Guide to Understanding Eczema Triggers, Treatment

A dermatologist answers questions about managing eczema, from the safety of topical steroids to the best type of moisturizer. 

This story originally appeared in NewYork-Presbyterian Hospital’s Health Matters.

By Dorothy Cucci 

Manhattan Voice 

December 12, 2024

Follow @x

NEW YORK - Dry, flaky skin, itching, redness, and blisters. These are just a few of the nagging symptoms of eczema — a common skin condition that affects up to 30 percent of children and up to 10 percent of U.S. adults.

People may see eczema appear as angry red patches or rashes in babies, and adults may experience itching or blisters that seem to come and go. While many experience this common chronic inflammatory skin condition, the cause of eczema is unknown, and eczema triggers (irritants or conditions that cause flare-ups) vary for each person.

“While there isn’t a cure for eczema, there are certain lifestyle changes that can help you manage symptoms,” Dr. Shari Lipner, a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine. “And for more severe cases, there are many medical treatments that can be very effective.”

Health Matters spoke with Dr. Lipner to better understand how eczema affects the body, at-home remedies, and long-term treatment options.

What are some common types of eczema?

While there are many forms of eczema, the most common is atopic dermatitis, which mostly affects babies and young children but can persist into adulthood. It first shows up as dry skin accompanied by an itchy rash and can develop into flaky, swollen patches of skin. Without treatment, eczema flare-ups can last for weeks to months at a time.

Contact dermatitis is a form of eczema that is triggered by an allergic reaction to certain substances, such as poison ivy, nickel, or products that contain irritating fragrances or preservatives.

Dyshidrotic eczema, another common type of eczema that mostly affects adults between the ages of 20 and 40, causes small itchy blisters mainly on the hands and feet.

In lighter skin tones, eczema may appear pink or red, while in darker skin tones, it may appear dark brown, gray, or purple and more difficult to see because it blends in with the surrounding skin.  

What causes eczema?

While the cause of the condition isn’t clear, many people with eczema have a family history of the skin condition, as well as allergies or asthma. It mainly affects babies and young children, most of whom will outgrow the condition. However, it can persist past childhood and sometimes won’t even appear until adulthood.

The skin barrier, or the outermost layer of the skin, is meant to protect us from pollutants like dust, smoke, and chemicals, as well as to help lock in moisture. The skin barrier of someone with eczema is damaged — basically, it’s full of little holes. This allows both environmental irritants to enter the skin and moisture to escape out of the skin, leading to infections and dryness. In addition, the immune system of someone with eczema is essentially overreacting to foreign substances, which causes inflammation and, consequently, a rash.

Eczema is not contagious or infectious, so there’s no risk of spreading eczema to another person.

What triggers can cause eczema a flare-up?

Common eczema triggers include stress and products that contain certain fragrances and chemicals — but it varies from person to person.

Climate also plays a role: Dry air, high humidity, as well as excessive heat or cold can all trigger a flare-up. Many people experience intense flare-ups in the winter, due to indoor heating (which strips moisture from the air) and cold outdoor conditions.

What are some tips on managing eczema?

There are at-home remedies and strategies that can significantly help control eczema symptoms.

Moisturize well

Keeping the skin moist is essential to managing eczema and protecting that outer skin barrier. When choosing the right lotion to treat your eczema, the thicker the better. Tip: If you apply the cream onto your palm and turn your palm upside down, it should stick to your hand; if it drips off, it’s too watery.

I recommend opting for hypoallergenic, fragrance-free lotions that contain more oil (such as petroleum jelly) than water. It’s helpful to keep a travel-size moisturizer with you on the go, so that you’re able to reapply throughout the day. For babies and kids, petroleum jelly is a great moisturizer.

You should moisturize your skin directly after showering or bathing, once you’ve patted the skin dry.

Sleeping with a humidifier can help keep the skin moist, especially in the winter months.

Proper moisturization will also help reduce itchiness; it’s important to avoid itching or picking at an eczema rash, as it will exacerbate the itch-scratch cycle and make you more prone to infections.

Take shorter showers and baths

People with eczema should limit baths and showers to about 10 minutes or less and use lukewarm water with gentle, fragrance-free soaps. Hot water, and too much water, can dry out the skin. Colloidal oatmeal baths can also be helpful in soothing irritated skin.

Avoid irritating products

Avoid soaps and skincare products with fragrances and preservatives; before trying any new products on your face, test a small amount on your arm to see how your skin will react.

Be aware of your clothes and outer layers, which help protect the skin.

Wearing loose clothing made of 100% cotton can also help minimize irritation. Make sure to wash them with a fragrance-free, gentle detergent. When venturing out into cold weather, try to cover as much of your skin as possible using gloves and scarves.  

When should someone see a doctor about eczema?

If at-home care is not helping to reduce eczema symptoms, it’s important to see a board-certified dermatologist. They can help you find a treatment plan that will help, in combination with those everyday lifestyle changes.

For mild eczema, a dermatologist might recommend trying an over-the-counter hydrocortisone 1% cream. But in severe cases (rashes that aren’t going away after treatment, swelling, severe pain, fever, etc.) medical treatment will likely be necessary. If severe eczema is left untreated, it can become secondarily infected, so it’s important to see a doctor if your eczema is not going away or is worsening.

What should people know about topical treatments for eczema and how long should they be used for?

Topicals are prescription medications that are applied to the affected area of skin and are meant to decrease itching and inflammation; they often contain steroids.

It’s important to apply topical steroids correctly to avoid damaging the skin. For example, certain creams that might work for the skin on your arms might not be suitable for the skin on your face, which is more delicate. Misuse can cause side effects such as stretch marks, broken blood vessels, and thinning the skin.

Topical steroids can be used to treat eczema in babies and children, but only under the direction of aboard certified dermatologist.

What are some eczema treatments for more serious cases?

If someone has extensive eczema covering the whole body or if the rash is severe (oozing and extremely itchy), topical treatments may not be effective. In these cases, a doctor may recommend oral medications or injectable medications (also known as biologics) that alter the immune system response.

Phototherapy, also known as light therapy, in which the affected areas are exposed to controlled UV rays for seconds or minutes, can also help reduce symptoms over time.

There are a wide variety of treatment options available, and it’s important to work with a dermatologist to find the most effective regimen for you.