What Are the Signs and Symptoms of Eczema (Atopic Dermatitis)?

Although several types of eczema exist, the term usually refers to the most prevalent kind, called atopic dermatitis — a chronic, severe form. Atopic dermatitis is most common in babies and young children.

Eczema is characterized by patches of discolored, itchy, dry skin, but symptoms may be different for each person.

People with eczema often cycle through long periods of symptom-free remission, followed by brief flare-ups that can be severe. (1)

People with eczema have very dry, itchy skin and rashes on various parts of the body — particularly the face, hands, feet, insides of the elbows, and behind the knees.

Skin lesions may also develop on the wrists, ankles, sides of the neck, or around the mouth.

Eczema typically appears red on white skin while on skin of color it may look darker brown, purple, or ashen gray.

The main symptom of eczema is itching, which can lead to frequent scratching and rubbing that further irritate and inflame the skin. This can, in turn, lead to increased itching and scratching, which only makes the eczema worse — this is called the itch-scratch cycle. (1)

Other skin symptoms associated with eczema include:

• Rough, leathery patches of skin from chronic scratching and rubbing
• Small, raised bumps (hives) that may appear after exposure to an allergen, during flare-ups, or after exercising or taking a hot bath or shower
• Increased skin creases on the palms of the hands
• An extra fold of skin that develops under the eye, called an atopic pleat, or Dennie-Morgan fold
• Patchy loss of eyebrows or eyelashes from scratching or rubbing
• Small, rough bumps on the face, upper arms, and thighs
• Scaly skin patches that may be rectangular
• Blisters or papules (small, raised bumps) that ooze or crust over when scratched
• Swollen, sore skin
• Skin color changes
• Ear discharge or bleeding if eczema occurs in the ear canal (2)

There are two major forms of eczema that predominantly affect the hands and feet: hand eczema (also known as hand dermatitis) and dyshidrotic eczema.

Aside from the common itchy rash, hand eczema is also often marked by dry, thick, scaly patches on the hands that may peel, crack, blister, and bleed. (3)

Dyshidrotic eczema, on the other hand, produces small, deep-set blisters on the edges of the fingers, toes, palms, and soles of the feet. These blisters may last up to three weeks before drying, possibly turning into cracks or causing the skin to feel thick and spongy.

Dyshidrotic eczema goes by many other names, including foot-and-hand eczema, vesicular eczema, palmoplantar eczema, and pompholyx (or cheiropompholyx). (4)

People with eczema may scratch themselves so much that they break the skin, which can often lead to infection.

But even eczema alone can break down the skin barrier and lead to infections from bacteria, viruses, and fungi.

A review published in December 2016 in the journal Clinical Reviews in Allergy & Immunology found that the inflammation caused by eczema increases a person's infection risk. (5)

Infections from staphylococcus and streptococcus bacteria are common in people with atopic dermatitis.

About 60 to 90 percent of people with eczema are likely to have staph bacteria on their skin, and many develop active infections that further worsen their condition, according to the National Institute of Allergy and Infectious Diseases. (6)

Signs of a bacterial infection include fever; swollen, sore skin that may ooze fluid; yellow crust on the skin surface; and small, yellow-white spots, particularly around the eczema. (7)

Additionally, people with eczema may become infected with the herpes simplex virus, a common cause of cold sores. This can lead to a viral infection called eczema herpeticum if the herpes simplex virus invades the damaged skin.

Eczema herpeticum causes red, purple, or black blisters that may pop and form ulcers, and the infection is often accompanied by fever, swollen lymph glands, and general malaise. The blisters, which can take up to two weeks to appear after contact with the virus, first appear on the face and neck but can also appear on the hands.

Over time, the viral infection can spread throughout the body and be fatal if it travels to the brain, lungs, or liver. (8)

It's important that people with atopic dermatitis do not get the live-virus smallpox vaccine, as it can lead to a severe and potentially fatal infection called eczema vaccinatum.

Eczema vaccinatum develops when the smallpox-vaccine components reproduce and spread throughout the body. People with eczema must avoid close contact with anyone who was recently vaccinated against smallpox. (6)

The infection typically looks similar to smallpox, causing a rash made up of small lesions. These lesions can break open and dry to form scabs. The damage to the skin can become so severe that it can be fatal. (9)

Eczema is not contagious, as people most often develop it only if they have a genetic predisposition. 

Research suggests that several genes may play a role in the development of atopic dermatitis. In some cases, a single mutation in CARD11 — a gene involved in the development and function of certain immune-system cells — can cause eczema, according to a study published in June 2017 in the journal Nature Genetics. (10,11)

It's important to understand that having a genetic predisposition to eczema doesn't mean that a person will inevitably get it.

While eczema is not contagious, the skin infections associated with the condition may be. Compared with eczema, these infections are often tender and may "weep" liquid.

Intense itching from eczema may disturb sleep, resulting in sleep deprivation, which can cause daytime fatigue. Lack of sleep may cause poor performance at school or work.

Eczema may also reduce self-confidence in both children and adults.

Children with highly visible eczema may experience bullying at school, which can be traumatic and lead to psychological effects, like becoming withdrawn and quiet. Eczema can also reduce self-esteem, potentially affecting children's ability to develop social skills and make friends. (7)

Additionally, adults with eczema are twice as likely to experience depression or anxiety compared to adults without eczema, according to a study published in September 2018 in the Journal of the American Academy of Dermatology. (12)

Atopic dermatitis is also associated with increased suicide risk. In a study published in December 2018 in the journal JAMA Dermatology, researchers analyzed data from 15 prior studies involving nearly 5 million participants and found that those with eczema were 44 percent more likely to have suicidal thoughts and 36 percent more likely to attempt suicide compared to people without eczema. (13)

The symptoms and complications of atopic dermatitis can significantly impact a person’s quality of life. (12)

Adults with eczema reported that their condition limited their lifestyle and affected their activities — and led them to avoid social interactions.

People with the condition were also more likely than those without it to report having poor overall health and being somewhat to very dissatisfied with life, according to a study published in September 2018 in the journal Annals of Allergy, Asthma, & Immunology. (14)

A diagnosis of eczema is based on the characteristic rash as well as a history of symptoms and a family and personal medical history.

Your doctor will conduct a physical examination, paying close attention to the state of your skin, and may perform a skin biopsy (removing a skin sample for viewing under a microscope) to confirm the diagnosis and also to rule out other skin conditions.

To better understand your symptoms and their potential causes, your doctor will also ask you a number of questions about your:

• Family and personal history of allergic conditions, including hay fever and asthma
• Exposure to irritants and allergens
• Sleep habits
• Use of medication
• Previous treatments for skin-related issues (2)

Your doctor may also give you a blood test to look for indications of a recent immune reaction, such as high levels ofeosinophils (a white blood cell) or antibodies calledimmunoglobulin E (IgE). Your physician will also perform allergy tests to determine possible allergic triggers for your skin flare-ups.

So-called patch tests can help determine if you have eczema triggers related to irritants.

Your doctor will place small patches covered with various chemicals onto your skin for 48 hours and then look for signs of a skin reaction 72 to 96 hours later. The tests will reveal if you are sensitive to fragrances, metals, lanolin, rubber, and other substances. (15)

What Is Usually the First Sign of Atopic Dermatitis?

Among the first signs of atopic dermatitis is a dry, itchy rash on the skin, sometimes with small bumps. (2) On white skin eczema typically looks red, while in skin of color it tends to look darker brown, purple, or ashen gray. The skin may also be dry and cracked, and it may thicken over time as it tries to regenerate itself. Some people with eczema have oozy and blistering, inflamed skin. (16)

What Does Atopic Dermatitis Look Like?

Atopic dermatitis can present itself as either a widespread, flat rash, or as thick, scaly patches. If you have drier skin, you may notice small, discolored bumps on your arms and thighs. Over time, the affected parts of your skin may change in tone and texture. This is due to long-term irritation and constant scratching, which can make your skin look lighter or darker with a thick, leather-like appearance. Permanent scarring is another possibility. (2,16)

Can Atopic Dermatitis Happen to Adults?

While atopic dermatitis is considered most common in children younger than 5, this type of eczema can develop at any age. You may also be more likely to experience atopic dermatitis as an adult if you had eczema during childhood. Atopic dermatitis has a tendency to flare up throughout your lifetime. (16) At the same time, some people with childhood eczema outgrow it during adulthood. (2) You may be more likely to experience lifelong atopic dermatitis if you also have allergies, hay fever, or asthma. (2,16)

Can Atopic Dermatitis Cause Hair Loss?

Atopic dermatitis can occur anywhere on the body, but another type of eczema called seborrheic dermatitis has a tendency to develop anywhere you have larger sebaceous glands. This includes your face, upper back, groin, and scalp. (17)

Dermatitis is not usually linked to hair loss. But it can happen temporarily as a result of an infection of the scalp caused by eczema, and not the dermatitis itself. Once you get the eczema on your scalp controlled, you should start seeing fewer cases of hair loss. (18)

Can Atopic Dermatitis Cause Alopecia Specifically?

Alopecia is a medical term for hair loss. It’s possible for infected eczema to cause temporary hair loss. (18) A more severe type of hair loss is an autoimmune condition called alopecia areata, which occurs when hair falls out in large, round patches. With this condition, your immune system attacks the hair follicles that are responsible for hair growth. (19)

Atopic dermatitis doesn’t directly cause alopecia areata. But it’s been noted that people who have alopecia areata are more likely to have atopic dermatitis, too. (20)

Can Atopic Dermatitis Lead to Swelling?

At its core, atopic dermatitis signals inflammation of the skin. Therefore, swelling is indeed possible. Your rashes and scales may thicken from swelling. It’s also possible for skin to have blister-like bumps that may ooze and become crusty if you scratch them. (2,16)

Are Swollen Lymph Nodes a Sign of Atopic Dermatitis?

Your lymph nodes are part of your body’s infection-fighting system. They are located throughout the body, including your neck, groin, and armpits. Unless these bean-shaped glands are swollen, you may not be able to notice them. (21)

Swollen lymph nodes, on the other hand, are a sign that your body is fighting an infection. In such cases, you may be able to see and feel the lymph nodes, and they can be tender to the touch. Atopic dermatitis won’t cause swollen lymph nodes unless you have an infection as a result of eczema. (21,22)

Additional reporting by Kristeen Cherney.