Adult Eczema Explained
Eczema is a skin disease that causes an itchy rash. It’s typically associated with children but can affect adults too. When eczema flares up in adulthood, it may affect people who had eczema as children or those who have never had it before. Adult eczema is prevalent, with one in four adults reporting their initial onset of symptoms after age 18.
What is Adult Eczema?
Adult eczema is a chronic, inflammatory skin condition that results in dry, inflamed, and itchy patches of skin. It affects the skin a bit differently than childhood eczema, targeting different areas.
Eczema may come and go over time, worsening when the affected person experiences a flare-up. These incidents are triggers, such as allergies or exposure to irritants. Most children outgrow eczema, but for adults who continue to have the condition or develop it in adulthood, it can be a serious issue. The peak time for developing adult-onset atopic dermatitis is in your 50s, however, it is uncommon for the condition to develop after age 60.
Adults may develop different types of eczema, and the type depends on the cause, shape, and location. Types of adult eczema include:
- Atopic dermatitis (AD): the most common type of eczema, usually affecting adults on the hands, inside of elbows, backs of knees, and the face or scalp.
- Contact dermatitis: stems from irritants touching the skin with direct or prolonged contact.
- Hand eczema: affects only the hands and is related to AD.
- Nummular: irritated areas are in coin size patches typically on the arms, legs, or chest. This type is related to AD and sometimes contact dermatitis.
- Asteatotic: causes dry skin which produces fine cracks. This type commonly occurs in the elderly during winter months or in low humidity environments.
- Statis dermatitis: found on the calves, ankles, and feet in those with poorly functioning veins in their lower legs.
- Seborrheic dermatitis: a greasy rash that appears as dandruff on adults. This type typically affects the face, neck, nose, and scalp line.
Adult Eczema Symptoms
Symptoms for adult eczema depend on the type and severity of the condition. Each person experiences adult eczema differently and symptoms may come and go or change. Symptoms that may appear, include:
- Extremely dry and scaly skin
- Skin that cracks and bleeds from dryness
- Patches of skin that are thick, leathery, or scaly
- Affected areas may be the hands, feet, backs of knees, crooks of elbows, back of the neck, face, around the eyes
- Color changes where patches are darker or lighter than the surrounding skin
- Intense or constant itchiness
- Sleep loss from itchiness
- Feeling anxious and/or depressed
- Skin infections in severe cases
- Symptoms that worsen with exposure to triggers or allergens
The exact cause of adult eczema is unknown, but researchers believe that most types of adult eczema stem from a combination of genes and triggers.
Some people with eczema have a mutation to the gene that creates filaggrin, a protein that helps maintain a protective barrier on the top layer of skin. Lack of filaggrin enables moisture to escape the skin and bacteria and viruses to enter. Research also shows that those with eczema usually have an overactive immune system. When presented with an external trigger, the immune system responds with inflammation.
Triggers, irritants, or allergens may prompt flareups, or amplify existing symptoms. These triggers may include weather changes, rough fabrics, certain cleaning products, fragrances, skincare products, and more.
Prevention Methods and Home Remedies
Adult eczema is not contagious, and the underlying cause is unknown; the best course of action is to avoid triggers and flareups. Here are some things you can try to prevent a flareup or treat symptoms at home:
- Drink more water
- Wear cool, smooth-textured clothing and avoid irritating fabrics and clothes that are too tight, rough, or scratchy
- Avoid harsh cleansers
- Avoid known triggers such as certain foods, cosmetics, soaps, allergens, climates, etc.
- Wear gloves in cold weather
- Use mild soap and moisturizer
- Use a humidifier
- Take a warm (not hot) bath with oatmeal or baking soda
- Protect skin with bandages to prevent scratching
- Treat stress and anxiety, as emotional turbulence can worsen symptoms
- Use bedding made of cotton and avoid stiff synthetics like polyester
Treatment Options for Adult Eczema
Adult eczema rarely has a one size fits all treatment. Depending on your specific needs and condition, you may need to try a few different treatments before finding one that controls your symptoms. Symptoms are treatable, however, even the most successful treatments are prone to occasional flareups.
Milder cases of eczema may be treated with over-the-counter petroleum jelly or moisturizers. These products should be applied daily, even during times where the skin seems fine.
For more advanced cases, prescription creams, like corticosteroid cream or topical ointments help control itching and repair skin. For medicated creams, use as directed and be sure not to overuse. Doctors may also prescribe antibiotic cream to fight infection for areas of open skin.
Oral drugs, such as corticosteroids like prednisone, may be prescribed for severe cases of adult eczema to control inflammation. These drugs are highly effective, but they should not be used long term. Oral antibiotics can also help fight infection if it presents.
A newer injectable biologic, dupilumab, treats severe cases of adult eczema that have not responded to other types of treatment.
Used in conjunction with topical corticosteroids, the affected areas are wrapped with wet bandages.
Light Therapy (Phototherapy)
Controlled amounts of natural or artificial sunlight are used on the skin to suppress overactive skin immune system cells.
Some techniques, such as behavior modification and biofeedback, may help habitual scratchers gain better control.
The itchiness and patchy dry skin of adult eczema can be managed with diligent care. Flare-ups may happen from time to time, but with prevention, home remedies, and medical treatments, living with adult eczema becomes easier.