Eczema is a long-term inflammatory condition of the skin that most commonly begins in infancy or early childhood but may persist into adulthood or develop later in life. It is characterized by intense itching, dryness, and recurrent rashes.

In many patients, eczema is related to a weakened skin barrier. Some individuals have a genetic variation affecting a protein called filaggrin, which normally helps the skin retain moisture and protect against irritants and allergens. When this barrier is impaired, the skin becomes more vulnerable to inflammation.

Eczema may appear differently depending on age and skin tone. In patients with darker skin, redness may be less visible, and rashes may appear gray, violet, or dark brown.

Eczema symptoms often worsen when the skin is exposed to irritants or allergens, including:

• Soaps, detergents, and fragrances

• House dust mites

• Pollens and animal dander

• Smoke and environmental pollutants

• Heat, cold, or low humidity

• Stress and illness

Identifying and minimizing triggers is an important part of long-term eczema management.

Common symptoms of eczema include:

• Persistent itching

• Dry, scaly, or rough skin

• Red or discolored patches

• Scratch marks or open areas

• Thickened skin from chronic scratching

In infants and young children, eczema often affects the scalp, cheeks, elbows, and knees. In adults, it commonly involves the wrists, elbows, knees, ankles, neck, and face.

Because other skin conditions such as psoriasis or contact dermatitis can resemble eczema, diagnosis should be made by an allergist or immunologist after careful evaluation.

Approximately half of individuals with eczema also have other allergic conditions, including asthma, allergic rhinitis (hay fever), or food allergies. Poorly controlled eczema increases the risk of skin infections caused by bacteria, viruses, or yeast.

Routine food avoidance or broad food allergy testing is not recommended without a clear history of food reactions. Any dietary changes should be discussed with your allergist.

The primary goals of eczema care are to:

• Reduce itching and inflammation

• Restore and protect the skin barrier

• Improve sleep quality and daily functioning

• Minimize medication side effects

• Improve skin appearance and confidence

Treatment plans are personalized based on disease severity, age, lifestyle, and patient preferences.

Skin Irritants

• Wear soft, breathable fabrics

• Wash new clothes before wearing

• Keep fingernails short

• Use fragrance-free skin care products

Environmental Allergens
Dust mites and animal dander may worsen eczema in sensitized individuals.

Foods
Infants with eczema may be more prone to developing food allergies, but eliminating foods without medical guidance is discouraged.

Other Triggers
Stress, illness, extreme temperatures, and dry environments may contribute to flares.

Topical treatments are applied directly to the skin and include:

• Moisturizers to repair the skin barrier

• Topical corticosteroids to reduce inflammation during flares

• Non-steroidal anti-inflammatory creams, including calcineurin inhibitors, phosphodiesterase inhibitors, JAK pathway inhibitors, and aryl hydrocarbon receptor agents

Your allergist will recommend therapies based on age, location, and severity of eczema.

Daily moisturizing is essential. After bathing in lukewarm water, gently pat the skin dry and immediately apply moisturizer to slightly damp skin to lock in moisture. Products containing petrolatum or ceramides are often beneficial.

Moisturizers are not steroids and are safe for frequent use.

For moderate to severe eczema that does not respond to topical therapy, systemic treatments may be considered:

• Biologic medications, including dupilumab (approved for infants through adults)

• Oral targeted therapies, such as JAK inhibitors, for adolescents and adults

• Other immunosuppressive medications in select cases

Your allergist will discuss benefits, risks, and monitoring.

Additional Treatment Options

• Phototherapy (light therapy)

• Wet-wrap therapy during severe flares

• Treatment of secondary skin infections

• Dilute bleach baths when appropriate

• Stress-management techniques

Antihistamines may help with sleep but do not directly treat eczema itch.