Author: Sanjana Badal
The constant itch and burning sensation of the skin as it fights off an unknown enemy is a daily battle for those who suffer from eczema, a general umbrella term for chronic inflammation of the skin (Myers et al., 2010). While it is common for eczema to begin in childhood, people of all ages can experience it for the first time, and many factors contribute to this. Most commonly, eczema is a combination of genetic and environmental factors. If someone has a family history of eczema, then they are more prone to developing some form of it (Myers et al., 2010). Several genes, for example the Filaggrin gene, are linked to eczema. This gene contains the instructions for producing a protein known as filaggrin, which plays a crucial role in preserving the skin barrier function (Nemeth et al., 2024). Since mutations in this gene are passed down, someone who inherits this mutation may be more prone to eczema due to increased sensitivity to allergens causing outside irritants to more greatly impact them. Many environmental factors also trigger eczema, including but not limited to dust mites, certain foods, temperature/humidity, and soaps (Langan & Williams, 2006). Therefore, there are many ways eczema can affect the body, both physically and mentally.
Some physical effects of eczema may include blistered, dry, or scaly skin. Furthermore, the skin could thicken and crack, appearing as different colors based on skin pigmentation. Eczema tends to look light red on lighter skin, while dark brown, purple, or gray on darker skin tones (Hanifin et al., 2022). The patch of skin affected with eczema can be swollen and itchy, and in some cases, it can also cause bruising from frequent scratching. Eczema often results in pigmentary changes, in which certain areas can either have hyperpigmentation (darker skin) or hypopigmentation (lighter skin). This can be caused by the eczema itself or the hard-to-control scratching. Many complications can arise from eczema, such as the inflamed skin becoming infected. This seems counterproductive since many people struggling with eczema have an overactive immune system, fighting off any small allergen. However, it is the overactive immune system that causes inflammation in the skin, increasing the risk of infections from scratching (Bos et al., 1992). Another noticeable effect that is caused by eczema is the disruption of sleep due to uncontrollable scratching all night long (Camfferman et al., 2010). Sleep is very crucial for everyone, but especially to adolescents who need sleep during this critical period of both physical and mental growth and development. This lack of sleep may cause adolescents with eczema to perform poorly in school as it may be hard to focus on school due to the itchiness and burning sensation (Shaw, 2023).
Additionally, eczema may cause many emotional effects. Adolescents with eczema become stressed when eczema appears since it impacts many daily activities. Getting stressed can lead to eczema getting more flared up, and many tend to get stressed when they see their eczema, creating a negative cycle. Insecurities and low self-esteem can also arise from eczema. Those with eczema often feel like they can’t wear the clothes they want since eczema can be visibly noticeable. Even after the inflammation is gone, eczema can deeply scar the skin as it heals, leaving visible scars. These scars can last for several years, which can destroy one’s confidence and hinder them from wearing certain clothes. Another consequence of eczema can be eating disorders. People with eczema are more prone to developing eating disorders (DiBenedetto, 2024). For example, binge eating is a way to cope with the feelings associated with eczema, such as depression and anxiety. People also tend to binge eat due to feeling that they have no control over their bodies when flare-ups happen. Anorexia appetite can also happen due to skin flare-ups from their favorite foods. For example, dairy is known to be a common trigger for eczema, so many popular foods like ice cream and cheese are off-limits for the best chance of avoiding eczema flare ups. A dairy lover realizing that cutting out dairy minimizes eczema flare-ups could result in them having a lack of appetite, while simultaneously taking a toll on their mental health. The foods that cause flare-ups may vary between individuals as everyone’s body reacts differently. Since eczema affects daily life, many teens can also face anxiety. They can feel overwhelmed about their condition due to the extensive regimen needed in order to manage it at such a young age.. Adolescence is a period where people shape their self-perception and identity, and this can be seen in a negative way or distorted by eczema. Therefore, many adolescents with eczema tend to have poor mental health (Schonmann et al., 2020).
Furthermore, eczema can influence many social interactions, relationships, extracurricular activities, and social participation. Teens are more likely to withdraw from their social circle, turning invitations down due to having a bad skin flare-up. Relationships can be hard to manage sometimes because people with eczema can feel like no one understands them, making them irritable (Loggins, 2022). Extracurriculars, such as sports, can also lack much participation. Sweat is a big trigger for eczema since the sodium in it can make the skin sting and irritated, so doing sports can be painful and uncomfortable due the excessive amount of sweat sports produce (Fuller, 2021). Itchiness can also distract the teen from playing the actual sport and instead push their focus on their eczema. Therefore, in addition to the many physical and mental adversities that come with eczema, eczema can also cause reclusion in many aspects of life.
With all the adverse side effects that come with eczema, it can raise the question: is there any cure to eczema? While there is no cure, there are ways to manage the condition and control these adverse effects of the condition. There is no definitive way that works for every person, but there are many different options that work for different people. The more common methods include steroids and biologics such as Dupixent. Steroids are used to treat eczema because of their anti-inflammatory properties. They come as ointments, creams, injections, and oral medications. Steroids reduce inflammation in the skin, which, in turn, helps reduce redness, swelling, and itchiness by suppressing the overactive immune system’s response. Furthermore, they constrict the blood vessels in the skin, known as vasoconstriction, which reduces the blood flow in affected areas (Melegrito, 2021). Steroids can help in stabilizing the skin cells, reducing the flakiness and cracking that often happens with eczema. Steroids work by blocking the production of substances like prostaglandins and cytokines, which are involved in the inflammatory process and itching in eczema. Despite the numerous benefits of steroids, there are many side effects that can occur from them. First, prolonged use of topical steroids can lead to thinning of the skin, known as atrophy. This makes the skin more fragile and prone to bruising and tears. Steroids can also cause the skin to lose elasticity, which may result in the formation of stretch marks, especially in areas where the skin folds or stretches. Furthermore, steroids can impair the skin’s ability to heal from cuts, scrapes, or infections. Since steroids suppress the immune system, they can make the skin more susceptible to bacterial, fungal, or viral infections. This includes conditions like impetigo or fungal infections. Long-term use, especially on the face, can lead to the development of rosacea or acne-like conditions, often referred to as “steroid acne.” Steroid use can also cause hypopigmentation in some areas. Long term use or use of very potent steroids lead to systemic effects. Some of them include Cushing’s syndrome, osteoporosis, and adrenal suppression. Cushing’s syndrome can occur if steroids are absorbed into the bloodstream over time and can lead to symptoms like weight gain, high blood pressure, and bone thinning. Long-term use of oral steroids can lead to a loss of bone density, also known as osteoporosis. Adrenal suppression can also occur because chronic use of steroids can suppress the body’s natural production of cortisol, leading to adrenal insufficiency (Ludmann, 2025). Despite all the negative side effects of steroids, many people with eczema are able to safely use steroids long term. To use steroids safely, it is highly recommended to apply the steroid only to the affected areas, making sure not to use an excess amount. Another successful way to use steroids safely is applying it for a certain period (for example a week) and then not using the steroid the following week. Using this method can prevent another adverse side effect known as Topical Steroid Withdrawal (TSW), a condition where the skin is in a worse condition after using steroids for a lengthy period and then discontinuing usage (Johnson, 2024).
Dupixent is a biological medication that has gained attention for treating patients with moderate to severe eczema who don’t respond well to traditional treatments like topical steroids. Dupixent works by targeting and blocking two key proteins involved in the inflammatory process of eczema: interleukin-4 (IL-4) and interleukin-13 (IL-13). By inhibiting IL-4 and IL-13, Dupixent reduces inflammation, alleviates itching, and helps to restore the skin’s barrier function, all of which are commonly disrupted in eczema (Harb & Chatila, 2019). Dupixent is given as an injection, typically being administered once every two weeks after an initial loading dose. This medication is also convenient for the patient because the injections can be done at home. Many people with moderate-to-severe eczema experience significant improvements in reduction in skin lesions and inflammation, decreased itching, and an overall improved quality of life (Silverberg et al., 2022). With symptoms under control, people using Dupixent tend to report better sleep, mood, and overall functioning. As with any medication, Dupixent has potential side effects. However, it is generally well-tolerated, and the side effects tend to be mild for most people. Common side effects include: redness, pain, or swelling at the injection site, eye problems (like pink eye or eye irritation), cold symptoms, and headaches (Parmar et al., 2022). There are additional biologics that may be tried for eczema if Dupixent does not work.
Personally, I have dealt with and continue to deal with many adversities that come with eczema; the physically as well as the mentally painful aspects. Furthermore, there is the pain of not finding any solutions. As a toddler, my parents couldn’t understand why my skin would itch and burn when I wore that dress, or when I wasn’t “allergic” to certain foods, but my skin would still react badly to it. We soon discovered that I had eczema, just as my dad also had extreme eczema and many others in his family. Eczema is strange in that it comes and goes without warning. There were so many periods of my life during which my eczema was clear and I didn’t have to think about it, but there were also times when my eczema would be all-consuming.
However, my eczema was its worst the summer before ninth grade, right as I was beginning high school. During that summer, I experienced an intense burning sensation around the fold of my left arm. I found this strange and had many questions: why now, why only my left arm, why not anywhere else on my body? These questions haunted me, but nothing haunted me more than the hyperpigmentation that would follow post-eczema. The marks are still on my arm to this day. It was mortifying for me to go to school in a simple t-shirt, as I thought everyone would notice the scars on my arms that I abhorred so much. I felt so insecure and went the entirety of ninth grade with my biggest insecurity being my left arm. Looking back, it seems like a small piece of my high school experience now, but it was mortifying in the moment. It was hard to go to crew because the sweat that came from the exercise would trigger my eczema, like a dormant volcano that could erupt at any moment. However it was equally terrible to wear clothes that would clearly display evidence of my eczema. It took a lot of mental work, but eventually I stopped putting all my focus on how bad my skin looked. Whether I had flare ups or not, I stopped getting too anxious about what others would think. Of course I still have negative thoughts about my eczema from time to time, just as anyone would. The process is long and I still have a long way to go, but it’s safe to say that I have come to terms with my eczema.
Eczema is more than just an itch; there are so many more negative aspects to it. It is important to note the several adverse physical, mental, and emotional effects of eczema. Next time you notice eczema or eczema scars on a person, instead of looking at them in disdain, look at them as battle scars.
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