There may be small blisters at this time but the main symptom is of intense itching - a fretful scratching child is commonly seen as a result. This itching sets up what is known as the 'itch-scratch' cycle where scratching makes the itching worse and aggravates the skin inflammation . This can lead to wet, bleeding patches on the skin as well as infection due to the skin being broken. In chronic eczema, scratching may thicken the skin - this is known as lichenification. Atopic eczema usually affects the face, neck, inside of the elbows and back of the knees, where the skin folds or clothes rub and it is usually the scratching of the skin itself rather than the patch of eczema which causes symptoms.
Most eczema is diagnosed simply from the appearance of the skin alone.
In adults, where there may be a question as to whether any work chemicals or other irritants are causing the skin irritation, patch testing is sometimes used. Any positive reactions are noted, along with what has caused them, and there is a further examination at 96 hours to detect any further reaction. The main aim of all treatment is to stop the itch-scratch cycle. Cotton underclothes and socks should be worn, and wool should be avoided since sharp fibres irritate the skin. Avoid frequent hot baths or showers.