Eczema (Atopic Dermatitis): Symptoms, Triggers and Treatment

Eczema (Atopic Dermatitis): Symptoms, Triggers and Treatment

Eczema, or atopic dermatitis, is a long-term skin condition that causes dry, itchy, inflamed patches that come and go in flares. It is not contagious, and most people can keep it under control with daily moisturizing, avoiding personal triggers and using prescription treatments matched to how severe it is.

This article is for general information and is not medical advice.

Key takeaways

  • Atopic dermatitis is a chronic, itchy rash that often starts in babies and young children, but it can begin at any age.
  • On brown and Black skin, eczema may look purple, gray, dark brown or lighter than the surrounding skin rather than red.
  • Moisturizing at least twice a day, and right after bathing, is the foundation of every treatment plan.
  • Prescription options range from topical corticosteroids and nonsteroid creams to light therapy, injectable biologics and pills.
  • Oozing, crusting, pain, fever or sudden spreading can mean infection and needs prompt medical care.

What is eczema (atopic dermatitis)?

Atopic dermatitis is the most common type of eczema: a chronic (long-lasting) condition that causes scaly, itchy rashes. "Atopic" means a tendency to develop allergic conditions such as asthma and hay fever, which often run in the same families.

According to MedlinePlus, affected skin may lack proteins that help it hold in water, which makes it drier and more sensitive. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) says the exact cause is unknown but likely involves gene changes that weaken the skin barrier, an overactive immune system, and environmental exposures such as tobacco smoke, some soaps and air pollution.

  • It usually starts in babies and young children. MedlinePlus notes it often begins between 2 and 6 months of age.
  • Many children outgrow it before their teen years, but some have symptoms into adulthood, and it occasionally appears for the first time in adults.
  • Risk is higher if close relatives have eczema, hay fever or asthma. NIAMS also reports it is more common in non-Hispanic Black children.
  • People with eczema often test positive on allergy tests, but allergies do not cause the condition.

If you are not sure whether your skin is simply dry or sensitive, our guide on how to find your skin type can help you tell the difference before you talk to a clinician.

What does eczema look like on different skin tones and ages?

Eczema is always itchy, but its color and location change with skin tone and age. Itching often starts before any rash appears.

On lighter skin, patches usually look pink or red. The NHS notes that eczema can look red, white, purple or gray, or lighter or darker than the surrounding skin, depending on your skin tone. On dark brown skin it may look gray, white and dry, and it can leave patches darker or lighter after a flare settles. NIAMS describes affected patches as "red to dark brown." Because redness is harder to see on darker skin, rely on itch, texture and thickening as clues.

Common symptoms at any age include dry, cracked or scaly skin, raw areas from scratching, rashes that ooze clear fluid or bleed, and thickened, leathery skin (called lichenification) from long-term rubbing.

Age groupWhere it usually appearsWhat it often looks like
Babies and children under 2Face, scalp, hands and feetItchy rash that may blister, ooze and crust
Older children and teensInside the elbows and knees, neck, hands, feetDry, scaly patches, sometimes thickened from scratching
AdultsHands, eyelids, genitals, or the creases of limbsDry, thickened or leathery patches; color changes

Source: MedlinePlus. In severe flares, the rash can appear anywhere.

What triggers eczema flares?

A trigger is anything that makes eczema worse, and triggers differ from person to person. The most common ones are irritants that touch the skin, dry or cold air, heat and sweat, allergens, infections and stress.

Triggers listed by MedlinePlus and the NHS include:

  • Irritants: strong soaps, detergents, solvents, and perfumes or dyes in skin products.
  • Weather: cold, dry winter air, heat and sudden temperature changes.
  • Fabrics: wool and other rough materials.
  • Allergens: pollen, mold, house dust mites and animal dander.
  • Illness: colds, flu and skin infections.
  • Body factors: sweating, emotional stress and hormonal changes such as pregnancy.
  • Water habits: frequent bathing or swimming that dries the skin.
  • Foods: certain foods can trigger flares in some people, but MedlinePlus advises talking to a provider before cutting foods from a young child's diet.

Keeping a simple diary of flares, products, weather and stress for a few weeks can show you patterns that are hard to spot day to day.

How should you bathe and moisturize eczema-prone skin?

Take short, lukewarm baths or showers with a gentle, fragrance-free cleanser, then apply a thick moisturizer within 3 minutes while your skin is still damp. Moisturize at least twice a day, even when your skin looks clear.

The American Academy of Dermatology (AAD) states that dermatologists recommend moisturizer for everyone with atopic dermatitis, because it helps prevent the cracks that worsen rash, itch and infection. Here is a daily routine based on AAD, NHS and MedlinePlus advice:

  1. Bathe or shower in lukewarm (not hot) water. The AAD's itch relief guidance suggests soaking for 10 to 15 minutes.
  2. Use a gentle cleanser or an emollient wash instead of regular soap, and skip harsh scrubbing.
  3. Pat your skin gently with a towel so it stays slightly damp. Do not rub it dry.
  4. Apply any prescribed medicine to the affected patches as directed.
  5. Within 3 minutes, spread a fragrance-free moisturizer over the rest of your skin.
  6. Reapply moisturizer at least once more during the day, and whenever skin feels tight or itchy.

Ointments vs creams vs lotions

An emollient is any moisturizer that softens skin and slows water loss. Emollients come in different thicknesses:

  • Ointments (such as petroleum jelly) are greasy and contain little or no water. They seal in moisture best, and the AAD says a thick layer of ointment works better than a cream or lotion for very itchy skin.
  • Creams are lighter and absorb faster, which makes them easier to use during the day.
  • Lotions are thin and watery and usually the least moisturizing.

Choose products without alcohol, fragrance or dyes, and use a pump or clean spoon rather than dipping fingers into a tub. The NHS advises avoiding aqueous cream, which can irritate skin, and warns that emollient residue on clothing or bedding can catch fire more easily, so keep away from flames and smoking.

For more on layering, see our guide to the moisturizer sandwich method, and our skincare routine for dry skin in winter. If your eczema affects your hands, our article on fixing dry, lined hands covers handwashing and glove tips.

What treatments work for mild, moderate and severe eczema?

Treatment steps up with severity: mild eczema usually responds to moisturizers plus short courses of topical medicine, while moderate to severe eczema may need light therapy, injectable biologics or pills.

Topical (applied to the skin) treatments

  • Topical corticosteroids: anti-inflammatory creams and ointments that, according to the AAD, can quickly relieve symptoms. Mild strengths are used first, with stronger ones if needed. Use them exactly as prescribed.
  • Topical calcineurin inhibitors (TCIs): nonsteroid medicines (pimecrolimus cream and tacrolimus ointment) that calm the immune response in the skin. The AAD says they may be prescribed if corticosteroids stop working, fail to work or are not a good option, for example on thin skin such as the face.
  • Crisaborole ointment: a nonsteroid option the AAD lists as approved for patients 3 months of age or older.
  • Newer nonsteroid creams: roflumilast cream and ruxolitinib cream (a JAK inhibitor, meaning it blocks certain immune signaling enzymes) are approved for ages 2 and older with mild to moderate disease. Tapinarof cream is approved for ages 2 and older and, per the AAD, can sometimes relieve itch within 24 hours.

Phototherapy

Phototherapy uses controlled ultraviolet light from special bulbs or a laser, typically 2 to 3 sessions per week for a set period. The AAD warns not to substitute tanning beds, sunlamps or sitting in the sun.

Systemic (whole-body) treatments

  • Biologics: injected medicines that target specific parts of the immune response. Dupilumab is approved from 6 months of age for moderate or severe disease not controlled by topical treatment. Tralokinumab and lebrikizumab are approved for ages 12 and older who weigh at least 88 pounds.
  • JAK inhibitor pills: abrocitinib and upadacitinib are approved for ages 12 and older with moderate to severe disease and are usually taken once daily.
  • Older immune-suppressing medicines: methotrexate, cyclosporine, azathioprine and mycophenolate mofetil. The AAD notes these may still be preferred for some patients.

Dermatologists may also recommend wet wraps (moisturizer or medicine covered with damp then dry layers) or dilute bleach baths during flares. Use these only with a dermatologist's guidance, because MedlinePlus notes wet wraps with steroids carry an infection risk.

How can you control the itch?

The best long-term itch relief is getting the eczema itself under control, but cool compresses, moisturizer, short nails and soft clothing can help in the moment. Scratching damages the skin barrier and feeds an itch-scratch cycle.

Tips from the AAD and MedlinePlus:

  • Hold a clean, damp, cool towel on the itchy area, then moisturize.
  • Try a lukewarm bath with colloidal oatmeal (finely ground oats that disperse in water).
  • Pinch or gently tap the skin near the itchy patch instead of scratching it.
  • Keep nails short and consider light cotton gloves at night.
  • Wear loose clothing made of soft, natural fabric.
  • Manage stress, which can trigger flares and make itch worse.
  • Ask about oral antihistamines, which MedlinePlus lists as an option for itching.

Avoid over-the-counter anti-itch products unless a dermatologist recommends one, since some ingredients can worsen eczema. If itch keeps you awake, our article on why skin itches at night explains why symptoms often peak at bedtime.

Common mistakes that make eczema worse

  • Stopping moisturizer when skin clears. The NHS advises continuing emollients even when skin looks better, to help prevent the next flare.
  • Taking long, hot showers. Hot water and long soaks strip oils. Keep it lukewarm and short.
  • Waiting too long to moisturize. Apply within 3 minutes of bathing while skin is damp.
  • Using scented products. Fragrance and dyes are common irritants, including in "natural" products.
  • Overusing or fearing steroids. Both are problems. Use the strength, amount and duration your clinician prescribes.
  • Cutting foods without guidance. Restrictive diets for children should be supervised by a provider.
  • Assuming any oil is safe. Plant oils suit some people and irritate others. Our review of coconut oil for skin covers the evidence and risks.

When to see a doctor

See a doctor or pharmacist if you think you or your child has eczema, if home care is not helping, or if treatment stops working. Get urgent care (same day) if you notice any of these red flags, which the NHS and MedlinePlus describe as possible signs of infection:

  • Skin that is blistered, crusty or leaking fluid, or has pus-filled spots.
  • Skin that is painful, swollen or warm, or redness that is spreading.
  • Eczema that suddenly gets much worse or spreads quickly.
  • Fever, or feeling generally unwell, along with a flare.
  • Any of the signs above, which the NHS says can point to infection or eczema herpeticum, a more serious condition that needs urgent treatment. If you have ever had cold sores, mention it.

Also see a dermatologist if eczema affects your sleep, work or school, or if it covers large areas of your body.

Frequently asked questions

Is eczema contagious?

No. You cannot catch eczema from someone else. However, eczema skin can become infected with bacteria or viruses, and those infections can spread.

Can children outgrow eczema?

Many do. NIAMS says many children outgrow atopic dermatitis before their teen years, though some continue to have symptoms into adulthood, and the skin may stay dry and sensitive.

Are topical steroids safe to use?

Used as prescribed, topical corticosteroids are a standard, effective eczema treatment. Long-term or incorrect use can cause side effects, so follow your clinician's directions on strength, where to apply and for how long.

Do skincare routines from other countries help eczema?

Gentle, layered hydration can suit eczema-prone skin, but fragrance and actives can irritate it. Our guide to Korean skincare for eczema-prone skin explains which steps to keep and which to skip.

What to do next

Start with the basics: switch to a fragrance-free cleanser, keep showers short and lukewarm, and apply a thick ointment or cream within 3 minutes of bathing, at least twice a day. Track possible triggers for a few weeks. If your skin is still itchy or flaring despite consistent care, or you see any red flags above, book an appointment with your doctor or a dermatologist and bring your trigger diary and a list of products you use.

Sources

Last reviewed: November 2026.

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