According to the National Eczema Association (NEA), around 31.6 million people in the United States – approximately 10% of the population – have some form of eczema. As an umbrella term, ‘eczema’ refers to a group of inflammatory skin conditions that can cause dry skin, itchiness, scaly patches, rashes, blisters and, in some cases, skin infections. While eczema can cause the immune system to overreact, it is not classified as an autoimmune disease.
There are seven main types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, neurodermatitis, nummular eczema, seborrheic dermatitis and stasis dermatitis. The most common type of eczema is atopic dermatitis. The NEA reports an estimated 16.5 million U.S. adults have atopic dermatitis, with 6.6 million having a moderate to severe case of the disease.
Weyman Lam, M.D., an allergist and immunologist with Warren Clinic Allergy and Immunology in Tulsa, explains that atopic dermatitis is a complex disorder involving gene mutations impairing the skin barrier, reducing the skin’s ability to protect itself.
“While environmental factors such as allergens can cause a flare-up or outbreak, due to the skin barrier dysfunction with atopic dermatitis, almost anything can serve as a trigger, such as stress or a person’s sweat,” says Lam. “However, with contact dermatitis, most flare-ups are directly related to specific triggers, like certain soaps or moisturizers, or exposure to metals or chemicals. For example, someone may wear a metal wristwatch and then develop a rash on their wrist.”
Atopic dermatitis is also part of the ‘atopic march’– this describes the common progression of allergic diseases in individuals. A person may develop eczema in infancy and/or early childhood and then as they grow older, develop food allergies, allergic rhinitis (hay fever) and asthma.
Regarding treatment, Lam says topical steroids are a reasonable and common first step when the disease is minor. However, if a patient is noticing that they’re using their medication almost daily and/or more than half the month, then the treatment isn’t adequately controlling their condition.
“We don’t want patients to use topical steroids for prolonged periods of time because there can be significant adverse effects, such as skin atrophy, telangiectasia and adrenal suppression if using a high potency steroid,” he says. “Instead, we want to try and switch them to a topical non-steroidal or biologic. Today, there are several great treatment options that are very safe and effective.”
Most recently in 2024, the Food and Drug Administration (FDA) approved four new treatments for eczema – two topical non-steroidal creams and two biologics – and research continues on additional new therapies.
For those living with the daily discomforts of eczema, the NEA offers these recommendations for managing the disease: know your triggers; implement a regular bathing and moisturizing routine; use over-the-counter and/or prescription medications consistently and as prescribed; and watch for signs of skin infection such as pus-filled bumps, pain, redness and/or heat.
Lam says a simple product like vaseline is an effective ointment to treat mild eczema as it helps moisturize and protect the skin – and in general, patients should try to use fragrance-free products and avoid triggers, when possible. He also shares the reminder that there’s no way to ‘avoid your way to a cure.’ Despite a person’s best efforts, there can still be unexpected flare-ups and prescription treatment may be needed.
