Eczema

Dr. Wu's analysis

What is eczema?

Eczema is a non-contagious inflammatory reaction of the skin. These are symptoms that can appear alongside or after each other, such as redness, flakes, itching, blisters, pimples, crusts, coarsening of the skin (lichenification). It often occurs together with asthma and allergic rhinitis (hay fever). This combination is known as the atopic triad.

How common is it?

Half of the people with severe atopic eczema develop asthma later on.
Three quarters of people with atopic eczema also suffer from allergic rhinitis.
Atopic eczema occurs in 15-30% of children and 2-10% of adults.
In 60% of cases, eczema begins in the first year of life.
Eczema is seen more often in urban areas than in rural areas.

Furthermore, 26% of people with eczema also have asthma, while this percentage is only 8% in people without eczema. This means that people with eczema have three times the risk of asthma compared to people without eczema. This strong relationship underscores the importance of a broad, multidisciplinary approach in the treatment of atopic conditions.

What causes eczema?

Eczema occurs due to a combination of a disrupted skin barrier, an overactive immune system, and environmental factors. As a result, the skin is less able to protect itself and becomes irritated more quickly. Various factors can worsen or trigger eczema.

Genetic predisposition

Many people with eczema have a genetic predisposition, where a deficiency of filaggrin plays a significant role. This protein is essential for the formation of a strong skin barrier and the retention of moisture. When filaggrin is lacking or reduced, the skin loses moisture faster and becomes more sensitive to irritations and allergens. As a result, the skin can react more strongly to external stimuli, such as: contact allergens, soap, cleaning products with aggressive ingredients, and weather conditions such as cold, wind, and dry air.

A disrupted skin barrier

The skin barrier has the task of retaining moisture and protecting against harmful external influences. In the case of eczema, this barrier works less effectively, causing the skin to dry out faster and become more susceptible to irritants. This can lead to dry, flaky skin and an increased risk of inflammation.

Overactive immune system

The immune system plays a major role in eczema. It often reacts too strongly to harmless stimuli, such as dust mites, pollen or certain skincare products, like perfume, nickel and preservatives. This leads to an inflammatory response, which manifests as redness, itching, and sometimes even blisters or cracks.

Environmental factors

Various external stimuli can influence the onset and worsening of eczema. Dry air and cold temperatures dry out the skin faster, while heat and perspiration can cause irritation. Skin care products with perfume or aggressive cleansers can also damage the skin barrier, making the skin more sensitive. In addition, allergens such as dust mites, pollen, and animal hair can play a role, as can certain materials such as wool or synthetic fabrics, which can irritate the skin.

Stress and hormonal influences

Stress can be a significant factor in eczema. It increases the production of inflammatory substances in the body, which can lead to a flare-up. Hormonal fluctuations, such as during menstruation or pregnancy, can also make the skin extra sensitive.

Who is susceptible to eczema?

Eczema can occur at any age, but some groups are at higher risk due to hereditary, environmental, and lifestyle factors.

Children and babies

Atopic eczema often starts at a young age. Babies and young children with a family history of eczema, asthma or hay fever have an increased risk. Their skin barrier is still developing, which causes the skin to dry out faster and become more sensitive to stimuli.

Hereditary predisposition

Eczema is more common in families where other atopic conditions, such as asthma and hay fever, also occur. A genetic deficiency of filaggrin, a protein that strengthens the skin barrier, plays an important role in this.

Sensitive skin

A dry or quickly irritated skin is more susceptible to eczema. People with thin or fragile skin can more quickly suffer from a disrupted skin barrier, which makes external stimuli more easily provoke a reaction.

Occupations with skin exposure

Occupations that frequently involve contact with water, soap, or chemical substances - such as hairdressers, cleaners, caregivers, and factory workers - increase the risk of eczema, especially on the hands. Prolonged exposure to water or cleaning agents can damage the skin barrier.

Allergies and immune system

People who are sensitive to allergens such as dust mites, pollen, or certain foods are at greater risk. An overactive immune system can make the skin extra sensitive to inflammation.

Hormonal fluctuations or stress

Hormonal changes, such as during pregnancy, puberty or menstruation, can worsen eczema. Stress also plays a significant role; it increases the production of inflammatory substances in the body, which can lead to flare-ups of eczema.

How do you recognize and distinguish pigmentation spots?

How can you recognize eczema?

Eczema can manifest in various ways, depending on the type and severity. It often starts with itching and redness, but a dry skin, flaking, or even blisters can also occur. The symptoms vary per person and can range from mild irritation to long-term inflammation. Below you can read what eczema looks like and what to watch out for.

1. Itching and redness

One of the first symptoms of eczema is an intense itch, often before visible skin abnormalities occur. The skin becomes red and feels warm due to the inflammatory response. The longer the irritation persists, the more sensitive the skin becomes.

2. Dry and flaky skin

Eczema disrupts the skin barrier, making the skin less able to retain moisture. This results in a dry, tight skin that often flakes or feels rough. A dehydrated skin is more vulnerable and can get irritated faster by external stimuli, such as weather conditions, soap or perfume.

3. Blisters and scabs

In some forms of eczema, small fluid-filled blisters, especially on the hands and feet, can develop. These blisters can burst and leave wet spots, after which crusts form on the skin. This can be accompanied by a burning or pulling sensation.

4. Thickened skin in chronic eczema

Long-term eczema and repeated scratching can cause the skin to become thicker and tougher. This process, also known as lichenification, gives the skin a leathery structure. As a result, the skin can become darker or lighter in color and often remains sensitive and itchy.

5. Preferred spots

Eczema often appears in specific places, depending on age. In babies, it often appears on the cheeks, scalp, and in the folds of the arms and legs. In older children and adults, it is more often seen in the back of the knees, elbow folds, on the hands, and in the neck. Hand eczema is especially common in people who work a lot with water or irritating substances.

Which skin problems resemble eczema?

Not all skin complaints that cause itching, redness, and flaking are eczema. There are various skin conditions that can resemble eczema, but have a different cause. Recognizing the differences can help to make the correct diagnosis and find the right approach. Below you can read about which skin problems are sometimes confused with eczema.

Psoriasis

Psoriasis and eczema can look similar, but psoriasis patches are often more sharply defined and covered with thick, silvery scales. With eczema, the patches are less sharply delineated, they have a more inflamed appearance and are accompanied by intense itching.

Contact allergies

Contact dermatitis and allergic skin reactions can strongly resemble atopic eczema, but only occur after direct contact with a specific substance, such as nickel, perfume or latex. The skin becomes red and flaky and may show blisters or swellings.

Fungal infections

A fungal infection can cause red, flaky patches that are sometimes confused with eczema. A key difference is that a fungal infection often has a sharply defined edge and expands in a ring shape. Athlete's foot, for example, mainly occurs between the toes and has a white, flaky appearance.

Hives (urticaria)

Hives cause sudden, itchy bumps that can quickly change and disappear within a few hours. Unlike eczema, it does not leave behind flaking or crusts and is often a short-term reaction to an allergy or stimulus.

Diaper rash

In babies, diaper rash can sometimes be confused with eczema. Diaper rash is caused by prolonged contact with moisture and irritating substances in urine and feces. The skin is red and sensitive, but unlike eczema, diaper rash usually disappears quickly after drying and protecting the skin.

What types of eczema are there?

Eczema is a collective term for various types of skin inflammations. Although all forms are accompanied by redness and itching, they have different causes and characteristics. Below are the most common types of eczema and how they differ.

Atopic eczema

This is the most common form of eczema and often occurs in people with a hereditary predisposition. The skin is dry, itchy, and sensitive to external stimuli such as allergens and weather changes. Atopic eczema usually begins in childhood and occurs in periods of flare-up and rest.

Contact dermatitis

Contact eczema occurs when the skin directly reacts to an irritating or allergenic substance. This can be an allergic reaction to, for example, nickel or perfume, or an irritation reaction due to frequent contact with water or cleaning agents.

Seborrheic eczema

Seborrheic eczema is caused by an excessive growth of yeast on the skin and an increased sebum production. It mainly occurs on the scalp, around the nose, and behind the ears, and is characterized by redness and greasy flakes.

Nummular eczema

Nummular eczema, also known as coin-shaped eczema, appears as round, red spots on the skin. These spots can itch intensely and are sometimes mistaken for a fungal infection.

Hypostatic eczema

Hypostatic eczema, also known as venous eczema, mainly occurs in people with poor circulation in the legs. The skin on the lower legs becomes red, flaky, and sensitive, and there may be visible fluid accumulations (edema) or varicose veins.

How do you effectively treat pigmentation spots?

What can I do about it myself?

Clown eczema can be annoying and persistent. Fortunately, you can do a lot yourself to get your skin calm and healthy again.

Step 1: Choose a mild cleanser

Wash the skin with a soap-free, fragrance-free wash gel or shower oil. Aggressive cleansers can damage the skin barrier and worsen eczema. Use lukewarm water and limit showering or bathing to a maximum of 5-10 minutes. Pat the skin gently dry with a soft towel, instead of rubbing.

Step 2: Hydrate the skin daily

A well-hydrated skin is better resistant to eczema. Use a rich, fragrance-free cream with skin-repairing ingredients such as ceramides and shea butter immediately after showering, which strengthen the skin barrier and counteract dehydration. Apply the cream at least twice a day to the affected skin.

Step 3: Avoid irritating substances

Eczema worsens through contact with irritants such as cleaning products, wool, and synthetic fabrics. Wear cotton or bamboo clothing and choose a fragrance-free detergent. When cleaning or washing dishes, you can wear cotton gloves under rubber gloves to protect the skin.

Step 4: Soothe the itch without scratching

Scratching makes eczema worse and can damage the skin. To reduce itching, you can apply a cold compress to the skin or a cooling cream. Short, clean nails help prevent damage from scratching.

Step 5: Keep your lifestyle in balance

Stress and disrupted sleep can exacerbate eczema symptoms. Ensure adequate relaxation, a regular sleep pattern, and avoid foods that may trigger an allergic reaction. Healthy skin starts from within, so a varied diet with sufficient omega fatty acids and antioxidants can contribute to a stronger skin barrier.

What other treatments are there?

Sometimes a more intensive treatment is needed to get eczema under control. In addition to good skin care and avoiding triggers, there are various medical treatments available:

Medicinal creams and ointments

In cases of severe eczema, a doctor may prescribe corticosteroids in the form of creams or ointments. These reduce inflammation and itching, but must be used carefully and according to prescription to prevent side effects. For milder forms, calcineurin inhibitors such as tacrolimus or pimecrolimus may be prescribed.

Light therapy (UVB therapy)

In cases of persistent eczema, UVB light therapy can help reduce inflammation. This treatment is carried out under the supervision of a dermatologist and can be particularly effective for eczema that does not respond well to creams.

Antihistamines for itching

Some people with eczema benefit from antihistamines, especially if eczema is accompanied by severe itching and sleep problems. These medications reduce itching, but do not address the cause of eczema.

Immunosuppressive medication

In cases of very severe eczema, a doctor may prescribe oral medication that suppresses the immune system, such as cyclosporine or methotrexate. This is usually only used if other treatments do not provide sufficient relief.

Biological medicines

For people with severe atopic eczema who do not respond well to other treatments, new biological drugs such as dupilumab can be effective. This treatment specifically targets inflammatory processes in the skin.

What should you avoid with eczema?

Certain factors can exacerbate eczema or trigger a flare-up. By avoiding these, the skin remains as calm as possible.

Perfume and irritating skincare products

Many cosmetics and skincare products contain perfume, alcohol or harsh preservatives that can worsen eczema. Always choose mild, fragrance-free products specifically for sensitive skin.

Showering long and hot

Hot water dries out the skin and disrupts the natural skin barrier. Shower for a maximum of 5-10 minutes with lukewarm water and use a soap-free wash gel or shower oil.

Stress and sleep deprivation

Stress is a well-known trigger for eczema. A disturbed night's sleep can worsen eczema symptoms, especially if you wake up due to itching. Relaxation techniques and a regular sleep pattern can help to keep the skin calmer.

Contact with irritating substances

Frequent contact with water, cleaning agents or latex gloves can damage the skin barrier. If necessary, wear gloves with a cotton lining and avoid direct contact with aggressive cleaning agents.

Wool and synthetic clothing

Rough materials such as wool can irritate the skin and worsen itching. Opt for soft, breathable materials like cotton or bamboo and avoid tight-fitting clothes that cause friction.

Product recommendations

The Iconic Elements skincare products are developed based on scientifically substantiated ingredients, have a skin-neutral pH of 5, and are free from microplastics. Awarded the Best Dermatologist Developed Skincare Brand 2024 and Best Holistic Skincare Line 2022 awards. More about the background and studies used can be found on the respective product pages.

🛈 These products are cosmetic and intended for the care of healthy, sensitive or unbalanced skin. They are not intended as a medical treatment or to replace professional medical advice. For personalized skin advice, we recommend consulting a skin therapist or doctor.

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Product

Description

Calming Cream

14.95

External influences can disrupt the skin’s balance, making it feel sensitive and unsettled. This cream with ectoine, oat extract and marshmallow root supports the skin barrier and helps to calm the skin. The rich, nurturing formula provides long-lasting hydration and contributes to a comfortable skin feel.

In shopping cart

Natural Moisturizer Cream

14.95

A good hydration balance is essential for a smooth, well-cared for skin. This body cream combines plant-based balm, glycerin, and ceramides to nourish the skin and support its natural moisture content. The intensely hydrating formula helps prevent dehydration and ensures a soft, resilient skin.

In shopping cart

Sensitive Cream

14.95

Some skin types react faster to external stimuli and require extra gentle care. This cream with oat extract, jojoba oil, and coconut oil helps to nourish and hydrate the skin without leaving a heavy or sticky feeling. The light texture absorbs quickly and supports the skin’s natural balance.

In shopping cart

Tinted Mineral Sunscreen SPF30

14.95

A sensitive skin reacts quickly to sunlight, making protection essential. This mineral sunscreen with titanium dioxide, zinc oxide and iron oxide is known for its gentle properties and is specially developed for sensitive skin. The formula with independently tested and certified SPF30 protects against harmful UV rays without weighing down the skin. The moisturizing, lightly tinted texture prevents dehydration and provides a natural, even appearance.

In shopping cart

Tips when you have eczema

Tip 1. Use a humidifier at home

Dry air can irritate the skin extra, especially in winter or with air conditioning. A humidifier helps to maintain humidity levels, which means the skin dries out less quickly and the chance of flare-ups is reduced.

Tip 2: Sun protection is your friend

Although a bit of sunlight can calm the skin in some people, excessive exposure can dry out and irritate the skin. UV radiation can also damage the skin barrier, which can worsen eczema. Use a mineral sunscreen without perfume or alcohol, preferably with zinc oxide or titanium dioxide, to protect the skin in a gentle way.

Tip 3: Protect your skin when swimming

Chlorinated water in swimming pools and salt water in the sea can damage the skin barrier and worsen eczema. Chlorine has a drying effect and can cause irritation, while salt water can sting on irritated skin. Apply a protective layer of vaseline or a greasy cream before swimming, and rinse off immediately after swimming with lukewarm water to remove residues.

Tip 4: Support the skin with a slightly acidic pH

A lower skin pH, around 5, contributes to the moisturizing function of the skin and helps keep the skin healthy. In skin conditions such as eczema, where the skin barrier is disrupted, the bacterium Staphylococcus Aureus can thrive better in a disrupted pH environment. This makes people with eczema more susceptible to bacterial infections. On the other hand, a more acidic skin environment can more effectively inhibit the growth of Staphylococcus Aureus.

Tip 5: Pay attention to nail polish and jewelry

Certain nail polishes and jewelry, especially those containing nickel, can cause an allergic reaction similar to eczema. This is called contact eczema and can lead to redness, flaking, and blisters. Opt for hypoallergenic jewelry and nail polish without irritating substances such as formaldehyde or toluene to prevent skin irritations.

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