Adult eczema: What is it and how does it differ from childhood eczema?

Although eczema is more common in babies and children, it also occurs in adults. Some people won’t grow out of their childhood eczema and others will develop eczema as adults, known as adult-onset eczema. We look at how patterns of eczema changes in adulthood, what treatments are available, and why avoiding eczema triggers is an important step in treating adult eczema.

How common is eczema in adults?

Eczema is an umbrella term that covers a number of inflammatory skin conditions characterised by itchy, dry skin, rashes, scaly patches, blisters and skin infections. Itching is the most common symptom. These conditions include atopic dermatitis, contact dermatitis, seborrheic dermatitis, varicose eczema, discoid eczema and pompholyx (or dyshidrotic) eczema. On lighter skin, eczema typically looks red and inflamed. On darker skin tones, eczema can look brown, purple, gray or ashen. These conditions affect around 1 in 10 adults in the UK.

Atopic dermatitis

Although atopic dermatitis, the most common form of eczema, is traditionally seen as a childhood disease it can also occur in adults. While some adults with atopic dermatitis and other forms of eczema will have had it in childhood, others will have had completely clear skin as a child. This pattern of late occurrence is often called adult-onset eczema. Where atopic dermatitis reoccurs in adults who had the disease as children, it is typically much milder.

Diagnosis of atopic dermatitis is low in adults under 50 (around 3-5%) after which there is a steady increase. This increase has been explained by the gradual decline in water holding properties of the skin barrier with age, but more investigation is needed to confirm this. While adult eczema is typically more of a problem for women, there is a marked increase in adult-onset eczema diagnoses in older men meaning that in the over 70s, eczema is more common in men than women¹.

Contact dermatitis

In contrast, contact dermatitis (eczema flare-ups resulting from coming into contact with substances that irritate the skin) is more commonly diagnosed in adults than children. This is likely to be due in part to under diagnosis in children², but also due to adults typically coming into more contact with a wider range of possible irritants, often as part of their work. Common irritants include fragrances (in toiletries and laundry products), antiseptics, cement dust, nickel, hair dye and preservatives (found in toiletries and cosmetics).

Around 15-20% of adults suffer from some form of contact dermatitis³. However, as it is generally relatively easy to avoid irritants once they have been identified.

Varicose eczema

Varicose eczema (also known as stasis or gravitational) is only found in adults. It occurs on the lower legs and is associated with poor circulation. It is typically associated with varicose veins but can develop for no obvious reason. Not surprisingly, this type of eczema is typically found in older adults with up to 70% of over 70s affected. Varicose eczema is more common in women as female hormones and pregnancy increase the risk of developing the condition.

As with other forms of eczema, varicose eczema appears as itchy, dry, flaky areas of skin. The skin may also change colour and become weepy and crusty. These areas are vulnerable, meaning that an otherwise minor knock or scrap can develop into an ulcer.

Does adult eczema differ from childhood eczema?

Atopic dermatitis

As with children, the most common form of eczema in adults is atopic dermatitis. However, in adults, it is usually extremely dry and scaly whereas in children eczema is characteristically angry, inflamed and oozing.

Atopic dermatitis in adults often appears around the eyes and on the face and hands as well as in the areas typical of eczema in older children (backs of knees and inside elbows). As with childhood eczema, adult atopic dermatitis can be extremely itchy and difficult not to scratch. If you’ve had patches of eczema for years which you have been scratching for years, you may have found that these areas of your skin have thickened and become leathery. They may also be darker (or lighter) than the surrounding skin. In these cases, habit reversal as part of a combined approach can be effective.

Seborrheic eczema

In babies and young children, seborrheic eczema (or seborrheic dermatitis) typically takes the form of cradle cap and usually clears up without intervention by the time a child is around 1 year old. In adults, seborrheic eczema is more persistent – flaring, clearing and flaring again over years.

Seborrheic eczema affects 4% of adults and typically affects men more than women. While adult seborrheic dermatitis can develop in puberty, prevalence rises sharply in the early 20s, with a peak at 30 years for men and 40 years for women.

Although this type of eczema affects the areas of skin with grease glands (scalp, eyebrows, eye lashes, forehead, around the nose and ears, front of the chest, between the shoulder blades), greasy skin is not the cause of seborrheic dermatitis. As with other forms of eczema, the skin of seborrheic eczema sufferers is typically dry. Adult seborrheic eczema is believed to be an inflammatory reaction related to an overgrowth of Malassezia yeasts. While these yeasts are a normal part of the skin’s flora, they appear to irritate the skin of seborrheic eczema sufferers.

Other types of eczema

Other types of eczema including contact dermatitis, discoid eczema, pompholyx (or dyshidrotic) eczema are much the same in adults and children.

Common triggers for adult eczema

Eczema tends to wax and wane but it’s often possible to track down and avoid your personal eczema triggers. If the neck or face are affected, consider airborne allergens such as house-dust mite, pollen, perfume, chemicals, etc. As skin becomes drier with age, it is possible for previously well-tolerated irritants to suddenly become problematic.

• Irritants: Soaps, detergents, perfumes, makeup, dust, sand, chlorine, solvents, cigarette smoke and acidic fruit and vegetable juices like tomato, citrus and potato can irritate the skin.
• Allergens: Dust mites, pet fur, pollen, moulds, and some foods can trigger eczema.
• Environmental factors: Cold and dry weather, dampness, and low humidity levels can dry the skin making it more vulnerable to other triggers.
• Hormonal changes: Women may experience worse symptoms during pregnancy or in the days before their period. Eczema can also appear during the menopause or in the years leading up to it (the perimenopause).
• Stress: Anxiety and stress can make eczema worse because the body’s stress hormones cause inflammation that irritates the skin.
• Skin infections: Staph infections and other skin infections can trigger eczema.

Treating adult eczema

The core eczema treatment for all ages is maintaining the skin barrier by applying emollients regularly. Identifying and avoiding eczema triggers is also key. Flare-ups are usually treated with short courses of steroid creams. It’s important to follow medical guidance when using steroid creams to minimise the risk of any side-effects.
If trigger avoidance, emollients and steroid creams are ineffective, stronger treatments are available. These include topical calcineurin inhibitors, phototherapy, oral steroids, immunosuppressant drugs, a biologic drug and JAK inhibitors. These second-line treatments have great risks of side-effects than steroid creams. As a result they are only prescribed if first line treatments, including trigger avoidance have not been effective.

Eczema is a condition that is managed rather than cured. Identifying and avoiding your eczema triggers is just as important as medical interventions. This is especially true for adult-onset eczema, which is often due to contact dermatitis. While medical professionals will be able to guide you with advice, prescriptions and, where appropriate, allergy testing, there is no magic pill or cream that will make your eczema vanish.

Managing eczema should be seen as a partnership between the eczema sufferer and their medical experts. It may be that a number of small changes in a number of areas (diet, stress, weather, etc) can accumulate to have a big impact on your skin. Only you can take responsibility for identifying and addressing these changes.

Our sources

1. de Lusignan, S, et al. “The Epidemiology of Eczema in Children and Adults in England: A Population-Based Study Using Primary Care Data.” Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, U.S. National Library of Medicine, Mar. 2021, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984097
2. Johnson, H, et al. “Prevalence of Allergic Contact Dermatitis in Children with and without Atopic Dermatitis: A Multicenter Retrospective Case-Control Study.” Journal of the American Academy of Dermatology, U.S. National Library of Medicine, Nov. 2023, https://pubmed.ncbi.nlm.nih.gov/37768237/
3. Peiser, M, et al. “Allergic Contact Dermatitis: Epidemiology, Molecular Mechanisms, in Vitro Methods and Regulatory Aspects. Current Knowledge Assembled at an International Workshop at BFR, Germany.” Cellular and Molecular Life Sciences : CMLS, U.S. National Library of Medicine, Mar. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276771/.

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