When you’re dealing with consistently itchy, flaky skin, most of us have one culprit on our minds: eczema. But there can be several culprits behind your skin symptoms and finding the right one can be difficult. In fact, according to the National Eczema Association, nearly 60% of people initially diagnosed with atopic dermatitis, the most common kind of eczema, receive a refined or changed diagnosis within a year. Here, we take a look at some of the most common conditions that get misdiagnosed as eczema, how it is identified and treated, and what you can do to prevent receiving a misdiagnosis.
What Is Eczema?
According to Beverly Hills dermatologist Ava Shamban, MD, eczema is a result an immune response. “Eczema is an immune response that is often genetic and triggered in many cases by environmental factors [irritants, allergens, foods] or stress,” Dr. Shamban explains. “Eczema is in the dermatitis family, specifically called atopic dermatitis. The trigger will activate the natural defense system within the body creating a response with inflammation and irritation manifested by dry scaly skin, redness, and itching.”
It’s those symptoms that are responsible for why this condition can be over-diagnosed.
Omaha, NE dermatologist Joel Schlessinger, MD explains that those symptoms can have a variety of different causes. “So many different conditions can present as itchy, flaky, and with redness,” Dr. Schlessinger says. “You may not get a diagnosis immediately from a board-certified dermatologist for this reason as, sometimes, we need to run tests to rule out other potential conditions.”
The other issue is that this condition doesn’t always present in a uniform way.
“Eczema can look different on each patient,” Dr. Shamban explains. “So, a person with a darker skin tone might have a rash that would be more purple or brown. In a lighter skin tone, it may present more pink or red.”
It’s diagnosed by a skin exam, and a dermatologist will often recommend a biopsy to be sure.
“A biopsy can be taken to differentiate various forms of eczema or other similar conditions,” Dr. Shamban says. “It is also very important to take a good medical history.”
What Can Eczema be Confused With?
According to Miami dermatologist Dr. Deborah Longwill, there are several conditions that present with similar symptoms to eczema. “Skin conditions frequently confused with eczema include contact dermatitis, psoriasis, seborrheic dermatitis, and ringworm,” Dr. Longwill explains.
These conditions are so similar that it’s often seemingly small details, like exactly how itchy your skin feels, that tells a dermatologist what your condition likely is.
“The amount of itching the patient endures and the type of patches on the skin is usually a good indicator of whether or not the skin condition is in fact eczema,” Dr. Shamban explains. “People with psoriasis typically experience milder itching and intense burning or pain, and cracking of the thicker scales.”
The other big culprit behind misdiagnosis is allergic contact dermatitis, another very similar condition.
“There are many other conditions that fall under dermatitis or atopic dermatitis skin conditions that mimic eczema, causing frequent misdiagnosis,” Dr. Shamaban says “Particularly allergic contact dermatitis (ACD) can be a common condition to confuse with eczema.”
How Can You Ensure You Get the Right Diagnosis?
When you’re ready to resolve a chronic skin condition, your first step is probably to schedule an appointment. But it’s important to consider who you schedule with.
“Board-certified dermatologists have studied these conditions for years to understand their complexities and their presentations,” Dr. Schlessinger explains. “Often times that initial diagnosis of eczema that a patient receives is from an urgent care facility, an ER, or a general practitioner. If there are further concerns, or if the condition isn’t responding promptly to treatment, it is best to see a dermatologist, who is able to narrow in and clarify that diagnosis and recommend the best treatment.”
The abundance of conditions that mimic eczema means that to diagnose correctly, your provider is likely to conduct a patch test.
“Because eczema and conditions like allergic contact dermatitis are difficult to differentiate by the presentation and appearance alone, often we recommend patch allergy testing before confirming which type of dermatitis is present on the skin.” Dr. Shamban says.
If you have received a diagnosis of a skin condition, received treatment, but still present with symptoms, it isn’t a bad idea to go see a board-certified dermatologist for a second opinion. And if you got a referral for a dermatologist from your GP or an urgent care facility, follow up and set up the appointment.
Your initial diagnosis can be considered the first step to fully resolving what can be a debilitating condition.
“There are also a whole new class of treatments, like Dupixent, that have revolutionized treatment-resistant eczema,” Dr. Schlessinger says. “So, even if you’ve been diagnosed with eczema and your initial treatment didn’t work, you may still have the condition. And these new injectable medications can treat even very severe eczema.”
If you suffer from eczema, we’ve covered treatment products that deliver on promised relief here.
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