Flexural eczema is a term dermatologists use to refer to atopic dermatitis that develops in the flexural areas of the body. These areas include the backs of the knees, the inner elbows, and the wrists. The condition usually develops during late childhood and young adulthood.

Atopic dermatitis is the most common type of eczema, affecting approximately 16.5 million adults in the United States.

This article reviews what flexural eczema is. It also covers its symptoms, causes, and treatment options.

Eczema refers to a group of skin conditions that result in patches of skin that are itchy, inflamed, cracked, and sore.

Flexural eczema refers to the location of a person’s eczema. A skin flexure refers to the sites on the body where the skin comes into contact across a bend or fold.

When a person has flexural eczema, rashes appear around the joints and creases in the skin. It most commonly occurs around the inner elbows and behind the knees but can also appear in other areas, such as the wrists and ankles.

A 2016 systematic review and meta-analysis states that flexural eczema is a classic presentation of atopic dermatitis in late childhood to adulthood.

However, the American Academy of Dermatology Association (AAD) notes that atopic dermatitis rashes that appear when a person is between 2 years of age and puberty often begin in the creases of the knees and elbows.

Other common places include the neck and the crease between the buttocks and the legs.

Eczema causes dry, itchy skin and a rash.

About 85% of people with atopic dermatitis report itchy skin as the most common symptom. Other symptoms can include:

The cause of eczema can depend on multiple factors, including genetics and environmental triggers.

Decreased barrier function

The AAD states that some genes affect the epidermal barrier. This is the outer layer of the skin that prevents germs from entering the skin and helps keep it from losing too much water.

Changes in some genes can increase a person’s risk of developing atopic dermatitis. In particular, changes to the FLG gene have strong associations with atopic dermatitis.

This gene is responsible for coding filaggrin, a protein that helps create the protective barrier between the skin and the environment.

Those with eczema also have lower levels of ceramides, a type of lipid present in the skin with a role in barrier function and water loss prevention.

A decrease in the epidermal barrier’s function allows allergens and irritants to enter the skin, resulting in inflammation.

Environmental triggers

People with eczema also have an overactive immune system. This means the immune system overreacts to stimuli such as pollen and pollution, which can result in flare-ups.

Atopic dermatitis has associations with other conditions associated with the immune system, such as hay fever, asthma, and food allergies.

Other triggers may include:

  • chemicals in the home or environment
  • detergents, fabrics, or other substances that come in contact with the skin
  • dry skin
  • stress

Learn more about eczema triggers here.

People can work with a dermatologist to create a treatment plan, which will most likely include the following:

It is important that a person follows the doctor’s instructions and lets them know if the medication does not appear to be working.

A person should attend regular appointments with a doctor or pediatrician so they can review any new symptoms or changes, identify triggers, or adjust medications based on needs.

Although a person may be unable to prevent flexural eczema from developing, they can take steps to help relieve discomfort.

These may include:

  • bathing for 5–10 minutes in lukewarm water each day to help moisturize the skin
  • applying a moisturizer, such as petroleum jelly, within 5 minutes of bathing or showering to keep the skin hydrated
  • using skin care products that are fragrance- and preservative-free to avoid flare-ups
  • testing skin care products on a small patch of skin before using them
  • wearing loose-fitting clothing consisting of 100% cotton to help the skin breathe

People may also wish to take antihistamines and keep a journal to help identify potential triggers.

To receive a diagnosis of eczema, a person may need to see a dermatologist.

Dermatologists can often diagnose the condition after reviewing a person’s medical history and family history and examining their skin.

If they cannot make a diagnosis on examination alone, they may order a skin biopsy. A biopsy can help identify eczema and allow the dermatologist to determine the best course of treatment.

If eczema appears on the joints or in skin creases, a doctor will likely diagnose flexural eczema.

The outlook for people with flexural eczema is generally positive. With regular treatment, they can typically find relief from symptoms and prevent the condition from getting worse.

Knowing triggers and making changes at home, such as avoiding scented products, can help decrease the frequency of flare-ups.

A person can treat any flare-ups immediately using topical medications.

A dermatologist can guide treatment and recommend changes if a person’s eczema does not improve.

For more in-depth resources on eczema treatment and management, visit our dedicated hub.

A person should contact a doctor if they develop symptoms of eczema, particularly if symptoms affect their daily lives or disrupt their sleep.

Treatment can help reduce the symptoms of eczema and prevent flares.

Scratching an eczema rash can result in a bacterial infection. A person should contact a doctor if they notice any signs of infection.

Flexural eczema is an itchy skin rash that develops around the joints or creases in the body, such as behind the knees and the inner elbows.

Management of flexural eczema typically consists of using topical ointments and creams, systemic medication, and lifestyle changes. Lifestyle changes may include avoiding triggers and applying moisturizers, among others.