How to Describe an Eczema Rash
Eczema rash is characterized by three cardinal morphological features: multiple pinpoint lesions, polymorphism (varied appearance), and pruritus (itchiness). 1
Acute Eczema Lesions
Acute eczema presents with erythematous papules, vesicles, serous exudates, weeping, and crusting. 2, 3 The polymorphic nature means you will observe a composition of:
- Erythema (redness) 1
- Papules (small raised bumps) 1
- Seropapules (fluid-filled papules) 1
- Vesicles (small blisters) 1
- Pustules (pus-filled lesions) 1
- Scales 1
- Crusts 1
- Excoriations (scratch marks) from intense scratching 3, 4
The lesions arise from numerous tiny foci, creating the characteristic "multiple pinpoint" pattern. 1
Subacute Eczema Lesions
Subacute lesions appear as erythematous scaling papules and plaques. 3 The weeping and crusting diminish, but erythema and scaling persist. 3
Chronic Eczema Lesions
Chronic eczema features lichenification (thickened skin with accentuated skin markings) and hyperpigmentation. 3, 1, 4 The skin develops:
- Thickened, leathery texture 4
- Prominent skin lines 3
- Darkened pigmentation 3, 1
- Possible hypopigmentation in some areas 1
Age-Specific Distribution Patterns
In infants, eczema typically affects the cheeks, forehead, scalp, and extensor surfaces of extremities, while sparing the diaper area. 5, 3
In older children and adults, lesions concentrate in flexural areas—antecubital and popliteal fossae—along with head and neck involvement. 3, 4
Associated Features
Xerosis (generalized dry skin) is a hallmark feature accompanying the rash. 2, 3
Pruritus is obligatory and can be observed as visible scratching or rubbing behavior in patients unable to verbalize symptoms. 2, 5
Red Flag Descriptors Requiring Urgent Evaluation
Crusting or weeping with honey-colored discharge suggests secondary bacterial infection with Staphylococcus aureus. 2, 5
Multiple uniform "punched-out" erosions or grouped vesiculopustular eruptions indicate eczema herpeticum (herpes simplex superinfection), a medical emergency. 2, 5, 6
Common Pitfall
Do not describe poorly delimited vesicular eczematous lesions with pruritus and excoriations as simple dermatitis without assessing for the characteristic polymorphism and distribution pattern. 2 The neck and axillary creases are particularly affected in drug-induced eczematous reactions, but atopic eczema follows age-specific patterns. 2