Papular eczema, also called papular dermatitis or subacute prurigo, is one of several subtypes of atopic dermatitis. It causes papules (small, itchy bumps) to appear on areas like the arms, legs, neck, torso, or buttocks. Because of its symptoms, papular eczema is sometimes called “itchy red bump disease.” Notably, papular eczema symptoms can vary in appearance based on skin tone — bumps may look red or pink on lighter skin and may appear brown, purple, or gray on darker skin tones.

There are seven main types of eczema, and you can have more than one type at the same time. You may also develop different forms throughout your life. Papular eczema may not be mentioned as a specific type of eczema. The term “papular” describes how the rash looks, not a separate type of eczema.

Knowing what type of eczema you have can help your dermatologist (skin specialist) create a treatment plan that works best for you. This can be especially important with papular eczema, which is sometimes mistaken for other skin conditions that aren’t eczema at all.

Papular Eczema Symptoms

Like other forms of eczema, papular eczema may be chronic (ongoing), with symptoms that flare and subside during periods of remission.

What sets papular eczema apart is the appearance of small, itchy papules instead of flaky patches and crusting characteristics of other types of eczema.

These bumps may appear on areas such as the arms, legs, neck, torso, and buttocks. They may also be surrounded by patches of skin that are darker than the person’s natural skin tone. In some cases, the bumps may look like pimples.

In addition to papules, people with papular eczema may experience symptoms similar to other types of eczema, especially during a flare-up. These can include:

• Dry skin
• Intense itching, often worse at night
• Cracked, scaly patches or thickened skin
• Infection, especially if the skin is scratched or broken

Papules are most common in atopic dermatitis in infants and young children, though they can also appear in adults.

Diagnosing Papular Eczema

A dermatologist can usually diagnose papular eczema by closely examining your skin and asking about your symptoms.

One of the main challenges with diagnosing papular eczema is distinguishing it from other skin conditions with similar symptoms — a process called differential diagnosis. Papular eczema is often misdiagnosed or overlooked because its small, itchy bumps can resemble other skin issues.

To make an accurate diagnosis, your dermatologist may need to rule out other conditions, such as:

• Dermatitis herpetiformis — A bumpy, itchy rash often associated with celiac disease
• Grover’s disease — A rare skin disease that causes small, discolored spots
• Lichen simplex — Thick, rough, and darkened skin caused by excessive scratching
• Scabies — An itchy and contagious skin rash caused by small mites that burrow into the skin
• Bug bites

If a doctor is unable to diagnose you after a clinical exam, they may perform a skin biopsy. This test involves removing a small piece of skin to be examined under the microscope, which can help your doctor determine the cause of your symptoms.

Causes of Papular Eczema

There’s no single known cause of papular eczema. Like other forms of eczema, it likely develops from a combination of genetic, immune, and environmental factors.

People with eczema tend to have a weakened skin barrier. This can be caused by a genetic variation, an imbalance of bacteria on the skin, or other factors. A weaker skin barrier makes the skin more reactive and vulnerable to inflammation from irritants or allergens in the environment.

Exposure to Certain Substances

Common triggers of atopic dermatitis, including papular eczema, may include:

• Soaps and harsh cleansers
• Weather changes, such as cold or dry air
• Increased stress
• Clothing detergents or fabric softeners
• Certain foods (especially in infants and young children)
• Tobacco smoke or air pollution

Allergies and Asthma

Eczema is more common in people who have allergies and asthma, or who have close relatives with these conditions. Asthma, allergies, hay fever, and eczema commonly appear together.

Treating Papular Eczema

Establishing consistent skin care practices, like regular moisturizing, is an important step for managing papular eczema symptoms. Some of the standard eczema treatments might not improve symptoms of papular eczema. However, some treatments can help reduce itching, keep the condition from getting worse, and bring on periods of remission.

Some people diagnosed with papular eczema find that one treatment works better than others. Other people find that combining treatments gives them the best results. Talk with your healthcare provider before making any changes to your treatment plan.

Avoiding Triggers

Once you know what your eczema triggers are, you can take steps to avoid them and reduce flares. Because triggers vary from person to person, learning to avoid yours is an important part of managing symptoms.

Practicing Gentle Skin Care

A gentle daily skin care routine can help prevent flare-ups while soothing your skin to make it less itchy. Choose fragrance-free moisturizers, lotions, and cleansers without alcohols and other harsh ingredients that might irritate the skin. Take a bath or shower every day using lukewarm water, and gently pat your skin dry with a clean towel. Always avoid scratching your skin. To manage the itch, you can press or pat your skin or apply ice instead.

Applying Wet Dressings

Applying wet dressings — sometimes containing topical corticosteroid cream — to the affected areas of your skin can soothe an eczema flare-up. Performing this therapy on yourself or using it at home can be tricky, but your dermatologist can provide guidance.

Using Prescription Treatments

Your dermatologist may prescribe treatments like:

• Topical (applied to the skin) corticosteroid creams
• Medical moisturizing creams
• Creams with a calcineurin inhibitor
• Other topical products

If your atopic dermatitis continues to flare regularly, there are some more advanced treatment options available to you. Several injectable biologic medications are safe for people with moderate to severe atopic dermatitis who don’t respond to other treatment options. Sometimes, healthcare providers will prescribe oral anti-inflammatory medications to help with persistent symptoms. They may also suggest phototherapy.

Undergoing Phototherapy

If your papular eczema is persistent and continues even after other treatments, your dermatologist may recommend phototherapy. This technique exposes the affected skin to either natural sunlight, ultraviolet (UV) A light, or UV B light. Typically, dermatologists recommend narrowband UV B (NB-UVB) phototherapy to treat eczema, as it uses a smaller range of light wavelengths in the UV spectrum. NB-UVB penetrates more deeply into the skin to treat eczema that doesn’t respond well to other treatments.

Phototherapy is a common alternative to drug treatment for papular dermatitis, as it has been proven to be highly effective and deliver longer-lasting results. However, long-term use of phototherapy can age your skin prematurely and raise your risk of skin cancer. You and your dermatologist can weigh the pros and cons of this treatment and decide if it’s right for you.

Treating Infections Related to Papular Eczema

Sometimes, people with papular eczema develop bacterial skin infections if scratching leads to open wounds. If your dermatologist thinks you have an infection or could develop one, they may prescribe an antibiotic to treat a secondary infection caused by eczema.

Talk With Others Who Understand

On MyEczemaTeam, the social network for people with eczema and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Do you have papular eczema? What treatments have worked for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.