Eczema Symptoms and Signs: Differentiating Acute and Chronic Eczema

Eczema is an inflammatory skin condition that worldwide has a lifetime prevalence of 12%. This means roughly one in eight people will experience the symptoms or visual signs of eczema at least once. The causes of eczema are multifactorial, but basically, it’s the manifestation of a hyperreactive immune system.

There are a number of ways to prevent and treat eczema but first, it’s important to identify whether your subjective symptoms and observable signs are in fact eczema.

What are the Symptoms of Eczema?

A symptom is a feeling that you have that you or your doctor cannot see. For example, when you get sick with the flu, the first symptom you experience might be fatigue or joint pains. These are maladies that one cannot objectively measure from the outside. It requires your own interpretation to help guide the diagnosis of flu.

The most common symptom of eczema is itching but some people don’t have the urge to scratch and instead feel an irritated or raw sensation. It is possible to have the sensation of eczema without any visual skin lesions. Patients can report feeling their skin stinging, burning, or itching without seeing any visual change in the appearance of the skin’s surface. This occurs especially early in the disease or in mild cases.

What is the Sign of Eczema?

A sign is a change that one can see. It is objective in that it can be measured or observed by the patient and doctor. Going back to the flu example, a sign of the flu could be an elevated body temperature recorded by a thermometer or perspiration on the forehead.

If the flu leads to a secondary lung infection that can often be visualized with a chest x-ray. These are all signs used in diagnosis. Signs of eczema can be wide-ranging. It may present as redness, scaling, or cracking. The skin lesions can weep fluid or be very dry.

Many of the signs of eczema are not caused by the inflammation itself –they are the result of scratching and rubbing secondary to the provoking symptoms.

The Signs and Symptoms Of Acute Eczema

  • Pruritus

The itching sensation is the most common and often also the most intense of eczema symptoms. The itching can be worse at night, during the winter, or in any condition that leads to skin drying.

  • Erythema


  • Vesiculation

Eczema eruptions can have fluid-filled bubbles, appearing as blisters on the skin’s surface. This most often occurs during the initial, inflammatory stages of a lesion or lesions.

  • Stinging

If eczema is prompted by exposure to an irritant or allergen, the skin surface can begin burning, stinging, or smarting immediately. Alternatively, these sensations can be delayed for up to 24 hours.

The Signs And Symptoms Of Chronic Eczema

  • Pruritus

Again, with chronic eczema a sensation of needing to itch is tantamount. Here, the repetitive rubbing and scratch lead to skin changes, oozing of fluid, and in some cases bleeding.

  • Xerosis

(dry skin) – due to water loss through the outer layer of the skin, called the epidermis. Nearly every person with chronic eczema will display some degree of dry skin. Unfortunately, dry skin can make it easier for allergens and irritants to penetrate the surface and then reactive the hyperimmune response—leading to a vicious cycle of eczema signs & symptoms.

  • Lichenification

The scratching and rubbing of chronic eczema produce a thickening of the skin, appearing at times almost leather-like. The skin markings are also more apparent in lichenification.

  • Fissures

Cracks can develop in the skin, caused by repeated inflammation, dry skin, and scar tissue from healing, and aggravated by scratching and rubbing.

  • Hyperkeratosis

The coloring of the skin can change in chronic eczema, usually becoming darker from frequent rubbing.

Other Skin Conditions That Can Be Mistaken For Eczema:

Eczema can easily be mistaken for other skin conditions such as psoriasis, scabies, or seborrheic dermatitis. Use the chart below to help you differentiate between these common dermatologic conditions.

Skin Condition






Wrists, ankles, feet, forehead, and around the eyes, hands, and fingers. Usually located on the flexing side of joints such as behind the knees or the front of elbows. Dry skin, reddened skin. Can have scales or ooze fluid. In later stages, the skin is thickened from continuous scratching and rubbing. Some appear as vesicles. Typically very pruritic/itchy. Can burn, tingle or sting. Symptoms are often worse in winter when the skin is drier. Associated with food and environmental allergies. Occurs in higher incidence in persons with asthma or allergic rhinitis (hay fever).


Lesions appear on the extending side of joints such as the front of the knees or the back of the elbows. Thick, silvery, and scaly plaques that will bleed slightly when the scales are scratched or picked. Lesions are well-defined with clear borders. Itching is common but not definite and ranges depending on the case. Often accompanied by joint pain or nail changes, especially nail pitting. Crohn’s disease and ulcerative colitis are associated with higher rates of psoriasis.


Most often found in skin webs found between the fingers, armpits, feet, thighs, elbows, male and female genitals, and any skin folds. Appears as small bumps with burrows where the mite has entered the skin. The bumps are reddened, inflamed, and crusty. Like eczema, scabies causes a great deal of itching. Itching increases at night, especially early in the infection. Caused by the human mite Sarcoptes scabiei. Contagious can be passed by bedding, sexual contact, clothes sharing, and even handshaking.

Seborrheic dermatitis.
(Commonly known as cradle cap or dandruff.)

Scalp, sides of the nose, chest, armpits, groin, ear canals, and eyebrows. Primarily occurs in oily skin areas. Yellowish, greasy scales. Skin can be reddened, but is not always. Can be pruritic (itchy) but not to the same degree as eczema. Thought is caused by a combination of a yeast called Malassezia and skin that overproduces oil.


We will be happy to hear your thoughts

Leave a reply

Eczema Free