Eczema is not just a childhood condition. Many adults live with recurring flare-ups of itching, redness, and dry skin that disrupt their daily lives, sleep, and sometimes their self-confidence. The good news is that eczema can be managed. With the right treatment and an understanding of personal triggers, it's possible to significantly reduce the frequency and intensity of flare-ups.
What is eczema?
Eczema is a general term for a group of skin conditions characterized by skin inflammation, itching, dryness, and sometimes weeping lesions. The most common form in adults is atopic dermatitis, a chronic inflammatory condition linked to skin barrier dysfunction and an exaggerated immune response.
Eczema is not contagious. It is not a lack of cleanliness. It is a medical condition with a genetic and immunological basis, often associated with asthma and allergic rhinitis (the «atopic triad»).
The different types of eczema in adults
The most common type. It often appears in childhood but can persist or reappear in adulthood. It primarily affects the folds of the elbow and knee, as well as the face, neck, and hands. Flare-ups alternate with periods of remission.
Contact dermatitis
It occurs in reaction to contact with an irritating substance (irritant dermatitis) or an allergen (allergic contact dermatitis). Common triggers include household products, metals (nickel in jewelry), cosmetics, latex, and certain topical medications. It can affect any area of contact.
Dyshidrotic eczema
It manifests as small blisters on the palms of the hands, fingers, and soles of the feet. It is often associated with stress, excessive humidity, or certain allergies. It can be very uncomfortable and difficult to treat.
Nummular eczema
It appears as well-defined, round or oval plaques that may ooze. It often affects the limbs and trunk, especially in winter. It is frequently aggravated by dry air.
Seborrheic dermatitis
It affects areas rich in sebaceous glands: the scalp, face (eyebrows, sides of the nose, around the ears), and chest. It appears as red patches with greasy scales. Despite its name, it is not directly linked to excess sebum, but to a reaction to a yeast naturally present on the skin.
The characteristic symptoms
Depending on the type and location, symptoms vary, but the most common manifestations include:
- Intense itching, often worse at night
- Dry, rough, sometimes cracked skin
- Redness and inflammation
- Small vesicles that can ooze and crust over
- Thickened plaques (lichenification) due to chronic scratching
- Cracked skin on hands or feet
Eczema triggers
Triggers vary from person to person. Identifying your own is a key step in managing the condition.
Environmental triggers
- Dry air, especially in winter with the heating
- Excessive heat and sweating
- Dust mites, pet dander, pollens
- Cleaning products, detergents, harsh soaps
- Hard water
Habit Triggers
- Baths or showers that are too hot or too long
- Wool or irritating synthetic fiber clothing
- Cosmetics with allergenic fragrances or preservatives
- Tobacco (active or passive)
Internal triggers
- Psychological stress — one of the most frequent and underestimated triggers
- Certain foods (in some cases, rarely documented in adults)
- Bacterial or viral skin infections
- Hormonal fluctuations (some women report breakouts before their period)
How is eczema diagnosed?
The diagnosis is clinical: a doctor examines the skin and asks questions about medical and family history, contact substances, and trigger factors. Additional tests may be offered:
- Patch tests — to identify specific contact allergies. Performed by a dermatologist or allergist.
- Skin or serum allergy tests — to assess awareness of airborne or food allergens when relevant.
- Skin biopsy — to rule out a bacterial infection (Staphylococcus aureus is frequently found in eczema) or another skin condition.
Eczema treatments for adults
Eczema cannot be cured, but it can be controlled. Appropriate treatment helps reduce flare-ups, relieve symptoms, and improve quality of life.
Regular application of emollients (rich moisturizers, ointments) is the cornerstone of maintenance treatment, even outside of flare-ups. It strengthens the skin barrier and reduces the frequency of flare-ups. Applying the emollient right after a bath or shower, while the skin is still slightly damp, maximizes its effectiveness. A doctor can recommend the formulations best suited to your skin type.
Cortisone creams or ointments are the most commonly prescribed anti-inflammatory treatments for flare-ups. They come in different strengths (from low to very high) and are chosen based on the location and severity of the eczema. When used correctly and under medical supervision, they are effective and safe. Concerns about side effects mainly relate to prolonged unsupervised use.
Tacrolimus and pimecrolimus are non-steroidal anti-inflammatory drugs available by prescription. They are particularly useful for delicate areas like the face, neck, or folds, where corticosteroids should be used with more caution.
For severe eczema that does not respond to topical treatments, systemic medications may be considered under specialist supervision:
- Immunosuppressants such as cyclosporine or methotrexate
- Modern biotherapies like dupilumab (Dupixent), a monoclonal antibody targeting key mediators of atopic inflammation—available in Canada with specific eligibility criteria
- JAK inhibitors (Janus kinase inhibitors) - next-generation oral medications for moderate to severe forms
These advanced treatments require follow-up by a dermatologist.
Phototherapy (controlled exposure to narrow-band ultraviolet UVB rays) can be effective for certain types of refractory chronic eczema. It is performed in a specialized clinic with several sessions per week.
Since stress is one of the most constant triggers, stress management approaches—relaxation, mindfulness, cognitive behavioral therapy—are an integral part of comprehensive care. The psychological impact of living with a visible skin condition is also real and deserves attention.
Good daily habits
Outside of medical treatments, certain habits reduce the frequency and intensity of flare-ups:
- Take lukewarm (not hot) baths or showers for a limited time
- Use mild, fragrance-free, and dye-free soaps
- Wear cotton or soft natural fiber clothing
- Wash new clothes before wearing them
- Maintain a cool room temperature and adequate humidity level (humidifier in winter).
- Avoid scratching — short, clean fingernails reduce the risk of injury and infection
- Apply emollient regularly, not just during flare-ups
When to see a doctor
Consult a healthcare professional if:
- Your symptoms are not improving with over-the-counter products
- Itching disturbs your sleep or work
- You are observing signs of infection: intense redness, heat, yellowish discharge, fever
- Are your flare-ups frequent or becoming more severe
- You need a prescription treatment adapted to your type of eczema
- Does eczema affect your quality of life or your self-esteem
Our doctors can assess your skin condition, provide a diagnosis, and recommend a suitable treatment — including prescriptions for medicated creams or systemic medications. An online consultation is available for an initial assessment or follow-up, without needing to travel.
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