Eczema (Dermatitis) Treatment | Dermatology Outpatient Clinic

💭 “What kind of condition is eczema?”
💭 “What causes eczema?”

You may have questions like these.

Eczema is a collective term for skin inflammation accompanied by symptoms such as blisters or red, bumpy rashes.

This article explains the causes and symptoms of eczema for those who have the above questions, as well as for those who want to know about treatment approaches and medications used for eczema.

⚠️ If left untreated, eczema may lead to ulcers and permanent scarring!

🔍 What is eczema?

Eczema is a collective term for skin inflammation accompanied by symptoms such as the following:

• 🔴 Redness
• 🔴 Bumps
• 💧 Blisters
• 😣 Itching

It affects a wide range of age groups, from infants to the elderly, making it a familiar condition for many people.

In addition, the causes of eczema and the degree of symptoms such as itching and pain vary widely, which can make accurate diagnosis challenging.

❓ Why does eczema occur? Causes of eczema

The causes of eczema can be divided into two categories: environmental factors and internal factors.

🌍 Environmental factors
Caused by external stimuli such as metals, pollen, house dust, medications, and bacteria

🧬 Internal factors
Refer to one’s general health, skin condition, atopic predisposition, and individual constitution

⚠️ Note
A combination of both factors may lead to varying symptoms, so please be aware.

📋 What are the symptoms of eczema?

Eczema symptoms differ between the acute phase (when symptoms appear suddenly) and the chronic phase. In the acute phase, a mixture of the following symptoms is commonly observed.

🔸 Early stage of inflammation
Small red bumps accompanied by itching appear. Scratching these bumps excessively can cause blisters or lead to fungal or bacterial infection, resulting in pain, fever, or pus, so care should be taken.

⚠️ As symptoms worsen…
Blisters may rupture, the skin may become raw, and ulcers—open sores in the skin—may develop.

After the initial inflammatory stage, scabs form; however, scratching due to continued itching can cause the scabs to come off, worsening skin rawness and ulcers, so caution is needed.

🔸 Chronic phase symptoms
The skin becomes thickened and raised while some acute-phase symptoms persist. In some cases, a dark reddish pigmentation may remain, or conversely, the skin may lose pigmentation and appear white.

📊 Are there different types of eczema? Types of eczema

There are many types of eczema. Below, we introduce them according to the following classifications:

• 🧪 Classification by cause
• 👤 Classification by body area
• 🩺 Classification by symptoms

Please refer to the summaries of the characteristics of each type of eczema below.

🧪 Types of eczema (1) Classification by cause

The table below introduces types of eczema classified by their underlying cause.

Eczema classified by cause is often triggered by allergic reactions.

💡 For those who work on their feet
Note that stasis dermatitis may develop after prolonged periods of standing, so please be mindful of this.

For more information on seborrheic dermatitis, please refer to the article below.

📖 Related article: What causes seborrheic dermatitis? Symptoms, treatment, and prevention explained

👤 Types of eczema (2) Classification by body area

Eczema can occur in specific areas of the body. The table below provides an overview.

👨‍👩‍👧 For parents
Without proper care for each area, eczema such as that described above may develop, so please be attentive. In particular, please make a point of caring for both your own hands and your baby’s skin.

🩺 Types of eczema (3) Classification by symptoms

The table below introduces types of eczema classified by their symptoms.

💧 Moisturising is key!
As some types of eczema are caused by repeated scratching, keep the skin well moisturised to help prevent itching from dry skin.

💊 Can eczema be treated with medication? How to treat eczema

The standard approach to treating eczema involves medications known as steroids.

This is because steroids have anti-inflammatory properties. When the skin is red, it is in a state of inflammation, so medications with anti-inflammatory effects can help improve symptoms.

🔸 For mild, localised eczema
Treated with topical steroid ointments

🔸 When eczema is widespread and severe
Treated with oral steroids

💡 Other medications
・When a fungal or bacterial infection is present → antifungal or antibacterial agents
・For managing itching → oral antihistamines

🔬 How is eczema diagnosed? Testing and diagnostic methods for eczema

For eczema, the physician will first conduct a medical interview covering the following:

• 📍 Location of symptoms
• 📋 Circumstances of onset
• 🔍 Possible causes
• 🩺 Nature of symptoms

After the interview, the colour and appearance of the affected area are examined. If an allergic cause is suspected, allergy testing may be performed; if an internal medical condition is suspected, blood tests may be carried out.

❓ Frequently asked questions about eczema

Finally, we address some frequently asked questions about eczema.

QIs stress the cause of eczema?

“Seborrheic dermatitis,” a type of eczema, is considered to be primarily associated with stress.

In addition to stress, the following factors are also considered potential causes:

• 🥗 Vitamin deficiency
• ⚖️ Hormonal imbalance
• 🌀 Irregular lifestyle
• 😰 Stress
• 😫 Fatigue
• 😴 Lack of sleep

When sebum balance is disrupted by any of the above factors, eczema may develop.

📖 Related article: What causes seborrheic dermatitis? Symptoms, treatment, and prevention explained

🏥 For eczema treatment in Tokyo, please consult IC Clinic

If eczema worsens, there is a risk of ulcers developing, so it is important to seek attention early.

To help minimise the likelihood of scarring after treatment, we recommend consulting us as soon as you notice any eczema-like changes on your skin.

⚠️ Regardless of the degree of inflammation, please consult IC Clinic before your eczema worsens.

🛡️ Prevention and self-care for eczema

🌟 Basic preventive measures

To prevent eczema from developing or worsening, daily prevention and self-care are extremely important. By putting preventive measures into practice, you may significantly reduce the risk of eczema recurrence.

💧 Core principles of skin care

Appropriate skin care forms the foundation of eczema prevention. To maintain the skin’s barrier function, please keep the following points in mind.

First and foremost, moisturising is essential. When the skin becomes dry, its resistance to external stimuli weakens, making eczema more likely to develop. Applying moisturiser within 5 minutes of bathing helps prevent moisture loss and supports the skin’s barrier function. Moisturiser is recommended 2 to 3 times a day, with particular attention to areas prone to dryness.

💡 Appropriate cleansing methods
Bathing in water that is too hot, or scrubbing the skin too vigorously, can damage the skin’s barrier function. Use lukewarm water at around 38–40°C, choose a mild, low-irritant soap or body wash, and cleanse gently using lather.

🏠 Prevention through environmental adjustments

Adjusting your home environment is also an important factor in preventing eczema.

🌡️ Managing indoor conditions

Maintaining an appropriate indoor environment can help prevent eczema triggered by environmental factors. Aim to keep indoor humidity at around 50–60%. Humidity that is too low can cause skin dryness, while humidity that is too high encourages the growth of mould and dust mites.

Using an air purifier and ensuring regular ventilation to remove allergens such as pollen and house dust can also be effective. Those with allergic dermatitis in particular should make a habit of washing bedding regularly and vacuuming frequently.

👕 Choosing clothing

The choice of fabric for clothing that comes into direct contact with the skin is also important. Natural fibres such as cotton and linen are gentle on the skin and breathable, making them well-suited for eczema prevention. Synthetic fibres and woollen garments may irritate the skin, so those with sensitive skin are advised to avoid them.

When laundering clothing, using fragrance-free, dye-free detergents and limiting the use of fabric softener can help minimise skin irritation from chemical substances.

🍽️ The relationship between lifestyle habits and eczema

🥗 Diet and nutritional management

Diet has a significant impact on skin health. A well-balanced nutritional intake can help normalise skin cell turnover and support immune function.

✨ Nutrients that support skin health

• 🥕 Vitamin A: Promotes skin cell turnover and strengthens the barrier function (found in carrots, spinach, and liver)
• 🍊 Vitamin C: Has antioxidant properties and helps with skin repair (found in citrus fruits, kiwi, and broccoli)
• 🌰 Vitamin E: Has antioxidant properties and helps protect the skin from ageing (found in nuts, vegetable oils, and fish)
• 🐟 Omega-3 fatty acids: May help reduce inflammation (found in oily fish, flaxseed oil, and walnuts)

⚠️ Foods to avoid
Excessive consumption of heavily spiced foods, alcohol, and caffeine may aggravate skin inflammation. Foods that trigger individual allergic reactions (such as eggs, milk, wheat, soy, and nuts) should also be avoided.

😴 Sleep and stress management

Adequate sleep and appropriate stress management are essential for maintaining skin health.

💤 The importance of sleep

During sleep, growth hormone is released, and skin repair and regeneration become active. Lack of sleep can impair immune function, increasing the risk of eczema developing or worsening. Ideally, aim for 7 to 8 hours of quality sleep.

The bedroom environment also matters. Keeping the room temperature at 20–22°C and humidity at 50–60%, along with using clean bedding, can help improve sleep quality.

🧘 Managing stress

Chronic stress has a negative impact on the immune system and can be a factor in eczema worsening. Finding effective ways to manage stress is important.

Relaxation techniques such as deep breathing, meditation, and yoga can help reduce excessive sympathetic nervous system activity and may support improvement in skin condition.

Regular exercise is also beneficial. Moderate physical activity promotes circulation and may help reduce stress hormone levels. However, since perspiration can sometimes aggravate eczema, it is important to shower promptly after exercise and maintain good hygiene.

📊 Eczema severity classification and management

🟢 Mild eczema: characteristics and management

Mild eczema presents as localised redness with mild itching. At this stage, appropriate self-care may help improve symptoms.

The basics involve keeping the affected area clean and avoiding irritants. Even when itching is present, try not to scratch; applying a cool, damp cloth to the area can help relieve itching. Use a commercially available, low-irritant moisturiser to support the skin’s barrier function.

🟡 Moderate eczema: management

Moderate eczema is characterised by clear inflammatory symptoms and persistent itching. At this stage, treatment at a medical institution is necessary.

Topical steroid medications prescribed by a physician should be used appropriately to help improve symptoms. Follow the physician’s instructions regarding how and for how long to use them, and avoid stopping or continuing treatment on your own judgement.

Oral antihistamines may also be used alongside other treatments to help manage itching. In daily life, it is important to minimise irritation to the affected area and continue appropriate skin care.

🔴 Severe eczema: treatment approach

Severe eczema may involve widespread inflammation, intense itching, and secondary infection. In such cases, intensive treatment is required.

Taking into account the systemic impact, the use of oral steroids or immunosuppressants may be considered. In severe cases, inpatient treatment may be necessary.

A comprehensive assessment of the patient’s age, severity of symptoms, and presence of complications is made, and an individualised treatment plan is developed.

👶 Eczema by age group: characteristics and management

👶 Managing eczema in infants and young children

In infancy and early childhood, the skin’s barrier function is not yet fully developed, making this a period when eczema is more likely to occur. In particular, eczema often appears from around 2 to 3 months of age, and appropriate care is important.

🧸 Key points for daily care

• Use mild, low-irritant soap or body wash
• Apply moisturiser promptly after bathing
• Keep nails trimmed short to prevent skin damage from scratching
• Using mittens or baby gloves at night can also be effective
• When introducing weaning foods, introduce new ingredients one at a time, starting with small amounts

🎒 Managing eczema in school-age children and adolescents

From school age through adolescence, new sources of irritation increase, such as sweating during school activities and club sports, and friction from school uniforms.

During this period, it is important to make it a habit to wipe away sweat and change clothes after physical activity, keeping the skin clean. Stress is also frequently a factor in eczema flare-ups, so managing stress from studies and social relationships is equally important.

During adolescence, increased sebum production makes seborrheic dermatitis more likely to develop. It is advisable to maintain the right balance of cleansing and moisturising, and to avoid over-washing.

💼 Managing eczema in adults

In adults, occupational contact dermatitis and hand eczema are commonly seen. Particular care is needed for those in occupations with frequent exposure to chemicals or water, such as healthcare workers, hairdressers, and cleaning staff.

Use protective equipment during work, and be diligent about thorough handwashing and moisturising afterwards to help prevent occupational dermatitis. Contact dermatitis from cosmetics is also common in adult women, so performing a patch test before using a new cosmetic product is recommended.

👴 Eczema care in older adults

As we age, the skin’s ability to retain moisture decreases, making dry skin eczema more common. Skin cell turnover also slows and wounds take longer to heal, so more careful management is needed.

In older adults, excessive cleansing can exacerbate dryness, so bathing frequency and cleansing methods should be adjusted, with a focus on thorough moisturising. Changes in drug metabolism mean that medication effects and side effects may differ from those in younger patients, so it is important to work closely with a physician throughout treatment.

🌸 Managing eczema by season

🌸 Spring measures

Spring is the pollen season, when contact dermatitis from pollen and flare-ups of existing eczema are more likely to occur.

• 😷 Wear a mask, hat, and long sleeves when going outdoors
• 🏠 Change out of outdoor clothing promptly upon returning home
• 💧 Wash your face and hair to remove pollen
• 🌡️ Temperature fluctuations can be significant, so layering clothes for warmth regulation is important

☀️ Summer measures

In summer, high temperatures and humidity lead to increased perspiration, and sweat-related irritation can cause eczema to flare up.

• 💦 Wipe away sweat and change clothes frequently
• 👕 Choose clothing with good moisture absorption and breathability
• ❄️ Regulate the indoor environment with air conditioning
• ☀️ Protect against UV rays with sunscreen and a hat

🍂 Autumn measures

In autumn, the air begins to dry out and skin moisture levels tend to decrease. The effects of UV damage accumulated over summer may also become more apparent.

• 💧 Step up moisturising care
• 💨 Begin using a humidifier
• 😴 Get sufficient rest and maintain a regular daily routine

❄️ Winter measures

Winter is the season when skin dryness is at its greatest throughout the year, and the risk of dry skin eczema increases.

• 💨 Use a humidifier to maintain appropriate humidity levels
• 🛁 Pay particular attention to bath water temperature and bathing time
• 💧 Apply moisturiser carefully after bathing
• ⚡ Use anti-static spray and choose clothing made from natural fibres

🏥 Conditions commonly associated with eczema

🤧 Association with allergic conditions

Many patients with eczema also tend to develop other allergic conditions. This is known as the allergic march, which may begin with food allergies in infancy and progress to atopic dermatitis, bronchial asthma, and allergic rhinitis.

Appropriate management from an early stage may help prevent progression of the allergic march. It is important to pay attention not only to skin symptoms, but also to respiratory and gastrointestinal symptoms, and to take a comprehensive approach to allergy management.

🦠 Risk of infection

When the skin’s barrier function is compromised by eczema, the risk of secondary infection from bacteria, fungi, and viruses increases.

⚠️ Infections requiring particular attention
Staphylococcus aureus infection is frequently seen in patients with eczema and may cause rapid worsening of symptoms and fever. If pus, odour, or fever is observed at the affected area, seek medical attention promptly to receive appropriate antibiotic treatment.

Herpes virus infection (eczema herpeticum) is another serious complication. If there is a sudden worsening or widespread blistering, urgent medical attention is required.

💉 Recent advances in eczema treatment

🧴 Topical immunomodulatory agents

In addition to conventional topical steroids, calcineurin inhibitors (tacrolimus ointment and pimecrolimus cream) have come into use.

These agents are non-steroidal anti-inflammatory medications and are particularly suitable for use on areas such as the face and neck where concerns about steroid-related side effects are greater. They allow effective treatment while avoiding the long-term side effects associated with topical steroids.

💊 Biological agents

Biological agents (such as dupilumab, tralokinumab, and nemolizumab) have become available for the treatment of severe atopic dermatitis.

These agents target specific inflammatory cytokines or their receptors and have shown favourable outcomes in patients who did not achieve sufficient results with conventional treatments. They are administered by subcutaneous injection and require regular outpatient visits.

🧬 JAK inhibitors

Oral JAK inhibitors (baricitinib, upadacitinib, and abrocitinib) have also emerged as newer treatment options.

By inhibiting inflammatory signalling pathways, they may act on both itching and inflammation. They represent an option for patients for whom topical treatment is difficult or for whom biological agents are not appropriate.

⚠️ Side effects and precautions in eczema treatment

💊 Appropriate use of topical steroids

Topical steroids are the foundational treatment for eczema, and understanding how to use them correctly is important.

📊 Potency classification and area-specific use

Topical steroids are classified into five levels of potency. Milder steroids are used on areas with thinner skin, such as the face and genitals, while moderate or stronger steroids may be used on the trunk and limbs depending on the severity of symptoms.

As a guide to the amount to apply, one Finger Tip Unit (FTU)—the amount squeezed from the tube from the tip of an adult’s index finger to the first joint—is sufficient to cover an area approximately equal to two adult palms.

💡 Preventing and managing side effects
Prolonged use may lead to side effects such as skin atrophy, telangiectasia, and purpura. Regular check-ups with a physician allow side effects to be monitored, and the medication can be changed or paused as necessary.

Some patients avoid treatment due to concerns about steroids, but when used appropriately, they have a good safety profile and may contribute to improved quality of life through symptom relief. If you have concerns, please speak to your physician to gain a proper understanding.

💉 Managing immunosuppressants

With immunosuppressants used in severe cases (such as ciclosporin and methotrexate), concerns include increased infection risk and effects on liver and kidney function.

Regular blood tests to monitor drug levels and organ function are carried out to help detect side effects early. Preventive measures against infection, such as avoiding crowded places and practising thorough handwashing and gargling, are also necessary.

🧠 Psychological support for patients with eczema

💭 Understanding the psychological impact

Chronic eczema is not merely a skin condition; it can have a significant impact on patients’ mental wellbeing.

Sleep disturbance caused by itching can lead to reduced daytime concentration and fatigue, affecting academic and work performance. Many patients also withdraw from social activities due to changes in appearance, which may increase the risk of social isolation and depressive symptoms.

🤝 The importance of psychological support

Listening to patients’ concerns and anxieties, and engaging with them in an empathetic manner, can contribute to improved treatment outcomes. Providing accurate information about the condition can help dispel excessive anxiety and misconceptions.

Where significant psychological symptoms are present, referral to psychiatry or psychosomatic medicine may be considered. Through counselling and cognitive behavioural therapy, patients can learn strategies for living well with their condition.

👥 Patient groups and support networks

The exchange of information and mutual support among patients with the same condition plays an important role in disease management.

By joining a patient group, individuals can share care methods and treatment information based on real-life experience, and gain emotional support. It may also encourage patients to learn more about their condition and take a more active role in their own treatment.

🔮 The future of eczema treatment

🧬 Advances in personalised medicine

Advances in genetic testing and skin function assessment are making it increasingly possible to select treatment approaches tailored to each individual patient.

Measurement of biomarkers is expected to enable prediction of treatment response and evaluation of side effect risk, paving the way for safer and more effective treatment.

💊 Development of new therapies

Many new treatments are currently under development. Transcutaneous vaccine therapy, stem cell therapy, and microbiome-based treatments are among the novel approaches being researched.

These emerging treatments hold the potential to provide improved options for patients who do not achieve sufficient results with current standard treatments.

📝 Practical advice for daily life

🛁 Bathing and skin care routine

Establishing an effective skin care routine is fundamental to eczema management.

🚿 Bathing guidelines

• Aim for 10 to 15 minutes in lukewarm water at around 38–40°C
• Avoid hot water, as it promotes skin dryness
• Choose a mildly acidic, fragrance-free soap or body wash
• Use a foaming net to create a rich lather and cleanse gently
• Take care to prevent shampoo or conditioner from coming into contact with the body

💧 Moisturising care

Moisturising within 5 minutes of bathing is ideal. Applying moisturiser while the skin is still slightly damp helps effectively prevent moisture evaporation.

When choosing a moisturiser, petrolatum-based creams and ointments offer high moisturising efficacy. If stickiness is a concern, using a lotion during the day and switching to a cream at night is also an option.

👕 Managing clothing and bedding

The selection and care of clothing and bedding that come into direct contact with the skin are important factors in preventing eczema from worsening.

👔 Points to consider when choosing clothing

• Prioritise natural fibres (cotton, linen, silk, etc.)
• Avoid synthetic fibres and woollen garments, as they may cause irritation
• Choose slightly loose-fitting sizes to minimise friction against the skin
• Wash new clothing once before wearing
• Use fragrance-free, dye-free detergents

🛏️ Bedding management

• Change pillowcases and sheets 2 to 3 times a week
• Using anti-dust-mite covers for bedding can also be effective
• Air duvets regularly in sunlight and vacuum them as well
• Managing bedroom humidity is also important

🍽️ Diet and nutritional guidance

For eczema improvement, care from within is also important. A well-balanced nutritional intake can help support the skin’s overall condition.

✨ Recommended nutrients

• 🦪 Zinc: Important for skin repair and regeneration (found in oysters, beef, and pulses)
• ☀️ Vitamin D3: Involved in regulating immune function (found in fish, egg yolk, and mushrooms)
• 🦠 Probiotics: Help maintain a healthy gut environment and support normal immune function (found in yoghurt and fermented foods)

⚠️ Foods to limit
Results may vary among individuals, but certain foods may aggravate eczema. Alcohol, excessive use of spices, and heavily processed foods with many additives may promote inflammation, so care should be taken with their consumption.

However, overly restrictive eating can lead to nutritional deficiencies and may actually worsen skin condition. It is important to work with a physician or dietitian to develop a well-balanced eating plan.

🚨 Responding in urgent situations

⚠️ Symptoms that require medical attention

If your eczema symptoms develop into any of the following, please seek medical attention promptly.

• 🔴 Sudden and rapid worsening of symptoms
• 📈 Spreading over a wide area
• 🌡️ Accompanied by high fever (possible bacterial infection or severe dermatitis)
• 😵 Symptoms suggesting anaphylactic shock, such as difficulty breathing, widespread swelling, or reduced level of consciousness

🩹 First aid measures

As first aid measures while awaiting medical attention, please do the following:

• 🧼 Keep the affected area clean
• ❄️ Cool with a cold, damp cloth
• ✂️ Keep nails trimmed short and wear gloves if necessary
• 💊 Take an over-the-counter antihistamine (to help relieve itching)

⚠️ Important note
Self-medicating carries the risk of worsening symptoms, so we recommend consulting a specialist as promptly as possible.

👨‍⚕️ Second opinions and specialist collaboration

🤔 Making informed treatment decisions

Eczema treatment requires an individualised approach tailored to the patient’s symptoms and lifestyle circumstances. If you are not achieving sufficient results with current treatment, or if you have questions about your treatment plan, seeking a second opinion is an important option to consider.

Particularly in severe or treatment-resistant cases, collaborative care involving multiple specialists—such as dermatologists, allergists, and immunologists—can be effective.

📊 Ongoing medical collaboration

Eczema is often a chronic condition that requires long-term management. Regular consultations allow changes in symptoms to be assessed and treatment approaches to be adjusted accordingly.

Patients themselves can achieve better treatment outcomes by keeping a record of changes in their symptoms and treatment responses, and actively sharing this information with their physician. Using a symptom diary and itch severity scale can facilitate objective assessment.

✅ Summary

Eczema is a condition in which appropriate knowledge and consistent care can help improve symptoms and enhance quality of life. A comprehensive approach tailored to each patient’s individual circumstances offers the best path to optimal treatment outcomes.

If you are troubled by any skin symptoms, we recommend consulting a specialist at an early stage. With appropriate diagnosis and treatment, recovery and maintenance of healthy skin is a realistic goal.