Types of eczema: atopic, contact, discoid and more

Eczema is the name for a group of skin conditions that make skin dry, itchy and irritated. Only a doctor can confirm which type a person has, and the type matters, because the American Academy of Dermatology (AAD) says each one needs different treatment. This guide describes the main types, where they appear and what causes them. The complete guide to eczema covers the condition as a whole.

The NHS names atopic eczema and four other types: contact dermatitis, discoid eczema, pompholyx (also called dyshidrotic eczema) and varicose eczema. The AAD lists seven types: atopic dermatitis, contact dermatitis, dyshidrotic eczema, hand eczema, neurodermatitis, nummular eczema and stasis dermatitis. MedlinePlus, the health site of the US National Library of Medicine, also counts seborrheic dermatitis as a form of dermatitis. Several of these have two names, which is why the lists look different.

Why the word "eczema" can be confusing

The AAD says eczema refers to a group of conditions that cause rashes, itchiness and dry skin, and that atopic dermatitis is one type of eczema. Because atopic dermatitis is the most common type, many people and many doctors use "eczema" to mean atopic dermatitis. The AAD suggests that if you hear the word eczema in a health care setting and are not sure what is meant, you ask which type the person is talking about.

Atopic eczema (atopic dermatitis)

Atopic eczema is the most common type. The NHS says it often runs in families and is linked to other conditions, such as asthma and hay fever. The word "atopic" means linked to allergies. It usually starts in childhood, and the AAD says most people who get it do so by age 5, although it can start at any age.

Atopic eczema makes skin itchy, dry, cracked, scaly or thickened. It comes and goes in flare-ups. In babies it often appears on the face and scalp, in children in the bends of the elbows and knees, and in adults on the hands, neck and around the eyes. The guide to what eczema looks like shows how it changes with age and skin tone.

Contact dermatitis

The NHS describes contact dermatitis as a type of eczema triggered by contact with a particular substance. The AAD says almost everyone gets this type of eczema at least once. It comes in two forms:

• Irritant contact dermatitis. A substance damages the outer layer of the skin directly. The NHS says this is the most common form, often caused by soaps and detergents, solvents or regular contact with water. MedlinePlus says people with atopic dermatitis have a higher risk of this form.
• Allergic contact dermatitis. The immune system reacts to a substance. The NHS names cosmetics and metals such as nickel. MedlinePlus lists fragrances, hair dyes, nail polish, rubber or latex, some plants such as poison ivy, and preservatives in some skin medicines.

The NHS says the reaction usually appears within a few hours or days of contact. MedlinePlus says an allergic reaction most often shows 24 to 48 hours after contact. The rash is itchy, dry, cracked or blistered, and it most often affects the hands and face.

Contact dermatitis is the type most likely to clear completely. The NHS says it usually improves or clears up completely if the substance causing it is found and avoided. MedlinePlus says it clears without problems in 2 or 3 weeks in most cases. To find an allergy, a doctor may arrange patch testing, in which small patches of possible allergens are placed on the skin and checked over several visits.

Discoid eczema (nummular eczema)

The NHS says discoid eczema causes skin to become itchy, swollen and cracked in circular or oval patches. It usually starts as a group of small spots or bumps that join into larger patches, from a few millimetres to several centimetres across. On lighter skin the patches are pink or red. On darker skin they can be dark brown or paler than the skin around them. At first they are often swollen, blistered and oozing, and later they become dry, crusty, cracked and flaky. The NHS says they are often itchiest at night.

The centre of a patch sometimes clears and leaves a ring of discoloured skin that can be mistaken for ringworm, a fungal infection. The NHS says discoid eczema does not usually affect the face or scalp.

The cause is unknown. The NHS says it may be linked to dry skin, and a minor skin injury such as an insect bite or a burn can start an outbreak. Some medicines have been linked to it, and the NHS says you should not stop taking any prescribed medicine without talking to the doctor who prescribed it. Without treatment, discoid eczema can last for weeks, months or even years.

Pompholyx (dyshidrotic eczema)

Pompholyx affects the hands or feet. The NHS says the first sign is often itchy skin with a burning or prickling feeling, followed by itchy blisters filled with fluid, most often on the fingers and palms, and sometimes on the toes and soles. The symptoms usually last 2 to 3 weeks at a time, and the condition comes and goes over a long period.

The NHS lists things thought to set it off in some people: strong chemicals in soaps, cleansers and detergents, an allergy or sensitivity to metals such as nickel or cobalt, getting the hands wet often, stress, and heat and sweat. The NHS also says not to burst the blisters. See a doctor if the blisters are painful, leak yellow or green pus, or have a yellow brown crust, because these are signs of infection.

Varicose eczema (stasis dermatitis)

Varicose eczema affects the lower legs. The NHS says it is also called venous, gravitational or stasis eczema, and that it is common in people with varicose veins, which are swollen, enlarged veins. It is usually caused by increased pressure in the leg veins, when small valves inside them stop working well.

The skin can become itchy, swollen, dry, flaky, scaly, crusty or blistered. On white skin it looks red or brown, and on black or brown skin it tends to look dark brown, purple or grey. The NHS says that without treatment, leg ulcers (open wounds) can develop. It is more common in women, in people with obesity, during pregnancy, with age, and after a blood clot in a leg vein. A doctor can offer treatment, which the NHS says may include moisturizers, steroid creams, compression stockings and ways to improve blood flow, such as staying active and raising the legs.

Seborrheic dermatitis

The AAD describes seborrheic dermatitis as a common skin condition that causes a scaly rash on oily areas of the body, like the scalp and face. MedlinePlus lists common areas: the scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in the outer ear and the middle of the chest. The AAD says dandruff may be the mildest form. In babies it is called cradle cap, and the AAD says cradle cap usually goes away on its own within a few months. A doctor should still look at any rash on a baby.

MedlinePlus says the exact cause is unknown, and that oil gland activity, a yeast called Malassezia that lives on the skin, changes in the skin barrier and genes may all play a part. The AAD says seborrheic dermatitis is not contagious (the guide is eczema contagious? covers every type), and that flare-ups are often worse in winter and early spring and when a person feels stressed.

Hand eczema and neurodermatitis

The AAD lists two more types. Hand eczema makes the skin on the hands dry, thick and scaly, and the AAD says relief requires finding the cause. For neurodermatitis, the AAD says it can clear completely with the right treatment, although finding what works can take time.

The main types side by side

Type	Where it usually appears	What it looks like	Known cause or link
Atopic eczema	Face and scalp in babies; elbow and knee creases in children; hands, neck and eyes in adults	Dry, itchy, scaly or thickened skin that flares and settles	Genes, immune system and environment; runs in families
Contact dermatitis	Where the substance touched, most often hands and face	Itchy, dry, cracked or blistered skin	An irritant or an allergen
Discoid eczema	Any part of the body, usually sparing the face and scalp	Round or oval patches, at first oozing, later dry and flaky	Unknown; linked to dry skin
Pompholyx	Fingers, palms, toes and soles	Itchy blisters lasting 2 to 3 weeks at a time	Unclear; strong chemicals, metals, wet hands, stress, heat
Varicose eczema	Lower legs	Itchy, swollen, dry or discoloured skin	Raised pressure in the leg veins
Seborrheic dermatitis	Scalp, eyebrows, sides of the nose, behind the ears, chest	Scaly, greasy or flaky rash	Unknown; oil glands and a skin yeast play a part

Sources: NHS, AAD and MedlinePlus pages listed below.

Can a person have more than one type?

Yes. The NHS says some people with discoid eczema also have a history of atopic eczema. It also says a doctor may refer someone with varicose eczema to a skin specialist if contact dermatitis might be present as well. MedlinePlus says people with atopic dermatitis have a higher risk of irritant contact dermatitis, and the AAD says seborrheic dermatitis can appear together with rosacea or psoriasis.

That is one reason to have a doctor confirm the type. Some conditions that are not eczema at all, such as psoriasis and fungal infections, also cause itchy patches, as the guide to what eczema looks like explains. Once the type is known, the guide on how eczema is treated describes what a doctor may offer, and eczema vs dry skin helps with the most common mix-up of all.