Symptoms typically include redness, cracking, weeping, soreness, itching, burning, blisters, crusting and scaling. These can be acute or chronic and, over a long time, after much scratching, the skin can bleed or become thickened and rough.
Contact eczema usually starts with a rash in the area where the skin is in contact with the trigger substance. Eventually this can spread almost anywhere.
Atopic eczema tends to occur in the face and/or in the skin creases but may spread to affect the whole body.
Another variety is seborrhoeic eczema which tends to occur on the face, centre of the chest and scalp. The skin may be greasy or scaly and, on the scalp, may contribute to dandruff.
Diagnosis is usually made by the patient’s General Practitioner, based on the history, family history and inspection of the skin, noting the type of rash and its distribution. A history of working with chemicals may be important, and a worsening of symptoms after eating certain foods should be considered. This may include salicylates which are found in certain fruits, vegetables, spices, nuts and drinks. Alternatively there may be a food intolerance to a commonly eaten food or colourings and flavourings, particularly those based on azo dyes.
Patch or skin prick testing is often used to identify allergic foods, chemicals or airborne particles and blood tests looking for antibodies can also help to identify various triggers. It is important to differentiate between allergy and intolerance as these involve different mechanisms and treatments.