Eczema is the result of immune system response to an irritant either through contact, inhalation or ingestion. The body activates an immune system response often resulting in a flushed appearance, a rash, or welts on the skin.

Each of the following patterns and types of an eczema rash is a part of a complex interaction of one or more physiological systems.

The most common form of eczema rash is atopic eczema. An atopic eczema rash is marked by dryness thickening, excoriation, and even scarring (Hall 79). This chronic condition is not contagious; the cause is hereditary and usually begins in infancy as a rash on the scalp, face or upper extremities of the baby. Atopic eczema is most commonly located in areas where the body bends or experiences contact thus creating friction that can cause eczema. Young housewives and househusbands may have their first recurrence of atopic eczema as an adult due to the tasks of dishwashing and raising a child (Hall 79). This type of eczema affects 15 million people and is usually accompanied by asthma and hay fever (Dermatology Times, October 1998). Trigger factors for atopic eczema may include soap, harsh chemicals, heat and humidity, stress, certain foods (most common offenders include eggs, milk, wheat, soy protein, and peanut). Many of these ingredients can turn up in unusual places, such as all-natural soaps, makeup, cream or lotions. Inhalant allergens such as house dust mites, pets, pollen and cut grass are also triggers that can cause eczema. Atopic dermatitis is normally associated with a family history of asthma or allergic rhinitis accompanied by chronic or recurrent dry, extremely itchy, inflamed lesions. Neurodermatitis is a chronic eruption of the skin that results from continuous scratching.

Atopic eczema may also affect the skin around the eyes, the eyelids, and the eyebrows and lashes. Scratching and rubbing the eye area can cause the skin to become red, irritated and inflamed. Scrathing and rubbing the area can result in patchy areas involving loss of eyebrows and eyelashes. Signs and symptoms of eye complications also include eye watering and inflammation of the eyelid (blepharitis) and the lining of the eyelid (conjunctivitis). These ocular symptoms of eczema can be very similar to ocular rosacea and can be treated as effectively as one would treat the symptoms of ocular rosacea.

Seborrheic eczema (also called seborrheic dermatitis, infantile seborrheic eczema, child/infantile eczema) is most commonly associated with flaking and sometimes redness of the skin (www.medinfo.co.uk). Seborrheic dermatitis occurs when there is inflammation of the skin where sebaceous glands are concentrated (Rouse). Seborrheic or baby eczema is genetically determined, and therefore is not contagious. This type of eczema rash can affect the face, chest, eyebrows and eyelids, nose, ears, chin, forehead, and most commonly affects the scalp. The symptoms can be unpleasant, unattractive, and uncomfortable especially during the winter months when there is less sunlight.

Seborrheic dermatitis begins with dry or greasy scaling of the scalp areas, which become red, oily and may possibly cause itching. The itching associated with seborrheic dermatitis is not as bad as the itching associated with psoriasis. Seborrheic dermatitis is often thought of as a severe case of dandruff accompanied at times by an odor, which is caused by the buildup of bacteria on the scalp. Seborrheic dermatitis cannot be cured. However, remissions due to treatment or natural reasons do occur for varying amounts of time (Hall 114).

Infantile seborrheic eczema, also called cradle cap, is a rash affecting the face, scalp, and upper extremities and is often associated with food consumption (cheese, egg whites, wheat, or nuts are a common cause of infantile seborrheic eczema). Other triggers that can cause baby eczema include soaps, laundry detergents, fabric softeners, wool, and polyester or blended fabrics. A natural treatment, feeding the baby breast milk can help to control or limit eczema in infants. The symptoms usually fade away, but can progress in older children to dermatitis of the neck and upper and lower extremities. Child/infantile eczema will fade away or may persist in localized areas of the hands and face. Oozing and crusting are common symptoms. The symptoms may also fade only to return in times of stress. Child/infantile eczema usually clears up by school age but can resurface in adulthood.

Perioral dermatitis is an eczema rash that affects mostly women. This rash usually occurs as redness around the mouth, the symptoms of perioral dermatitis may also include small red bumps or even pus bumps and mild peeling. Treatments include using a non-tartar, non-fluoride toothpaste. Lip balms, lipstick, mouthwash or toothpaste can also cause perioral dermatitis.

Contact eczema is an inflammatory response by the skin to an outside allergen or irritant. Again this type of eczema rash is caused by an allergic reaction through contact with an irritant. Substances that cause contact eczema include household items, clothing, cosmetics, and plants. The types of substance that cause the symptoms to appear can further define contact eczema. A substance that has a direct toxic effect or exposure to an irritant produces irritant contact eczema and a skin reaction can occur immediately or gradually after repeat exposure. Examples of substances that cause irritant contact eczema include acids, certain toilet bowl cleaners or drain cleaners, oven cleaners, detergents, ammonia, lye, cement, turpentine, and paint thinners. Allergic contact eczema will trigger an immunologic response that causes inflammation called a skin allergy. Examples of substances that cause allergic contact eczema include poison ivy, poison sumac, poison oak, dyes, fragrances, leather, rubber compounds (gloves and shoes) and nickel (jewelry accessories). Itching and burning are common symptoms in both types of contact dermatitis. Typically the symptoms of contact dermatitis include redness, swelling and oozing. If left untreated, contact dermatitis can result in dry, thickened, cracked skin. The webs of the fingers, back of the hands and forearms are common sites of contact. Local contact with an allergen followed by exposure to ultraviolet radiation (sunlight) can cause photo allergic eczema rash.

The symptoms of dyshidrotic eczema include itching of the hands and feet, which can cause a sudden onset of blisters. Symptoms of this rash include burning pain or itching may be experienced before blisters appear. The cause of dyshidrotic eczema may be sensitivity to nickel or other metals such as chromium or cobalt, also fragrances, fungal infection (tinea pedis), stress, aspirin, oral contraceptives, smoking, and implanted metals. Dyshidrotic eczema is a form of hand eczema, which is more common in women and starts on the sides of the fingers as itchy little bumps and then develops into a rash. Dyshidrotic eczema may affect only the feet. Some patients have involvement of both hands and feet. It takes a long time for skin to recover, and unless you're careful, the dermatitis will reoccur. The symptoms of hand eczema include red, itchy, scaly, cracked skin with blisters up to one inch in diameter, usually on the palms of the hands. Dentists are prone to hand eczema. The cause of hand eczema is usually a combination of sensitive skin and irritation or an allergic reaction from materials touched. Prevention and avoidance can be a powerful treatment. The following suggestions will be helpful for anyone with symptoms of hand eczema: wear waterproof or cotton-lined gloves, avoid contact with soaps, detergents, scouring powders, and irritating chemicals. Wear waterproof gloves when peeling or squeezing lemons, oranges, or grapefruit, peeling potatoes, or handling tomatoes. Wear heavy-duty gloves while gardening, wash dishes in a dishwasher, do not wash clothes by hand, avoid contact with turpentine, paint, and paint thinner, floor polish, and shoe polish. Wash hands in warm water and a small amount of mild soap, rinse carefully and dry gently. Wearing rings can cause hand eczema to become worse.

Pustular eczema may cause blister-like lesions of noninfectious pustules (yellow pus spots) and intense scaling usually found on the hands or feet. The blisters tend to become red and scaly and may crack. Individuals with pustular eczema can be seriously ill and may require hospitalization during the course of their treatment. Hyper linearity atopic eczema occurs in the palms and results in increased numbers and depth of the lines on the palms of the hands with little redness.

Foot eczema is a rash concentrated in scaly areas of irritated skin, common in children during wintertime when the air contains less moisture. Foot eczema can cause feet to dry out and crack. The most common cause of foot eczema is dyes used in the manufacture of shoes and sneakers, which are made with dyes and/or rubber. These irritants cause rashes and dry or scaly skin. Leather shoes also contain dyes. Also known as dyshidrosia or dyshidrotic eczema, foot eczema has nothing to do with sweating feet. Sweating is an important symptom in that it washes off natural oils, which lead to additional dryness. The symptoms of foot eczema are characterized by the sudden onset (1 to 3 days) of deep-seated, clear vesicles, which resemble the pearls in tapioca pudding. In the later stages, scaling, thickening, and painful fissuring may occur. Secondary bacterial infection is very often a complication with dyshidrotic eczema. Successful treatment may include wearing socks that are 60% cotton and changing shoes every day -- alternate 2 to 3 pairs of shoes. Follow recommended treatments for at least 4 months after skin has healed. It takes a long time for skin to recover, and unless you're careful the eczema will reoccur. Pompholyx or pedopompholyx eczema is vesicular foot eczema. In early stages it is seen as tiny blisters deep in the skin associated with itching and may cause a burning feeling. In later stages, it shows more peeling, cracking or crusting.

Xerotic eczema, winter itch, or asteatotic eczema is a rash that occurs in winter and in the elderly on the legs, arms, and hands. It is characterized by dry, cracked, fissured skin and redness. Stasis eczema is a rash of the lower legs, which is due to poor return of blood to the heart. Usually the inner leg is more involved than the outer lower leg. Sometimes the rash breaks down into a sore resulting in a stasis ulcer. It affects people with varicose veins.

Nummular eczema is a ringworm-like rash of circular, itchy, scaling patches, widespread on the arms and legs but may also be found on the trunk and buttocks. Nummular eczema is most common in older people with very dry skin.

Discoid eczema is found in adults and appears suddenly as a few coin-shaped areas of red skin, normally on the trunk or lower legs. The areas become itchy and may weep fluid. Eczema diabetes is also known as leg ulcers. Venous stasis eczema is a persistent inflammation of the skin of the lower third of the legs associated with erythema and brown hyper pigmentation.

Clock or systemic flushing is a type of temporary or transient rash - the body does operate on a clock! Universally, hospital physicians have known for years that the lowest body temperature of the 24-hour day is usually around 3:00 to 4:00 A.M. while the highest temperature of the day is generally 7:00 to 8:00 P.M. The average eczema sufferer does not have hospital waking and sleeping hours, therefore their temperature lows and highs may vary 3 to 5 hours each way. A high temperature for some may be as early as 3:00 P.M.

Flushing usually occurs when the body becomes fatigued and/or stressed which stimulates the sympathetic nervous system. The key to this is the autonomic nervous system (more specifically, the sympathetic postganglionic efferent nerves). This flush generally occurs in the facial area and may extend from the top of the head to the neck and upper chest area. Any activation of these nerves causes vasoconstriction of "body blood vessels" -- except in the "facial blush/flush areas" where it induces potent vasodilatation or flushing with the resulting red face appearance often associated with rosacea.

Things that can trigger the sympathetic nervous system include:

  • Stress stimulates the sympathetic nervous system.
  • Lack of sleep stimulates the sympathetic nervous system with a minimum of 8 hours being needed.
  • Anxiety at work or home (fight or flight) stimulates the sympathetic nervous system.
  • Increase in internal body temperature stimulates the sympathetic nervous system when "acid drinks, foods, and cigarettes" are consumed, whereas obviously a decrease in body temperature and skin heat results when the parasympathetic system calms the body and brain over a period of time such as at night when sleeping. By consuming the alkaline foods and drinks, the parasympathetic nervous system can very quickly take control of the body and brain stress.

Adrenaline induced rash - an adrenaline rush or a large supply of adrenaline under pressure with immediate or instant rash or flushing causes this kind of vascular dilation. It is the same as sympathetic nerves, but it is hormone released. Stress is the body's reaction to a perceived threat. Adrenaline and hormones are released, and the nervous system is activated, sharpening our senses, but simultaneously our pulse rises, our muscles tense and our immune system begins to shut down.

Those that cannot relieve stress as needed may experience fatigue, upset stomach, and frequent headaches, and a flushing face. Long-term stress can contribute to family breakdown, job fatigue, with resulting long-term health problems such as eczema, psoriasis, depression, heart disease, high blood pressure, and rosacea.

Adult acne is one type of eczema or dermatitis adrenal related skin flare which occurs in both "men and women" as a reaction to mental stress or body stress. In women testosterone is produced by the ovaries with the other half of testosterone in women being produced by the adrenal glands. Obviously, estrogen smoothes out the testosterone produced by the ovaries, but when the estrogen level drops several days before the menstrual periods, sometimes resulting acne occurs especially when the adrenal glands over produce due to stress or fatigue. The adrenal glands can be stressed continually in both men and women resulting in too much testosterone with the resulting over stimulation of the sebaceous glands. These glands produce testosterone directly or via peripheral conversion of DHEAS (dihydropiandrosterone sulfate), DHEA (dihydropiandrosterone), and androstenedione which are the three major adrenal androgens. Similarly, in the male an over abundance of testicular testosterone especially with overly stimulated adrenal glands causes the overly stimulated sebaceous glands. Quite often more stress is placed on the adult after puberty resulting in over active sebaceous glands. While we cannot produce more estrogen to level out the testosterone, we can drink more water, which will help relieve stress and assist both acne and eczema. Getting enough sleep and finding ways to relax will help relieve stress and reduce the adrenaline reaction that follows.

Hot shower/bath induced rash - The skin becomes redder by the stimulation of hot showers/baths, which is a vascular dilation as opposed to an immune system related rash. Overall, it is better to shower in tepid water in the range of 85 to 95 degrees to cool the body and prevent vascular dilation. You may choose to shower with warmer water to open the pores up to clear them or for relaxing, however, remember to begin to lower the temperature to a much lower degree for cooling off to prevent the skin from turning red or to reduce the redness from the prior higher temperature. The cooler water temperature produces vascular constriction.

Food allergy rashes - A food allergy can cause redness, flushing, itching and fluid-filled pustules to appear on the skin. Food allergies can also cause itching, tearing and a discharge from the eyes. Please consider 'food allergy testing' from your Ear, Nose & Throat (ENT) doctor to confirm which foods you are allergic to as you may not be familiar with them. Some of the worst items are cantaloupes and various melons as well as beef, pork, and chicken while fish very rarely causes a flushing problem. Asthma and eczema may be triggered or worsened by food allergies. For more information on food allergy flushing see our Lifestyle Changes page.

Pollen and contact rash - spring in most countries is the time for pollen and mold spores as trees, plants, and grass are providing pollen for self-production with the result that it affects many eczema sufferers. Also, some areas have enough warm weather and proper vegetation for pollen and mold spores year around. You may even see mold spores growing in your bathtub or shower. Of course you need to keep all spores cleaned out of the home. Clorox liquid is very good and may be diluted by using half Clorox and half water if the full strength smell is offensive to you. Another good cleanser is "Clorox Clean-Up" which disinfects and destroys many allergens and has a much nicer fragrance.

The simplest and least expensive way to decrease pollen and contact rashes is simply bathing and shampooing your hair every night to get the clinging pollen molecules off the body and out of the hair. If allowed to remain on the body and hair during your sleep time, the pollen gets in your pillow, which means that you are inhaling pollen during the night. Allergy 'mold spores' begin to grow in the home at humidity levels higher than 60% to 65% depending on the amount of dust, dirt, plants, etc. available for the food source of mold spores that many of us are allergic to. Also, the purchase of a dehumidifier for summer use to reduce the amount of humidity will reduce the mold spores while at the same time making the air more comfortable as the air has less humidity and therefore, dryer.

Brush dogs regularly and bathe them frequently depending on their outings or at least once per week. Brush and wipe cats down with a 'damp wash cloth' as they will tolerate the 'damp wash' and you can enjoy your cat much more.

Frequent vacuuming of the home which ideally should be 2 to 3 times per week with a good quality vacuum cleaner will help to eliminate dust, pollen, mold spores, etc. Also, change the air filter in your home every week using the very best quality filter if you have severe problems with allergies. This will also give you the benefit of not having to dust as often. You will feel better, reduce your allergy problem and reduce facial redness.

These are some of the primary types of rashes, and there are other types of eczema rashes such as sun exposure flushing, drug medication flushing or drug/sun sensitivity flushing, laughter flushing, allergy/histamine flushing, etc. The goal is to decrease vascular dilation through vascular constriction, which will minimize flushing of any type.

Eczema is a progressive and recurrent skin disorder unless treated.