Dr. Lio shares. “It has a huge impact on patients' lives and on the quality of lives, [affecting relationships with] family members, friends, school, work, and beyond.”

While types of eczema include contact dermatitis, dyshidrotic eczema, neurodermatitis, nummular eczema, seborrheic dermatitis, and stasis dermatitis—the form of eczema synonymous with the word is atopic dermatitis. Dr. Lio says the most common type of the condition affects a huge percentage of the population, both children and adults. 

Dermatologist Candrice Heath, MD, goes on to say, “It involves a compromised skin barrier that allows moisture to escape, making the skin more vulnerable to irritants.”

Contact dermatitis, in particular, “occurs when the skin reacts to an allergen or irritant, such as nickel in jewelry or belt buckles, poison ivy, or even wet diapers,” she adds.

What Causes Eczema? 

1. Genetics

When we talk about the aforementioned atopic dermatitis, genetics can put someone at increased risk. 

“If a parent or close relative has eczema, asthma, or allergic rhinitis (seasonal allergies), there's an increased likelihood that a child may also develop atopic dermatitis due to these genetic factors,” explains Dr. Heath. “This triad of conditions—eczema, asthma, and seasonal allergies—often travels together genetically and makes individuals more predisposed to eczema.”

2. Environmental Stressors

You know how lingering smoke from forest fires can have a chemical effect on our skin? Well, “It turns out there are many, many other things in the environment that can cause trouble,” Dr. Lio explains. “Everything from detergents and soaps to microplastics. And of course, we know the gut is also related to the skin barrier.”

But the doctor is excited about new developments that reveal more chemicals we need to avoid. “In the last couple of years, we've learned about isocyanates,” he says. “These are a type of chemical that seems to damage the microbiome, which is the healthy bacterial, viral, and fungal community on our skin. It also damages our skin barrier directly.”

3. Internal Triggers

Because everyone’s body is different, there could be isolated triggers that affect one person more than another. Dyes and fragrances are known triggers.

“There are many things that can trigger a flare for a given patient,” Dr. Lio says. “This can be something seemingly as banal as being hot and sweaty, to environmental changes, to certain types of clothing, and, of course, as a reaction to things put on or around the skin. When things are not under control, for some patients, it seems like almost anything and everything can trigger a flare-up. It's incredibly frustrating.”

The doctor notices many patients and their families blame food allergies for flare-ups, but in his experience and research, he doesn’t believe this is as definitively a culprit as other factors.

Are Certain People More Prone to Eczema? 

Genetics play a big role in contracting the skin disease, which can be a good thing or a bad thing, depending on your lineage. It’s not as common to develop the condition if it doesn’t run in your family. But, “A family history of eczema, asthma, or allergies, means one is more likely to develop it,” explains Dr. Lio. “This may be due to skin barrier issues and/or a very reactive immune system. For most eczema patients, things that wouldn't normally bother the skin of someone without eczema can cause itch, irritation, and even barrier breakdown. This suggests some people really are more susceptible.”

Developing eczema is also largely attributed to ethnicity and dark skin tones. “People of color—especially those of African descent—tend to have higher rates and severity of atopic dermatitis,” says Dr. Heath. “Interestingly, those of East Asian descent may also experience eczema rashes that may present differently, sometimes resembling psoriasis. This unique presentation is linked to specific genetic markers, such as higher levels of interleukin-17, which is associated with both psoriasis and severe eczema in this population.”

How to Treat Eczema

1. Tackle the Very Basics

While there’s no cure for the chronic condition, you can conquer what you have control of. “We tend to think of it like a ladder, starting at the base,” Dr. Lio explains. “This is really just about good education, avoiding known triggers, and using gentle yet effective skincare. For the mildest patients, that might be all they need. We view that as a huge victory. Sometimes just finding the right products can be the difference between needing treatment or not.”

The doctor goes on to point out his appreciation for oil-based cleansers and rich moisturizers or lotions that not only can protect the skin, but add beneficial lipids to help actually strengthen the barrier. To learn more about products considered “safe” for eczema patients, the National Eczema Association's Seal of Acceptance program is a great place to start. 

When it comes to over-the-counter care, Dr. Lio recommends his Dr. Lio's Skin Rescue Trio from SKINFIX, which features a hand relief cream, prebiotic foaming oil cleanser, and dermatitis relief balm. We’re personally fans of the TOWER 28 SOS Daily Rescue Facial Spray made with hypochlorous acid to soothe irritation and itchiness, and calm reactive skin. If you experience sensitivity around the eyes, we also recommend the PACIFICA BEAUTY Vegan Ceramide Barrier Eye Cream to calm, smoothe, and moisturize the eye area. You also can’t go wrong with traditional ointments and doctor-approved home remedies. Antihistamines are also recommended on occasion, but you’ll definitely want to speak to a medical expert before diving in.

2. Opt for a Reactive Treatment

The next step would be a "reactive" treatment, meaning using something just when you need it. “For the vast majority of patients, this can work well,” Dr. Lio shares. “Once in a while, they have eczema flares, they use their medication to the affected area, and they're better. Then, they can stop and go back to the gentle skincare and avoid triggers.”

While this can be a useful approach, it only applies to patients who have relatively limited flare-up areas that respond quickly to these treatments. “If we find either they can't get clear or they're having trouble staying off the medication to a point it’s becoming unsafe, we need to think about more of a proactive approach where we might use a milder medication.”

In this case, he may suggest a nonsteroidal agent applied to the troublespots to prevent flare ups. “This can be extremely helpful and help a huge swath of people,” he says.

3. Test Systemic Treatments

Should these reactive treatments fall flat, Dr. Lio says it may be time to consider systemic treatments, such as ultraviolet B phototherapy, biologics, and even some of the more powerful immunosuppressive prescription medications. 

“Of course, before we go there, we often have to retest to see if there are allergens, irritants, or other triggers that might be fueling the fire,” he explains. “Sometimes we even have to do tests to confirm to the best of our ability that it is atopic dermatitis in the first place because there are things that can mimic it. There are literally textbooks written about this topic, so it's difficult to summarize everything except to say that this is a complex area with lots of different options and many strong opinions. There is never a dull moment when treating eczema.”

Adds Dr. Heath, “In more severe cases, prescription topical steroids, non-steroidal anti-inflammatory creams, or immunomodulating medicines (injections or pills) that work systemically can help reduce inflammation and control symptoms. It’s important to make a doctor’s appointment and seek the guidance of a dermatologist to avoid overuse, discuss potential side effects, and find out which tailored treatment approach is best.”

Final Thoughts

Eczema is a chronic skin sensitivity condition that affects people in varying levels. The most common form is atopic dermatitis, which causes a compromised skin barrier and leads to the skin being easily triggered. Triggers, often inherited genetically, can include environmental and personal stressors. These triggers result in dry, itchy, patchy skin that can appear anywhere on the body. Darker skin individuals of African or East Asian descent are most susceptible to the condition. 

While there’s no cure for eczema, there are proactive measures that can be taken with the lighter cases to keep the issue at bay. It’s a nuanced condition, so it’s best to speak with a health care provider before making a diagnosis or opting for treatment. The condition can be especially overwhelming for young children, so if you think your child may be experiencing this issue, speak to a pediatrics professional immediately.