Eczema Explained
Eczema, more formally referred to as atopic dermatitis, is a common inflammatory skin condition affecting around 13% of children and 10% of adults in the United States. Most cases of eczema develop before age five. However, some patients develop eczema much later in life. Although many children with mild disease outgrow their eczema, for some, it is a chronic disease that waxes and wanes throughout life, with flare-ups triggered by various environmental and internal factors. While it is not contagious, eczema can significantly affect an individual’s quality of life due to its persistent and uncomfortable symptoms.
The symptoms of eczema, also known as atopic dermatitis, can vary in severity and appearance. Common symptoms include:
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Itchy skin: Often the most noticeable symptom, leading to scratching that can exacerbate the condition.
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Red, scaly patches: These commonly appear on the bends of the elbows and knees, hands, neck, and face.
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Fluid filled bumps: Small, raised bumps that may leak fluid and crust over when scratched.
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Thickened, rough, cracked skin: This occurs from chronic scratching, which can lead to toughened, itchy areas of skin.
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Raw, sensitive, swollen skin: Prolonged scratching can cause the skin to become more irritated and inflamed.
Symptoms can flare up periodically and then subside. In some cases, eczema can lead to complications, such as skin infections, especially when the skin is broken due to excessive scratching.
The causes of eczema are multifactorial and include genetic predisposition, environmental influences, microbiome imbalances, and immune system dysregulation. The microbiome refers to the diverse community of microorganisms, such as bacteria, viruses, and fungi, that live on and within the human body. These microorganisms play crucial roles in maintaining health. Immune system dysregulation occurs when the body’s immune response is not functioning correctly, leading to excessive inflammation. A family history of allergic conditions, such as hay fever or asthma, increases the likelihood of developing eczema.
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Dry skin
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Cool, dry climates
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Excessively hot, long, or frequent showers/baths
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Exposure to allergens or irritants, such as fragrances
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Stress
Eczema is typically diagnosed through a combination of medical history and a physical examination. The process involves:
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Medical history: The dermatologist will ask about your symptoms, duration, and any family history of eczema or allergic conditions like asthma or hay fever.
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Physical examination: The dermatologist will examine your skin for signs of eczema, such as rash, dryness, and inflammation.
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Symptom pattern recognition: Eczema often presents in characteristic patterns
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Ruling out other conditions: Since other skin conditions may resemble eczema, your provider may need to rule out other issues, such as psoriasis or fungal infections.
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Patch or allergy testing: In some cases, if a specific allergen is suspected of triggering flare-ups, your provider may recommend patch testing.
There is no specific laboratory test for eczema; diagnosis is based on clinical evaluation. In uncertain cases, a skin biopsy may be performed to confirm the diagnosis.
Although there is no cure for eczema, it can be effectively managed through various treatments, including:
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Moisturizers to maintain skin hydration and barrier function.
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Trigger avoidance through lifestyle modifications, such as avoiding allergens or irritants.
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Topical anti-inflammatory medications such as corticosteroids or calcineurin inhibitors.
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For more severe cases, oral anti-inflammatory medication, injectable biologic medications, or phototherapy (light therapy).
Treatment Options
Atopic dermatitis (often called “eczema”) is a chronic, inflammatory skin condition that causes dry, red, and intensely itchy skin. It can begin in childhood or adulthood and often cycles between periods of flares and remissions. Though there is no permanent cure, newer treatments can dramatically improve comfort, appearance, and quality of life.
At its core, eczema involves two main factors:
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A weakened skin barrier, which allows moisture to escape and irritants or allergens to enter.
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An overactive immune response, which triggers inflammation, redness, and itch.
Because these processes reinforce one another, successful treatment focuses on restoring the skin barrier and calming the immune system. We take an individualized approach to eczema management—addressing the root causes, identifying triggers, and tailoring treatment to each patient’s needs.
Before reaching for prescription medications, it’s important to recognize and minimize triggers that contribute to flares.
Common Triggers
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Harsh soaps, detergents, and fragrances
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Wool or synthetic fabrics
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Dry air or extreme temperatures
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Heat, sweat, and friction
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Environmental allergens (dust mites, pollen, pet dander)
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Stress or sleep disruption
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Skin infections, especially Staphylococcus aureus
Daily Skin Care Habits
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Moisturize regularly: Apply a thick, fragrance-free cream or ointment at least twice daily and immediately after bathing.
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Gentle cleansing: Use mild, fragrance-free cleansers and avoid very hot water or long showers.
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“Soak and seal” technique: After a short lukewarm bath, lightly pat skin dry and apply moisturizer while still damp.
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Avoid scratching: Keep nails trimmed and use cool compresses or anti-itch products for relief.
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Wear breathable fabrics: Choose soft cotton over rough or synthetic materials.
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Maintain indoor humidity: Use a humidifier in dry environments.
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Reduce stress: Mindfulness, relaxation, and consistent sleep can help limit flares.
These foundational habits are essential even when prescription therapies are used—they form the basis of long-term eczema control.
Eczema management often requires a combination of treatments. We tailor each plan to the individual’s symptoms, lifestyle, and goals.
Topical (On-the-Skin) Therapies
Topical creams and ointments remain the cornerstone of eczema treatment and are used to calm inflammation, reduce itch, and repair the skin barrier.
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Topical corticosteroids: Time-tested anti-inflammatories that reduce redness, swelling, and itching. Potency and duration are carefully selected based on the treatment area and severity.
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Topical non-steroidal options:
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Calcineurin inhibitors – Tacrolimus (Protopic®) and Pimecrolimus (Elidel®)
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JAK inhibitors – Ruxolitinib (Opzelura®)
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PDE4 inhibitors – Crisaborole (Eucrisa®) and Roflumilast (Zoryve®)
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AhR modulator – Tapinarof (Vtama®)
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When used correctly and in conjunction with moisturization, topical therapies can dramatically reduce flare frequency and improve overall skin health.
Phototherapy (Light Therapy)
For moderate cases not controlled with topical treatments, narrowband UVB phototherapy can be highly effective. This controlled light treatment helps reduce inflammation, itching, and bacterial colonization, promoting longer flare-free periods. Treatments are performed in-office several times per week under medical supervision.
Systemic (Oral and Injectable) Therapies
For patients with moderate to severe eczema or those whose skin does not respond adequately to topical care, systemic treatments offer powerful and often life-changing results.
Injectable Biologic Therapies
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Dupilumab (Dupixent®) – The first FDA-approved biologic for atopic dermatitis, it blocks key inflammatory pathways (IL-4 and IL-13) to relieve itch and reduce flares.
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Tralokinumab (Adbry®) and Lebrikizumab (Ebglyss®) – These biologics specifically target IL-13, providing additional treatment options for patients who may respond differently to certain immune pathways. These medications offer long-term disease control with excellent safety profiles.
Oral JAK Inhibitors
Upadacitinib (Rinvoq®) and Abrocitinib (Cibinqo®) – Once-daily oral medications that inhibit Janus kinase (JAK) signaling to quickly reduce inflammation and itching. These treatments can be especially effective in severe or refractory cases and are closely monitored for safety.
Cyclosporine and Methotrexate – Immunosuppressive medications that can still be useful for short-term control but are now less commonly used as newer targeted options have become available.
With today’s biologic and JAK-inhibitor therapies, most patients can achieve clearer, more comfortable skin and maintain long-term control with fewer side effects than traditional systemic drugs.
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Dr. Michael Tee
Clinical Director & Founder
Dr. Michael Tee focuses on helping patients manage a comprehensive range of skin conditions that can significantly impact daily comfort and confidence. He works extensively with patients experiencing skin changes during pregnancy, helping them navigate the complex dermatological shifts that occur during this important time. His practice also centers on mole evaluation and management, including atypical moles that require careful monitoring and assessment. Dr. Tee regularly treats patients dealing with acne, seborrheic dermatitis, and various forms of eczema, conditions that can affect both appearance and quality of life.