Recognizing the Typical Symptoms of Eczema Types

Healthy skin is supple and smooth with no breaks in the surface. Whereas, individuals with eczema often have dry, flaky, and/or scaly skin. Dry skin is less flexible and elastic, so it cracks easily under movement increasing the permeability of the skin to new triggers, making the skin sensitive and easy to agitate.

Mildly dry skin can feel rough, while severely dry skin can have deep fissures and dead skin flaking off. In some cases, the skin can appear scaly with a number of large, thickened flakes on the affected area.

Inflammation is part of the body's defense mechanism, indicating that the immune system is actively trying to remove damaged cells and/or fight infection.^{(PAH 2022)} Inflammation in eczematous skin is caused by the activity of the immune system reacting to a trigger. 

The skin can feel warm to touch, itchy and in some instances swollen. In people with lighter skin, the inflammation may appear red. For those with darker skin, the inflammation may appear more purple or gray.^{(CAS 2016)}  For both, the inflamed areas may feel warm, itchy, or swollen. The inflammation results from the immune system reacting to a trigger, such as an allergen, irritant, or emotional stressor.

An itch is defined as an “unpleasant sensation that leads to the need to scratch”.^{(MIS 2018)} There are four sources of itches as defined by medicine: neurogenic, neuropathic, psychogenic and pruritoceptive. 

Pruritoceptive itches are generated in the skin as a reaction to inflammation or skin damage and subsequently is the predominant source of itch for eczema sufferers.^{(TIV 2009)} 

During the initial phase of an eczema flare, histamines are a key component to pruritoceptive itches. In the mid- and late-stage flare, itch is often driven by IL-4 production (which antihistamines are not effective in relieving).^{(GAR 2013)} 

Itching can be the most unpleasant and debilitating symptom of eczema. The severity can range from mild and acute, to totally continuous and overwhelming. The resulting scratching can damage the skin and result in increased intensity of itchiness. 

Emotional stress from eczema can contribute towards a psychogenic itch and itch sensitization can occur where itchiness can increase and be triggered more easily. 

Heavy scratching or rubbing of the skin can lead to thickened skin.^{(TIV 2019)} This is also known as secondary lichenification.^{(ABO 2022)} Thickened skin can appear to have exaggerated skin markings and feel leathery. The skin will remain thickened whilst the scratching or rubbing continues.

Blisters are clear-fluid sacks on the skin. They can be found in three types of eczema: pompholyx, contact and discoid. In pompholyx eczema where they appear primarily on hands and feet.^{(CHA 2006)} 

In contact eczema, small blisters can appear anywhere on the body, often in the area of skin which was in contact with the trigger.^{(CHA 2016)} It can also indicate an allergen was present rather than an irritant. In discoid eczema, small blisters can appear within the discoid patch.^{(CHA 2006)}

The color of your skin can change if you have eczema. The change in color depends on the initial color of the skin and the type of eczema present. For people with darker skin, patches of eczema might look darker or lighter than the original shade.^{(CHA 2006)} 

Patches of dry skin can have higher cell turnover and therefore can cause a dappled effect on tanned skin, where the eczema patches appear paler. For people with lighter skin, inflammation appears pink or red whereas it can appear gray or purple on darker skin. 

Scratching skin can change the tone of skin color, darker or paler, and the skin eventually returns to the normal coloring when the scratching is under control.^{(CHA 2006)} With seborrheic eczema, the affected skin can appear yellowed.

Inflamed skin can release a clear or yellowish fluid from the surface. Serum, the fluid-component of blood, can leak dilated blood vessels found in inflamed tissue. 

The leakage can lead to swelling and ooze from the skin.^(MHJ) As the fluid dries on the surface of the skin, it leaves behind yellow or orange crusting. Oozing and crusting can be experienced with any type of eczema but it is unlikely in asteatotic.

Oozing of puss-colored or foul-smelling fluid can be a sign of infection, a complication from a compromised skin barrier.

Atopic dermatitis, the most common form of eczema, can present differently depending on the individual's age. In infants, it often appears as red, scaly patches on the cheeks, forehead, and scalp. 

In children, the rash typically occurs in the creases of the elbows and knees, while in adults, it may be more widespread and involve the hands, feet, and neck. Atopic dermatitis is characterized by intense itching, and scratching can lead to skin infections and scarring.

Contact eczema is triggered by direct contact with an irritant or allergen, which leads to inflammation and irritation of the skin. There are two types: irritant contact dermatitis and allergic contact dermatitis. Symptoms for both types can include redness, itching, burning, stinging, and swelling at the site of contact. 

In more severe cases, the skin may develop blisters, oozing, or crusting. Allergic contact dermatitis symptoms may take longer to appear (up to 48 hours) and can last for several weeks, while irritant contact dermatitis symptoms usually appear more quickly (within minutes to hours) and resolve within a few days, provided the irritant is removed.

Seborrheic eczema is characterized by red, inflamed skin with yellowish, greasy, and flaky scales. It commonly affects areas of the body with a high concentration of oil-producing (sebaceous) glands, such as the scalp, face, and upper chest. 

Symptoms can include dandruff, itching, redness, and scaling on the scalp, as well as red patches with yellowish scales around the nose, ears, eyebrows, and eyelids. In severe cases, seborrheic eczema can cause hair loss.

Nummular eczema, also known as discoid eczema, is characterized by round or oval patches of inflamed skin. These patches can be pink, red, or brown and may have a scaly, crusty appearance. 

Nummular eczema can occur on any part of the body, but it is most commonly found on the lower legs, arms, and trunk. This type of eczema can be triggered by factors such as dry skin, insect bites, or skin injuries.

Dyshidrotic eczema is a distinct form of eczema that primarily affects the hands and feet. It is characterized by small, intensely itchy blisters filled with clear fluid. These blisters may eventually rupture, leading to oozing, crusting, and peeling skin. 

Triggers for dyshidrotic eczema may include stress, exposure to certain metals, or contact with irritants. Severe cases can lead to painful fissures and an increased risk of infection.

Asteatotic eczema, sometimes referred to as xerotic eczema or eczema craquelé, is characterized by dry, cracked skin that resembles a cracked porcelain or parched riverbed. This type of eczema typically affects older adults and is most common on the lower legs, though it can also occur on the arms and trunk. 

Asteatotic eczema can be caused by factors such as cold weather, low humidity, and excessive use of soaps or hot water, which strip the skin of its natural oils.

Gravitational eczema is caused by poor circulation, typically affecting the lower legs and ankles. The weakened blood flow results in increased pressure in the veins, leading to fluid buildup and skin changes. Symptoms can include swelling, redness, itching, aching or heaviness in the legs, skin darkening (hyperpigmentation), and skin that feels hard or tight. In advanced cases, the skin may break down, resulting in open sores or ulcers.

Eczema can weaken the skin's natural barrier, making it more susceptible to bacterial, viral, and fungal infections. Scratching the affected area can also introduce bacteria from the nails into the broken skin, further increasing the risk of infection. 

Common infections associated with eczema include impetigo, cellulitis, and herpes simplex. To prevent infections, it is crucial to maintain proper skincare, avoid scratching, and seek medical attention if signs of infection are present, such as increased redness, warmth, pain, or pus.

The visible symptoms of eczema, such as redness, scaling, and oozing, can lead to social stigma and self-consciousness. This can be particularly challenging for children and adolescents, who may feel embarrassed, isolated, or bullied because of their skin condition. It is essential to provide support and understanding to individuals with eczema, encouraging them to seek appropriate treatment and engage in activities that promote self-esteem and resilience.

Living with eczema can take a significant toll on mental well-being. The constant itch-scratch cycle, time consuming skin routines, , fear of triggers, sleep disturbances, and appearance concerns can lead to increased stress, anxiety, and depression. In children, poor sleep could disrupt development and has been linked to various other health conditions.^{(RAM 2019)} 

The result can be emotional burnout, low self-worth, depression, anxiety and chronic stress. See the stress and mental health pages for more on this subject.