Eczemasymptoms can range from mild to severe. For some adults,atopic dermatitis(the most common type of eczema) can affect over 40% of their body surface area.Severe eczema can impair quality of life. This chronic inflammatory skin condition affects more than 31 million Americans.
Itchiness is the most common symptom of eczema. Other possible symptoms include dry skin, rashes, blisters, and scaly patches. About half of people with moderate to severeeczemaalso have asthma, allergic rhinitis (hay fever), or food allergies.
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Severe eczema can be managed with the help of a board-certified dermatologist who can determine an effective treatment plan.
This article discusses how to recognize severe eczema, its types, symptoms, and diagnosis, and what can be done to relieve it.
Types of Severe Eczema
Theseven types of eczemaare:
Unless a different type is specified, “eczema” often refers to atopic dermatitis.
Severe Eczema Symptoms
Specific symptoms depend on the type of eczema. Symptoms that may indicate eczema include:
Eczema can look different depending on skin tone. On lighter skin, it may appear red. On darker skin, eczema may appear as ashen skin, gray skin, darker brown, or purple in color.Black Americans are more likely to experience severe symptoms.
Severe eczema can cause symptoms intense enough to affect your quality of life. The itchiness, pain, and other symptoms can causeloss of sleep, make it difficult to focus at school or work, and make it hard to participate in activities. With severe eczema, the itching can be constant and difficult to control.
Periods when symptoms are worse are calledflare-ups. Between flare-ups, the skin heals, and symptoms are milder or not present.
The eczema rash is usually the same on both sides of the body. Where the eczema presents depends on the type of eczema and theperson’s age, such as:
Eczema can cause skin to become infected, especially from scratching. Talk to your healthcare provider if you see signs of infection, including:
Eczema on Dark Skin: Common Triggers, Symptoms, and Treatment
Causes
Eczema results from problems with the skin barrier allowing moisture to “leak out.”
The exactcause of eczemaisn’t known, but it is believed to result from acombinationof genetic, immune, and environmental factors.Eczema often occurs along with hay fever, allergic asthma, and/or food allergies.
Risk factors for eczema include:
Eczema flare-ups often have triggers, which means something in the body or the environment is causing a flare-up.
Common Triggers of Eczema Flare-Ups
Diagnosis
To make a diagnosis, your dermatologist or healthcare provider will:
They may also look for other conditions that could be causing your symptoms or that might affect treatment. This may include running tests such as:
If a food allergy is suspected, your healthcare provider may suggest removing the suspected food for two weeks to see if the symptoms improve. If the eczema gets better, the food is added back into the diet to see if a flare-up occurs within two hours of eating the food. Talk to your healthcare provider before trying this with your child.
Topical Therapy TermsTerms for topical therapies include:Topical therapy: Applied directly to the skinOintment: Typically has more oil than water, usually more thick and greasy.Cream: Has a mix of oil and water, usually white and smooth.Solution: More liquid, feels like waterLotion: Thicker than a solution but more water than ointments and creams
Topical Therapy Terms
Terms for topical therapies include:Topical therapy: Applied directly to the skinOintment: Typically has more oil than water, usually more thick and greasy.Cream: Has a mix of oil and water, usually white and smooth.Solution: More liquid, feels like waterLotion: Thicker than a solution but more water than ointments and creams
Terms for topical therapies include:
Topical therapy: Applied directly to the skinOintment: Typically has more oil than water, usually more thick and greasy.Cream: Has a mix of oil and water, usually white and smooth.Solution: More liquid, feels like waterLotion: Thicker than a solution but more water than ointments and creams
Treatment
Treatmentdepends on the severity of the symptoms. While milder eczema can sometimes clear up on its own or witha simple skin care routine, more severe eczema may require medical treatment.
Skin Care
A good skin care routine that helps hydrate your skin is vital for managing eczema. Your individual skin care regime should be determined with your dermatologist if you have severe eczema.
Key components of basic eczema skin care include:
Look for products that are fragrance-free, and choose creams or ointments over lotions.Eucerincream,Moisturelcream, andCetaphilcream may be good starting options.
Medication
Severe eczema often requires medication in addition toavoiding triggersand using a thorough skincare routine.
Topical Treatments
Topical steroids should be used short term. Long-term use can cause adverse effects such as thinning of the skin,depigmentation(a change in the color of skin), andacne-like eruptions.
Topicalimmunomodulatorsare another option. They help calm the immune system, similar totopical steroids, but do not cause skin thinning. They can be used for people aged two and older.
Currently, two topical immunomodulator drugs are available:
Topical products that contain menthol orpramoxine, such as Aveeno cream,Pramasonecream/lotion, or Prax lotion may help relieve itching.
Oral Medications
Oral steroids may be used for severe eczema flares but should be used sparingly because of potentially seriousside effects. It’s also possible that severe flares will happen when they are discontinued. To help prevent this, an intensified skin care routine should be used while tapering off oral steroids.
Antihistaminesmay help make itching more bearable and let you get a better night’s sleep. They may not work directly on the itch, but they have sedative effects and can make you drowsy.
Injectable Medications
Procedures and Further Treatment
For adults and children over age 12 who have severe eczema,phototherapyorphotochemotherapymay be helpful, as follows:
Eczema and Cold SoresThe herpesvirus can cause a serious skin infection in children with eczema. Keep your child away from anyone who hascold sores(also called fever blisters).
Eczema and Cold Sores
The herpesvirus can cause a serious skin infection in children with eczema. Keep your child away from anyone who hascold sores(also called fever blisters).
Prognosis
Eczema is a chronic condition, but it tends to get better with age. Eczema that is more severe and persistentin childhoodis more likely to persist into adulthood.People who have other signs of atopy, such as asthma or allergic rhinitis, may also experience persistent eczema.
Treatments may not completely eliminate severe eczema flare-ups, but they can help improve symptoms.
Coping
Although it is hard to do, try to resist scratching. Scratching can make the itch worse andlead to infection.
Wet wrap therapy can help during a flare to treat the skin and keep it covered so you can’t scratch.You soak the area for 15 to 20 minutes in lukewarm water, pat dry, and apply topical medications. Then you apply a wet dressing and cover it with a dry dressing. Leave this in place for two to six hours.
Talk to your healthcare provider about other tactics to cope with the itching. Stress management techniques may help to reduce stress as a trigger for flares.
If you find you have symptoms of anxiety or depression, talk to your healthcare provider. These mental health conditions are more likely in people with eczema, and depression risk increases with the severity of eczema.
Summary
Frequently Asked QuestionsFood allergies can increase symptoms such as skin redness or discoloration and itching in people with eczema. Food allergies are a factor in 30% of young children who have severe eczema, particularly in infants.Cow’s milk and eggs are the main allergic foods associated with eczema.Learn MoreHow Eczema and Food Allergies Are LinkedEczema flare-ups can’t always be prevented, but there are some measures you can take to try to minimize them, including:Avoid your triggers as much as possible.Skip the bubble bath.Try to avoid extreme heat or cold, and dry air.Use a humidifier.Wear vinyl or plastic gloves with cotton gloves underneath when doing activities during which your hands will be exposed to water or irritants (make sure to take breaks and air your hands out to prevent sweat buildup).Wear gloves outside during winter.Try stress-reduction techniques to manage stress you can’t eliminate.
Frequently Asked Questions
Food allergies can increase symptoms such as skin redness or discoloration and itching in people with eczema. Food allergies are a factor in 30% of young children who have severe eczema, particularly in infants.Cow’s milk and eggs are the main allergic foods associated with eczema.Learn MoreHow Eczema and Food Allergies Are Linked
Food allergies can increase symptoms such as skin redness or discoloration and itching in people with eczema. Food allergies are a factor in 30% of young children who have severe eczema, particularly in infants.Cow’s milk and eggs are the main allergic foods associated with eczema.
Food allergies can increase symptoms such as skin redness or discoloration and itching in people with eczema. Food allergies are a factor in 30% of young children who have severe eczema, particularly in infants.
Cow’s milk and eggs are the main allergic foods associated with eczema.
Learn MoreHow Eczema and Food Allergies Are Linked
Eczema flare-ups can’t always be prevented, but there are some measures you can take to try to minimize them, including:Avoid your triggers as much as possible.Skip the bubble bath.Try to avoid extreme heat or cold, and dry air.Use a humidifier.Wear vinyl or plastic gloves with cotton gloves underneath when doing activities during which your hands will be exposed to water or irritants (make sure to take breaks and air your hands out to prevent sweat buildup).Wear gloves outside during winter.Try stress-reduction techniques to manage stress you can’t eliminate.
Eczema flare-ups can’t always be prevented, but there are some measures you can take to try to minimize them, including:
14 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ, in collaboration with the U.K. Translational Research Network in Dermatology and the U.K. Dermatology Clinical Trials Network.Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists.Br J Dermatol. 2017;176(6):1617-1623. doi:10.1111/bjd.15235National Eczema Association.What is eczema?American Academy of Allergy, Asthma & Immunology.Eczema (atopic dermatitis) overview.American Academy of Dermatology Association.Can anything relieve severe atopic dermatitis?National Eczema Association.An overview of the different types of eczema.Mount Sinai.Eczema.National Eczema Association.Eczema in skin of color: what you need to know.Seattle Children’s Hospital.Eczema.American Academy of Family Physicians.Eczema and atopic dermatitis.American Academy of Pediatrics.How to treat & control eczema rashes in children.Food and Drug Administration.FDA approves new eczema drug Dupixent.American Osteopathic College of Dermatology.Eczema.Cancer Therapy Advisor.Severe eczema.Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030
14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ, in collaboration with the U.K. Translational Research Network in Dermatology and the U.K. Dermatology Clinical Trials Network.Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists.Br J Dermatol. 2017;176(6):1617-1623. doi:10.1111/bjd.15235National Eczema Association.What is eczema?American Academy of Allergy, Asthma & Immunology.Eczema (atopic dermatitis) overview.American Academy of Dermatology Association.Can anything relieve severe atopic dermatitis?National Eczema Association.An overview of the different types of eczema.Mount Sinai.Eczema.National Eczema Association.Eczema in skin of color: what you need to know.Seattle Children’s Hospital.Eczema.American Academy of Family Physicians.Eczema and atopic dermatitis.American Academy of Pediatrics.How to treat & control eczema rashes in children.Food and Drug Administration.FDA approves new eczema drug Dupixent.American Osteopathic College of Dermatology.Eczema.Cancer Therapy Advisor.Severe eczema.Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ, in collaboration with the U.K. Translational Research Network in Dermatology and the U.K. Dermatology Clinical Trials Network.Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists.Br J Dermatol. 2017;176(6):1617-1623. doi:10.1111/bjd.15235National Eczema Association.What is eczema?American Academy of Allergy, Asthma & Immunology.Eczema (atopic dermatitis) overview.American Academy of Dermatology Association.Can anything relieve severe atopic dermatitis?National Eczema Association.An overview of the different types of eczema.Mount Sinai.Eczema.National Eczema Association.Eczema in skin of color: what you need to know.Seattle Children’s Hospital.Eczema.American Academy of Family Physicians.Eczema and atopic dermatitis.American Academy of Pediatrics.How to treat & control eczema rashes in children.Food and Drug Administration.FDA approves new eczema drug Dupixent.American Osteopathic College of Dermatology.Eczema.Cancer Therapy Advisor.Severe eczema.Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030
Taylor K, Swan DJ, Affleck A, Flohr C, Reynolds NJ, in collaboration with the U.K. Translational Research Network in Dermatology and the U.K. Dermatology Clinical Trials Network.Treatment of moderate-to-severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists.Br J Dermatol. 2017;176(6):1617-1623. doi:10.1111/bjd.15235
National Eczema Association.What is eczema?
American Academy of Allergy, Asthma & Immunology.Eczema (atopic dermatitis) overview.
American Academy of Dermatology Association.Can anything relieve severe atopic dermatitis?
National Eczema Association.An overview of the different types of eczema.
Mount Sinai.Eczema.
National Eczema Association.Eczema in skin of color: what you need to know.
Seattle Children’s Hospital.Eczema.
American Academy of Family Physicians.Eczema and atopic dermatitis.
American Academy of Pediatrics.How to treat & control eczema rashes in children.
Food and Drug Administration.FDA approves new eczema drug Dupixent.
American Osteopathic College of Dermatology.Eczema.
Cancer Therapy Advisor.Severe eczema.
Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM.Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study.J Allergy Clin Immunol Pract. 2020;8(1):248-257.e16. doi:10.1016/j.jaip.2019.08.030
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