What is Eczema and What Causes Eczema2016-12-19T16:52:54+00:00

Eczema Causes | What is Eczema and What Causes Eczema

Eczema in Singapore

Eczema is a common skin problem that's especially prevalent in developed countries such as Singapore.

Do you know that over 20%, or 1 in 5 people in Singapore suffer from eczema? What is eczema and what causes eczema?

What Is Eczema?


Persons suffering from eczema can fully appreciate the origin of the term. It comes from the Greek word “ekzema” meaning “eruption” or “to boil out”. These aptly describe the condition’s most common appearance of skin that is dry, cracked, red and often oozing.

Eczema is a form of dermatitis (inflammation of the skin). The term covers a particular group of skin disorders which share similar characteristics, among them inflammation. Quite often, however, the terms “eczema” and “dermatitis” are used interchangeably to refer to any inflammation of the skin. Another common usage of the term “eczema” is to refer to a specific type of dermatitis called atopic dermatitis.

This article will use “eczema” as in the first instance stated above, that is, a particular group of skin disorders. We will take an in-depth look at eczema, it causes, types and their symptoms.

Some Eczema Statistics

In its November/December, 2011 issue, Singapore Health Magazine quoted figures of nearly one in five persons in the country being affected with eczema.

For the United States, the available figures from the National Eczema Association say just over 30 million Americans have eczema.

Within the United Kingdom, the National Eczema Society reveals that 1 in 5 children (or 20%) is affect by eczema, while the number of affected adults stands at 1 in 12 (or roughly 8%).

How Does Healthy Skin Behave?

Image of Skin with Eczema dermatitis compared to Normal Skin

Skin changes due to dermatitis/eczema.

Skin is made up of three layers (Epidermis, Dermis, Hypodermis) with cells, fats, oils and water in each layer assisting in keeping the skin healthy. Healthy skin is able to protect against infection and damage, regulate the body’s temperature and stop microorganisms and irritants from entering the body.

The National Eczema Society likens skin cells to bricks, with the fats and oils cementing and sealing them much in the same way that mortar does to bricks. The fats and oils help to hold water in the skin, keeping the cells hydrated. The cells absorb the water and swell to form a close fit. This also helps to improve water retention, resulting in healthy moisturized skin.

It is felt that eczema prone skin does not produce sufficient fats and oils. Thus its water retention ability is lowered and consequently so is its protective function. The cells are not as swollen and spaces form between them, making it possible for water contained in the deeper layers to evaporate from the skin leaving it drier. At the same time it also becomes easier for microorganisms and irritants to enter.

Causes of Eczema

A single underlying cause of eczema remains unknown, but Dr Koh Hong Yi, Registrar, Department of Dermatology at Singapore General Hospital points to recent studies which found that apart from lower amounts of oil in their skin, many eczema sufferers also have a protein mutation called filaggrin in their skin, making it weaker.

Dr Koh cites another common trait among persons with eczema as he goes on to say that healthy skin has sufficient amounts of a natural antimicrobial agent that keeps bacteria found naturally on the skin in check. On eczematous skin, however, low levels of this anti-microbial agent leads to high levels of bacteria.

Several other factors are associated with the occurrence of eczema. The factors may vary from person to person and among the different types of the disorder. Some of the more common factors are listed below.

Eczema shows signs of being hereditary.

Person with eczema tend to have other allergies such as asthma, hay fever and food allergies.

Food allergies act as triggers for some persons, with peanuts, eggs, cows’ milk, soya and wheat being among the main culprits.

A room that is damp, has dust mites, pet fur or mould increases the risk of an eczema outbreak.

Symptoms of eczema can be brought on or worsened by stress and emotional trauma.

Certain fabrics (such as synthetics and wool) worn close to the skin have also been highlighted as setting off or aggravating an eczema episode.

Hormonal changes during pregnancy or before a period tends to worsen eczema symptoms in women

The weather acts as a trigger for some people who report that dry or dusty air and air that is either too hot or cold makes their eczema flare up.

Certain soaps, detergents and harsh chemicals act as eczema triggers for many people.

Eczema Causes in Our Daily Lives

Eczema can be caused by many external or internal factors. Here are some of the major causes of eczema:

  • Growing up in an overly hygienic environment. Lack of exposure to many kinds of bacteria from an early age prevents skin from developing its natural immunity. Living in Singapore, many of us are super clean, use anti-bacterial soap, wipes, etc. Therefore children who have lacked exposure to bacteria from a young age are more likely to develop eczema.
  • Reaction to harsh chemicals in skin cleansers. The most common skin irritants/allergens include Sodium Lauryl Sulfate (SLS), Sodium Laureth Sulfate (SLES), Propylene Glycol and Cocamidopropyl Betaine. These chemicals are found in practically ALL commercial foams, baby wash, shampoos, liquid soap, facial cleansers, lotions, moisturisers, sunscreens and cosmetics etc. All you have to do is read the ingredient’s label to find these chemicals that are actually harsh detergents. They are sold and marketed as skincare because they are cheap to produce and boost commercial profit margins at the expense of your money, skin and health. Start by checking the ingredients list of your cleansers, creams, lotions and other skincare products. Almost every commercial skincare product on store shelves contains some or all of these chemicals. Thankfully natural and organic alternatives are easily available.
  • Irritation or allergy to certain materials touched including solvents, detergents, cement, glues, perfumes, nickel etc.
  • Stress. In a stressful society with many demands pulling on all sides, one can suffer an eczema flare up due to the pressures one face.
  • Environmental factor. The presence of haze particles/pollutants, dust in the air can trigger an eczema flare up as well.
  • Hormonal changes in the body. After/during pregnancy, some women can be struck with skin sensitivities or eczema due to fluctuation of hormones in the body and it does not help to slap more estrogen-mimicking Parabens onto the body. To know more about the dangers of Parabens, click here.
  • Hereditary. Some people have an inherited sensitive skin.

Above are some of the causes in modern, overly sanitised, developed countries like Singapore, where constant advertising for profits has influenced the population into lifestyle choices that prioritises convenience, quick fix solutions that do more harm than good.

Continue reading below for more information about the causes of eczema, types of eczema, triggers and symptoms.

Or discover safe and effective Eczema Treatment.


Some common descriptions and types of Eczema: baby eczema, hand eczema, dermatitis, atopic dermatitis, atopic eczema, dyshidrotic eczema, discoid eczema, eczema herpeticum, nummular eczema, stasis eczema.

Types of Eczema and Symptoms

The following is a look at some of the more common forms of eczema and their individual symptoms.

1. Atopic Dermatitis (Atopic Eczema)

Overview – Atopic dermatitis is a chronic (long lasting) type of eczema and the most common form of the disorder. The National Eczema Association informs us that of the 31.6 million people in the US affected by eczema, 17.8 million of them have atopic dermatitis.

Although the condition can occur at any age, it usually begins in infancy, causing it to be regularly referred to as infantile or childhood eczema. The UK’s National Health Service (NHS) notes that of all children with atopic dermatitis, 8 out of 10 of them develop the condition before the age of five.

The NHS goes on to point out that in roughly 50% of cases, the children see marked improvement in their atopic dermatitis by the age of eleven. A full 67% of them see this improvement by the age of sixteen. The general rule seems to be that milder cases will clear while more severe cases will persist into adulthood.

Adults who had atopic dermatitis in childhood that has since cleared up are often left with sensitive skin that is prone to become dry and irritated. They may also become more predisposed to developing hand dermatitis (discussed later), as well as, skin infections such as herpes and staph. Cataracts and eyelid dermatitis may also pose a problem for these persons.

Cause and Triggers – The term “atopic” is defined as a sensitivity to allergens. In most instances of atopic dermatitis there is a family history of eczema or another ‘atopic’ condition (such as hay fever or asthma). If one parent has an atopic condition then the child has a 25% chance of also having an atopic condition. This figure doubles to a 50% chance when both parents are atopic.

Atopic dermatitis is thought to result from a combination of this genetic predisposition and environmental factors. Common triggers for atopic dermatitis are:

  • teething
  • detergents, soaps and perfumes or fragrances
  • very hot or very cold environments
  • changes in temperature
  • humidity
  • sweating
  • skin infection
  • dust mite droppings
  • animal fur, hair and saliva
  • pollen from trees, grasses and weeds
  • clothing made of wool or synthetic fibres
  • There is some connection between atopic dermatitis and stress, but it is as yet unclear which results in the other: stress-induced eczema or eczema induced stress or both.

Symptoms – Atopic dermatitis is characterized by dry skin that becomes cracked, itchy, red and sore. Even as the other symptoms fade, excessive itching may persist and become virtually unbearable especially at night, waking the sufferer from sleep to scratch almost uncontrollably. The itching is, in fact, the most characteristic trait of atopic dermatitis.

Apart from disrupting sleep, scratching can cause bleeding and lead to infections. Scratching also tends to lead to worse itching and then even more scratching, in what is called the “itch-scratch cycle”.

Perhaps the final symptom of an atopic eczema outbreak is the discolouration of the skin as the condition clears. The colour change is temporary and more pronounced in persons with darker skin who may see their skin colour become lighter or darker. Eventually, the skin will return to its normal colour.

While atopic dermatitis may arise anywhere on the body and can result in near full scale coverage, some parts appear to be more susceptible than others. These include:

  • In adults, it is more common for the face to be affected.
  • fronts and backs of the knees
  • hands, especially the fingers
  • inside and outside of the elbows
  • around the neck
  • cheeks
  • scalp

2. Seborrhoeic Dermatitis (or Seborrhoea)

Overview – Seborrhoeic dermatitis refers to a rash on areas of the skin that have numerous oil glands (sebaceous glands). It is one of the most common forms of eczema, usually appearing on the scalp, at the hairline, on the eyebrows and sides of the nose, as well as behind the ears. It can also show up on the chest. It may appear similar to dandruff but with more itching and signs of redness and inflammation.

Cause and Triggers – Seborrhoeic dermatitis is thought to be caused by a yeast (Malassezia) found normally on the skin, but to which eczematous skin has an abnormal reaction. The yeast thrives in areas of the body that have an abundance of oil glands.

Along with the action of the yeast, some other factors have been identified as triggers for seborrhoeic dermatitis. These factors include:

  • stress and emotional trauma
  • genetics
  • change of seasons
  • cold, dry weather

Contrary to what many people think, the condition does not result from poor hygiene or from exposure to allergens. It can however be kept under control with good skin care.

Certain medical conditions and medicines may also trigger an episode of seborrhoeic eczema or make a pre-existing outbreak worse. Some of these are:

  • alcoholism
  • eating disorders
  • depression
  • heart attack or stroke recovery
  • Parkinson’s disease
  • acne
  • Rosacea – chronic discolouration of areas of skin on the face.
  • psoriasis – a condition in which skin cells multiply at as much as 10 times the normal rate.

Symptoms – The main symptoms of seborrhoeic dermatitis are redness, itching and skin that is dry and flaking. There may also be burning and scaling, where the scales that flake off are either yellowish or white and appear oily or moist.

The condition is described as chronic, but many persons experience fluctuations in the severity of the symptoms. Treatment can cause the symptoms to subside, but they tend to flare up again when the treatment is stopped. Occasionally, there are person who seem to have “outgrown” it.

New-born babies are among those most likely to have seborrhoeic eczema and for them it is usually called “cradle cap”. Adults between the ages of 30 and 60 are also at increased risk of developing this type of eczema, with men more likely than women to suffer from it.

Infantile Seborrhoeic Dermatitis

Infantile seborrhoeic dermatitis commonly occurs in children less than one year old, with a sudden onset of the condition in babies between 2 weeks and 6 months old. Once the condition clears up, it is not normally seen again. A family history of eczema does not appear to place babies at higher risk of developing seborrhoeic dermatitis.

As the name “cradle cap” suggests, infantile seborrhoeic dermatitis frequently affects the scalp. It is not uncommon, however, for it to also be found on the face, neck, ears and in the diaper area. The folds behind the knees, as well as those inside the elbows and armpits are also susceptible to developing the condition.

The symptoms of infantile seborrhoeic dermatitis vary depending on its location. In the case of cradle cap, there are thick, yellow and waxy scales that form a crust on the scalp. The scales do not cause any itching or discomfort to the infant but are difficult to remove because they stick to the hair. The scales may also affect the eyebrows, behind the ears, forehead, neck folds and temples.

In the diaper area the condition makes the skin of the bottom inflamed, red and flaky. It may also result in easily dislodged small, white scales whose removal leaves the skin shiny. The redness may progress to areas close by such as the genitals, the folds at the tops of the legs and in between the buttocks. The potential then exists for it to rapidly spread to various other areas on the body.

On other parts of the body, infantile seborrhoeic dermatitis usually appears as small, dry, salmon-pink patches that eventually link to cover larger areas.

Adult Seborrhoeic Dermatitis

In adults, seborrhoeic dermatitis tends to begin as dandruff that becomes red, irritated and shows increased scaling. As the inflammation of the scalp worsens, the condition begins to affect the skin of the face and neck. It is not uncommon for men, especially, to see the symptoms spread to their chest and back.

Other areas with a tendency to be affected by adult seborrhoeic dermatitis are:

  • eyebrows
  • folds at the sides of the nose
  • temples
  • neck

In these areas the condition shows up as reddening of the skin and shedding of small white flakes.

The skin behind the ears is particularly susceptible to severe seborrhoeic dermatitis, which covers the area in large, greasy scales that also stick to nearby hair. Ear eczema may develop as a result of the condition spreading to the folds of the ear and into the ear canal, where irritation is experienced.

3. Contact Dermatitis

Overview – This is inflammation caused by contact with certain substances. The substances may be irritants that act by directly damaging the skin’s outer layer or they may be allergens triggering an immune response that adversely affects the skin. According to the NHS, in roughly 80% of cases of contact dermatitis, the cause is an irritant not an allergen.

Irritant contact dermatitis

Cause and Triggers – Having atopic dermatitis increases the risk of developing irritant induced contact dermatitis. Among the irritants frequently identified as leading to the condition are:

  • soaps and detergents
  • disinfectants, antiseptics and antibacterial agents
  • toiletries and cosmetics containing perfumes and preservatives
  • dust, powders, soil and cement
  • water – especially heavily chlorinated water or water that is hard and chalky
  • solvents
  • machine oils
  • acids and alkalis
  • many plants, including mustards, Ranunculus, Boraginaceae and spurge

Strong irritants may cause an immediate reaction, but quite often the symptoms show up after repeated exposure over the course of a few hours or several days. Some irritants only show their effects when the skin is exposed to sunlight after being exposed to the irritant. This phenomenon is known as photosensitivity.

Symptoms – Contact dermatitis may occur anywhere on the body but usually affects the hands and face. The symptom shows up at the point of contact with the irritant and include:

  • redness
  • swelling
  • blisters
  • burning or stinging
  • scaling
  • cracking

These symptoms can be worsened by rubbing against the irritant, dry air, heat and cold.

The term “occupational irritant dermatitis” is used in situations where exposure to the irritant occurs on the job. Occupations with the highest frequency of person suffering from occupational irritant dermatitis include:

  • hairdressers and beauticians
  • healthcare and social care workers
  • machine operators, mechanics and vehicle assemblers
  • caterers and cooks
  • metal, chemical and electronics workers
  • cleaners
  • construction workers
  • agricultural workers

Hand eczema, which affects roughly 10% of the population, is classified as an irritant contact dermatitis condition. A specific type of hand eczema is pompholyx which is discussed shortly.

Allergen Contact Dermatitis

Your immune system acts as your natural defence mechanism whenever your body is exposed to infection or develops an illness. Allergic reactions arise when the immune system mistakenly attacks healthy cells and tissues, and not just the cause of the infection.

Interestingly, your body does not show any reaction to the allergen when first exposed to it. It is subsequent contact that causes the symptoms to occur. These will usually take a few days to develop, usually as an itchy red rash at the sites of contact with the allergen.

The NHS lists the following as common allergens that lead to allergic contact dermatitis.

  • hair dye, nail varnish hardeners, preservatives, fragrances and other cosmetic ingredients
  • textiles, in particular the dyes and resins they contain
  • metals used in jewellery (including nickel or cobalt)
  • some medicines applied on the skin (topical medicines)
  • naturally occurring latex and other forms of rubber
  • strong glues, among them epoxy resin adhesives
  • some plants including chrysanthemums, daffodils, primula, sunflowers and tulips

Precaution – It is possible for a skin infection to develop in the area affected by contact dermatitis. You will need to get in touch your doctor at the first sign of an infection, as an antibiotic treatment may need to be prescribed. Warning signs of an infection include:

  • rapid worsening of the existing symptoms
  • discharge from your skin
  • fever
  • increased pain
  • feeling generally sick

Recurrent, persistent or severe symptoms should also be reported to your doctor who will help you to determine the cause of the condition. You may also have to undergo tests to identify your exact irritant or allergen. Your doctor will most likely suggest treatments appropriate to both the cause and the symptoms.

4. Dyshidrotic Eczema (Pompholyx)

Overview – a condition characterized by tiny blisters on fingers, toes, the palms of the hands and soles of the feet. In extreme cases of pompholyx, the blisters are much larger and can be found on the backs on the hands and the limbs. The skin around the nails, as well as, the nail folds may also be affected and become swollen.

Cause and Triggers – Pompholyx can occur at any age but adults under 40 are more likely to be affected. It is also twice as likely to affect women as men. A family history of atopic dermatitis is thought to predispose you to developing pompholyx. It has been observed that about 50% of pompholyx sufferers either have atopic dermatitis or it runs in their family.

While there are cases in which pompholyx can become chronic, it is not uncommon for it to occur just once or twice in an individual. Most often, however, it clears and recurs over a period of several months or years. The triggers looked at below may cause a reappearance of the condition or make an existing outbreak worse.

  • stress and emotional tension
  • sensitivity to chromium, nickel or cobalt compounds
  • contact with cosmetic products or perfume, detergents, household chemicals, shampoo or soap
  • sweating, especially excessive sweating (or hyperhidrosis), common in spring and summer
  • frequent exposure to water or damp conditions
  • fungal skin infections which can coexist with pompholyx and are not necessarily at the site of the outbreak

Symptoms – Pompholyx begins with intense itching and a burning, prickling sensation in the palms or soles. Small blisters then appear which get bigger and ooze. They may become infected leading to pain, swelling and redness. The blisters may also develop pus or have a golden crust form over them.

This stage is usually followed by the skin drying out and peeling. The skin then becomes red, with the dryness leading to painful cracks or skin fissures. These are actually signs that the skin is beginning to heal. In most cases the blisters heal in a few weeks.

5. Discoid Eczema (Nummular Eczema)

Overview – It is rare to find the condition occurring in children, with adults being the ones most affected by it. Among adults, young women in their teens to 20’s and men from 50 to 70 years old are the most likely to suffer from the condition. Discoid eczema tends to accompany other forms of eczema.

Cause and Triggers – The most apparent triggers of this chronic form of eczema are insect bites and dry skin due to winter weather.

Symptoms – Although the condition is characterized by oval or circular patches about the size of a coin on the skin, it does not begin this way. In the early stages, persons notice a cluster of bumps or small red spots on their skin. Within a short space of time, the bumps or spots come together as the tell-tale pink, red or brown patches for which discoid eczema is known.

The patches are swollen, cracked and itchy, with the itchiness most pronounced at night. They may also be covered with blisters which initially ooze and then over time become cracked, dry, crusty and flaky.

The patches may occur anywhere on the body but are not usually seen on the face and scalp. The number of patches varies from person to person. Whereas some people only have one patch, others may have several patches with dry skin in between them. If left untreated, it may take anywhere from weeks to years for the patches to clear up but they recur in the same locations as before.

It is not uncommon for the appearance of the patches, as they clear up, to be mistaken for a case of ringworm. Additionally, discoid eczema has the tendency to leave the skin discoloured once the symptoms have improved.

Precaution – It is advised to seek medical attention immediately if you suspect you have developed discoid eczema. There are two main reasons for this: firstly, the condition lasts much longer when untreated and is much more likely to just keep coming back. Secondly, the patches are susceptible to infection. Signs that indicate an infection include:

  • pain, tenderness, redness and swelling of the skin around of the patches
  • skin around the patches feel hot to the touch
  • a yellow crust forming over the patches
  • excess oozing
  • an onset of the chills
  • feeling generally sick

6. Varicose Eczema (Stasis Eczema)

Overview – a chronic condition predominantly seen on the lower legs and resulting from problems with blood circulation along the veins in the legs. Varicose eczema occurs more in women than in men and often accompanies pregnancy. Since older people tend to have a problem with mobility, they often experience poor circulation which can lead to varicose eczema.

Cause and Triggers – The problem usually arises when the veins become weakened, lose their elasticity and become stretched. This causes the small valves in the veins to malfunction, leading to backflow of blood. As the blood pools in the veins, the pressure inside them increases and fluid oozes into the surrounding tissues. It is felt that the immune system’s response to this fluid under the skin is the cause of varicose eczema.

The risks of developing varicose eczema are greater in persons who:

  • have had deep vein thrombosis (blood clots in leg veins)
  • have had to remain in one position (standing or sitting) for a long period of time
  • suffer from varicose veins
  • are overweight
  • have had cellulitis (a bacterial skin infection)
  • have had phlebitis (inflammation in a vein)

Symptoms – Some of the symptoms of varicose eczema are common to all types of eczema and include itching, redness and swelling, as well as skin that is dry, flaking, scaly and possibly crusty. Other symptoms experienced by some persons include:

  • skin that is red, tight, tender and may thicken over time
  • pain
  • tiny blisters above the ankles
  • small white scars
  • affected skin develops a brown tinge
  • eczema elsewhere on the body

Severe cases of varicose eczema may result in infection, cracking or large leg ulcers and oozing.

7. Xerotic (Asteatotic or Dry Skin) Eczema

Overview – a chronic form of eczema characterized by cracking and oozing of severely dry skin. The condition tends to flare up when the air is dry with very low humidity, as in wintertime, hence its nickname “winter itch”.

Cause and Triggers – It is more prevalent among the elderly, with persons over the age of 60 generally affected. This is because as we age, our skin loses some of its water retention capability, tending to dry out easily.

The risk of developing xerotic eczema increases with:

  • long, hot baths and showers
  • exposure to chemicals such as harsh soaps
  • excessive scrubbing of the skin
  • too much skin washing
  • very rough drying of the skin after washing
  • decrease in oils on the skin’s surface
  • a pre-existing condition of dry, rough skin
  • dehydration
  • dry environments
  • malnutrition

Symptoms – Xerotic eczema generally affects the limbs and trunk, usually being more pronounced on the arms and shins. The symptoms of xerotic eczema mirror those of most other types, in that the skin becomes red, dry, itchy, cracked, sore and flaky. One difference is that blisters are not seen in this condition.

What is sometimes seen is well defined plaque formation on the affected area of skin, most often on the shins. The shins may take on a “crazy paving” pattern and develop superficial cracks that are pink and red in appearance.


Healthy skin is able to withstand the effects of triggers, with symptoms ranging from none to mild. The reaction of eczema prone skin is worse, with inflammation, irritation and cracking readily appearing. Regardless of the form eczema takes, its symptoms can have serious, adverse effects on the quality of life of the affected person and their family.

There is usually embarrassment and low self-esteem arising out of the unsightly appearance of skin afflicted with the condition. The symptoms themselves may impact the ability to work or attend school, as well as they may interfere with sleep or the ability to perform basic self-care tasks.

While eczema has no known cures, there are ways to relieve its symptoms. This allows the individual to pursue normal daily activities without the discomfort and embarrassment that normally accompany the condition.

Next: Eczema Treatment

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This article in based on information gathered from the following sources:









Singapore Health Magazine; November/December, 2011 issue; Stop That Itch!

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