Eczema: Types, Symptoms, Causes and Treatment — A Dermatologist’s Guide for Children and Adults
A common story I see in my dermatology clinic
Many families come to see me after weeks or months of an itchy, red, recurring rash. Often a parent will describe a child who scratches at night, sleeps poorly, and has eczema that keeps coming back despite months of creams, moisturisers and repeated consultations.
I often meet parents who arrive exhausted and frustrated. They have already changed their child’s soap, detergent, food, milk, bedding and skincare products. Some have been told that their child is “allergic to many things”. Others are worried because they have been using steroid creams and wonder whether the treatment itself may be harming their child.
The first question I usually ask is surprisingly simple:
“Are we sure this is eczema, and if it is eczema, do we know what type and how severe it is?”
That distinction matters.
Eczema is not one single skin disease. It is a broad term used for several inflammatory skin conditions that can look similar but have different causes, patterns and treatments. Atopic dermatitis is the most common form of eczema, particularly in children, but contact dermatitis, dyshidrotic eczema and nummular eczema can present differently and may require a different approach.
As a dermatologist, my approach is therefore not simply to prescribe another cream. I first try to establish what the skin condition actually is, how active it is, what is driving the flare, and how much it is affecting the patient’s quality of life.
This is especially important in children because eczema affects not only the child’s skin. Persistent itching can disturb sleep, affect concentration and play, and place considerable stress on the entire family (seluruh keluarga).
The good news is that eczema can usually be controlled much better than many families initially believe. The goal is not simply to treat today’s flare. It is to build a long-term treatment strategy that controls inflammation, repairs the skin barrier, reduces flares and allows the child or adult to live normally.
DLI am Dr Loh Ken Chen, a consultant dermatologist practising in Kedah. In this guide, I will explain the main types of eczema, how dermatologists distinguish eczema from other itchy rashes, when allergy testing is useful, and how modern eczema treatment is selected according to disease severity.
What is eczema?
Eczema refers to a group of inflammatory skin conditions that commonly cause itching, dryness, redness, scaling and sometimes blistering or oozing.
The term is often used interchangeably with atopic dermatitis, but they are not exactly the same thing.
Atopic dermatitis (AD) is the most common form of eczema. It is a chronic inflammatory skin disease associated with impaired skin-barrier function and immune dysregulation. It commonly begins during childhood, although adults can also develop or continue to experience atopic dermatitis.
The appearance of eczema can change over time. During an acute flare, the skin may become red, swollen, itchy, weepy or crusted. With chronic disease, repeated scratching can produce thickened, darker and more leathery skin.
This is one reason why photographs or internet searches alone cannot reliably determine which type of eczema a person has.
The main types of eczema
1
Atopic dermatitis
Atopic dermatitis is the most common type of eczema and is particularly common in children. Typical features include:
Intense itchingDry or sensitive skinRed or inflamed patchesRecurrent flaresScratching & excoriationsThickened skin when chronic
The distribution also changes with age. In infants, eczema may commonly affect the cheeks and outer surfaces of the limbs. In older children and adults, the flexures — such as the elbows, knees and neck — are commonly involved.
Atopic dermatitis is diagnosed primarily from the history and clinical examination. There is no single blood test that proves a person has atopic dermatitis. Malaysian clinical guidance specifically advises against using serum IgE, skin-prick testing, patch testing or skin biopsy simply as diagnostic tests for atopic eczema.
Why does atopic dermatitis keep coming back?
This is one of the most important questions parents ask. Atopic dermatitis is a chronic inflammatory disease. Even when the skin looks relatively normal, the underlying tendency toward inflammation and skin-barrier dysfunction may remain. Treatment therefore has two components:
1. Treat the flare
Reduce active inflammation and itching.
2. Maintain the skin
Moisturise regularly, recognise early flares and use an appropriate maintenance strategy when indicated.
Modern eczema management is therefore much more than simply “put moisturiser on the skin”.
2
Contact dermatitis
Contact dermatitis occurs when the skin becomes inflamed following exposure to a substance. There are two important forms.
Irritant contact dermatitis
An irritant directly damages the skin. Common examples: detergents, cleaning chemicals, frequent hand washing, solvents, certain cosmetics or skincare products.
Allergic contact dermatitis
A delayed allergic reaction to a substance. Possible triggers: fragrances, preservatives, nickel, hair-dye ingredients, cosmetic ingredients, rubber chemicals.
Allergic to nickel
Allergic to shoes
The distinction matters because avoiding the trigger is a central part of treatment. In persistent or unexplained cases, patch testing may help identify the responsible allergen.
3
Dyshidrotic eczema
Dyshidrotic eczema (pompholyx) causes small, deep, intensely itchy blisters, typically on the sides of the fingers, the palms and the soles of the feet.
Tiny deep blistersIntense itchPalms & solesSides of fingersPeeling as it healsRecurrent episodes
Flares may be triggered by heat, sweating, stress or contact with certain metals such as nickel. As the blisters resolve, the skin often peels and can crack.
Treatment focuses on calming inflammation, managing itch, protecting the skin barrier and reducing exposure to identifiable triggers.
4
Nummular eczema
Nummular (discoid) eczema appears as coin-shaped patches of inflamed, itchy skin. The patches can be dry and scaly or wet and crusted, and are often mistaken for a fungal infection.
Coin-shaped patchesWell-defined edgesItchyDry or oozingLegs, arms, trunkCan mimic ringworm
It is more common in drier skin and colder weather. Because it can look like other conditions, an accurate diagnosis helps ensure the right treatment.
5
Seborrheic dermatitis
Seborrheic dermatitis is a common, long-term form of eczema that affects oil-rich (seborrhoeic) areas of the skin. In babies it is often called cradle cap, while in adults it tends to come and go over many years, flaring in cold, dry weather or during stress.
Greasy yellow scalesFlaking / dandruffRednessMild itchScalp & faceRecurrent flares
It typically appears on the scalp, eyebrows, sides of the nose, behind the ears and on the chest. A yeast that normally lives on the skin (Malassezia) is thought to play a role, which is why medicated antifungal shampoos and creams often help.
Seborrheic dermatitis is usually diagnosed clinically. Treatment focuses on gentle cleansing, antifungal or anti-inflammatory topicals, and controlling flares — it is well managed but tends to recur.
6
Asteatotic eczema
Asteatotic eczema (also called eczema craquelé) is a dry-skin eczema most often seen in older adults and during cold, low-humidity weather. The skin loses moisture and its surface cracks into a pattern that looks like a dried-up riverbed or crazy paving.
Very dry skinFine cracks“Crazy-paving” patternItchShins & lower legsWinter flares
It commonly affects the shins and lower legs, but can appear on the arms and trunk. Frequent hot showers, harsh soaps, air-conditioning and central heating all strip natural oils and make it worse.
The mainstay of treatment is intensive, regular moisturising with emollients, avoiding harsh soaps, and short courses of topical steroids for inflamed areas. Restoring the skin barrier usually settles it well.
7
Lichen simplex chronicus
Lichen simplex chronicus is a thickened, intensely itchy patch of skin that develops from repeated scratching or rubbing — an itch-scratch cycle. It is not a separate disease so much as the skin’s response to chronic irritation, often on top of another form of eczema.
Intense itchThickened skinLeathery textureExaggerated skin linesNeck, ankles, forearmsChronic scratching
Over time the affected skin becomes leathery with exaggerated skin markings (lichenification) and may darken. Common sites include the nape of the neck, wrists, forearms, ankles and genital area.
Breaking the itch-scratch cycle is key: potent topical steroids or occlusive dressings to calm inflammation, treating any underlying eczema, and addressing stress or habit scratching. It improves once the scratching stops.
Conditions that can look like eczema
Not every itchy, red or scaly rash is eczema. A dermatologist may also consider conditions such as:
PsoriasisFungal infection (tinea)ScabiesSeborrhoeic dermatitisAllergic or irritant contact dermatitisDrug eruptionsOther inflammatory skin diseases Because several of these conditions can look almost identical to eczema, an accurate diagnosis is the foundation of effective treatment. This is why a proper dermatological assessment (penilaian oleh pakar kulit) is so valuable.
How is eczema diagnosed?
In most cases, eczema is diagnosed clinically — from the history and physical examination — rather than from a single test. A dermatologist will typically consider when the rash started, how it behaves over time, where it appears on the body, what makes it better or worse, and the personal and family history of eczema, asthma or allergic rhinitis.
Investigations such as swabs for infection, patch testing for contact allergy, or occasionally a skin biopsy are used selectively when the diagnosis is unclear or when another condition needs to be excluded — not as routine tests for every patient.
Does every child with eczema need an allergy test?
This is one of the most common questions I am asked. The short answer is no — most children with atopic dermatitis do not need routine allergy testing.
Atopic dermatitis is primarily a skin-barrier and inflammatory condition. Widespread allergy testing often produces “positive” results that are not actually relevant to the eczema, which can lead to unnecessary food restriction and anxiety. Testing is most useful when there is a clear, consistent trigger or a history suggesting immediate allergic reactions.
How is eczema treated?
Treatment is individualised according to the type of eczema, its severity and the patient’s age. In general, a dermatologist works through a step-by-step approach:
1Step 1: Repair and protect the skin barrier
Regular use of moisturisers (emollients) and gentle skin care is the foundation of every eczema treatment plan, whatever the type or severity.
2Step 2: Control inflammation during flares
Topical anti-inflammatory treatments such as topical corticosteroids are used appropriately to bring active flares under control. Used correctly and under guidance, they are both effective and safe.
3Step 3: Consider non-steroid anti-inflammatory treatments
Depending on age, location and disease pattern, dermatologists may consider non-steroidal topical treatments such as topical calcineurin inhibitors.
4Step 4: Escalate treatment when eczema is moderate or severe
For patients whose eczema remains uncontrolled despite appropriate topical treatment, options can include phototherapy, systemic immunomodulatory treatment, biologic therapy and JAK inhibitor therapy. The choice should be individualised rather than based on any one particular day.
The 2026 American Academy of Dermatology pediatric atopic dermatitis guidelines also emphasise a range of evidence-based topical, phototherapy and systemic treatment options for children with atopic dermatitis. See the American Academy of Dermatology eczema resource for more.
When should you see a dermatologist for eczema?
✓Your child’s eczema keeps recurring despite treatment
✓The diagnosis is uncertain
✓The rash is widespread or severe
✓Itching is disturbing sleep
✓The skin is becoming thickened or scarred from scratching
✓There are frequent infections
✓Treatment repeatedly works only temporarily
✓You are concerned about long-term steroid use
✓You suspect a contact allergy
✓Eczema is significantly affecting school, work, sleep or quality of life
A particularly important situation is eczema that does not behave like eczema. If an apparently appropriate treatment repeatedly fails, the answer may not always be “stronger medication”. Sometimes the diagnosis needs to be reconsidered.
Frequently Asked Questions About Eczema
What is the most common type of eczema?
Atopic dermatitis is the most common type of eczema, especially in children. It is a chronic condition linked to a weakened skin barrier and an over-reactive immune response.
Is eczema contagious?
No. Eczema is not contagious. You cannot catch it from, or pass it to, another person through contact.
Can eczema be cured?
For many people eczema cannot be permanently cured, but it can usually be very well controlled. The goal is to reduce flares, repair the skin barrier and keep symptoms to a minimum so daily life is not affected.
Are steroid creams safe for my child?
When used correctly, for the right strength and duration under professional guidance, topical corticosteroids are both effective and safe. Concerns usually arise from using the wrong strength, for too long, or in the wrong areas.
Does my child need to avoid many foods?
Most children with eczema do not need to avoid multiple foods. Unnecessary restriction can cause nutritional and social problems. Food should only be restricted where there is a genuine, confirmed allergy.
Why does eczema get worse at night?
Skin loses moisture and body temperature changes at night, which can intensify itching. A good moisturising and maintenance routine helps reduce night-time flares and improve sleep.
Can adults develop eczema for the first time?
Yes. While atopic dermatitis often begins in childhood, adults can develop eczema for the first time, and other types such as contact, asteatotic or nummular eczema are common in adults.
When should I see a dermatologist rather than manage it myself?
See a dermatologist if the eczema is severe, widespread, recurrent, disturbing sleep, becoming infected, not responding to treatment, or if you are simply unsure of the diagnosis.
Eczema treatment in Alor Setar, Kedah
At Loh & Celine Skin Specialist Clinic in Alor Setar, Kedah, we assess and treat all types of eczema for children and adults. Our approach begins with an accurate diagnosis, followed by an individualised treatment plan to control inflammation, repair the skin barrier and reduce flares — so you can get back to living comfortably (hidup dengan selesa).
If you or your child has itchy, recurring or hard-to-control skin, a proper dermatological assessment can make all the difference. We welcome patients from across Kedah and the northern region.
References & further reading: NHS – Atopic eczema, American Academy of Dermatology – Eczema types, Journal of the American Academy of Dermatology (JAAD).
