Making sense of eczema, together

Eczema, most often meaning atopic dermatitis, is a common long-term skin condition that causes dry, itchy and inflamed skin. It affects people of all ages, though it usually begins in childhood.

It happens when a weakened skin barrier and an overactive immune response combine. Eczema flares up and settles over time, and it is not contagious. Most people can keep it under control with regular moisturizing, trigger avoidance and treatment from a clinician.

No, eczema is not contagious.

You cannot catch eczema from someone else or pass it on by touching, sharing towels or being close. Eczema is driven by genetics, the skin barrier and the immune system. However, eczema skin can become infected, and some of those infections, such as a herpes skin infection or impetigo, can spread. If your skin looks weepy, crusted or blistered, see a doctor.

No. Eczema is generally classed as an inflammatory, allergic-type condition rather than an autoimmune disease.

In an autoimmune disease, the immune system attacks the body’s own healthy tissue. In atopic dermatitis the immune system overreacts, particularly through type 2 inflammation, but it is not mistakenly targeting the skin. Autoimmune skin conditions, such as lupus or vitiligo, are separate conditions. People with eczema do have a slightly higher chance of some autoimmune conditions, which is why new symptoms are worth mentioning to your doctor.

There is no single cause. Eczema develops from a mix of factors:

• Genes: changes in genes that make skin barrier proteins, such as filaggrin, are common, and eczema often runs in families.
• Immune system: an overactive immune response causes inflammation and itch.
• Skin barrier: moisture escapes and irritants and allergens get in more easily.
• Environment: dry air, cold weather, harsh products and allergens can set off or worsen flares.

Eczema is not caused by poor hygiene, and it is not your fault.

Triggers vary from person to person, and many flares have no obvious cause. Common ones include dry skin, irritants such as soaps, detergents and fragrances, heat and sweating, cold dry weather, stress, poor sleep, infections, and allergens such as dust mites, pet dander or pollen.

In some people, particular foods can trigger flares, though this is less common than many believe, especially in adults. Keeping a simple diary of flares and what was going on helps you and your doctor spot your own patterns.

Atopic dermatitis is the most common type, but several other forms exist, and some people have more than one at a time.

A clinician can tell which type you have, which affects the treatment that will help most.

Both cause dry, red, scaly patches, so they can look alike. Eczema tends to be more itchy and often affects skin creases, while psoriasis tends to form thicker, well-defined plaques with silvery scales, often on the elbows, knees and scalp.

Psoriasis is an autoimmune condition, while eczema is not. If you are not sure which you have, see a doctor, because treatments differ.

There is currently no cure for eczema, but it can be well controlled. Many children see their eczema improve or clear as they grow, while others continue to have it into adulthood, and some people first develop it as adults.

Even when eczema settles, the skin stays prone to flares, so continuing a gentle skin routine helps keep it calm. If your current plan is not working, there are more treatment options available than there used to be, so it is worth going back to your doctor.

Yes, when they are used as directed. Topical corticosteroids are one of the safest and most effective treatments for flares, and the risks come mainly from using strong steroids for too long on thin skin, such as the face and skin folds, without supervision.

Your clinician will choose a strength that matches the body area and severity, and tell you how long to use it. Do not stop treatment early because you are worried, and do not use leftover steroid creams on a new area without checking first. Topical steroids used this way do not usually cause the effects associated with steroid tablets.