How Do You Classify Severe Eczema?

In this article, we will explore the classification of severe eczema and help you better understand this common skin condition. Eczema affects millions of people worldwide and can vary in severity from mild to severe. We will discuss the different types of severe eczema, how it is diagnosed, and the available treatment options. By the end, you will have a clearer picture of what severe eczema entails and how it can be managed effectively.

Definition of Severe Eczema

Severe Eczema, also known as severe atopic dermatitis, is a chronic and inflammatory skin condition characterized by intense itching, redness, dryness, and a thickened appearance of the skin. It is considered severe when the symptoms are persistent, recurrent, and significantly impact daily activities and overall quality of life. Severe eczema can occur at any age, but it commonly begins in childhood and may continue into adulthood. The severity of eczema can vary from person to person, ranging from mild to moderate to severe.

Symptoms of Severe Eczema

The symptoms of severe eczema can vary but often include intense itching, redness, scaling, dryness, and thickened skin. The affected areas of the skin may become rough, scaly, and develop small bumps or blisters. Continuous scratching can lead to open sores, skin infections, and bleeding. Additionally, severe eczema can cause pain and discomfort, leading to sleep disturbances and mood changes.

Causes of Severe Eczema

The exact cause of severe eczema is still unknown, but it is believed to be a combination of genetic and environmental factors. People with a family history of allergies or asthma are more likely to develop severe eczema. Environmental factors such as exposure to certain irritants, allergens, or microbes can trigger or worsen symptoms. Other factors that may contribute to severe eczema include a dysfunctional immune system, impaired skin barrier, and an overactive inflammatory response.

Diagnosing Severe Eczema

To diagnose severe eczema, healthcare professionals typically rely on a combination of physical examination, medical history, skin biopsy, patch tests, and blood tests.

Physical Examination

During a physical examination, the healthcare provider will carefully examine your skin, looking for typical eczema symptoms such as redness, scaling, dryness, and thickening of the skin. They may also evaluate the extent and severity of the affected areas and assess any associated complications such as infections.

Medical History

Your healthcare provider will inquire about your medical history, including any previous instances of eczema or other allergic conditions, your family history of allergies or asthma, and any known triggers or allergens that worsen your symptoms. This information helps establish a comprehensive understanding of your condition.

Skin Biopsy

A skin biopsy involves taking a small sample of the affected skin for further examination under a microscope. This procedure helps rule out other conditions with similar symptoms and confirms the diagnosis of severe eczema.

Patch Test

A patch test is performed to identify specific allergens that may be triggering your eczema. Small amounts of common allergens are applied to patches which are then placed on your skin. After a specified period, the patches are removed, and any reactions or sensitivities are evaluated.

Blood Tests

Blood tests may be conducted to check for elevated levels of certain antibodies or to identify potential underlying conditions that could be contributing to your severe eczema. These tests can help guide treatment decisions and management of your condition.

Differentiating Severe Eczema from Mild or Moderate Eczema

Differentiating between severe, mild, and moderate eczema is crucial for proper treatment and management. Healthcare professionals employ various methods to assess the severity of eczema, including severity score systems, evaluation of body surface area, assessments of symptoms, and evaluating the functional and emotional impact on daily life.

Severity Score Systems

Severity score systems, such as the Eczema Area and Severity Index (EASI) or Scoring Atopic Dermatitis (SCORAD), are tools used to measure the severity and extent of eczema symptoms. These scoring systems take into account factors like redness, scaling, itching, skin thickening, and body surface area affected. They provide a standardized measure of severity and aid in treatment decisions.

Evaluation of Body Surface Area (BSA)

The evaluation of the body surface area affected by eczema is another key method of assessing severity. Healthcare providers estimate the percentage of the body surface area involved, which helps determine the severity of the condition and guide treatment choices.

Assessment of Symptoms

Assessing the severity of individual symptoms such as itching, redness, and pain is important in distinguishing severe eczema from milder forms. Healthcare providers ask detailed questions about the frequency, intensity, and impact of these symptoms on daily activities.

Functional and Emotional Impact

Understanding the functional and emotional impact of eczema on daily life is crucial in determining the severity of the condition. Severe eczema can significantly impair a person’s ability to perform regular activities, sleep properly, concentrate at work or school, and even impact their emotional well-being.

Characteristics of Severe Eczema

Severe eczema is distinguished by certain characteristics that differentiate it from milder forms of the condition.

Intensity of Symptoms

Severe eczema is characterized by intense itching, relentless redness, dryness, and thickening of the skin. The symptoms are typically more severe and persistent than in mild or moderate eczema.

Persistent or Recurrent Nature

Severe eczema often exhibits a chronic course, with symptoms persisting for extended periods or recurring frequently. Unlike mild or moderate eczema, severe eczema may not respond well to initial treatment attempts and requires long-term management strategies.

Impact on Daily Activities

Severe eczema significantly affects daily activities due to intense itching, discomfort, physical limitations, and associated complications such as sleep disturbances, infections, and pain. It can hinder productivity at work or school, limit participation in social activities, and affect overall quality of life.

Psychological Impact

Living with severe eczema can take a toll on one’s emotional well-being. The constant itching, physical appearance changes, and the impact on daily life can lead to feelings of frustration, embarrassment, anxiety, and even depression. Addressing the psychological impact is an important aspect of managing severe eczema.

Subtypes of Severe Eczema

Severe eczema can manifest in various subtypes, each with its own unique characteristics and triggers.

Atopic Dermatitis

Atopic dermatitis is the most common subtype of severe eczema. It commonly develops in childhood and often persists into adulthood. Atopic dermatitis is characterized by dry, itchy, and inflamed skin, and it frequently occurs in individuals with a family history of allergies or asthma.

Nummular Eczema

Nummular eczema, also known as discoid eczema, is characterized by coin-shaped patches of red and inflamed skin. These patches can be extremely itchy, scaly, and prone to crusting. Nummular eczema can be chronic and frequently occurs in individuals with dry skin.

Contact Dermatitis

Contact dermatitis occurs when the skin comes into direct contact with an irritating substance or allergen. It can cause severe eczema symptoms in individuals who are sensitive to certain substances such as soaps, detergents, cosmetics, metals, or plants. The affected skin may become red, swollen, and blistered.

Dyshidrotic Eczema

Dyshidrotic eczema primarily affects the hands and feet and is characterized by the development of small, itchy blisters. These blisters can be painful and may cause the skin to crack or peel. The exact cause of dyshidrotic eczema is unknown, but it is believed to be influenced by factors like stress or exposure to allergens.

Stasis Dermatitis

Stasis dermatitis, also known as venous eczema, typically affects the lower legs and occurs due to poor circulation in the veins. It often develops in individuals with venous insufficiency or varicose veins. Stasis dermatitis is characterized by red, itchy, and swollen skin, and may progress to open sores and skin infections if left untreated.

Seborrheic Dermatitis

Seborrheic dermatitis primarily affects the scalp, face, and other oily areas of the body. It is characterized by red, scaly patches that may be itchy or sensitive. Seborrheic dermatitis can also lead to dandruff and cause greasy or flaky skin.

Complications Associated with Severe Eczema

Severe eczema can lead to several complications that require attention and management.

Secondary Infections

Continuous scratching of the affected skin can break the skin barrier, making it susceptible to bacterial, fungal, or viral infections. Common infections associated with severe eczema include impetigo (bacterial infection), eczema herpeticum (herpes simplex virus infection), and fungal infections.

Chronic Itch and Scratching

The intense itching associated with severe eczema can result in a vicious cycle of scratching, leading to further skin damage, inflammation, and worsened symptoms. This constant itch-scratch cycle can be challenging to break and significantly impact the quality of life.

Sleep Disturbances

The persistent itching, discomfort, and pain caused by severe eczema can interfere with a person’s ability to sleep peacefully. Sleep disturbances can further exacerbate daytime fatigue and mood changes, ultimately affecting overall well-being.

Psychological Disorders

Living with severe eczema can take a toll on mental health. The constant physical discomfort, impact on appearance, social limitations, and repeated treatment attempts can lead to psychological disorders such as anxiety and depression.

Effects on Quality of Life

Severe eczema can have a profound negative impact on a person’s overall quality of life. It can affect self-esteem, limit social interactions, cause work or school-related challenges, disrupt sleep patterns, and contribute to emotional distress.

Treatments for Severe Eczema

Several treatment options are available for managing severe eczema. The choice of treatment depends on the severity of symptoms, individual preferences, and response to previous treatments. It is essential to work closely with a healthcare provider to develop an effective treatment plan.

Topical Medications

Topical corticosteroids, calcineurin inhibitors, and phosphodiesterase inhibitors are commonly prescribed to reduce inflammation and relieve symptoms. These medications are applied directly to the affected skin and help restore its natural barrier and reduce itching and redness.

Oral Medications

In severe cases, oral medications such as corticosteroids, immunosuppressants, or antihistamines may be prescribed. These medications help manage inflammation, control itching, and reduce the risk of complications. Oral medications are typically used for short durations due to potential side effects.

Injectable Biologics

Injectable biologics, such as dupilumab, may be prescribed for individuals with severe eczema that does not respond well to other treatments. Biologics work by targeting specific molecules involved in the inflammatory response, thereby reducing symptoms and improving overall control of the condition.

Wet Wraps

Wet wraps involve applying a layer of moisturizer to the affected areas and covering them with damp bandages or clothing. This technique helps lock in moisture, reduce inflammation, and enhance the absorption of topical medications. Wet wraps can provide immediate relief and improve the effectiveness of other treatments.


Phototherapy, also known as light therapy, involves exposing the skin to ultraviolet (UV) light under controlled conditions. This treatment helps reduce inflammation, control itching, and promote skin healing. Phototherapy can be performed in a healthcare setting or with an at-home UV light device.

Systemic Immunomodulators

Systemic immunomodulators, such as cyclosporine or methotrexate, may be prescribed for individuals with severe eczema that does not respond to other treatments. These medications help modulate the immune system and reduce inflammation. Systemic immunomodulators require close monitoring due to potential side effects.

Management of Severe Eczema

Managing severe eczema requires a comprehensive approach focused on reducing symptoms, preventing flare-ups, and improving quality of life. In addition to prescribed treatments, several self-care strategies can be beneficial.

Identifying Triggers and Avoidance Strategies

Identifying and avoiding triggers that worsen symptoms is essential. Common triggers include certain foods, allergens, irritants, stress, and climate changes. Once identified, individuals can take proactive steps to minimize exposure and prevent flare-ups.

Skin Care Regimen

Implementing a consistent and gentle skin care routine is crucial in managing severe eczema. This involves using non-irritating cleansers, moisturizers, and avoiding harsh soaps or cleansers that can further dry out the skin. Regular moisturization helps maintain skin hydration and prevent dryness and itching.

Hydrating the Skin

Keeping the skin well-hydrated is essential for managing severe eczema. Applying moisturizers immediately after bathing or showering while the skin is still slightly damp can help lock in moisture. Using thick, fragrance-free moisturizers or emollients throughout the day can also provide relief and maintain skin hydration.

Importance of Ongoing Treatment

Severe eczema is a chronic condition requiring ongoing treatment and management. It is important to continue prescribed medications and follow-up with healthcare providers regularly. Regular monitoring and adjustment of treatment plans may be necessary to maintain symptom control.

Lifestyle Changes

Certain lifestyle changes can support the management of severe eczema. Avoiding excessive heat or sweating, wearing soft, breathable fabrics, and maintaining a healthy and balanced diet can help minimize triggers and promote overall well-being.

Support and Resources for Individuals with Severe Eczema

Living with severe eczema can be challenging, but there are resources and support available to help individuals cope with their condition.

Support Groups

Joining support groups or online communities can provide individuals with severe eczema an opportunity to connect with others who understand their experiences. Sharing experiences, tips, and coping strategies can be immensely beneficial.

Educational Materials

Access to credible educational materials, such as brochures, websites, or online forums, can provide individuals with valuable information about the condition, treatment options, and self-care strategies. It empowers individuals to make informed decisions and actively participate in their treatment.

Dermatologist Referrals

Referrals to dermatologists specialized in eczema management can ensure individuals with severe eczema receive appropriate care. Dermatologists can provide expert guidance, recommend relevant treatments, and monitor progress.

Advocacy Organizations

Advocacy organizations dedicated to eczema, such as the National Eczema Association, provide support, resources, and advocacy efforts to raise awareness about the condition. These organizations often offer educational materials, patient forums, and opportunities to get involved in research or awareness campaigns.

Research and Future Directions

Continuous research is being conducted to improve the understanding, diagnosis, and treatment of severe eczema. Several areas of research and future directions focus on advancing the field:

Advancements in Treatment Options

Researchers are exploring new treatment options, including novel topical medications, innovative immunomodulators, and targeted therapies. These advancements aim to provide more effective and safer treatment alternatives for individuals with severe eczema.

Genetic Studies

Genetic studies are uncovering vital information about the underlying mechanisms and genetic factors responsible for eczema. Understanding the genetic basis of the condition may lead to personalized treatment approaches and interventions targeting specific subtypes of eczema.

Role of the Microbiome

Research investigating the role of the skin microbiome in eczema is gaining momentum. The microbiome refers to the community of bacteria and other microorganisms that reside on and in the body. Altered microbial communities on the skin have been associated with eczema, and researchers are studying ways to manipulate the microbiome for therapeutic benefits.

In conclusion, severe eczema is a chronic inflammatory skin condition that significantly impacts an individual’s quality of life. Accurate diagnosis, identification of severity, and appropriate treatment strategies are essential for effective management. With ongoing research and advancements, the future holds promising prospects for improved understanding and treatment of severe eczema, offering hope to individuals living with this condition.