Eczema is one of the most common skin diseases – and at the same time one of the skin problems that, in my opinion, is the most misunderstood.

Because eczema is not one specific disease.

It is a collective term for several different inflammatory skin conditions, which can have different causes and therefore also require different treatment. Atopic eczema, contact eczema, hand eczema, nummular eczema, and stasis eczema can all cause red, dry, and itchy skin, but the biology behind them is not necessarily the same.

Therefore, the first question is not just:

How do I get rid of my eczema?

It is also:

What type of eczema do I have – and what is it that keeps my eczema going?

That is what this guide will help you understand.

In this article, you will get answers to:

• What is eczema?
• Why do you get eczema?
• What is actually happening down in the skin?
• Why does the skin become dry, red, and extremely itchy?
• What role do the skin barrier, the fats in the skin, and the immune system play?
• Why can scratching make eczema worse?
• Which different types of eczema are there?
• How do you find out which type you have?
• What can worsen eczema?
• What skincare makes biological sense?
• When is skincare not enough?
• How is eczema treated medically?
• How can you try to prevent new outbreaks?

What is eczema?

Eczema is an inflammatory reaction in the skin.

Dermatologically, one sees, among other things, inflammation in the epidermis – the outer layer of the skin – and a process called spongiosis, where fluid accumulates between the skin cells. In acute eczema, this can, among other things, cause redness, swelling, small blisters, and weeping skin. In more chronic eczema, one sees more frequent dryness, scaling, thickening, and cracks.

But the interesting thing is that what we can see on the surface of the skin is only the result of what is going on underneath.

To understand eczema, we must therefore understand the skin.

Eczema is not just dry skin

Dry skin and eczema are not the same thing.

You can easily have dry skin without having eczema.

With eczema, on the other hand, an inflammatory skin reaction has occurred, and in several forms of eczema, a compromised skin barrier plays a central role.

This also means that the solution is rarely just to add a little moisture.

With atopic eczema, for example, there is a complex interaction between the skin barrier, the skin's lipids, the immune system, the nervous system, genetics, and the microbiome.

This is where it gets interesting.

For when we understand these mechanisms, it also becomes much easier to understand why some people experience a significant effect from a fatty ointment – while others are in need of actual anti-inflammatory medical treatment.

What happens in the skin with eczema?

Even though the different types of eczema do not have exactly the same cause, a number of mechanisms recur.

I find six to be particularly important to understand.

1. The skin barrier becomes weakened

The outermost layer of the skin is called the stratum corneum.

You can very simply compare it to a wall.

The skin cells are the bricks, while the fats between them function as mortar.

When the wall is intact, it keeps water in and at the same time helps to keep irritants, allergens, and microorganisms out.

Especially in atopic eczema, this barrier functions poorly.

In some, this is partly due to genetic variations in the protein filaggrin, which is important for building a well-functioning skin barrier. But the skin barrier is also affected by inflammation, the environment, washing, chemicals, and the skin's lipid composition.

When the barrier becomes leaky, a double problem arises:

More gets out – and more gets in.

The skin loses water faster, while at the same time it becomes more susceptible to substances from the outside.

2. The skin loses too much water

Here comes an important term:

TEWL – Transepidermal Water Loss.

It describes the amount of water that evaporates through the skin's surface.

All people lose water through the skin.

The problem arises when the barrier no longer retains water sufficiently well.

Then TEWL increases.

The skin becomes:

• dry
• rough
• less supple
• more delicate
• more easily irritated
• more prone to cracking

This can, in turn, weaken the barrier further.

Therefore, fat and moisture care are not just cosmetics for eczema. It is an important part of the basic treatment of, among other things, atopic eczema. International dermatological guidelines consistently recommend emollients and moisturizing products as a basic treatment.

3. The skin's fats matter more than most think

A healthy skin barrier does not just consist of skin cells.

Between the cells lies an organized lipid structure consisting of, among other things:

ceramides, cholesterol, and free fatty acids, exactly like in the Repair Barrier Cream.

It is this lipid matrix that is a large part of the skin's waterproof seal.

When the structure becomes disturbed, the skin retains water poorly and becomes more permeable to influences from the outside.

This explains why a very fatty ointment can make a big difference for dry, cracked, and eczema-prone skin.

It does not necessarily provide medical treatment for the inflammation itself.

But it can help to solve one of the very central problems:

A skin surface that can no longer hold itself together properly.

4. The immune system is activated

Eczema is not just a barrier problem.

It is also an inflammatory problem.

With atopic eczema, for example, the immune system is dysregulated, and type 2 inflammatory signaling pathways, among others, play a central role.

This means that the skin can react disproportionately strongly to influences that a normal skin barrier would be able to handle much better.

Inflammatory signaling substances – cytokines – are released, which contribute to:

• redness
• irritation
• itching
• swelling
• further barrier disturbance

And thus, a vicious circle can arise:

Weakened barrier → inflammation → even weaker barrier → more inflammation.

This is one of the reasons why more severe eczema cannot always be treated with skincare alone.

5. The microbiome changes

Billions of microorganisms live on the skin.

This is called the skin's microbiome.

It is not something we should try to wash away. On the contrary, a varied and stable microbiome is part of healthy skin.

Especially in atopic eczema, one often sees changes in the microbiome and increased colonization with the bacterium Staphylococcus aureus, especially during outbreaks. At the same time, bacterial diversity often decreases.

This does not mean that eczema is just a bacterial infection.

This is important.

But the microbiome is part of the complex interaction between the barrier and the immune system and can contribute to maintaining inflammation in some patients.

6. Scratching creates more eczema

Itching is not just an annoying symptom of eczema.

The itching can become part of the disease mechanism.

When the skin itches, we scratch.

When we scratch, we damage the skin barrier further.

This can increase inflammation and stimulate the skin's nerve endings so that the skin itches even more.

This is called:

the itch-scratch cycle.

Modern research shows that itching in atopic eczema, in particular, involves a complicated interaction between skin cells, the immune system, and the nervous system.

So:

Eczema → itching → scratching → skin damage → more inflammation → more itching.

Breaking that cycle can be at least as important as adding moisture.

Why do you get eczema?

There is no single cause.

It depends, among other things, on the type of eczema.

Eczema can be driven by:

• genetic predisposition
• reduced barrier function
• immunological mechanisms
• allergic contact reaction
• repeated irritation
• very dry skin
• occupational influences
• venous insufficiency in the legs
• microbiological conditions
• climate and environment

Therefore, the phrase “I have eczema” is really only the beginning of the diagnosis.

The next question is:

What type?

What type of eczema do I have?

The appearance can provide some clues, but you cannot always determine the type of eczema by looking at the skin.

Several skin diseases can resemble each other, and some people have more than one type of eczema at the same time.

Here is the quick way into our eczema universe:

Dry, itchy skin and recurring eczema – perhaps since childhood?

It could be atopic eczema, also called atopic dermatitis.

Here, genetics, skin barrier, immune system, microbiome, and environment interact.

→ Read our comprehensive guide to atopic eczema.

Baby or child with eczema?

Eczema in young children requires special attention because both location, treatment, and skincare change with age.

→ Read our guide to childhood and baby eczema.

Does the eczema appear after contact with certain products or materials?

Then one should, among other things, think of contact eczema.

There are both:

Irritant contact eczema, where the skin is damaged by repeated influence, and allergic contact eczema, where the immune system reacts to a specific allergen.

→ Read our guide to contact eczema.

Do you have dry, cracked, itchy hands?

Hand eczema can, among other things, be related to wet work, frequent hand washing, cleaning agents, contact allergy, and atopic disposition.

→ Read our guide to hand eczema.

Is the eczema primarily located on the face?

Red, dry, and scaly skin on the face is not necessarily atopic eczema.

It can be, among other things, contact eczema, seborrheic eczema, rosacea, psoriasis, or perioral dermatitis.

→ Read our guide to eczema on the face.

Is it on or around the eyelids?

The eyelid skin is extremely thin and can react to, among other things, cosmetics, skincare, hair products, and contact allergens – even products that have not been applied directly around the eye.

→ Read our guide to eczema around the eyes and eyelid eczema.

Are the patches round or coin-shaped?

It could be nummular eczema, also called discoid eczema.

But round skin changes can also resemble, among other things, fungal infection, so the diagnosis is important.

→ Read our guide to nummular eczema.

Do you have red, itchy, or brownish lower legs?

Here, one should, among other things, think of stasis eczema/venous eczema, especially if the legs are also swelling.

Stasis eczema is caused by problems with blood circulation in the veins, and skincare alone therefore does not solve the underlying cause.

→ Read our guide to eczema on the legs and stasis eczema.

What does eczema look like?

Eczema can look very different.

Typical symptoms are:

• itching
• dryness
• redness
• swelling
• scaling
• small blisters
• weeping skin
• cracks
• wounds after scratching
• thickened skin in chronic eczema

On darker skin tones, eczema is not necessarily clearly red. It can instead appear brownish, grayish, violet, or as areas with obvious dryness and thickening.

With prolonged itching and scratching, the skin can become thicker and coarser. This is called lichenification.

What can eczema be confused with?

It depends a lot on the location.

Eczema-like symptoms can be seen with, among other things:

• psoriasis
• rosacea
• perioral dermatitis
• fungal infection
• scabies
• hives
• bacterial skin infection
• seborrheic dermatitis

This is yet another reason why skincare should not continue for months against an “eczema” that never improves.

If the treatment does not work, the diagnosis must be reconsidered.

What worsens eczema?

Triggers are individual, but some influences recur.

These can include:

• cold and dry winter air
• heat and sweat
• long hot baths
• frequent hand washing
• strong cleansing products
• perfume
• cleaning agents
• friction
• wool directly against the skin
• stress
• known contact allergens
• scratching

With atopic eczema, dust, pollen, animal dander, and other environmental factors can also contribute to worsening the disease for some.

But be careful about turning eczema into an endless hunt for one hidden trigger.

Often the biology is more complex.

Why does regular skincare not always work against eczema?

Because eczema is rarely just about a lack of water.

If the skin barrier is compromised, a light moisturizing gel can add water – but the water can quickly evaporate again.

If the skin is also inflamed, itchy, and being scratched, the problem is even greater.

And if it is a case of allergic contact eczema, it doesn't help much to repair the barrier if you continue to expose the skin to the substance you are reacting to.

Therefore, I think of eczema in several layers:

1. Remove or reduce what provokes the skin.

2. Limit water loss and protect the skin barrier.

3. Try to break the itch-scratch cycle.

4. Treat inflammation correctly.

5. Find the right diagnosis if the eczema continues.

This is also the principle behind my approach to skincare for eczema.

Raz Signature Treatment for eczema-prone skin

When I recommend skincare for people with eczema-prone skin, I begin with the product that for more than 20 years has been absolutely central to my work with problem skin.

1. Repair – our absolute bestseller for eczema-prone skin

Repair is Raz Skincare’s absolute best-selling product for eczema-prone skin. And that is no coincidence.

For more than 20 years, I have experienced how big a difference this simple, very fatty ointment can make for people with dry, cracked, and irritated skin.

Repair is water-free and forms a protective layer that limits the skin's water loss (TEWL), reduces friction, and protects a weakened skin barrier.

It is especially relevant for:

• pronounced dryness and roughness
• cracks and fissures
• tightness and discomfort
• mechanical irritation
• a skin barrier that has difficulty retaining moisture

Research supports the importance of regular use of fat and moisture care for eczema. It can reduce outbreaks and, for some, reduce the need for medical treatment.

Repair is not a medicine. But a well-functioning skin barrier is a crucial foundation for calming eczema-prone skin.

Original Repair or Repair Perfume Free?

Both are based on the same fat-rich base with, among other things, olive oil, safflower oil, shea butter, beeswax, and cocoa butter.

For perfume allergy or very sensitive skin, I recommend Repair Perfume Free, which is without the essential oils in the original.

My experience is simple: When the skin is very dry and compromised, Repair is often the most important place to start.

2. Repair Barrier Cream – advanced rebuilding of the skin barrier (Coming soon)

Where Repair primarily protects and limits water loss, Repair Barrier Cream is developed to support the lipid structure and moisture balance of the skin barrier itself.

The formulation combines three central components from the skin's natural lipid matrix: ceramides, cholesterol, and fatty acids.

These are supplemented by ectoin, panthenol, hyaluronic acid, glycerin, and sodium PCA, which help the skin bind and retain moisture.

This makes Repair Barrier Cream particularly relevant for dry, sensitive, and eczema-prone skin, where the barrier needs more than a protective surface.

My recommendation is to use Repair Barrier Cream as barrier care and supplement with Repair on top when the skin needs extra protection.

They are two different formulations that each offer something different – and that is why they work together so well.

3. Ai Anti-Irritation – when itching, flaking, and irritation occur

Repair protects the skin. Repair Barrier Cream supports the lipid structure. Ai has a third function.

Ai Anti-Irritation is developed for itchy, flaky, and irritated skin and contains, among other things, mineral-rich salt brine from Læsø, glycerin, purple willow bark extract, and lactic acid.

In our signature treatment, Ai is used first on the irritated areas. Once the skin is dry, Repair Barrier Cream or Repair is applied as needed.

This provides three different functions:

Ai → care for itchy, flaky, and irritated skin.

Repair Barrier Cream → support for the skin's lipid structure and moisture balance.

Repair → protection and reduction of water loss.

Ai must be adapted to the skin’s tolerance. For very sensitive or damaged skin, dilution may be necessary, and the product should be used with special care around the eyes.

What do our customers say?

There is a difference between clinical documentation and the experience we have built over more than 20 years.

Repair is our absolute bestseller for eczema-prone skin, and over the years, we have received a very large number of positive feedbacks.

Our own empirical data suggest that about 50% find that Repair alone is sufficient to bring their eczema-prone skin significantly to rest.

When Ai is combined with Repair or Repair Barrier Cream, our reported success rate is around 90%.

These are experience-based figures from our own work and customer feedback – not results from randomized clinical trials. The numbers can therefore not be used as documentation that the products cure eczema.

However, these experiences have been central to the development of our signature treatment.

4. Powder to Mousse – gentle cleansing that respects the skin barrier

A good eczema routine begins with cleansing.

Strong cleansing products can strip the skin of its natural oils and worsen the dryness we are trying to remedy afterward.

Powder to Mousse is developed as a mild cleanser with Sodium Methyl Cocoyl Taurate as a cleansing active ingredient and Moroccan Lava Clay.

For eczema-prone skin, cleansing is not about getting the skin squeaky clean.

It is about cleansing effectively without unnecessarily stressing the skin barrier.

Do I need to use all four products?

No. It depends on the skin's needs.

If the skin is very dry, cracked, and exposed, I would start with Repair. It remains my first choice.

If the skin also needs targeted support for its lipid structure and moisture balance, Repair Barrier Cream is an obvious supplement.

For itching, flaking, and irritation, Ai can be included in the routine.

Powder to Mousse is used when there is a need for gentle cleansing.

You don't need four products just because there are four products. You should use the ones that make sense for your specific skin.

A simple routine for eczema-prone skin

Morning

1. Gentle cleansing – only where necessary

Use lukewarm water, avoid long hot baths, and use Powder to Mousse when the skin needs cleansing.

2. Ai for itching and irritation

Apply Ai as needed and according to the product's instructions. Adapt the use to your skin's tolerance.

3. Repair Barrier Cream (Coming soon)

Apply Repair Barrier Cream to dry and vulnerable areas where the skin's moisture balance and barrier need support.

4. Repair – the protective finishing layer

Finish with Repair on particularly dry, cracked, or exposed areas.

Repair can also be used alone. For perfume allergies, I recommend Repair Perfume Free.

Evening

Repeat according to skin needs.

For very dry and compromised skin, I recommend using Repair Barrier Cream followed by a more generous layer of Repair.

Repair Barrier Cream supports the skin's lipid structure and moisture balance. Repair acts as a protective layer that helps lock in moisture.

It is a combination where the products complement each other instead of just doing the same thing.

When do you see results?

It depends on the type of eczema, the condition of the skin barrier, and the level of inflammation.

Repair can quickly make very dry and tight skin more comfortable because it protects the surface and limits evaporation.

Repair Barrier Cream is developed to support the skin's lipid structure and moisture balance with regular use.

Ai can supplement for itching and irritation when the skin tolerates the product.

However, there is a difference between:

Symptom relief – the skin feels less dry, tight, or irritated.

Barrier stabilization – the skin gradually becomes better at retaining moisture and resisting stress.

Inflammation control – may require medical treatment.

Prevention of new outbreaks – often requires ongoing skincare and awareness of relevant triggers.

My most important advice is therefore still:

Start with Repair. Only build further on the routine when the skin needs it.

When is skincare not enough?

This section is important.

Eczema is a skin disease.

Skincare can be an important part of treatment, but cosmetic products should not be presented as a substitute for necessary medical treatment.

For atopic dermatitis, moisturizing care is the basic treatment, while topical corticosteroids – corticosteroid creams – are among the most important established treatments for active inflammatory outbreaks. Other options include, among others, calcineurin inhibitors and newer topical treatments, and for moderate to severe disease, there is phototherapy, biologics, and JAK inhibitors.

It is not a defeat to use steroid cream correctly.

On the contrary.

Insufficiently treated inflammation can keep the eczema active, increase itching, and continue to damage the skin barrier.

Talk to your doctor or dermatologist if:

• the eczema is widespread
• it itches so much that sleep is affected
• the skin is weeping
• there are yellow crusts or signs of infection
• the eczema is painful
• the treatment is not working
• the eczema keeps returning to the same place
• you suspect contact allergy
• a child has severe eczema
• the eczema significantly affects your everyday life or quality of life

Maintenance – the mistake many make

When the eczema disappears, many stop all skincare.

And then the cycle starts all over again.

Especially with atopic dermatitis, the skin barrier may be biologically different, even when the skin looks normal.

Therefore, dermatological guidelines recommend continued use of emollients between outbreaks.

It makes sense.

If you only fix the roof when it rains but stop maintaining it as soon as the sun shines, the next rain will rarely be easier.

With eczema:

Consistency is more important than intensity.

Frequently asked questions about eczema

What is eczema?

Eczema is a group of inflammatory skin diseases that typically cause itching, dryness, redness, flaking, cracks, or weeping skin. There are several different types with different causes.

Is eczema contagious?

No. Common forms of eczema are not contagious.

Can eczema be cured?

It depends on the type. Some forms of eczema can disappear when the cause is removed, while atopic dermatitis, for example, is a chronic, relapsing disease that can be brought to rest but not necessarily cured permanently.

Why does eczema itch so much?

The itching is caused by a complex interaction between the damaged skin barrier, the immune system, and the skin's nervous system. Scratching can then worsen the barrier and inflammation and create an itch-scratch cycle.

Is eczema just very dry skin?

No. Dry skin can be part of eczema, but eczema also involves inflammation. In atopic dermatitis, for example, both barrier, immune system, genetics, and microbiome play a role.

Which cream is best for eczema?

The two most used in Denmark are Raz Skincare Repair and Raz Skincare Ai.

There is no one product that is best for all forms of eczema. Generally, regular emollient/barrier care is well-documented, and very dry skin often benefits from a richer cream or ointment.

Can stress cause eczema?

Stress is not necessarily the underlying cause, but in some people, it can worsen existing eczema and itching.

Can food cause eczema?

Food allergy and atopic dermatitis can occur in the same person, especially in children, but food allergy is not generally the cause of atopic dermatitis. Therefore, you should not put children or adults on restrictive diets without a professional reason.

Should you avoid bathing if you have eczema?

No. But long, very hot baths can dry out the skin. Lukewarm water, gentle washing, and subsequent emollient is generally a better strategy.

Can eczema become infected?

Yes. A damaged skin barrier increases the risk of infection. Weeping skin, increasing pain, yellow crusts, or rapid worsening should be assessed by a doctor.

Can you be allergic to your eczema cream?

Yes. Allergic contact dermatitis can occur from ingredients in both skincare and medications. If a product consistently worsens the skin, you should consider contact allergy. Patch testing is the standard method for investigating allergic contact dermatitis.

What is the most important thing I can do myself?

First, find out what type of eczema you have.

Then, daily skincare is often about reducing unnecessary irritation, retaining water in the skin, supporting the skin barrier, and using necessary medical treatment when the inflammation requires it.

REMEMBER

You can always book a skin analysis with me, and I will be happy to help. You can read much more about my skin analysis and service at this link.

But if your eczema is severe, weeping, infected, very painful, affects your sleep, or does not respond to regular treatment, you must contact your doctor or a dermatologist.

Skincare can do an incredible amount for a compromised skin barrier.

But the correct diagnosis comes first.

Hugs Raz

Curious for knowledge?

If you want to read more or see where I get my knowledge, here are some articles that I think are good.

1. American Academy of Dermatology – Guidelines of care for the management of atopic dermatitis

One of the most important modern guideline collections on atopic dermatitis. It reviews the documentation for, among other things, moisturizers, steroid creams, calcineurin inhibitors, PDE-4/JAK treatments, and systemic treatments.

2. European guideline (EuroGuiDerm) on atopic eczema – Part II

The European guideline is particularly relevant because it reviews basic treatment with emollients, topical anti-inflammatory treatment, itching, provoking factors, and phototherapy.

3. European Guideline (EuroGuiDerm) on atopic eczema – Living update

The updated European guideline simultaneously shows how much the treatment of moderate and severe atopic dermatitis has evolved with biologics and JAK inhibitors.

4. Emollients and moisturisers for eczema – Cochrane Review

A large systematic review with 77 randomized studies and more than 6,600 participants. It is particularly interesting because it examines something as fundamental as: Do moisturizers actually work for eczema? Overall, among other things, fewer flare-ups and less need for steroid cream are seen in some groups.

5. The immunological and structural epidermal barrier dysfunction and skin microbiome in atopic dermatitis – an update

A strong review of the connection between the skin barrier, filaggrin, skin lipids, the immune system, and the microbiome. Good if you want to understand why modern eczema research no longer sees the disease as "just dry skin".

6. Skin microbiome dysbiosis and the role of Staphylococcus aureus in atopic dermatitis

Reviews the interesting connection between atopic dermatitis and changes in the skin microbiome – especially the increased prevalence of Staphylococcus aureus during outbreaks.

7. Exploring the skin microbiome in atopic dermatitis pathogenesis and disease modification

A newer review that goes even deeper into the microbiome and explains the interaction between pH, skin barrier, immune system, and Staphylococcus aureus.

8. Atopic Dermatitis Itch: Scratching for an Explanation

A modern review on one of the most overlooked parts of eczema: the itch. The article explains the communication between skin, immune system, and nervous system and provides a good biological basis for understanding the itch-scratch cycle.

9. Contact Allergy Screening for Atopic Dermatitis

Atopic dermatitis and allergic contact dermatitis can look alike and exist simultaneously. The review discusses when contact allergy should be suspected and why patch testing can be relevant.

10. Atopic eczema – The Patient Handbook, sundhed.dk

A Danish medical review of the treatment of atopic dermatitis. It is especially good for Danish readers because it explains moisturizer, steroid cream, and other treatment options in a Danish clinical context.