Eczema Symptoms: Identification and Understanding

Itching or Pruritus

The most common symptom of eczema is itching (or pruritus). These sensations of skin inflammation, of varying severity, are often more intense during the night. Repeated scratching due to itching can worsen skin lesions and increase the risk of infections.

Eczema Skin Lesions

Eczema typically presents with characteristic skin lesions, including: 
- Inflammation with reddened skin patches. 
- These often swollen patches have a rough surface topped with small, fluid-filled bumps (vesicles). 
- These vesicles ooze upon bursting spontaneously and form crusts as they dry.

Xerosis or Dry Skin

In eczema, the skin loses its natural hydration, leading to dry skin with a rough texture, flakiness, and sensations of tightness.

Symptoms in Infants¹ ² ³ ⁴

Symptoms of infant eczema are characterized by dry, swollen patches, redness, and vesicles (small, fluid-filled bumps). These vesicles on the surface of the patches burst, leading to oozing, which then forms crusts as it dries. 
In babies, lesions of atopic dermatitis are symmetrical and typically found on the face (cheeks, forehead, chin, sparing the nose), neck folds, ear folds, scalp, and extensor surfaces of joints (wrists, elbows, ankles, knees). The diaper area is rarely affected but is sensitive to other types of eczema (irritative contact dermatitis, seborrheic dermatitis). 
Infant itching may manifest as sleep disturbances, restlessness, and rubbing of cheeks against bed sheets.
 

Symptoms of Eczema in Children¹ ² ³

As they grow, lesions become more localized, less weepy, and drier. The itching is often very intense, putting children at risk of scratching lesions and local infectious complications. 
Symptoms are less marked on the face as much and tend to be more intense on the flexural folds (anterior face of the elbows, posterior face of the knees). The lower eyelids are often darker and thickened with notable folds (Dennie-Morgan sign). Lesions may also affect the area around the mouth.

Eczema Manifestations in Adults² ³ ⁵

In adults, chronic lesions become thick with pronounced skin markings (lichenification) and typically predominate on the hands. They are also found on the insides of the elbows and the popliteal fossa (behind the knees). 
As atopic eczema is a chronic disease alternating between flare-ups and remissions, it can impair quality of life and have a significant psychological impact on adults, including sleep disturbances and symptoms of anxiety or depression.

 

Viral Infections¹ ² ³

The herpes virus can cause a severe infection during dermatitis flare-ups. Eczema herpeticum is characterized by widespread vesicles, fever, and fatigue. It can lead to severe complications such as keratoconjunctivitis (eye infection), meningitis, or encephalitis (brain infection). For this reason, any child with eczema should avoid close contact with someone who has a "cold sore." 
Eczema coxsackie is a hand-foot-mouth disease related to the coxsackievirus A16 occurring in children with atopic dermatitis. It is characterized by widespread vesicles and abrasions in areas affected by atopic dermatitis, possibly with general symptoms such as fever, loss of appetite, and fatigue.

Contact Dermatitis¹

Individuals with atopic dermatitis are more likely to develop contact eczema in reaction to certain irritants and allergens, such as fragrances, preservatives, or certain metals.

Chronic Hand Eczema ⁶

Individuals with contact dermatitis who frequently use water and irritative/allergising products can develop chronic hand eczema.