Chronic inflammatory skin condition

Eczema: Pictures, Symptoms, Causes & Treatment

Eczema — most often atopic dermatitis — is a long-term condition in which the skin barrier leaks moisture and overreacts to irritants, producing dry, intensely itchy, inflamed patches that flare and settle over time. It affects roughly 1 in 5 children and 1 in 10 adults.

Medically reviewed by Dr. Celina Kazumi Iwasa, MD · Last reviewed 2026-08-23

Quick answer

Eczema is dry, itchy, inflamed skin caused by a weakened skin barrier and an overactive immune response. Typical patches are red or darker than surrounding skin, scaly, sometimes weeping or crusted, and usually appear in the elbow creases, behind the knees, on the hands, neck and face. Treatment centres on daily emollients, topical steroids or calcineurin inhibitors during flares, and avoiding personal triggers such as soap, heat, sweat, dust mites and stress.

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What eczema looks like

Eczema looks different depending on how long a patch has been active. Acute eczema is red or dusky, swollen and may weep; chronic eczema becomes dry, thickened and leathery from repeated scratching (lichenification). Itch is the defining symptom — a rash without itch is usually something else.

Common locations

Inner elbows and behind the knees (classic in children and adults)
Hands and fingers, especially with wet work
Face, eyelids and around the mouth
Neck and upper chest
Ankles, wrists and nipples

Typical signs

Persistent, sometimes sleep-disturbing itch
Dry, scaly, cracked or flaking skin
Weeping, oozing or golden crusting (suggests infection)
Thickened, leathery skin with exaggerated lines
Pale or dark marks left behind after a flare settles

On brown and Black skin

On brown and Black skin, eczema often looks purple, grey or darker brown rather than red, and small bumps around hair follicles are common. Post-inflammatory lightening or darkening can last months after the flare itself has settled.

Causes and triggers

Eczema comes from a combination of a genetically weaker skin barrier (often involving filaggrin gene variants) and an immune system that overreacts to everyday exposures. The barrier defect lets water out and irritants and allergens in, which drives inflammation and more itching.

Trigger	Why it matters
Family history of atopy	Eczema, asthma and hay fever cluster in families and often appear together.
Soaps and detergents	Strip skin lipids and raise skin pH, which weakens the barrier further.
Heat and sweat	Overheating and sweat trapped under clothing are among the most common flare triggers.
Dust mites, pollen, pet dander	Airborne allergens can drive flares, especially on the face and eyelids.
Stress and poor sleep	Raise inflammatory signalling and increase scratching, feeding the itch–scratch cycle.
Infection	Staphylococcus aureus overgrowth is common on eczema skin and can turn a stable patch into a sudden severe flare.

Conditions that look similar

Several conditions are mistaken for eczema. The pattern, the borders and whether the rash itches are the most useful clues.

Condition	How to tell it apart
Psoriasis	Sharply bordered plaques with thick silvery scale on elbows, knees and scalp; itch is usually milder.
Contact dermatitis	Rash matches the shape of what touched the skin (a watch strap, a glove line) and clears when the trigger is removed.
Fungal infection (ringworm)	Ring-shaped with a raised, scaly leading edge and clearer centre; spreads outward.
Scabies	Ferocious night itch, burrows in finger webs and wrists, and other household members itching too.
Seborrhoeic dermatitis	Greasy yellow scale on scalp, eyebrows, sides of nose and chest rather than dry flexural patches.

Treatment options

Eczema cannot be cured, but it can be controlled well. Treatment works in layers: daily barrier care all the time, anti-inflammatory treatment for flares, and trigger management to lengthen the quiet periods.

Emollients (every day)

Thick, fragrance-free moisturisers applied at least twice daily — and immediately after bathing — are the foundation. Ointments hold moisture better than lotions. Use a soap substitute instead of foaming washes.

Topical corticosteroids

Short courses of an appropriate strength calm flares quickly. Milder steroids are used on the face and folds, stronger ones on the body and hands. Used correctly for defined periods, they are safe and effective.

Steroid-sparing topicals

Calcineurin inhibitors (tacrolimus, pimecrolimus) and crisaborole suit delicate areas such as eyelids and skin folds, or long-term maintenance twice weekly to prevent relapse.

Treating infection

Weeping, golden crusting, pain or a sudden severe flare may mean bacterial infection and needs medical assessment; antiseptics or antibiotics may be required.

Advanced therapy

For moderate to severe eczema unresponsive to topicals, dermatologists may use phototherapy, biologics such as dupilumab, or oral JAK inhibitors. These require specialist supervision.

When to see a doctor

See a clinician if eczema is not controlled by moisturisers and short steroid courses, if it disturbs sleep or daily life, or if you are unsure whether a rash is eczema at all. Photographing patches at each flare helps a clinician judge severity and progress.

Red flags

Painful, weeping or golden-crusted skin (possible bacterial infection)
Clustered blisters or punched-out sores, especially on the face (possible eczema herpeticum — urgent)
Fever, spreading redness or feeling unwell with a flare
A single patch that does not respond to eczema treatment (may not be eczema)
Widespread redness covering most of the body (erythroderma — urgent)

Frequently asked questions

What does eczema look like?

Eczema looks like dry, scaly, inflamed patches that are red on lighter skin and purple, grey or darker brown on deeper skin tones. Acute patches may weep or crust; long-standing patches become thickened and leathery. It is almost always itchy, and it typically appears in the elbow creases, behind the knees, on the hands, neck and face.

What triggers an eczema flare?

Common triggers are soaps and detergents, heat and sweat, wool and synthetic fabrics, dust mites, pet dander, pollen, dry indoor air, stress, poor sleep and skin infection. Triggers are individual, so a short flare diary is often the fastest way to identify yours.

Is eczema contagious?

No. Eczema cannot be passed from person to person. It is driven by an inherited skin-barrier weakness and immune overreaction. However, eczema skin can become infected with bacteria or viruses, and those infections can be transmissible.

How do I stop eczema itching at night?

Apply a thick emollient before bed, keep the bedroom cool, use cotton bedding and nightwear, treat active inflammation with the topical your clinician prescribed, and keep nails short. If itch still breaks your sleep, ask about a sedating antihistamine at night or a step up in treatment.

Can eczema be cured?

There is no cure, but most people achieve long periods with clear or nearly clear skin. Many children improve substantially by their teens. Consistent emollient use plus prompt treatment of flares is what keeps eczema quiet over the long term.

What is the difference between eczema and psoriasis?

Eczema is intensely itchy with poorly defined, dry or weeping patches, usually in skin creases. Psoriasis produces sharply bordered plaques with thick silvery scale, typically on the outer elbows, knees, scalp and lower back, and is more often described as sore than itchy.

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This page is for general information and does not replace a medical consultation. If you are worried about a skin change, see a qualified clinician.