What Is Eczema?
Eczema, also called atopic dermatitis, is an inflammatory skin condition that affects up to 30% of children and 10% of adults all around the world (Nemeth et al., 2024). It manifests as a dry, itchy, inflamed rash that can be really uncomfortable.
There are many different causes for eczema, but it’s tough to pinpoint a specific cause for any one person. Research is still developing in this area, but studies show that several regenerative treatments can improve eczema, prevent flare ups, and improve your quality of life.
What Causes Eczema?
The root causes of eczema aren’t fully understood, but there are a few factors that contribute to its development. Eczema appears to run in families, suggesting a genetic component, but there’s also evidence supporting allergies, stress, and other factors.
Genes
Researchers have identified two different types of genes that may contribute to eczema: skin barrier genes and immune-related genes (Nemeth et al., 2024). The most likely culprit is the filaggrin gene, which gives your body instructions for creating a protein called filaggrin that helps support your skin’s function as a barrier. Mutations in the filaggrin gene may make your skin more vulnerable to environmental irritants and allergens—and that vulnerability can contribute to eczema. Other skin barrier genes may also play a role, including the ceramide synthase gene.
Immune-related genes have also been linked to eczema. The genes responsible for regulating T-cells, cytokines, and immunoglobulins are suspected. However, genetic testing isn’t usually considered in the diagnosis of eczema.
Gut-Skin Axis
Your gut microbiome influences your health from head to toe—including your skin. This relationship is called the gut-skin axis and research suggests it influences the development of eczema. Research shows that the proportion of Clostridia, Clostridium difficile, Escherichia coli, and Staphylococcus aureus is higher in people who have eczema, while the proportion of Bifidobacteria, Bacteroidetes, and Bacteroides is lower.
Clostridia and Escherichia coli may also contribute to eczema through another mechanism. They can cause eosinophilic inflammation, which can lead to an eczema flare up (Lee et al., 2018).
Stress
The mind-body connection explains how different aspects of your health influence each other. If you’re feeling mentally unwell or stressed, that may manifest in physical symptoms and vice versa. So it’s unsurprising that there may be a direct link between eczema and your mind. The type or level or stress you’re experiencing can also influence how itchy or bothersome your eczema is (Lönndahl et al., 2023).
Dietary Triggers
The things you eat have a strong influence on your body, including your skin. Certain foods can trigger and even prolong an eczema flare up. Research shows that eliminating white flour products, gluten, dairy, and nightshades can help improve eczema. And adding vegetables, fruit, and fish oil to your diet may also help (Nosrati et al., 2017).
Nutritional Deficiencies
Initial findings suggest that there may be a link between eczema and nutritional deficiencies—specifically vitamin D. Several studies show evidence that vitamin D supplementation may help improve eczema and maybe even prevent it (Nielsen et al., 2024). There are similar findings for fatty acids, so further study in this area is promising.
Who Is at Risk?
Age and race may influence your risk for eczema. It’s more common in children than adults, and Black people have higher rates of eczema than non-Hispanic white people in the United States. Research suggests that Black children may be up to 2.1 times more likely to develop this itchy skin condition than white children (Croce et al., 2019).
Environmental factors also increase your risk for eczema. Black children who live in racially segregated communities have more severe eczema than those who don’t. And lower socioeconomic status has similar outcomes (Croce et al., 2019). Adults also experience these differences.
What Are the Symptoms?
The symptoms of eczema vary. Most people experience persistent itching, inflammation, and dry skin. You may also experience blisters, flaking, scaling, and other symptoms.
Your skin tone influences the way eczema looks. In lighter skin tones, it is usually red. In darker skin tones, it may darken the skin or appear purple or ashen. In either case, the skin may feel rough and bumpy (National Eczema Association, 2022).
How Is Eczema Diagnosed?
Getting a diagnosis for eczema depends on the signs and symptoms you have. Itching, discolored, dry, and rough skin can be symptoms for several different skin conditions, so a dermatology specialist is your best bet for accurate diagnosis. They’ll be able to rule out other conditions with similar symptoms.
A dermatology specialist has several tools at their disposal to examine and diagnose skin conditions. They’ll collect your medical history, ask about environmental exposures, and visually examine your skin. If they are unsure about a diagnosis, a dermatology specialist can collect a small biopsy to confirm.
Skin biopsies can usually be done in an office. Your provider will administer medicine to numb you and scrape a bit of skin off the affected area for analysis under a microscope. They’ll be looking for signs of spongiosis, which is extra fluid between your skin cells arranged in small sacs called spongiotic vesicles, and extra T-cells (Tokura et al., 2025). This differentiates eczema from other skin conditions, like psoriasis.
If you have a darker skin tone, you may want to choose a provider who has experience working with people of color.
How Is Eczema Treated with Regenerative Therapies?
There are a number of ways to manage eczema, both with medication and other therapies.
Phototherapy
Using phototherapy, also called light therapy, is a popular way to manage eczema symptoms. Certain wavelengths of light disrupt the processes in your skin that cause eczema symptoms. Narrowband UVB and broadband UVB light may help, but narrowband is more effective and causes fewer side effects (Molla, 2024; Lee, 2024).
You’ll visit your provider for phototherapy sessions. The length and frequency of sessions will depend on your individual circumstances and can vary from once a week to several times a week for several months.
Bacteriotherapy
Many patients who have eczema have a bacteria called Staphylococcus aureus, which worsens the inflammation caused by eczema. Researchers have found that another bacteria, Staphylococcus hominis A9 (ShA9), that is present on healthy skin can kill S. aureus through a process called bacteriotherapy.
ShA9 also prevented S. aureus from producing a toxin that promotes inflammation, even if it didn’t kill the S. aureus. This shows that bacteriotherapy may be an effective way to treat the inflammation people with eczema experience (Nakatsuji et al., 2021).
Education
The mind-body connection isn’t just related to stress—it also explains why education can help you manage eczema symptoms. People who are taught how to manage their eczema experience short-term improvement in their symptoms. These improvements were observed in both individual and group education interventions, but there’s no evidence of long-term effectiveness (Singleton et al., 2024).
Topical Medication
Your provider may prescribe topical medication to help manage your eczema symptoms. These medications, which include topical corticosteroids and Janus kinase (JAK) inhibitors, come in cream, lotion, or ointment form. You will apply a small amount to the affected area as directed. For many people, this will help clear the skin and stop uncomfortable symptoms like itching (Lax et al., 2024).
What Are Possible Complications?
Effectively managing eczema symptoms can help prevent complications. The main complication caused by eczema is infection. Because it compromises your skin barrier, it can make it easier for bacteria and other microorganisms to infect your skin (Wang et al., 2020).
An infection can make your skin feel warmer than usual, cause a fever, cause pus and other fluid to ooze from the affected area, or other symptoms. If you suspect you have an infection, make sure you see a healthcare provider for proper diagnosis and treatment.
Can Eczema Be Prevented?
Eczema can’t always be prevented, especially if there isn’t a specific allergen or environmental factor playing a role. Keeping the skin moisturized, getting outside to absorb the UVB rays from sunlight, and using any medications as prescribed may help prevent flare ups. Avoiding allergens and other environmental irritants can also help.
If you have dietary triggers, avoiding those is a great way to prevent an eczema flare up. If you aren’t sure if you have dietary triggers, try an elimination diet to see if your eczema improves. You can start by eliminating dairy, gluten, and/or nightshades. There are plenty of substitutes you can use in your diet if you find that these foods aggravate your eczema.
Make sure you’re getting enough vitamins and minerals. Since vitamin D deficiency is linked to eczema and essential fatty acids and other nutrients might also be linked, avoiding nutrient deficiency can help improve eczema and prevent flare ups.
Takeaway
Eczema is likely caused by both genetic and environmental factors. There are numerous ways to manage eczema symptoms using medication, education, light therapy and other methods. Managing your symptoms is important to help prevent infections and keep your skin healthy. And addressing root causes through focusing on gut health and avoiding dietary triggers can go a long way in improving your daily quality of life.
