Intrinsic Eczema: Everything You Need to Know

Medically reviewed by Katlein Franca, MD

There are two types of eczema (atopic dermatitis): extrinsic and intrinsic. Intrinsic eczema is characterized by normal immune system antibody levels and is not caused by an allergen, while extrinsic eczema is associated with high levels of antibodies and allergies.

This article presents intrinsic eczema pictures and discusses the symptoms, causes, and treatment options for intrinsic eczema.

What Is Intrinsic Eczema?

Intrinsic eczema is a subtype of eczema, a chronic inflammatory skin condition. It may also be called nonallergic eczema or intrinsic atopic dermatitis. It affects about 20% of people with eczema. Most people with intrinsic eczema are female.

People with intrinsic eczema tend to be extremely sensitive to metal contact. They may not have signs and symptoms of the disease until later in life, and their skin barrier function stays intact.

Intrinsic eczema and extrinsic eczema may look similar from the outside of the body, but there is a key difference inside: People with extrinsic eczema typically have high levels of a specific antibody known as immunoglobulin E (IgE). In people with intrinsic eczema, however, the levels of IgE are typically normal and there are no other atopic (allergic) conditions present.

Research has examined the immune system’s role in intrinsic eczema and has found that although there is no connection to higher levels of IgE, other immune activations may take place that could play a role. These activations happen to specific cells known as T cells, which are cells that activate other immune cells to fight off infections and other pathogens.

Intrinsic Eczema vs. Extrinsic Eczema

Intrinsic eczema is marked by normal IgE levels and a lack of atopic diseases. Extrinsic is the opposite: When people have this type of eczema, high levels of IgE and other atopic conditions are typically found. Roughly 20% of eczema cases are considered to be intrinsic.

Intrinsic Eczema Causes

While researchers have yet to find a direct cause of intrinsic eczema, there is evidence to support that several factors may come into play in regard to its development. These factors include:

• Genetic mutations

• The overactivity of the immune system

• Environmental factors such as dry weather or stress

Risk Factors for Intrinsic Eczema

The biggest risk factor associated with intrinsic eczema is family history. If a person in your family has it, you are more likely to get it. While extrinsic eczema may be associated with an allergy risk factor, intrinsic is not.

Related: Find Out What May Be Triggering Your Eczema

Intrinsic Eczema Symptoms

The symptoms of intrinsic eczema are the same as those with extrinsic eczema. The rash can appear anywhere on the body and may be characterized by:

• Dry patches of skin

• Discolored skin

• Rashes that may ooze, weep clear fluid, or bleed when scratched

• Thickening and hardening of the skin

Beyond skin symptoms, the eczema itch can also cause difficulty concentrating and sleeping. This can have a huge impact on quality of life.

When to See a Healthcare Provider

If you experience any signs of a rash that is intensely itchy and interferes with your day-to-day life, you should see your healthcare provider. Healthcare providers will be able to provide you with treatment to help reduce the itch and clear up the rash.

Intrinsic Eczema Diagnosis

Typically, a physical examination is all that’s needed to diagnose eczema. Your healthcare provider will collect your symptoms and examine the affected area to determine if it's eczema or something else. They may also ask if anyone in your family has eczema.

To diagnose between intrinsic and extrinsic, your healthcare provider will order tests to check your IgE levels. This will help them determine the subtype of your eczema.

In some cases, a skin biopsy, which removes a sample of tissue to be examined in a lab, may be performed to determine this, but a blood test is often used to determine levels of IgE.

Intrinsic Eczema Treatment

Intrinsic eczema, like all other types of eczema, is not curable. However, there are eczema treatment options that can help lessen the itch and improve the skin’s overall health. Treatment options for eczema include medications and at-home remedies.

Medications

Medications used to treat eczema typically include a combination of therapies:

• Moisturizing creams to restore the skin barrier

• Topical corticosteroids to help reduce inflammation in the skin and reduce itchiness

• Medications that suppress the immune system, such as calcineurin inhibitors

• Phosphodieterase-4 inhibitors, a topical cream used for inflammation that does not respond to other treatment

• Pills to reduce the abnormal immune response, such as Janus kinase (JAK) inhibitors

• Biologics, which are genetically engineered proteins artificially manufactured as medications to help reduce inflammation, like the human monoclonal antibody dupilumab (Dupixent) and those targeting cytokine pathways
  

At-Home Remedies

You may be able to find symptom relief for intrinsic eczema and prevent flare-ups by following these tips:

• Practice good skin care by keeping your skin hydrated.

• Use skin moisturizers, including immediately after bathing.

• Take lukewarm baths and pat the skin dry after bathing.

• Avoid scratching and rubbing. Keeping your fingernails short can help reduce scratching.

• Manage stress levels, such as by using stress management and relaxation techniques and developing a strong support network.

• Wear clothing that isn't rough so it doesn’t cause itchiness.

• Avoid triggering metals.

• Bathe regularly.

• Eat a healthy diet.

• Get restful sleep.

• Use mild cleaners.

• Avoid scented or harsh soaps or detergents.

• Talk to your healthcare provider about possible food allergies.
  

Expert Tip

Before purchasing skincare, haircare, laundry, or cleaning products, look for the National Eczema Association Seal of Acceptance. These products do not contain triggering substances like fragrance, UV absorbers, or formaldehyde releasers and are gentler on your skin.

Related: The 10 Best Lotions for Eczema of 2024, Tested and Reviewed

Summary

Intrinsic eczema is a type of atopic dermatitis that is characterized by its underlying physiological mechanism, or lack thereof. Unlike with extrinsic eczema, people with this less common type don't have high levels of a specific antibody known as IgE.

Even though intrinsic and extrinsic have different IgE levels, they share the same symptoms, diagnosis, and treatment. For people with both types, practicing good skin hygiene can help greatly when it comes to symptom relief and flare-up prevention.

Some treatment options don't work for everyone. Finding the right type of treatment and skin care for eczema may take time. To help keep your eczema at bay, speak to your healthcare provider. Your provider can give you a diagnosis for your subtype and make sure you get the right treatment option for your specific case.

Read the original article on Verywell Health.