Eczema, or atopic dermatitis if you’re feeling formal, is a hereditary condition that prevents skin from healing as well as it should, resulting in sensitivity and inflammation. While incurable, it’s not dangerous in itself unless it starts blistering and weeping, which is a solid indicator of it being infected. About 1 in 10 Americans suffer from eczema, and depending on its severity, may have to go to extraordinary lengths to manage it. Many people find it exacerbated by common things like soap, coarse clothing, heat and non-hypoallergenic cosmetics. Relentlessly avoiding these can quickly become difficult and time-consuming, making eczema one of those conditions that worms its way into large parts of your life. While the direct effects are definitely unpleasant, the true cost of eczema comes from all the ways it indirectly affects people.

Because exertion can make it flare up, adults with eczema tend to get far less exercise than their uninflamed counterparts. It’s also thought to take an emotional toll all the way from early childhood, when it usually emerges. It’s speculated that this contributes to eczema sufferers being far more likely to smoke and drink heavily. All these incidental factors combine into a perfect storm of bad health. Consequently, adults with eczema are 54% more likely to be “morbidly obese”, 48% more likely to have high blood pressure and 42% more likely to have diabetes than those without eczema.

It’s also a common cause of insomnia. Unsurprisingly, it can be kind of hard to nod off while itching all over. This means people with eczema are far more prone to fatigue and overall tiredness. While this might sound like nothing a cup of coffee can’t fix, it’s actually quite dangerous. Eczema sufferers are far more likely to experience fractures, broken bones or basically any other bodily injury. Tired people make mistakes and mistakes cause injuries.

And then there’s the financial cost. The average eczema sufferer spends hundreds of dollars a year on health care costs ($481 on average in 2012) just for things directly related to eczema. That number would be substantially higher when factoring in the costs incurred by all the obesity, fatigue and broken bones. This is compounded by the fact that people with eczema have to take more sick days than most and often rely on expensive, specialised products. With all these factors in play, it’s clear that eczema hits your wallet harder than most people will ever realise.

And that’s why eczema is so scary. Its extraordinarily high prevalence and myriad devastating effects are hidden in the background. The inflamed skin might be plain to see, but that’s just the tip of the expensive, itchy eczema iceberg.