The 3 Stages of Eczema

Different Stages, Different Treatment

Acute Phase of Eczema. Photo © Heather L. Brannon, MD

Eczema is a term that's often used to describe skin conditions, but it can be confusing because it's often used incorrectly. As research progresses, scientists are learning more and more about what actually causes eczema. This has led researchers to split eczema into two group: atopic and non-atopic. Whether or not it is atopic or non-atopic depends on whether certain parts of the immune system are overactive.

There are a few subtle differences between the appearance of atopic and non-atopic eczema, but they generally look the same depending on how long the rash has been present. Both types of rashes can cycle through the three different stages of eczema the longer they persist.

The different stages of eczema play heavily into treatment. Certain treatments work better during different stages of a rash. The three stages of eczema are the acute stage, the subacute ​stage and the chronic stage. All three stages respond well to topical steroids and antihistamines like Benadryl and Zyrtec. If bacteria have invaded the skin during any stage, an oral antibiotic such as cephalexin or dicloxacillin is useful.

Acute Stage

"Acute" refers to the fact that the rash has just started. Some characteristics of acute eczema include:

  • Blisters
  • Extreme redness
  • Intense itching
  • Pain
  • Tenderness
  • Swelling
  • Heat

An over the counter hydrocortisone cream or antihistamine can be used to suppress the immune system.

Antibiotics can be prescribed to reduce inflammation and treat infection. Eczema tends to be very intense during this initial phase, and in some cases, steroids are used. Additionally, cold, wet compresses can help soothe symptoms.

Subacute Stage

The subacute stage is the transitional phase between the acute stage and chronic stages.

The eczema rash evolves and takes on these new characteristics:

  • Flaky, scaly skin
  • Less redness
  • Cracks in the skin
  • Itching, burning and/or stinging

Symptoms are still present during the subacute stage, but they are much less intense than the acute stage. Moisturizers can be used to hydrate dry, flaky skin, coal tar can be used to relieve itching and antihistamines can be used to reduce inflammation.

Chronic Stage

Eczema doesn't spend a certain amount of time in the subacute stage. Each case of eczema transitions from stage to stage differently. The chronic stage refers to eczema flares that last 3 or more months. Chronic eczema is quite different from the other two stages in the following ways:

  • Thickened, leathery-looking skin, or lichenification
  • Accentuated skin lines
  • Cracks in the skin
  • Skin appears dark and dull
  • Larger areas of skin breakdown called excoriations
  • Itching

Symptoms are at their most severe during the chronic stage, thusly affecting the course of treatment. If commonly used over the counter products cannot ease symptoms, prescription topical steroids can be used.

They are often more effective when covered with a barrier such as plastic wrap. Moisturizers are also very helpful during this stage.

Eczema Causes and Triggers

The exact cause of eczema is unknown, but it is believed to be linked to certain allergens, irritants, and other environmental factors. Common triggers of eczema include:

  • Detergents
  • Shampoos
  • Dust mites
  • Pollen
  • Mold
  • Hot weather
  • High and low humidity
  • Sweating
  • Stress
  • Hormonal changes
  • Food allergens, such as dairy, soy and nuts

Sources

Causes & Triggers. (2013). Retrieved  from https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/

Habif, Thomas. "Eczema and Hand Dermatitis." Clinical Dermatology, 4th Edition. Ed. Thomas Habif, MD. New York: Mosby, 2004. 41-9.

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