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Illness & Conditions - Health Conditions
Atopic DermatitisTopic OverviewWhat is atopic dermatitis?Atopic dermatitis is a long-lasting (chronic) skin problem. It causes dry skin, intense itching, and then a red, raised rash. In severe cases, the rash forms clear, fluid-filled blisters. It cannot be spread from person to person. Atopic dermatitis is most common in babies and children. Some children with atopic dermatitis outgrow it or have milder cases as they get older. 1 Also, a person may get atopic dermatitis as an adult. Atopic dermatitis is sometimes called eczema or atopic eczema. But atopic dermatitis is only one of many types of eczema. See a picture of atopic dermatitis . What causes atopic dermatitis?The cause of atopic dermatitis is not clear. People with atopic dermatitis seem to have very sensitive immune systems that are more likely to react to irritants and allergens. Most people who have atopic dermatitis have a personal or family history of allergies, such as hay fever ( allergic rhinitis ) and asthma. The skin inflammation that causes the atopic dermatitis rash is thought to be a type of allergic response. Things that may make atopic dermatitis worse include:
What are the symptoms?The main symptom of atopic dermatitis is itching, followed by rash. The rash is red and patchy and may be long-lasting (chronic) or may come and go (recurring). Tiny bumps or blisters may appear and ooze fluid or crust over. Scratching can cause the sores to become infected. Over time, a recurring rash can lead to tough and thickened skin. People tend to get the rash on different parts of the body, depending on their age. Common sites include the face, neck, arms, and legs. Rashes in the groin area are rare. How severe the symptoms are depends on how large an area of skin is affected. It also depends on how much you scratch the rash and whether the sores get infected. Mild atopic dermatitis usually affects a small area of skin. It does not itch much and goes away with enough moisturizing. Severe atopic dermatitis usually covers a large area of skin that is very itchy. It does not go away with moisturizing. How is atopic dermatitis diagnosed?A doctor can usually tell if you have atopic dermatitis by doing a physical exam and asking questions about your past health. Some of the questions might be: Do allergies run in your family? When did the itch first start? When did the rash first appear? Checking to see what the rash looks like and where it is located will help your doctor decide if you have atopic dermatitis. Your doctor may advise allergy testing to find the things that trigger the rash. Allergy tests are done by an allergist (immunologist). How is it treated?Although atopic dermatitis is an ongoing problem, there are things you can do to control it.
In severe cases, your doctor may prescribe pills or give you a shot to stop the itching. Or you may get ultraviolet (UV) light treatment at a clinic or doctor’s office. Can you prevent your baby from getting atopic dermatitis?If you or other family members have atopic dermatitis or other allergies, there is a chance that your baby could get it. If possible, breast-feed your baby for at least 6 months to boost the immune system and to help protect your baby. Frequently Asked Questions
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| Actionsets are designed to help people take an active role in managing a health condition. |
| Atopic dermatitis: Taking care of your skin | |
The cause of atopic dermatitis is poorly understood and is the subject of active research. Research shows that it develops as a result of interaction between the environment, your immune system , and genetics (heredity). People with this condition seem to have very sensitive immune systems that are more prone to react to numerous irritants and allergens .
Most people who have atopic dermatitis have a personal or family history of allergic conditions, such as hay fever ( allergic rhinitis ). The skin inflammation that causes the atopic dermatitis rash is considered a type of allergic response. Research has shown that even the unaffected skin of people with atopic dermatitis does not hold water as well as it should. 2, 3
Itching and rash can be triggered by a variety of factors, including:
The main symptom of atopic dermatitis is itching. The itching can be severe and persistent, especially at night. Scratching the affected area of skin usually causes a rash. The rash is red and patchy and may be long-lasting (chronic) or come and go (recurring). The rash may:
The severity of symptoms depends on how large an area of skin is affected, how much you scratch the rash, and whether a secondary infection develops. Mild atopic dermatitis usually involves a small area of skin that does not itch much and goes away with adequate moisturizing. Severe atopic dermatitis usually involves a large area of skin that is very itchy and does not go away with moisturizing.
The usual location of the rash on the body varies by age group.
There are other conditions with similar symptoms or conditions that may be associated with atopic dermatitis, such as dry skin (xerosis), ringworm , and poison ivy and other forms of contact dermatitis .
Atopic dermatitis causes repeated attacks of itching and rash that can become quite severe. It is most common in babies and children. Older studies indicated that most children outgrow the condition. More recent studies report that many people continue to have relapses or to have the condition, although not as severely, as teenagers and adults. 1 Also, a person may develop atopic dermatitis as an adult.
Atopic dermatitis may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.
Teens and adults with a history of atopic dermatitis usually continue to itch and have a rash.
Some people with atopic dermatitis develop patches of lighter skin, especially on the face, upper arms, or shoulders. Chronic scratching or rubbing of the skin can also lighten or darken skin color. When atopic dermatitis has been successfully controlled, it takes about 9 months for skin color to return to normal. The darker the natural skin color, the longer this might take. 5
Infections caused by bacteria are common. Infected skin may become red and warm, and a fever may develop. Skin infections are treated with antibiotics.
Atopic dermatitis can affect the skin and tissue surrounding the eyes, but these eye problems are rare.
Eczema herpeticum results when atopic dermatitis is infected with the herpes simplex virus, the virus that causes cold sores and genital herpes . In this condition, the rash blisters and may begin to bleed and crust, and you may have a high fever. This is a serious infection—contact your doctor immediately.
People with skin conditions such as atopic dermatitis have a high risk of developing a severe rash called eczema vaccinatum if they receive the smallpox vaccine or touch another person’s vaccination mark before the scab has fallen off. Although most people recover from eczema vaccinatum, the rash can be quite severe, sometimes leading to death. People who do not have eczema at the time of vaccination but have a history of eczema also are at increased risk of developing eczema vaccinatum.
The major risk factor for atopic dermatitis is having a family history of the condition. You are also at risk for developing atopic dermatitis if family members have asthma , allergic rhinitis , or other allergies.
An infant who has a parent or sibling with atopic dermatitis, asthma, or allergic rhinitis has a 60% to 80% chance of developing atopic dermatitis. 6
Call your doctor if you or your child has atopic dermatitis and:
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment.
For the diagnosis and treatment of atopic dermatitis, consult with a:
If food or other allergies are suspected to be a factor in atopic dermatitis, consider seeing an allergist (immunologist) for specialized evaluation. For more information, see the topic Food Allergies.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Most cases of atopic dermatitis can be diagnosed from a medical history and a physical exam. You will be asked about your family history of allergic conditions, when the itch first started, and when the rash first appeared. What the rash look likes and where it is located will help your doctor make a diagnosis. Your or your child's condition is more likely to be atopic dermatitis if a parent or brother or sister has an allergic condition (especially asthma , allergic rhinitis , or atopic dermatitis).
Your doctor may recommend allergy testing to identify any factors that are related to atopic dermatitis flares. Allergy testing is most helpful for people with atopic dermatitis who also have respiratory allergies or asthma. Allergy testing can help identify certain allergens . But test results are often false-positive . For more information, see the topic Allergy Tests.
If a specific allergen is thought to trigger your atopic dermatitis, you and your doctor will discuss how to eliminate it from your diet or environment while closely observing and recording your symptoms.
Although there is no cure for atopic dermatitis , it can be controlled with preventive measures and medicines. Treatment helps stop the rash from recurring (flares) and controls itching. You can generally bring the rash and itching under control within 3 weeks of a flare. Specific treatment depends on the type of rash you have. Generally, a combination of corticosteroid medicines and moisturizers is used.
Counseling also can be helpful for children and adults with atopic dermatitis. Talking with a counselor can help reduce stress and anxiety caused by atopic dermatitis and can help a person cope with the condition.
Initial and ongoing treatment for atopic dermatitis includes:
You may need medicine to heal your rash and reduce itching.
For severe cases of atopic dermatitis or cases that do not improve with other treatment, treatment can include:
In severe cases, hospitalization may be needed. A short stay in the hospital can quickly control the condition.
A combination of preventive measures, such as moisturizing your skin and avoiding irritants, along with medicines usually works best to control atopic dermatitis. You may need to try different treatments before finding what works best for you or your child.
The regular use of moisturizers may help reduce the need for high-strength corticosteroid medicines. 2
Atopic dermatitis sometimes improves when daily stresses are reduced. Relaxation techniques, such as meditation or imagery exercises, can help relieve stress. For more information, see the topic Stress Management.
Atopic dermatitis may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.
If you have problems with skin infections along with atopic dermatitis, your doctor might suggest soaking in a weak bleach solution.
If your baby is at risk for developing atopic dermatitis because you or other family members have it or other allergies, these steps may help prevent a rash or reduce its severity:
If you or your child has atopic dermatitis, you may decrease flares by:
Home treatment for atopic dermatitis may include:
Medicines for atopic dermatitis include the following.
If the rash becomes infected, antibiotic, antiviral, or antifungal medicines are used. Skin that has been broken down by scratching and inflammation can become infected.
Coal tar preparations applied to the skin may help reduce itching. They are sometimes used to control the condition after a stronger medicine has successfully improved atopic dermatitis.
Mild- to moderate-strength corticosteroids that are applied to the skin, together with heavy moisturizing, are effective in reducing atopic dermatitis rash in most cases. Specific treatment depends on the type of rash you have.
If you or your child has a very mild itch and rash, you may be able to control it without medicine by using home treatment and preventive measures. But if symptoms are getting worse despite home treatment, it is essential that you use medical treatment to prevent the itch-scratch-rash cycle from getting out of control.
There is no surgical treatment for atopic dermatitis .
Other treatment for atopic dermatitis includes light therapy and complementary therapies.
Light therapy
Severe atopic dermatitis may be treated by exposing affected skin to ultraviolet (UV) light. There are two types of ultraviolet light, called ultraviolet A (UVA) and ultraviolet B (UVB).
Excessive sun exposure and light treatment (such as with UVA or UVB treatments) increases your risk of skin cancer.
Complementary or alternative treatments used for atopic dermatitis include:
If you are interested in these treatments, ask your doctor about their use, their effectiveness, and any possible interactions related to other medicines you are taking.
| American Academy of Allergy, Asthma, and Immunology | |
| 555 East Wells Street | |
| Suite 1100 | |
| Milwaukee, WI 53202-3823 | |
| Phone: | 1-800-822-2762 (doctor referral information only) (414) 272-6071 |
| E-mail: | info@aaaai.org (For general questions only. The AAAAI cannot answer individual questions relating to the diagnosis or treatment of allergies.) |
| Web Address: | www.aaaai.org |
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The American Academy of Allergy, Asthma, and Immunology publishes an excellent series of pamphlets on allergies, asthma, and related information. It also provides physician referrals. |
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| American Academy of Dermatology | |
| P.O. Box 4014 | |
| Schaumburg, IL 60618-4014 | |
| Phone: | 1-866-503-SKIN (1-866-503-7546) toll-free (847) 240-1280 |
| Fax: | (847) 240-1859 |
| E-mail: | mrc@aad.org |
| Web Address: | www.aad.org |
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The American Academy of Dermatology provides information about the care of skin, hair, and nails. You can find a dermatologist in your area by calling 1-888-462-DERM (1-888-462-3376). |
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| National Eczema Association for Science and Education | |
| 4460 Redwood Hwy | |
| Suite 16-D | |
| San Rafael, CA 94903-1953 | |
| Phone: | (800) 818-7546 (415) 499-3474 |
| Fax: | (415) 472-5345 |
| E-mail: | info@nationaleczema.org |
| Web Address: | www.nationaleczema.org |
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The U.S. National Eczema Association for Science and Education works to improve the health and quality of life of people living with atopic dermatitis/eczema. |
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| National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health | |
| NIAID Office of Communications and Public Liaison | |
| 6610 Rockledge Drive, MSC 6612 | |
| Bethesda, MD 20892-6612 | |
| Phone: | 1-866-284-4107 toll-free (301) 496-5717 |
| Fax: | (301) 402-3573 |
| TDD: | 1-800-877-8339 |
| Web Address: | www3.niaid.nih.gov |
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The National Institute of Allergy and Infectious Diseases conducts research and provides consumer information on infectious and immune-system-related diseases. |
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Citations
- Boguniewicz M, Leung DYM (2003). Atopic dermatitis. In N Franklin Addison Jr et al., eds., Middleton's Allergy Principles and Practice, vol. 2, pp. 1559–1580. New York: Mosby.
- Grimalt R, et al. (2007). The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: A randomized controlled study. Dermatology, 214(1): 61–67.
- Loden M (2003). The skin barrier and use of moisturizers in atopic dermatitis. Clinical Dermatology, 21(2): 145–157.
- Leung DYM, et al. (2008). Atopic dermatitis (atopic eczema). In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 146–158. New York: McGraw-Hill.
- Kristal L, Klein P (2000). Atopic dermatitis in infants and children. Pediatric Clinics of North America, 47(4): 877–895.
- Jones SM, et al. (2007). Atopic dermatitis. In P Lieberman, JA Anderson, eds., Allergic Diseases Diagnosis and Treatment, 3rd ed., pp. 217–247. Totowa, NJ: Humana Press.
- Rudikoff D, Bos JD (2006). Atopic dermatitis. In MG Lebwohl et al., eds., Treatment of Skin Disease, pp. 62–68. London: Mosby.
- U.S. Food and Drug Administration (2006). FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. FDA News . Available online: http://www.fda.gov/bbs/topics/news/2006/NEW01299.html.
- Bath-Hextall F, Williams H (2007). Eczema (atopic), search date February 2005. Online version of BMJ Clinical Evidence . Also available online: http://www.clinicalevidence.com.
- Leung D (2000). Atopic dermatitis: New insights and opportunities for therapeutic intervention. Journal of Allergy and Clinical Immunology, 105(5): 860–76.
- Kalliomäki M, et al. (2001). Probiotics in primary prevention of atopic disease: A randomised placebo-controlled trial. Lancet, 357(9262): 1076–1079.
- Kalliomäki M, et al. (2003). Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet, 361(9372): 1869–1870.
Other Works Consulted
- Berger TG (2008). Atopic dermatitis (eczema) section of Dermatologic disorders. In SJ McPhee, et al., eds., Current Medical Diagnosis and Treatment, 47th ed., pp. 92–94. New York: McGraw-Hill.
- Habif TP, et al. (2005). Atopic dermatitis. In Skin Disease: Diagnosis and Treatment, 2nd ed., pp.64–69. Philadelphia: Elsevier Mosby.
- Stevens SR (2005). Eczematous disorders, atopic dermatitis, and ichthyoses. In DC Dale, DD Federman, eds., ACP Medicine, section 2, chap. 4. New York: WebMD.
| Author | Maria G. Essig, MS, ELS |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Pat Truman, MATC |
| Primary Medical Reviewer | Martin Gabica, MD - Family Medicine |
| Specialist Medical Reviewer | Anne C. Poinier, MD - Internal Medicine |
| Last Updated | May 5, 2008 |
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ReferencesLast Updated: May 5, 2008
Author: Maria G. Essig, MS, ELS
Medical Review: Martin Gabica, MD - Family Medicine & Anne C. Poinier, MD - Internal Medicine
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