Appearance of Eczema (Atopic Dermatitis)
Eczema presents as erythematous (red), pruritic (itchy) skin lesions with a characteristic age-specific distribution pattern, accompanied by xerosis (dry skin), and varying morphology depending on whether the lesions are acute, subacute, or chronic. 1, 2
Key Clinical Features by Lesion Stage
Acute Lesions
- Erythematous papules with serous exudates (oozing) 1, 3
- Edema (swelling) of affected areas 1
- Erosions and excoriations from scratching 1, 3
- Crusting when secondary bacterial infection is present 1, 2
- Grouped, punched-out erosions or vesiculation suggest herpes simplex superinfection 1
Subacute Lesions
Chronic Lesions
- Lichenification (thickened skin with accentuated skin markings) 1, 3
- Hyperpigmentation in affected areas 3
- Persistent xerosis (dry skin) 1, 2
Age-Specific Distribution Patterns
Infants and Young Children (Under 4 Years)
- Cheeks and forehead are commonly affected 1, 3
- Scalp involvement 3
- Outer limbs (extensor surfaces) 1
- Notably spares the diaper area in infants 3
Older Children and Adults
- Flexural areas are predominantly affected 1, 3
- Antecubital fossae (inner elbows) 3
- Popliteal fossae (behind knees) 3
- Neck region 1, 3
- Skin creases and folds 1
Universal Features Across All Ages
- Symmetrical distribution of lesions 2
- Xerosis (generalized dry skin) is present even in unaffected areas 1, 2
- Intense pruritus is the hallmark symptom, often described as "the itch that rashes" 2, 4
Common Pitfalls in Recognition
Bacterial superinfection should be suspected when you observe weeping, crusting, or sudden worsening of previously stable eczema 1, 2. Staphylococcus aureus is the most common culprit 2, 3.
Eczema herpeticum (herpes simplex superinfection) presents with grouped, punched-out erosions or discrete vesicles and can be life-threatening, requiring immediate recognition 1, 3.
Contact dermatitis may develop as a complication and should be considered when previously controlled eczema suddenly deteriorates 1, 2.