Causes, Symptoms, Triggers and Treatment

Eczema—whether you live with it yourself or know and love someone who does—is rarely far from your orbit. In the United States, nearly 32 million people, about 10 percent of the population, have some form of eczema, according to the National Eczema Association.

That’s not to say eczema is the most intuitive topic to unpack. To make it easier to understand, I spoke with four board-certified dermatologists to break down what they spent years studying into a clear, easy-to-digest guide to what eczema is, what triggers it and what actually helps keep flares under control.

Featured Experts

• Dendy Engelman, MD is a board-certified dermatologist in New York
• Shira Wieder, MD is a board-certified dermatologist in New York
• Ariel Ostad, MD is a board-certified dermatologist in New York
• Morayo Adisam, MD is a board-certified dermatologist and dermatopathologist in Chicago

What Is Eczema?

“Eczema, most commonly atopic dermatitis, is a chronic inflammatory skin condition where the skin barrier doesn’t function the way it should,” says New York dermatologist Dendy Engelman, MD. “When that barrier is compromised, moisture escapes and irritants, allergens and bacteria can penetrate more easily, leading to redness, itching, dryness and sometimes cracking or oozing.”

The hallmark symptom of eczema is “recurrent itchy patches of skin,” says New York dermatologist Shira Wieder, MD. While it often begins in childhood, eczema can develop at any age. “The cause of eczema is multifactorial, involving genetic predisposition,  immune system sensitivity and skin barrier dysfunction,” adds Chicago dermatologist and dermatopathologist Morayo Adisa, MD—and it is not contagious.

While many people use “eczema” and “atopic dermatitis” interchangeably, the term eczema is actually an umbrella term that includes several types, Dr. Wieder explains. These include atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular dermatitis, seborrheic dermatitis, neurodermatitis and stasis dermatitis—each with its own triggers and patterns.

What’s Happening During a Flare?

During a flare, that weakened skin barrier sets off a chain reaction. Once external triggers penetrate the skin, the immune system mounts an exaggerated inflammatory response. “Inflammatory cytokines are released, leading to redness, swelling and that hallmark intense itch,” Dr. Engelman explains.

Scratching then further damages the barrier, fueling what New York dermatologist Ariel Ostad, MD calls the “itch–scratch cycle,” which he explains “further damages the barrier and prolongs inflammation,” helping explain why eczema can be so persistent and difficult to calm once it begins.

How Is Eczema Different From Other Rashes?

Because eczema can resemble other inflammatory skin conditions, it’s often confused with psoriasis or contact dermatitis. Here’s how each differs:

Eczema (Atopic Dermatitis)

Dr. Engelman explains that eczema “tends to be very itchy and shows up as dry, inflamed, sometimes rough patches,” commonly in the creases of the elbows, behind the knees, on the neck or around the eyes. Over time, repeated scratching can cause the skin to thicken.

Psoriasis

Psoriasis, by contrast, tends to form thicker, more clearly outlined plaques. “The plaques are thicker, with a silvery-white scale on top of red skin,” Dr. Engelman continues. They’re often found on the scalp, elbows, knees and lower back and are driven more by rapid skin-cell turnover than barrier dysfunction.

Contact Dermatitis

Contact dermatitis usually has a clear trigger. “It appears exactly where the skin touched an irritant or allergen: new skin-care product, fragrance, detergent or even nickel jewelry,” she explains. The rash may burn or sting in addition to itching, and once the trigger is removed, it often improves.

“Location and symmetry, thickness and scale of the rash, intensity of itch, can help identify which is which,” Dr. Engelman adds. That said, rashes can overlap in appearance, so if you’re unsure, it’s best to see a dermatologist for an accurate diagnosis.

Common (and Overlooked) Eczema Triggers

Because atopic dermatitis is the most common form of eczema, it’s often what people mean when they refer to “eczema.” Its triggers are also the most widely studied.

“Typical triggers for atopic dermatitis include cold weather, dry air, pet dander, sweat, dust mites, pollen and even viral illnesses like the common cold,” Dr. Wieder explains. “While a consistent skin-care routine involving moisturizers and avoiding triggers like fragrances can be helpful to prevent mild flares, atopic dermatitis is a chronic recurrent disease that has flares and quiet periods. A consistent skin-care routine is often not enough.”

In other words, eczema-prone skin is reactive—and sometimes the triggers are hiding in plain sight. While triggers vary depending on the type of eczema, many everyday exposures can aggravate multiple forms of the condition. “The most frequently missed triggers are personal care products—like soaps, shampoos, conditioners and laundry detergents—with fragrances, dyes or essential oils,” warns Dr. Wieder.

Beyond that, subtle habits can add up. Cologne, perfumes, fabric softeners and scent boosters can irritate sensitive skin. Harsh hand cleansers may weaken the skin barrier. Even long, hot showers and rough fabrics like wool can provoke itching and redness. “I recommend switching out your wool sweaters (or any rough, itchy fabric) for cotton if possible,” Dr. Wieder suggests.

How to Manage Eczema—and When to See a Dermatologist

While eczema can’t be cured, it can absolutely be managed. The focus is on supporting your skin barrier, calming inflammation and avoiding the things that tend to set it off.

Make Moisturizing Non-Negotiable

Daily moisturizing is foundational. “I recommend daily use of thicker moisturizers and applying them within 90 seconds of getting out of the shower,” says Dr. Wieder on what she recommends to eczema patients. “It’s important to apply while skin is still damp,” she adds, because it helps trap water in the skin and prevent it from drying out.

Keep Showers Short and Warm

Since prolonged heat exposure can weaken the skin barrier, keep showers short and use warm (not hot) water. While long, steamy showers may feel soothing in the moment, they can worsen dryness over time.

Read the Ingredient List Carefully

Management also means choosing products strategically. Dr. Wieder suggests looking for moisturizers that contain petroleum, glycerin, colloidal oatmeal, ceramides and hyaluronic acid to help support the skin barrier. Niacinamide may also calm inflammation.

On the flip side, ingredients like retinoids, fragrance, lanolin (including products that contain it, such as Aquaphor) and urea can trigger irritation during active flares, she warns.

Keep Your Routine Simple

When eczema-prone skin is flaring, less is more. “Cleanse with a gentle, fragrance-free cleanser using lukewarm water followed immediately with application of bland moisturizer,” Dr. Adisam.

When Moisturizer Alone Isn’t Cutting It

For moderate to severe eczema—or for those experiencing frequent flares—at-home care may not be sufficient. In those cases, Dr. Wieder recommends speaking with a dermatologist about maintenance therapy, or a preventative treatment plan designed to keep symptoms under control. This may include applying a topical steroid two to three times per week or incorporating a non-steroidal prescription option for longer-term management.

Mild eczema that responds to generous use of over-the-counter moisturizers or 1 percent hydrocortisone can often be managed at home, she explains. If symptoms improve and flares become less frequent, a prescription may not be necessary.

But if irritation persists, worsens or continues despite consistent at-home care, it’s time to seek professional guidance. “Anything that does not improve with over-the-counter products should seek out an appointment with a dermatologist,” says Dr. Wieder. “No need to suffer—we can really help.”

Signs an Eczema Flare May Be Infected

Typical eczema is itchy and inflamed, but infection adds new symptoms. Warning signs include increased pain (rather than just itching), pus, yellow or honey-colored crusting, rapidly spreading redness or fever, says New York dermatologist Ariel Ostad, MD. “Because eczema disrupts the skin barrier, patients are more prone to bacterial infections, particularly from Staphylococcus aureus,” he explains. If those symptoms appear, it’s important to seek care promptly.

Treatment Options for Moderate to Severe Eczema

“For moderate to severe eczema that doesn’t improve with topical steroids or moisturizers, we now have more advanced options,” says Dr. Ostad. Prescription treatments may include stronger topical medications, non-steroidal anti-inflammatory creams and, in more persistent cases, targeted biologic injections such as Dupixent (dupilumab) or Adbry (tralokinumab), which block specific inflammatory pathways involved in atopic dermatitis.

Ultimately, treatment isn’t one-size-fits-all. It depends on how extensive the eczema is, how often it flares and how much it disrupts daily life. A board-certified dermatologist can help map out the next step so you’re not left guessing.