What is Eczema?

If your skin keeps turning dry, itchy and red no matter how much cream you use, you are not alone. Eczema is one of the most common reasons people see a skin specialist. Yet many people live with it for years without ever understanding why eczema occurs in the first place. Once you know what is going on beneath the surface, it becomes much easier to calm your skin and keep flare-ups away.

Eczema is a group of inflammatory skin conditions. Atopic dermatitis is the most common type of eczema and is often what people mean when they use the term “eczema”. It usually begins in childhood, although it can show up for the first time at any age. The exact cause of eczema is not fully understood. A combination of genetic factors, skin-barrier dysfunction, immune-system activity and environmental exposures can contribute to its development.

Why Does Eczema Occur?

Several factors can contribute to eczema. It is important to understand the difference between the factors that contribute to eczema and those that trigger a flare-up.

1. Impaired Skin Barrier

Think of healthy skin as a brick wall. The skin cells are the bricks, while natural fats and proteins act as the mortar that holds them together. In eczema, this protective barrier is often weaker, allowing small gaps to develop.

Through these gaps, water escapes more easily, which is why eczema-prone skin often feels dry and tight. The gaps can also allow irritants, allergens and germs to enter the skin more easily. This can trigger inflammation and cause the skin to lose even more moisture.

2. Immune System Response

In people with eczema, the immune system can react strongly to substances that are usually harmless, such as dust or mild soaps. It releases inflammatory signals, particularly through what is known as a type 2 immune response. These signals can lead to redness, swelling and intense itching.

A type 2 immune response is a part of the immune system that helps protect the body against certain threats. In eczema, this response can become overactive, causing inflammation and contributing to the intense itching and skin-barrier problems typical of the condition.

Scratching then damages the skin barrier further, allowing more irritants to enter and making the itching worse.

3. Genetic Factors

Eczema often runs in families, so the genes you inherit can play an important role. One of the best-known genetic links involves filaggrin, a protein that maintains the skin barrier. When the filaggrin gene does not function properly, the skin may lose more moisture and become more easily irritated.

If a parent or sibling has eczema, asthma/hay fever, your chances of getting eczema are higher. Doctors refer to these linked conditions as atopic diseases. However, eczema can also develop in people without a family history.

4. Environmental Factors

Where and how you live can also influence eczema. Several environmental factors can make eczema more likely or cause symptoms to become more severe.

Weather changes: Sudden fluctuations in temperature or humidity can irritate sensitive skin.
Air pollution: Smoke and other pollutants can irritate the skin and may affect the skin barrier.
Environmental irritants: Everyday chemicals, dust and allergens that come into contact with the skin can contribute to irritation.

What Triggers Eczema Flare-Ups?

Causes and risk factors explain why eczema may develop, whereas triggers can make existing eczema flare up. Common eczema triggers include:

Soaps and harsh detergents: These can disrupt the skin's natural oils and weaken the skin barrier, making dryness and irritation worse.
Fragrances and perfumes: Fragrances in soaps, lotions, cosmetics and other personal-care products can irritate sensitive skin and may trigger a flare-up in some people.
Certain skincare products: Ingredients such as alcohol, preservatives or other irritating substances in skincare products may cause burning, itching or inflammation.
Wool or rough fabrics: Rough materials can rub against the skin and cause irritation. Some people with eczema find that soft, breathable fabrics are more comfortable.
Heat and sweating: Excessive heat and sweating can increase itching and irritate eczema-prone skin, particularly in warm or humid conditions.
Stress: Emotional stress does not cause eczema, but it can worsen itching and may contribute to flare-ups in some people.

What are the Symptoms of Eczema?

Eczema can look different depending on your age, skin tone and the intensity of the condition. Common symptoms include:

Intense itching: Itching serves as the most characteristic symptom of eczema and is often worse at night. It can disturb sleep and contribute to the itch-scratch cycle. The itch-scratch cycle is a continuous loop in which skin irritation causes itching, scratching provides temporary relief but further damages the skin barrier, and this damage triggers inflammation that leads to even more intense itching.
Dry, scaly skin: Because the skin barrier allows more water to escape, the skin may feel rough and tight. Fine flakes or scaly patches may also appear.
Red or discoloured patches: On lighter skin, eczema patches are usually red or pink. On brown or darker skin, they may appear dark brown, purple or grey.
Rash and inflammation: The affected skin may become swollen, warm or sore. In older children and adults, eczema commonly affects the creases of the elbows and the areas behind the knees.
Small bumps: Some forms of eczema can cause small raised bumps or fluid-filled blisters that may ooze or crust after scratching.

Where Does Eczema Usually Appear?

Babies and young children: Eczema commonly appears on the face, scalp, cheeks, and outer surfaces of the arms and legs. It may also affect the trunk.
Older children: It often affects the creases of the elbows and knees, along with the neck, wrists, ankles, and hands.
Adults: Eczema commonly appears on the hands, face, eyelids, neck, and skin folds, particularly the elbows and knees. The feet and ankles may also be affected.

How is Eczema Treated?

There is currently no permanent cure for eczema, but the condition can be managed effectively. Treatment focuses on repairing the skin barrier, controlling inflammation and preventing flare-ups.

Moisturisers and skin care: Moisturising every day is one of the most important steps in managing eczema. Use fragrance-free creams or ointments, preferably after a short, lukewarm bath. Gentle cleansers and avoiding heavily scented products can also help protect the skin barrier.
Topical corticosteroids: Topical corticosteroids are commonly used to reduce inflammation and control eczema flare-ups. The strength and duration of treatment depend on the severity and location of the eczema.
Non-steroid topical treatments: Non-steroidal options may be recommended when corticosteroids are not suitable or for sensitive areas such as the face and eyelids. These include topical calcineurin inhibitors, PDE-4 inhibitors, and aryl hydrocarbon receptor-targeting treatments.
Phototherapy: If topical treatments do not provide adequate relief, your doctor may recommend phototherapy. This treatment uses controlled ultraviolet light and is usually provided in a clinic under medical supervision.
Systemic medicines and biologic treatments: For moderate to severe eczema that does not respond adequately to topical treatments, doctors may prescribe medicines that work throughout the body. These may include oral immunosuppressants, JAK inhibitors or biologic medicines, depending on the individual's condition.
Managing triggers and preventing flare-ups: Identifying and avoiding personal triggers can help reduce flare-ups. Common triggers include dry weather, heat, sweating, irritants, fragrances and stress. Regular moisturising, gentle skin care and following the prescribed treatment plan can help keep eczema under control.

When Should You See a Doctor?

It is a good idea to see a dermatologist if the itching is keeping you awake at night or interfering with your daily activities. You should also seek medical advice if your skin does not improve with regular moisturising, or if the rash is spreading, cracking or bleeding.

Medical attention is particularly important if you notice signs of infection, such as yellow crusts, pus, fever or painful blisters. Children with eczema symptoms that do not settle should also be evaluated by a doctor.

Why Choose Narayana Health?

At Narayana Health, our dermatologists take the time to understand the factors contributing to your eczema and identify triggers that may make your symptoms worse. Depending on your needs, your treatment plan may include everyday skincare advice, prescription creams, phototherapy or advanced treatments for moderate-to-severe eczema

FAQs

1. Can eczema spread from one part of the body to another?
A. Yes, new patches can develop on different areas of your own skin, particularly during a flare-up.

2. How is eczema diagnosed?
A. Eczema is usually diagnosed by examining the skin and reviewing your symptoms, medical history and possible triggers. There is no single test that can confirm eczema in every case. If your doctor suspects an allergy or another skin condition, additional tests may be recommended.

3. Can eczema go away permanently?
A. Eczema can improve or remain quiet for long periods, but it can also flare up again. While there is currently no permanent cure, appropriate treatment and regular skin care can help control symptoms and reduce flare-ups.

4. Can children outgrow eczema?
A. Some children experience significant improvement as they grow older, while others continue to have eczema into adulthood. The course varies from person to person.

5.What is the fastest way to calm an eczema flare-up?
A. The fastest way to calm an eczema flare-up is to moisturise the skin regularly and use a prescribed topical corticosteroid as directed to reduce inflammation. Avoiding known triggers, harsh soaps and scratching can also help prevent the flare-up from worsening.