Clinical Features

The main symptom is itching of the skin associated with reddening and puffiness of the area affected. The skin may be hot, dry and scaly. Vesicles tend to form that break down and weep particularly when the skin is scratched. Crusting of the lesions occurs and secondary bacterial infection can complicate the process.

Areas commonly affected in atopic eczema are the friction areas of the groins, armpits, elbow creases and the back of the knees. Contact eczema tends to occur at the main site of contact although friction areas where sweating occurs such as the groins or beneath the beltline at the waist may be involved.

The hands are commonly affected in contact eczema and may show thickening and cracking of the skin (fissuring) as well as the primary symptoms.

Specific areas may also be affected such as at the site of wearing jewellery or beneath metal buttons. The area below the umbilicus is a common site of presentation of nickel allergy from metallic buttons on jeans as may be the feet and lower legs in someone allergic to rubber in boots.

In allergic eczema there may be a more generalised rash from systemic reaction to the allergen.

Atopic eczema may reduce the resistance of skin to irritants resulting in a superimposed contact dermatitis.