What does eczema (atopic dermatitis) look like?

Appearance of Eczema (Atopic Dermatitis)

Eczema typically appears as an itchy skin condition with visible flexural involvement, particularly affecting the folds of the elbows, around the neck in adults, or the cheeks and forehead in children under 4 years. 1

Characteristic Features of Eczema

• Intense itchiness is the hallmark symptom, leading to scratching that worsens the condition 1
• General dry skin is commonly present throughout the affected areas 1
• In acute eczema, polymorphic appearance with erythema, papules, vesicles, and crusting 2
• In chronic eczema, lichenification (thickened skin with enhanced skin markings) and hyperpigmentation develop 2
• Location varies by age:
  • In children under 4 years: primarily affects cheeks, forehead, and outer limbs 1
  • In older children and adults: predominantly affects flexural areas (elbow folds, neck, behind knees) 1

Visual Diagnostic Criteria

The diagnosis of atopic dermatitis is based on the following visual criteria:

• An itchy skin condition plus three or more of the following: 1
  • Visible flexural eczema (or eczema affecting cheeks/forehead in young children) 1
  • History of itchiness in skin creases 1
  • General dry skin in the past year 1
  • History of asthma or hay fever (or family history of atopic disease in young children) 1
  • Onset in the first two years of life (for children) 1

Signs of Complications

• Bacterial infection is indicated by crusting, weeping, or pustules 1, 3
• Herpes simplex infection presents as grouped, punched-out erosions or vesiculation 1
• Extensive scratching may lead to excoriations and secondary infection 3

Common Pitfalls in Diagnosis

• Eczema may be confused with other skin conditions such as scabies (look for burrows in finger webs) 1
• Lymphadenopathy may cause concern but is usually secondary to extensive skin disease 1
• Deterioration in previously stable eczema often indicates secondary infection rather than worsening of the primary condition 1
• The presence of crusting or weeping strongly suggests bacterial infection requiring specific treatment 1

Age-Specific Presentation

• Infants (0-2 years): Primarily affects the face, scalp, and extensor surfaces of extremities 3
• Children (2-12 years): Typically involves flexural areas, especially antecubital and popliteal fossae 3
• Adolescents and adults: Predominantly affects flexural areas, hands, and neck 4

Remember that eczema is a chronic, relapsing condition that requires ongoing management to control symptoms and prevent complications that can significantly impact quality of life 5, 4.