The most commonly affected areas in adults are the face, neck, hands, elbow pits and back of the knees. In darkly pigmented skin, eczema can have a purple to brown hue. In acute eczema, the skin is swollen and weepy. In chronic eczema, the skin is thickened and occasionally has fine fissures. After skin inflammation resolves, there may be residual skin pigment changes called postinflammatory hypo- or hyperpigmentation (PIH). Hypopigmentation is where the skin is lighter than the normal skin tone, whereas hyperpigmentation is where the skin is darker than the normal skin tone and may look like bruises on those with darker skin.
Eczema is commonly known as the “itch that rashes.” Itching typically comes before any visible skin rash and is worsened by scratching and further irritation. Burning and stinging sensations are common when the skin is further injured from rubbing and scratching. Compared to healthy skin, eczema skin lacks compounds that naturally fight bacteria, such as beta-defensin, and is therefore more prone to infections.
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