Eczema (Atopic Dermatitis): Symptoms, Triggers, and New Treatments

Your skin is red, dry, and itchy - sometimes unbearably so. You scratch, which makes it worse. You try lotion after lotion. Some days are okay, and then suddenly you're in the middle of a flare-up that makes you want to crawl out of your skin.

If this sounds familiar, you're likely dealing with eczema, also called atopic dermatitis. One in 10 people will develop it at some point in their lifetime. It's chronic, frustrating, and can seriously impact quality of life.

The good news? We understand eczema way better than we used to, and treatment options have exploded in the past few years. The FDA approved four new eczema treatments in 2024 alone, with more coming in 2025.

Let's break down what's happening with your skin and what you can actually do about it.

What It Feels Like

Eczema symptoms vary by severity, but the consistent theme is inflammation and that maddening itch:

The itch: This isn't normal dry skin itching. It's intense, persistent, and hard to ignore. It's worse at night when you're trying to sleep. The urge to scratch is overwhelming, but scratching makes everything worse - it damages skin, increases inflammation, and can lead to infection.

The appearance: Patches of dry, discolored skin (red on light skin, darker brown or purple on darker skin). The skin might be rough, scaly, or thickened from repeated scratching. During bad flare-ups, the rash might "weep" - oozing clear fluid and forming crusts.

Common locations:

• Hands and feet
• Inside elbows and behind knees
• Face and scalp (especially in children)
• Neck
• Wrists and ankles

The cycle: Eczema follows a pattern - good days or weeks, then flare-ups triggered by something (or seemingly nothing). The unpredictability is its own kind of stress.

Beyond physical symptoms, eczema affects mental health. Studies show 28-55% of people with eczema experience depression. The constant itching disrupts sleep, the visible rash affects confidence, and the chronic nature is exhausting.

Common Causes and Triggers

Eczema isn't caused by one thing - it's a complex interaction between genetics, immune system dysfunction, and environmental factors.

Genetics and Immune System

If you have eczema, your skin barrier doesn't work right. Genetic mutations (particularly in the filaggrin gene) disrupt the outer layer of skin, making it harder to keep moisture in and irritants out.

Your immune system is also overreactive, responding to normal substances as if they're threats. This immune dysregulation causes the inflammation that makes skin red, swollen, and itchy.

Family history matters: If one parent has eczema, asthma, or hay fever, there's a 50% chance their child will develop eczema. If both parents have these conditions, the chance jumps to 80%.

Common Triggers

Knowing what sets off your eczema helps you avoid flare-ups:

Irritants:

• Harsh soaps and detergents
• Fragrances and dyes in products
• Rough fabrics (wool, synthetic materials)
• Disinfectants and cleaning products
• Chlorine in pools
• Cigarette smoke

Allergens:

• Dust mites
• Pet dander
• Pollen
• Mold
• Certain foods (eggs, dairy, nuts - mostly in children)

Environmental factors:

• Dry air (especially winter heating)
• Hot, humid weather
• Sweating
• Sudden temperature changes

Stress and hormones:

• Emotional stress triggers immune responses
• Hormonal changes (menstrual cycle, pregnancy)

Other triggers:

• Bacterial or viral skin infections
• Scratching (creates vicious cycle)
• Certain fabrics touching skin
• Not moisturizing enough

When to See a Doctor

See a dermatologist if:

• Your symptoms aren't improving with OTC treatments after 2-3 weeks
• The rash is widespread or very severe
• It's significantly disrupting sleep or daily life
• You notice signs of infection (increased redness, warmth, pus, fever)
• You're unsure if it's actually eczema (many skin conditions look similar)
• You need help identifying triggers

Treatment and Management

There's no cure for eczema, but plenty of ways to control it. Treatment focuses on repairing the skin barrier, reducing inflammation, and preventing flare-ups.

First-Line Basics (Start Here)

Moisturize religiously: This is non-negotiable. Apply thick, fragrance-free moisturizer (creams or ointments, not lotions) multiple times daily, especially right after bathing while skin is damp.

• Look for ceramides, hyaluronic acid, or colloidal oatmeal
• Avoid products with fragrances or dyes
• Thicker is generally better (ointments > creams > lotions)

Gentle bathing:

• Use lukewarm (not hot) water
• Limit baths/showers to 10-15 minutes
• Use soap-free, fragrance-free cleansers
• Pat dry, don't rub
• Apply moisturizer within 3 minutes of getting out

Avoid triggers: Once you identify your triggers, avoid them as much as possible. This might mean switching products, changing laundry detergent, using a humidifier, or managing stress differently.

Over-the-Counter Treatments

Hydrocortisone cream (0.5-1%):

• Mild topical corticosteroid for itch and inflammation
• Use for short-term flare-ups
• Don't use on face or thin skin without doctor approval

Colloidal oatmeal products:

• Soothing for itchy, irritated skin
• Available as creams or bath treatments

Antihistamines:

• Can help with itching, especially at night
• Diphenhydramine (Benadryl) or cetirizine (Zyrtec)
• Sedating types help with sleep disruption

Prescription Treatments

Topical corticosteroids: First-line treatment for flare-ups. Stronger than OTC options, with different strengths for different body areas. Use as prescribed - too much can thin skin, but they're safe when used correctly.

Topical calcineurin inhibitors:

• Tacrolimus (Protopic) and pimecrolimus (Elidel)
• Non-steroid options for face and sensitive areas
• Good for long-term use without skin thinning

PDE4 inhibitors (NEW in 2024):

• Zoryve (roflumilast cream 0.15%) approved July 2024
• For mild to moderate eczema in adults and kids 6+
• Non-steroid anti-inflammatory option

Topical JAK inhibitors (NEW in 2024):

• Vtama (tapinarof cream 1%) approved December 2024
• For adults and children 2+
• Works by blocking inflammatory pathways

Injectable Biologics (Moderate to Severe Eczema)

Dupilumab (Dupixent):

• Injectable given every two weeks
• Approved for people 6 months and older
• Controls inflammatory response at immune system level
• Game-changer for severe eczema that hasn't responded to other treatments

Lebrikizumab (Ebglyss) - NEW September 2024:

• For moderate-to-severe eczema
• Adults and children 12+
• Another biologic option for severe cases

Oral Medications

Oral corticosteroids:

• Short-term use for severe flare-ups
• Not for long-term due to side effects

Immunosuppressants:

• Cyclosporine, methotrexate, azathioprine
• For severe eczema not controlled by other treatments
• Require monitoring for side effects

Oral JAK inhibitors:

• Newer option for severe eczema
• Pills instead of injections

Light Therapy (Phototherapy)

UV light therapy can help when topical treatments aren't enough. Usually involves 2-3 sessions per week at a dermatology office. Takes weeks to see results but can be very effective.

Emerging Treatments (2025 and Beyond)

The NIAID is launching clinical trials in 2025 to test bacteria found on healthy skin as a topical therapy for eczema. The idea is to restore the skin's natural microbiome to improve barrier function.

Prevention and Long-Term Management

You can't prevent eczema if you're genetically prone, but you can reduce flare-up frequency and severity:

Identify and avoid triggers: Keep a diary of flare-ups and potential triggers. Common culprits are certain foods, environmental allergens, stress, and product ingredients.

Maintain skin barrier:

• Moisturize before skin gets dry (preventive, not just reactive)
• Protect hands when doing dishes or cleaning
• Wear soft, breathable fabrics (cotton is usually best)
• Dress in layers to avoid overheating and sweating

Manage stress: Easier said than done, but stress is a major trigger. Exercise, meditation, therapy, or whatever helps you decompress.

Watch for infections: Eczema-damaged skin is vulnerable to bacterial and viral infections. Keep an eye out for spreading redness, increased pain, or pus.

Humidity control:

• Use a humidifier in dry winter months
• Keep bedroom cool and humid for better sleep
• Air conditioning in summer to prevent sweat triggers

Living with Eczema

Eczema is a marathon, not a sprint. Some people grow out of it (more common in childhood eczema), but many deal with it lifelong.

The key is finding a management routine that works for you - the right combination of moisturizers, prescription treatments, trigger avoidance, and lifestyle adjustments.

Don't minimize the mental health impact. If eczema is affecting your quality of life, talk to your doctor about both the physical symptoms and the emotional toll. Treatment should address both.

The Bottom Line

Eczema is chronic, but it's also very manageable with the right approach. The explosion of new treatments in 2024-2025 means more options than ever before.

If OTC treatments aren't cutting it, see a dermatologist. Moderate to severe eczema responds to prescription treatments, and there's no reason to suffer when solutions exist.

Be patient with the process. It often takes trial and error to find what works for your specific triggers and skin. But with consistency and the right treatment plan, you can get flare-ups under control and get back to not thinking about your skin 24/7.

References

1. Mayo Clinic - Atopic dermatitis (eczema): Diagnosis and treatment
2. Cleveland Clinic - Atopic Dermatitis: Symptoms, Causes & Treatment
3. National Eczema Association - 2024 Eczema Treatment Roundup
4. NIAID - Eczema Treatment Research (2025 clinical trials)
5. AAD - Eczema types: Atopic dermatitis diagnosis and treatment
6. AAFP - Atopic Dermatitis: Diagnosis and Treatment