Eczema
Eczema is a chronic skin condition that causes itchy and inflamed rashes. It affects over 31 million people in the United States. Impacted by genetic and environmental factors, it can make daily life uncomfortable. Managing flare-ups involves personalized care, like medications and lifestyle adjustments.
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What Is Eczema?
Eczema, or atopic dermatitis, is a chronic skin condition that causes dry, itchy skin. It is a common condition, affecting 10 to 30% of children and 2 to 10% of adults.
Eczema is part of the “atopic march,” meaning it’s linked to conditions like asthma and allergic rhinitis – also known as hay fever. Although its exact cause is unclear, genetic and environmental factors could play a role in the development of eczema.
Scratching your itchy skin may lead to infections and worsened symptoms. Regular moisturizing, medicated creams and other treatments can help manage flare-ups and prevent complications.
- Darkened skin around the eyes
- Dry and cracked skin
- Feeling itchy
- Raw and sensitive skin caused by scratching
- Skin oozing and crusting
- Skin rash that is swollen and changes color based on your skin tone
- Small bumps on brown or black skin
- Thickened skin
Types of Eczema
All types of eczema involve skin inflammation and irritation. However, eczema can manifest in different ways, each with its own causes, symptoms and treatments.
Knowing your specific type of eczema may help determine the best ways to treat it.
- Atopic dermatitis
- This is the most common type of eczema. It causes dry, itchy and inflamed skin. People with atopic dermatitis could be at risk of developing asthma, food allergies and hay fever.
- Contact dermatitis
- As the name suggests, contact dermatitis is triggered by contact with allergens or irritants. It causes red, blistered or burning skin.
- Dyshidrotic eczema
- This is characterized by small, itchy blisters on your hands and feet. It commonly affects people ages 20 to 40.
- Lichen simplex chronicus (neurodermatitis)
- This type of eczema usually forms as just one or two thickened patches of skin and is intensely itchy. The cause is unclear, but it seems to be triggered by stress and irritants like insect bites and tight clothing.
- Nummular eczema
- Nummular eczema creates round, itchy patches of inflamed skin, usually on your arms and legs.
- Seborrheic dermatitis
- This causes scaly, red patches in areas rich in oil glands, like the scalp and face.
Causes of Eczema
Eczema is a complex condition influenced by genes and the environment. Your genes, especially a gene called filaggrin (FLG), help keep your skin healthy.
Changes in this gene can cause allergic reactions or make your skin more sensitive to irritants. If eczema, asthma or allergies run in your family, you might be more likely to develop eczema.
- Filaggrin gene
- This gene helps maintain the skin barrier. Mutations increase susceptibility to irritants and allergens.
- Other skin barrier genes
- Genes involved in lipid synthesis, an enzyme reaction that converts nutrients into lipids, also contribute to eczema. Lipids help skin cells stay hydrated and protected against irritants, so lacking them may contribute to skin issues.
- Immune-related genes
- Genes regulating immune responses, including cytokines, immunoglobulins and T-cells, are linked to eczema. An overactive immune system can lead to skin flare-ups.
- Environmental factors
- Irritants like detergents and soaps, allergens including dust mites and pet dander, and stress can all trigger eczema flares.
All these factors can weaken your skin’s defense and cause an overactive immune system response, leading to the inflammation seen in eczema.
Topical Medications for Eczema
Topical treatments for eczema include creams and ointments that you apply to your skin to help alleviate symptoms like itching and redness. Different options exist, including some that require a prescription. These can include steroids, which come in varying strengths, and other medications that help reduce inflammation.
- Topical JAK inhibitors
- These medications, like Opzelura (ruxolitinib), block chemical pathways called JAK1 and JAK2 enzymes. These pathways are part of the immune system and can cause inflammation. Blocking them can reduce itchiness, rashes and skin redness.
Side effects include bronchitis, ear infections, headache, nausea and urinary tract infections.
- Topical calcineurin inhibitors
- Nonsteroidal treatments, including Protopic (tacrolimus) and Elidel (pimecrolimus), prevent immune system cells from triggering eczema symptoms. Common side effects include local skin irritation, burning and erythema at the application site.
- Topical PDE4 inhibitors
- Medications like Eucrisa (crisaborole) block the phosphodiesterase 4 (PDE4) enzyme to reduce inflammatory cytokines in atopic dermatitis. Cytokines are proteins that are part of a typical immune response. Side effects include burning, dryness, itchy skin, irritation at the application site and stinging.
- Topical steroids
- These reduce inflammation and itching to promote healing. Steroids vary by strength and come in different forms, like creams, lotions, ointments and sprays. Side effects include skin thinning, stretch marks and acne or rosacea-like rashes.
Oral Medications for Eczema
Doctors may prescribe oral medications for eczema when topical treatments prove ineffective. These medications generally consist of immunosuppressants, anti-inflammatories or antibiotics.
Typically used for short periods, oral treatments can be helpful for severe eczema that significantly impacts daily life. Some of these medications are taken for weeks or months, with long-term use reserved for persistent cases.
- Oral immunosuppressants
- These drugs treat eczema by reducing the immune system’s inflammatory response, which helps decrease itching, redness and rashes. Common side effects include acne, diabetes, fatigue, hair changes, headaches, high blood pressure, mouth sores, osteoporosis, tremors, upset stomach and weight gain.
- Oral corticosteroids
- These are strong anti-inflammatory medications that quickly relieve eczema symptoms like itching, redness and rash. They are typically a short-term solution due to the risk of side effects.
Side effects include behavior changes, fluid buildup that causes swelling in the lower legs, decreased bone density, high blood pressure, memory problems, mood swings, upset stomach and weight gain.
- Oral antibiotics
- Oral antibiotics treat eczema by targeting bacterial infections from broken or scratched skin. Doctors prescribe these for short durations. Side effects include allergic reactions, nausea and the potential development of antibiotic-resistant infections. Their use is limited to active infections only.
Doctors may recommend injectable immunosuppressants for severe eczema or dermatitis if other treatments have failed. These are administered by a medical professional or self-injected at home.
Once your condition improves, doctors may lower or stop giving oral medications or injections to see if symptoms can be controlled with creams, light therapy or treatments at home. This approach helps reduce the need for strong medications while keeping your skin healthy and comfortable.
Drugs That May Cause or Exacerbate Eczema
Several medications can cause or worsen eczema and its symptoms by triggering immune responses or inflammatory reactions.
- Antibiotics
- A study published by JAMA found that antibiotic use in utero and early infancy can be associated with a higher risk of atopic dermatitis during early childhood. Certain genetic factors may also impact this increased risk.
- Antidepressants
- Selective serotonin reuptake inhibitors (SSRIs) might cause eczema, though the evidence is limited. They can raise serotonin levels in the skin, which may result in itchiness.
An animal study in Neuron found that mice given SSRIs scratched more, suggesting they became more sensitive to itching. However, these mice received SSRI injections, whereas humans typically take them as pills. There is, however, at least one study in which someone taking Prozac (fluoxetine) developed a rash after eating chocolate, indicating a potential link to changes in serotonin levels.
- Blood pressure medications
- A 2024 study published in JAMA Dermatology discovered that adults over the age of 60 who begin taking new blood pressure medications might have a higher chance of developing eczema. The study found that hypertensive drug use was linked to a 29% increased risk of eczema.
- NSAIDS
- Some nonsteroidal anti-inflammatory drugs, including ibuprofen, may cause skin reactions like eczematous eruption. While rare, this generally occurs if you are hypersensitive to NSAIDS and have predisposing factors like atopic tendencies.
- Statins
- A 2021 research letter in the Journal of the American Academy of Dermatology found that people with a history of heart disease who take statin drugs are more likely to develop eczema. The risk of eczema was four times higher in statin users, especially in those over the age of 60. The study observed two statin classes: atorvastatin (Lipitor) and simvastatin (Zocor).
Statins, commonly prescribed to manage cholesterol, may cause unexpected side effects, including skin conditions. A Case Reports in Dermatological Medicine report explores an unusual rash in an elderly patient on long-term Pravachol (pravastatin) therapy.
An 82-year-old man developed an itchy, red rash on his arms after increasing his pravastatin dose. Despite using steroid creams, the rash spread to his thighs and back.
A biopsy confirmed an eczematous process, but standard treatments like methotrexate did not help. After discontinuing pravastatin, his rash gradually disappeared.
This case highlights the potential for statins, like pravastatin, to cause skin reactions. Stopping the medication resolved the patient’s symptoms, emphasizing the need to evaluate medications when new skin conditions arise.
Lifestyle and Integrative Care Tips for Eczema
Eczema can make daily life challenging, but the National Eczema Association says that lifestyle changes may reduce flare-ups and improve overall skin health.
By incorporating a few adjustments into your routine, you can take control of your symptoms and experience improvements in your skin’s condition.
- Commit to a consistent skincare routine
- Establish a daily regimen that includes gentle cleansing, moisturizing and avoiding known irritants to keep your skin healthy.
- Choose skin-safe products
- Always check labels for eczema-friendly ingredients and avoid harsh chemicals that could irritate your skin.
- Identify and avoid triggers
- Use tools like an eczema tracking app to identify potential eczema triggers, such as certain foods, environmental factors or stress.
- Stay hydrated
- Drink plenty of water throughout the day to keep your skin hydrated from the inside out.
- Exercise routines
- Opt for light, breathable clothing, and moisturize before and after workouts to prevent flare-ups caused by sweat or friction.
- Develop a bedtime ritual
- Follow a calming routine to reduce nighttime itching and improve sleep quality. Logging off your devices an hour before bed and playing soothing music can be beneficial.
While eczema can be uncomfortable, several medications and lifestyle changes can help. Your health care provider can offer the best solutions for your situation.
Editor Lindsay Donaldson contributed to this article.
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