Eczema & Mental Health
Understanding Eczema (Atopic Dermatitis)
Jeffrey McBride, MD, PhD, FAAD
Director of Dermatopathology for OU Health Department of Dermatology
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Eczema describes a group of skin conditions that cause itch, dry skin, rashes and skin infections. Rashes may appear red in lighter skin tones and purple, brown or gray in darker skin tones. Eczema is not contagious. This means that you can’t catch it from someone else.
You may have heard healthcare professionals refer to eczema as atopic dermatitis or atopic eczema. Atopic dermatitis (AD) is the most common type of eczema. Atopic dermatitis often starts in infancy or early childhood. For children, the most commonly affected areas are the cheeks, neck, hands, inner arms, behind the knees, ankles and feet.
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Children and adults can have atopic dermatitis.
Children whose family members have atopic dermatitis, asthma or allergic rhinitis (allergies to things in the environment) are more likely to have it.
People of all races and ethnicities can develop atopic dermatitis.
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Atopic dermatitis is caused by both genes and triggers in the environment.
An overactive immune system causes inflammation. This makes the skin more dry, itchy and prone to rashes.
The “skin barrier,” or outer protective layer of the skin is not as strong as it should be. Water escapes more easily, causing dryness and itch. Bacteria, viruses, and allergens can get in more easily, which can cause infections or trigger flares.
Scratching causes more inflammation and causes more damage to the skin barrier. This is called the “itch-scratch cycle.”
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Atopic dermatitis is a chronic disease. This means it may not completely go away. Some children have milder symptoms over time.
Atopic dermatitis comes in cycles. There may be times it gets better and times it gets worse (called flares).
There is no cure for atopic dermatitis, but good management routines can help control symptoms and help your child feel better.
Learn more about:
The Social and Emotional Impact of Eczema
Eczema is a skin disease, but its impact can go far beyond the visible rash to emotional stress that others can’t always see.
Jennifer LeBovidge, PhD
Psychologist in the Atopic Dermatitis Center at Boston Children’s Hospital
If eczema has affected your family’s emotional and social well-being, you are not alone. Research has found that eczema has a bigger impact on quality of life than many other chronic diseases. There are many reasons why this may be the case.
Itch and sleep disruption are often the biggest stressors for families of children with eczema. Itch can make it hard to fall asleep, stay asleep and get good quality sleep. Poor sleep affects mood, behavior and attention during the day.
Some children may experience bullying or unwanted questions or attention because of their skin, or feel self-conscious about their appearance during flares.
When the skin is flared, eczema can also get in the way of doing the very things that typically help manage stress. For example, children may avoid social activities if they feel embarrassed or skip sports or other exercise if they cause more itch or skin pain.
Consistency with daily skincare and eczema treatments is important, but treatments can also be stressful for some families.
GPER’s Eczema Breakthroughs Podcast: Episode 24- Is it in your head? How to recognize and address the mental health impacts of eczema
Eczema also affects caregivers. Many parents describe feeling overwhelmed with managing their child’s eczema at times. It’s difficult to see your child uncomfortable or to feel helpless to stop their itch. Parenting can be harder if your child is more irritable during a flare. If your child isn’t sleeping, then most likely you are exhausted as well. You may have concerns about whether treatments are safe. Even when your child’s eczema is in good control, there can be uncertainty and anxiety about when the next flare may occur.
Sometimes, other people might not fully understand the day-to-day demands or emotional side of managing eczema. This can lead to a sense of isolation or feeling that you’re not doing enough.
Managing a child’s eczema is not easy. ECZHALE was developed to help bring the mental health impact of eczema to light and to empower families through tools and support for living well with eczema.
Eczema and Mental Health Conditions
Studies have shown that children and teens with eczema have an increased likelihood of developing depression, anxiety, and attention deficit hyperactivity disorder (ADHD), compared with children without atopic dermatitis. The increased risk of having a mental health condition is greatest for people with moderate to severe atopic eczema.
There are multiple factors that may influence the relationship between eczema and mental health. This relationship appears to be bi-directional, meaning that eczema can impact mental health and mental health can impact eczema.
Having eczema is stressful. Itch, unpredictable flares, and visible rash can impact self-esteem, increase anxiety and affect mood. Research shows that mental health symptoms improve when eczema symptoms are improved.
Eczema can affect things that are important to mental wellness - such as getting good sleep, exercise, or spending time in social activities.
Sleep disruption can affect behavior, thinking, mood and attention. It can also increase risk for development of mental health conditions.
Inflammation in the body (which occurs with eczema) can also increase risk for mental health conditions, such as anxiety, depression and ADHD.
Emotional stress can also worsen eczema. Stress and anxiety cause the body to produce hormones such as adrenaline and cortisol. For people with eczema, these stress hormones can trigger more inflammation or itch. Ongoing stress can also make it harder for the skin to heal.
Understanding the connections between eczema and mental health is a first step in reducing the physical and emotional burden of eczema. Most children will do best with a good eczema management plan and tools for coping with stress.
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