More Than Itchy Skin: The Full Impact Of Living With Eczema

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Common misconceptions about eczema (pronounced eg·zuh·muh) are that "it's just dry skin" or generally clears up in adulthood. However, it's possible to develop eczema at any stage of life.¹

While researchers don’t fully understand eczema’s cause, it’s well-established that immune system function plays a central role. According to a population-based survey taken in 2007, 31.6 million people in the US have some type of eczema.²

Between 2000–2010, the Centers for Disease Control & Prevention (CDC) conducted a household survey and found a rising number of cases of eczema in children.³

Dermatologists theorize that urbanization and other environmental factors are to blame, along with genetic disposition.⁴

Unfortunately, this inflammatory disease is usually more complex than itchy, uncomfortable skin (though the challenges of living with this symptom shouldn’t be minimized). 

Having eczema often involves emotional distress, social isolation, reduced job performance, and disturbed sleep. These and many other factors can result in poor self-esteem and other issues that lower a person’s quality of life. 

These hardships are among the many reasons researchers seek improved treatments for eczema and, hopefully, an eventual cure. 

Here are some crucial things to understand about life with eczema and tips for managing its symptoms.

One in ten people experience eczema

Roughly 10% of the global population will experience eczema at some point in their lifetime, with cases being most common in childhood. 

90% of patients experience their first symptoms before the age of five.⁵ The onset of symptoms is most common between three and six months of age.⁶

People of all races and ethnicities are affected by eczema.¹

Approximately 10–30% of individuals  will continue experiencing eczema as an adult, and for some, the onset of eczema won’t happen until adulthood.⁷

The most common symptom: itchy skin

The most prevalent symptom of eczema is itchy skin — medically known as pruritus. 

The degree of itchiness from eczema can range from mild to moderate, but it may be much worse for some. One survey found that 91% of participants experienced itchy skin daily.⁸

In severe cases of eczema, a vicious “itch-scratch” cycle will happen. The more scratching a person does, the more the skin barrier breaks down, letting bacteria and allergens in. 

Subsequently, the body responds with more inflammation and itchiness, leading to more scratching.

Untreated eczema can make a person more vulnerable to infections, which is one of the many reasons it’s essential to seek medical attention and manage the disease as effectively as possible.⁹

Other signs and symptoms of eczema may include skin that is

• Inflamed and discolored 

• Dry, sensitive, or swollen 

• Rough, leathery, or scaly 

Different types of eczema

It’s important to note that there are multiple types of eczema, including:

Atopic dermatitis

Atopic dermatics (AD) is the most well-known form of eczema. It’s also the most common skin condition worldwide, affecting 20% of children and 5% of adults.¹⁰ AD occurs when the skin’s natural barrier becomes weakened, making it more vulnerable than usual. The skin, therefore, is less able to protect the body from irritants and allergens. 

Atopic dermatitis occurs due to genetics, immune system issues, environmental triggers, and dry skin. 

Other types of eczema include:

Contact dermatitis

As the name suggests, this form of eczema happens when the skin comes in contact with an allergen, such as jewelry made from nickel or scented soap.

Dyshidrotic eczema

This type of eczema causes itchy blistering on the hands and feet and is linked with fungal infection.¹¹

Nummular eczema

This form of eczema presents as round, itchy lesions prone to infection. It is sometimes linked to poor circulation or trauma to the skin, but the cause is not well understood.

Hand eczema

With this form of eczema, the fingers and palms of the hands will be red, cracked, and itchy. It may be caused by occupations that require a lot of handwashing or involve exposure to chemicals.

Stasis dermatitis

Poor circulation caused by other health conditions can cause stasis dermatitis and make the skin thickened and itchy.

Diagnosis and treatment

Not all itchy skin is caused by eczema. Therefore, it is important to get assessed by a qualified doctor or dermatologist to know whether any skin issues are eczema-related. 

A doctor can also refer you to an allergy specialist to see what environmental allergens and food triggers might contribute to flare-ups.

An allergy specialist will usually conduct a patch test on the skin whereby small amounts of substances — like pollen, dairy, or wheat are placed on the skin to test for a reaction. Avoiding those substances will be recommended if there is an allergic response.

After an eczema diagnosis is made, various treatments may be prescribed, including:

• Topical creams - steroidal and non-steroidal creams or ointments that manage inflammation

• Injectable biologic drugs - medications that stop or decrease the immune response

• Oral medications - drugs that suppress the immune system or inhibit inflammation

• Phototherapy - UV light therapy may be recommended if topical treatment is ineffective

While there is currently no cure for eczema, there are a variety of promising treatments in development. 

Some eczema treatments on the horizon explore the use of substances from living organisms (biologics) or aim to change the organisms living on and in the skin (the microbiome).¹²

Eczema and mental distress

When itchiness is severe, it can be downright torturous and may lead to mental health issues.¹³

Research has shown that those with eczema are less likely to thrive at school, less likely to have romantic relationships, and more likely to experience bullying.¹⁴

Embarrassment and low self-esteem are additional factors that can occur as a result of social stigma.¹⁵

For example, the International Study on Life with Atopic Eczema discovered that 27% of participants had been bullied due to their eczema. 36% of individuals reported that it affected their self-confidence.¹⁶

Dr. Jonathan Silverberg, the Northwestern Medicine Multidisciplinary Eczema Center director, believes that eczema can have significant psychological impacts. 

"Because eczema often starts in early childhood, people are affected throughout their developmental years and adolescence. It hurts their self-esteem and identity,” says Silverberg. 

Lack of sleep is another issue that impacts mental health. For eczema sufferers, sleep disturbance is one of the most commonly reported symptoms.¹⁷

Even more concerningly, research shows that those with eczema are also at an increased risk for suicidal thoughts — yet another reason why diagnosis, treatment, and support are essential.¹⁴

Eczema reduces work performance

Eczema can have a significant impact on both patients and their families. And the symptoms can result in missed school and work. 

One study found that eczema has a profound impact on a person's career and livelihood. The participants had both out-of-pocket costs for healthcare and lost days of work due to their condition, which in turn impacted their financial health.¹⁸

Work productivity can be affected too. A US Health and Wellness survey also found that work performance was substantially impacted for eczema sufferers.¹⁹ 46% of patients reported that itchiness disrupted their work or study. 

Additionally, those affected are also more likely to change their occupation due to eczema flare-up triggered by handling chemicals, working outdoors, or working near allergens.²⁰

14% of adults believe that their career trajectory has been negatively impacted by their condition.¹⁶

Atopic dermatitis is estimated to have an annual cost of USD 5.2 billion with costs attributed to physician visits, prescriptions, hospital costs, and indirectly to work absence and decreased productivity.¹⁶

Risks and complications

One study found that adults with eczema had higher rates of smoking and alcohol consumption.²¹

Researchers also discovered that people with eczema were 54% more likely to be severely obese, and 48% more likely to have high blood pressure. Patients with eczema were also found to exercise less, putting them at a greater risk of cardiovascular disease, diabetes, and insomnia.

Unfortunately, sweat can be a trigger for eczema flare-ups. Another study showed that 77% of people with atopic dermatitis had an allergic response to sweat.²²

People with eczema also have been found to have lower antimicrobial properties in their sweat, increasing the risk of skin infection.²³

What can cause an eczema flare-up?

Heat and cold

Extreme temperatures, both hot and cold, can negatively impact skin conditions. 

Hot temperatures can lead to sweating, while colder temperatures can dry out the skin — both of which are problematic for those with eczema. 

Environmental allergies

Eczema is an immunological disease —a condition related to the immune system — and it can make people especially sensitive to allergens.

In particular, pollen, mold, tobacco smoke, and pet dander are known to aggravate eczema.¹³

Eczema is also prevalent in people who experience asthma and hay fever.²⁴

The reason for allergens worsening eczema relates to the production of the antibody Immunoglobulin E (IgE). An antibody is a protein your body produces when it discovers a harmful substance and your immune system tries to destroy it. 

Dermatologist and associate professor of medicine, Brian S. Kim, MD has researched the connection between IgE and acutely itchy eczema. 

"Environmental allergens actually promote this type of itch. Say a patient with eczema goes to Grandma's house, where there's a cat, and that person's itching just goes crazy. It is likely cat dander is activating IgE, and IgE is activating the itch,” explains Kim.²⁵

Stress

Stress affects immune cells, immune responses, and the regulation of inflammation.²⁶

Ultimately, stress can reduce the immune system's efficiency while also elevating inflammation, making the symptoms of eczema noticeably worse.²⁶

Food reactions

Food allergies can have an impact on eczema as well. While food allergies aren’t thought to cause eczema, they can make the condition worse.²⁷

In 86% of food allergies, the skin is affected, making it a key area of focus for those with skin conditions.²⁸

Many different foods may impact individuals with eczema. Some of the most common offenders include cow's milk, eggs, wheat, and peanuts.²⁷ One way to help identify triggers is to keep a food allergy journal or use a food diary app and make notes about adverse reactions so you can avoid those ingredients in the future.

Genetics

While genetics are not the sole cause of eczema, they do play a role. If eczema runs in a person’s family, then the likelihood of developing the condition increases. For example, a 2015 twin study, found that participants had a 75% chance of inheriting eczema.²⁹

Four ways to ease eczema symptoms

In addition to following your doctor's recommendations and taking medication as prescribed, there are several ways to manage and treat eczema at home that can offer relief.

Keep your skin well-moisturized

Moisturizing twice a day can reduce the symptoms and help to prevent future flare-ups. 

Prescription creams and ointments can be beneficial for moderate to severe symptoms.

Avoid scratching

While it will be challenging not to scratch itchy skin, scratching worsens the condition. 

Gently patting the skin, applying creams and ointments, and wearing soft clothing over the affected areas can help. 

Trimming your fingernails and wearing gloves at night time to avoid scratching in your sleep can be helpful.

Stay away from allergens

Discovering what triggers your allergic response can be beneficial. 

Avoiding certain foods, not lying down on carpets or grass, and minimizing contact with animals can be especially helpful if those triggers are known to affect you.

Manage stress

While eczema is not a psychological condition, stress can make it worse. 

Figuring out what helps you manage stress effectively is crucial to keeping symptoms in check. 

This might mean trying mind-body practices like belly breathing, meditation, or speaking with a trusted counselor or friend. 

The lowdown

 If you suspect that you or someone you care for has eczema, speak to your doctor or a dermatologist for a diagnosis and specialized care. Eczema has far-reaching impacts that go beyond itchy skin. This immune disease often impacts a person’s mental health, career, education, self-esteem, sleep, and relationships. Fortunately, evolving treatment options exist, and avoiding triggers can help manage the condition and improve quality of life.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s).

Have feedback? Send an email to content@healthmatch.io.

Sources:

1. Eczema stats | National Eczema Association

2. A population-based survey of eczema prevalence in the United States (2007)

3. QuickStats: Percentage of children aged ≤17 years with eczema or any kind of skin allergy,* by selected races/ethnicities† --- National health interview survey, United States, 2000--2010 | Centers for Disease Control and Prevention

4. The rise in atopic dermatitis in young children: What is the explanation? | Allergy and Clinical Immunology (2018)

5. Guidelines of care for the management of atopic dermatitis (2015)

6. Atopic dermatitis: Global epidemiology and risk factors (2015)

7. Understanding and managing atopic dermatitis in adult patients (2012)

8. Itch characteristics in atopic dermatitis: results of a web-based questionnaire (2009)

9. Skin infections and eczema | National Eczema Society

10. Significance of skin barrier dysfunction in atopic dermatitis (2018)

11. Swiss scientists identify link between skin fungi imbalance, atopic dermatitis | National Eczema Association

12. Eczema treatment in development | National Eczema Association

13. Acute itching in eczema patients linked to environmental allergens: Newly identified pathway explains why antihistamine drugs often don't work to control severe itch | Science Daily

14. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study (2014)

15. Appearance-related bullying and skin disorders (2013)

16. The burden of atopic dermatitis: Summary of a report for the national eczema association (2017)

17. Illness perception in individuals with atopic dermatitis (2007)

18. Health care utilization, patient costs, and access to care in US adults with eczema: A population-based study (2015)

19. Emerging science and management of atopic dermatitis | Global Academy for Medical Education

20. Influence of childhood atopic dermatitis on future worklife (2005)

21. Eczema and cardiovascular risk factors in 2 US adult population studies (2015)

22. Sweat allergy (2018)

23. Atopic dermatitis: Identification and management of complicating factors (2020)

24. Eczema, atopic dermatitis and allergies: What is the connection? | National Eczema Association

25. Study: Environmental allergens linked to acute itching in eczema patients | South Asia's Leading Multimedia News Agency

26. Psychoneuroimmunology of psychological stress and atopic dermatitis: Pathophysiologic and therapeutic updates (2013)

27. Eczema; food allergies and other triggers | The Royal Children's Hospital Melbourne

28. Prevalence of common allergens among patients with atopic dermatitis in Eastern Iran (2018)

29. Twin studies of atopic dermatitis: Interpretations and applications in the filaggrin era (2015)

General sources:

• What is eczema? | National Eczema Association

Chloe Garnham is a writer exploring a broad range of topics, including healthcare, education, and technology.