Eczema (Atopic Dermatitis): Causes and Treatment

What is eczema?

Eczema, also called atopic dermatitis, is a chronic inflammatory skin condition that causes dry, itchy, sensitive, and inflamed skin. It often begins in childhood, but it can also continue into adulthood or begin later in life.

Eczema is not contagious. However, it can have a major effect on sleep, comfort, self-confidence, and quality of life.

What causes eczema?

Eczema develops from a combination of skin-barrier dysfunction, immune-system overactivity, genetics, and environmental triggers.

Some people with eczema have changes involving filaggrin, a protein that is important for a healthy skin barrier. When the barrier does not work well, the skin loses moisture more easily and becomes more vulnerable to irritants, allergens, and inflammation.

Common triggers can include:

• Dry air

• Harsh soaps or fragranced products

• Wool or rough fabrics

• Heat and sweating

• Stress

• Infections

What are the symptoms of eczema?

Symptoms can vary by age, skin tone, and body site, but often include:

• Dry, rough, or sensitive skin

• Red, pink, brown, gray, or violaceous patches depending on skin tone

• Itching, sometimes severe

• Scaling, cracking, or oozing in flares

• Thickened skin from repeated rubbing or scratching

Common locations include the face, neck, hands, wrists, inside the elbows, behind the knees, and other skin folds.

How is eczema treated?

Treatment depends on severity, body location, patient age, and prior response to therapy.

Common treatment options include:

• Moisturizers and gentle skin care as the foundation of treatment

• Topical corticosteroids for many flares

• Topical calcineurin inhibitors such as tacrolimus and pimecrolimus

• Steroid-free topical options such as crisaborole (Eucrisa), roflumilast (Zoryve), tapinarof (VTAMA), and ruxolitinib (Opzelura) in appropriate situations

• Phototherapy for some patients with more widespread disease

• Oral medications

• Injectable biologics including Dupilumab (Dupixent), Nemolizumab (Nemluvio), Lebrikizumab (Ebglyss), and Tralokinumab (Adbry) when eczema is more significant or not controlled with topical treatment alone

Newer injectable and targeted options have expanded treatment choices considerably for moderate-to-severe eczema.

How do I prevent eczema?

Helpful habits include:

• Moisturizing regularly, especially after bathing

• Using fragrance-free cleansers and skin-care products

• Avoiding known triggers when possible

• Keeping showers and baths lukewarm rather than hot

• Treating flares early before they become more severe