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Eczema is a common skin condition that results in red, itchy and inflamed skin. The terms eczema and dermatitis are often used interchangeably to describe the same condition so you may see both words being used when you’re researching the topic.
There are various different types of eczema and understanding which one you have can be helpful in managing and treating your skin. It is possible to have more than one type of eczema at a time.
Here we discuss how to recognise each type of eczema, the symptoms, triggers and how it can be caused. We also discuss the basics of treating eczema, but for more on this topic see our page dedicated to eczema treatment.
Contact eczema, also commonly known as contact dermatitis, is caused by coming into contact with something that you’re sensitive to. There are two main types of contact dermatitis - irritant contact dermatitis and allergic contact dermatitis.
Irritant Contact Dermatitis Irritant
Contact Dermatitis s triggered by an irritant touching the skin directly and usually frequently. It’s often associated with repeated use of something, for example if you work as a cleaner, hairdresser, construction worker or in the healthcare industry.
Irritants include soaps, chemicals, solvents, resins, metals or even repeated and excessive contact with water. It can also be caused by exposure to harsh environmental conditions such as cold winds.
Irritant contact dermatitis most commonly affects the hands and face and causes the following symptoms:
- Painful ‘burn-like’ redness
- Fluid filled ulcers
Allergic Contact Dermatitis
Allergic Contact Dermatitis is less common and is triggered by an internal allergic response within the immune system to something touching the skin. Allergic responses tend to build up over time, and something that you used to be able to tolerate could become an allergic trigger with repeated use. The reaction can be instant or delayed.
Allergens include nickel (found in jewellery and watches), perfumes and certain ingredients used as preservatives in skincare products and hair dyes.
Allergic contact dermatitis is most commonly seen on the hands and causes the following symptoms:
- Painful stinging
- Split or cracked skin
- Fluid filled blisters
- Avoiding the trigger irritant or allergen will help to control contact dermatitis.
Atopic means to have a family history of a condition and therefore a genetic predisposition to develop the condition. Atopic eczema or atopic dermatitis is a type of skin condition that can run in families. That said, it isn’t guaranteed that you’ll have it if a family member does, and it can skip whole generations.
Atopic eczema is the most common type of eczema and is normally a long term condition. It usually develops in infants, meaning that it can continue to affect an individual at various points in their lives. Some people however do ‘grow out’ of their atopic eczema.
This type of eczema is triggered by a combination of genetic factors, dry skin and an immune response to an environmental irritant such as soaps or perfumes or an allergen such as pollen, animal fur or house dust mite droppings. Excessive sweating and wearing woollen clothing can also be a trigger. It usually develops alongside hay fever and asthma.
Atopic eczema causes the following symptoms:
It can affect any part of the body but most commonly the hands, insides of the elbows, behind the knees, behind the ears, face and scalp. It can be so severe that it can cause cracking behind the ears and on the insides of the elbows and other creases.
Resisting the urge to scratch the skin affected by flare ups will help to prevent symptoms getting worse.
Follicular eczema is a type of atopic eczema that affects the hair follicles all over the body. Like atopic eczema, follicular eczema often runs in families and can begin in infancy. It’s caused by the same triggers as atopic eczema – irritants and allergens that the skin cannot cope with.
It causes the following symptoms:
Clean flannels soaked in warm water and applied to the affected areas can help to soothe the symptoms.
Seborrheic dermatitis, or seborrheic eczema, usually occurs on areas of skin that naturally have a higher concentration of sebaceous glands. Sebaceous glands produce a substance called sebum, which is a natural, wax like skin oil that keeps it hydrated.
It’s as yet unclear what cases seborrheic dermatitis but doctors think that our genetics and hormones play a role. It isn’t caused by external irritants or allergens but can be triggered by inflammation caused by an overgrowth of a yeast that naturally lives on the skin.
Seborrheic dermatitis affects oily areas of skin such as that on the scalp, nose, ears, chest and upper back, more commonly in men than women. In babies it’s known as cradle cap when it affects their scalps.
- This type of dermatitis causes the following symptoms:
- Flaking skin Dandruff (if on the scalp)
Seborrheic dermatitis is difficult to treat but anti-fungal creams available on prescription from your GP can help to keep the itching and flaking at bay. Medicated shampoos containing ketoconazole, coal tar or zinc can also help if your scalp is affected.
Varicose eczema usually affects the skin of the lower legs, most commonly in those who also have varicose veins. It’s a long term condition that can come and go and is also known as venous eczema.
This type of eczema, whilst caused by having varicose veins, can be triggered by long periods of standing that leads to the swelling of the legs and a flare up of the itching, redness and other symptoms associated with varicose eczema.
Varicose eczema causes the following symptoms:
Some people with varicose eczema can also develop discoloured or hardened skin or small white scars called atrophie blanche. If you’re suffering with varicose eczema, particularly if your skin has patches of brown discolouration or scarring, seek help from your GP. If left untreated, you could develop painful leg ulcers.
Varicose eczema can also be triggered by an immune response to fluid leaking from the varicosed veins in the legs, so it’s important to keep moving and not sit still for too long. Raising your legs when resting will also help.
You may also need to be referred to a vascular, or vein, specialist if your varicose veins are causing you a lot of discomfort.
Pompholyx (Dyshidrotic Eczema)
Pompholyx, also referred to as dyshidrotic eczema, usually affects adults under the age of 40. It’s more common in women than in men.
It affects the fingers and palms of the hands and less commonly, the toes and soles of the feet. When it affects the hands, it’s also sometimes called vesicular palmoplantar eczema. Pompholyx can clear up on its own after a few weeks, and generally causes the following symptoms, usually in the following order:
Burning Multiple, small blisters
Larger, weeping blisters that spread to the limbs
Infected skin with pus and golden crusting
Drying, cracking and peeling as the skin begins to heal
Doctors cannot be sure what causes dyshidrotic eczema but they think it could flare up due to fungal infections, skin irritants and allergens including soap, perfumes and nickel plated jewellery, stress and profuse sweating.
If your dyshidrotic eczema doesn’t clear up on its own, or keeps flaring up, your GP can help.
Most common in adults over 60 years old, asteatotic eczema is also known as eczema cracquelée. This kind of eczema is characterised by a painful cracking of the skin that looks like crazy paving.
Asteatotic eczema mainly affects the skin on the shins but can also develop on the thighs, lower back and upper arms. Doctors are unsure what causes asteatotic eczema but they think it’s triggered by a reduction of the natural oils that hydrate the skin.
Vigorous scrubbing of the skin during showering or towel drying, hot baths and naturally having dry, rough skin can also trigger flare ups.
This kind of eczema causes the following symptoms:
- ‘Crazy paving’ looking skin
- Severe dryness
- Bright pink or red grooves in the skin
Keeping the skin moisturised by using a strong emollient cream, avoiding hot baths and treating your skin gently in the shower and whilst drying will all help to reduce flare ups.