The acute phase of eczema may be the first time a person notices symptoms. In this phase, itchy lesions with scaly patches can form. The next stages of eczema are typically subacute and chronic.
This article thoroughly examines acute eczema, including symptoms, causes, treatment, diagnosis, and prevention. We also consider the outlook of acute eczema and answer some frequently asked questions.
People with eczema have a dysfunction in the skin barrier, which allows water to escape from the skin more easily, leaving it susceptible to damage.
Harmful substances can penetrate dry skin more easily, making people with eczema more at risk of skin infection. Allergens and fragrances more easily irritate eczema due to an inflammatory immune response.
There are three stages of eczema:
This is the beginning phase of eczema, which doctors call atopic dermatitis, in which noticeable symptoms first appear.
This phase occurs between acute and chronic eczema, during which skin can become flaky and cracked. Itching may reduce during this phase, but this may not mean the condition is healing or receding.
The condition may revert to acute, stay subacute, or progress to chronic. People should consult a dermatologist to determine the phase of their symptoms.
Chronic or severe eczema
A 2021 study found that
In chronic eczema, itching can intensify, and lesions may spread to cover larger areas of the skin. The skin may result in:
- thickening and cracks in the skin
- scaling being more prominent
Symptoms may be mild during the acute phase and gradually worsen into the subacute and chronic phases.
The symptoms of any phase of eczema can vary from person to person and differ according to:
- a person’s age
- skin care routine
- type of eczema
Eczema symptoms almost always include itching skin, called pruritus, which can range from mild to severe.
A person can also have all or a few of the following symptoms:
- dry skin
- inflamed and discolored skin
- oozing, weeping, and crusting
- thick, leathery, rough skin
- scaly patches
The rash can appear red on lighter skin, while in darker skin tones, the lesions may appear purple, gray, or brown and include dry, scaly patches.
Learn more about eczema on skin of color.
Age and symptoms
Where the rash appears on the body
- Infants: Red, dry, scaly patches on the face, especially the cheeks, and widely distributed across the body.
- Toddlers and young children: The rash may become more localized and typically occurs on the:
- School-aged children and adults: Flexural surfaces, where joints crease, especially the backs of the knees and inner elbows.
There are several potential reasons why eczema may occur.
A potential cause of eczema involves a genetic component. People with a deficiency of a protein called filaggrin, which helps the skin maintain moisture, can experience dry, itchy skin.
The immune system may also react with an inflammatory response when an environmental irritant or allergen triggers it, which can cause a flare-up on the skin’s surface.
The potential environmental triggers of eczema include:
- certain types of fabric in clothing or bedding, such as polyester and wool
- exposure to extreme temperatures and dry air
- laundry detergents and fabric softeners
- some beauty, cleansing, and skin products, such as:
- body wash
- bubble bath
- metals such as nickel, especially in jewelry
- household cleaners and disinfectants
- emotional stress
A person can avoid allergens and irritants that may trigger eczema flare-ups as much as possible. This can help prevent eczema from worsening or progressing to further stages.
Treatment may depend on the type and severity of a person’s eczema, as well as their age and medical history. These may include:
- topical steroids to reduce acute inflammation
- emollients, which moisturize and hydrate dry skin
- topical anti-inflammatory agents
- JAK inhibitors such as ruxolitinib, which also suppress the immune system
- calcineurin inhibitors, such as tacrolimus and pimecrolimus, suppress the immune system
- antibiotics to help treat infection, which has proceeded to the acute phase
- antihistamines to suppress acute itching
- biologic medications, which may reduce inflammation
- immunosuppressive medications to modify the immune response
A dermatologist may use ultraviolet B and psoralens UVA light waves in light therapy to treat affected areas. This treatment may only apply to people with eczema that has advanced to more chronic stages.
Regular moisturizing with gentle products can help heal and hydrate skin in the acute phase. A person may also benefit from oatmeal baths in lukewarm water, which can alleviate itching. Read more about home remedies for eczema.
Taking probiotics may also positively affect the microbiome, which can help reduce inflammation, although more research is necessary to determine their effect on eczema.
A doctor or dermatologist can diagnose eczema after a physical examination and questions about a person’s medical history.
If eczema is at the acute stages, symptoms will have begun to appear but may not be as advanced. Doctors can conduct testing which can involve:
- patch testing to identify potential allergens
- skin swabs to test for infection
- skin scraping to exclude fungal infection
- skin biopsy to exclude other conditions
- blood tests
Frequent moisturizing can help prevent eczema flare-ups during the acute phase and avoid potential triggers as much as possible.
People can also adopt the following measures when bathing:
- limit the frequency and length of showers or baths
- wash only in lukewarm water
- pat themselves dry after washing instead of rubbing
The following section answers some common questions about eczema.
Is eczema contagious?
Eczema is not contagious at any phase. However, if eczema becomes infected, this infection could transmit to other people. A person should receive prompt treatment for eczema to avoid causing damage from itching.
What does the pain feel like?
Eczema typically causes intense itching rather than pain. However, dry skin and scratching can cause stinging, burning pain, especially if a person scratches wounds into the skin.
How do people move through the stages of eczema?
As skin lesions from acute eczema heal, they may become subacute.
Eczema does not always, or even typically, progress from acute to subacute to chronic in order. The condition can revert to acute, remain subacute, or may progress to chronic and become long lasting.
What doctors will a person speak to discuss eczema?
A dermatologist, a doctor specializing in skin conditions, is best suited to discuss eczema. However, a person can speak with their regular doctor, who may refer them to a dermatologist.
Acute eczema is usually the phase in which a person first notices signs and symptoms of the condition. These typically include an itchy rash.
Eczema may progress into the subacute phase, during which itching may become less intense. Alternatively, eczema may advance into the chronic phase, which is long lasting and can produce more severe symptoms.
A person should see a dermatologist if they suspect they have eczema. Various treatments may help alleviate symptoms, including topical, oral medication, and light therapy.