Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The term eczema is derived from the Greek, meaning "to boil out." The
name is particularly apt since to ancient medical practitioners it may have
appeared that the skin was "boiling." Today the usage is rather imprecise since
it is frequently used to describe any sort of dermatitis (inflammatory skin
condition). Not all dermatitis is eczematous. All eczematous dermatitis has a
similar appearance. Acute lesions are composed of many small fluid-filled
structures called vesicles that usually reside on red, swollen skin. When these
vesicles break, fluid leaks out, causing characteristic weeping and
oozing. When the fluid dries, it produces a thin crust. In older lesions, these
vesicles may be harder to appreciate, but an examination of the tissue under the
microscope will reveal their presence. Eczematous dermatitis has many causes.
One of the most common is a condition called atopic dermatitis. Often those using
the term eczema are referring to atopic dermatitis. Although atopy refers to a
lifelong inherited (genetic) predisposition to inhalant allergies such as
asthma and allergic rhinitis (hay fever), atopic dermatitis is not an allergic
disease. Atopic patients are likely to have asthma, hay fever, and dermatitis.
Atopy is a very common condition, and it affects all races and ages, including
infants. About 1% to 2% of adults have the
skin rash, and it is even more
common in children. Most affected individuals have their first episode before
5 years of age. For most, the dermatitis will improve with time. For an unlucky few,
atopic dermatitis is a chronic, recurrent disorder.
Other eczematous dermatoses include, but are not limited to, allergic contact
dermatitis (cell-mediated allergy to a common substance such as poison oak or
nickel), irritant dermatitis (from excessive contact with
a harsh chemical substance),
fungal infections, scabies infestations, stasis dermatitis,
very dry skin (asteatosis),
pompholyx (dyshidrosis), nummular dermatitis, and seborrheic dermatitis. The
differentiation among these conditions is often difficult and time-consuming. In
addition, it is not uncommon for atopic dermatitis to coexist with another
The main symptom of atopic dermatitis is itching. The itching can be severe and persistent, especially at night. Scratching the affected area of skin usually causes a rash. The rash is red and patchy and may be long-lasting (chronic) or come and go (recurring). The rash may:
Develop fluid-filled sores that can ooze fluid or crust over. This can happen when the skin is rubbed or scratched or if a skin infection is present. This is known as an acute (sudden or of short duration), oozing rash.
Be scaly and dry, red, and itchy. This is known as a subacute (longer duration) rash.
Become tough and thick from constant scratching (lichenification).
How bad your symptoms are depends on how large an area of skin is affected, how much you scratch the rash, and whether the rash gets infected.
The areas most often affected are the face, scalp, neck, arms, and legs. The rash is also common in areas that bend, such as the back of the knees and inside of the elbows. Rashes in the groin area are rare. There may be age-related differences in the way the rash looks and behaves.