Atopic dermatitis
Infantile eczema; Dermatitis - atopic; Eczema
Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes. It is a type of eczema.
Other forms of eczema include:
Your skin used to be soft and smooth, but now it's itchy and scaly. It's gotten so bad that you're wearing long sleeves every time you go out, even in the summer. There's a chance you could have eczema, and if you do, there are treatments to smooth out your skin and get you back into t-shirts again. Eczema is like an allergic reaction on your skin. Instead of your eyes watering or your nose running, your skin swells up in response to an allergy trigger. A lot of people who have eczema also have allergies to pollen, mold, animal fur, dust, or sensitivities to products they use around the house. It could be that the detergent you're using or the perfume you're wearing is leaving its mark on your skin. To know if you have eczema, when you look at your skin, you'll see redness, dryness and maybe swelling, and blisters that may ooze or crust over. In babies and young kids, you'll see these sores mainly on the face, scalp, hands, and feet. In older kids and adults, the spots are typically on the insides of the knees and elbows, as well as on the neck, hands, and feet. But really, if you're having a bad eczema flare-up, you might see red patches on any part of your body. Eczema patches get so itchy that you'll probably be tempted to scratch at them. After a lot of scratching, they'll get red, thick, and irritated. Your doctor should be able to tell that you have eczema just by looking at your skin. If allergies are causing your eczema, you may need allergy tests to find out just what's setting off your skin reaction. To treat Eczema, you can apply creams or lotions to soothe and moisturize your skin. Just pick a product that's free from dyes and scents, which could irritate your skin even more. Your doctor can also prescribe a steroid cream or ointment to relieve the swelling. Medicines called antihistamines can calm the reaction that's causing your eczema and relieve the itchiness. There are a number of other eczema treatments if these don't work for you. Eczema is a chronic condition. Although kids usually outgrow it by age 5 or 6, most adults tend to get stuck with it for a long time. When you've got an eczema flare-up it will be itchy, but try not to scratch. You could give yourself an infection, or leave your skin permanently scarred. Instead, keep your skin moisturized and avoid whatever trigger is causing your eczema.
Keratosis pilaris is seen most commonly during childhood and presents as small, rough, raised lesions that are called papules. These papules are described as spiny and keratotic and are typically skin colored. The papules are usually found on the outer surface of the upper arms and thighs, although it may occur elsewhere on the body. The roughness is accentuated by dry skin and the condition is often worse in the winter. It tends to be inherited and may be associated with atopic dermatitis.
The term dermatitis describes an inflammatory response of the skin, caused by contact with allergens or irritants, exposure to sunlight, or by poor circulation, even stress. An example of atopic dermatitis is eczema, an itchy rash that produces redness, blisters and scaling. AVOID SCRATCHING. Scratching the rash may spread the inflammation, lead to infection and even leave scars.
Atopic dermatitis occurs in individuals with tendencies towards allergies and who seem to have very sensitive skin. The persistent itching often encourages scratching, causing the skin to become raw or leathery. Here, the ankles and feet are affected.
Atopic dermatitis is quite often seen on the cheeks of infants. It consists of red, scaling plaques that are diffusely scattered over the infant's body and face.
This view shows the red, scaly patches called plaques that are characteristic of atopic dermatitis.
Lupus erythematosus often produces what is often called a butterfly rash or malar rash, seen here on a young girl's face. This is the characteristic appearance of the butterfly rash.
Keratosis pilaris occurs most commonly during childhood and produces small, rough spots, called papules, that are typically the same color as the skin. They usually appear over the outer surface of the upper arms and thighs, but may also occur elsewhere on the body. Dry skin, especially during winter months, makes the condition worse. Keratosis pilaris tends to be inherited and may be associated with atopic dermatitis.
These red, scaly plaques on the legs are caused by an inherited allergic condition called atopic dermatitis. Many of these areas have been scratched until they are raw and infected, with the infection triggering and perpetuating the problem. In adults, atopic dermatitis frequently involves the body creases, such as inside the elbows and behind the knees.
People with atopic dermatitis frequently have hyperlinearity, which is a thickening of the skin on the palms and soles with an increase in the number of lines in the skin. This characteristic is closely associated with genetic predisposition.
Causes
Atopic dermatitis is due to a reaction in the skin. The reaction leads to ongoing itching, swelling and redness. People with atopic dermatitis may be more sensitive because their skin lacks specific proteins that maintain the skin's barrier to water.
Atopic dermatitis is most common in infants. It may start as early as age 2 to 6 months. Many people outgrow it by early adulthood.
People with atopic dermatitis often have asthma or seasonal allergies. There is often a family history of allergies such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive for allergy skin tests. However, atopic dermatitis is not caused by allergies.
The following can make atopic dermatitis symptoms worse:
- Allergies to pollen, mold, dust mites, or animals
- Cold and dry air in the winter
- Colds or the flu
- Contact with irritants and chemicals
- Contact with rough materials, such as wool
- Dry skin
- Emotional stress
- Drying out of the skin from taking frequent baths or showers and swimming very often
- Getting too hot or too cold, as well as sudden changes in temperature
- Perfumes or dyes added to skin lotions or soaps
Symptoms
Skin changes may include:
- Blisters with oozing and crusting
- Dry skin all over the body, or areas of bumpy skin on the back of the arms and front of the thighs
- Ear discharge or bleeding
- Raw areas of the skin from scratching
- Skin color changes, such as more or less color than the normal skin tone
- Skin redness or inflammation around the blisters
- Thickened or leather-like areas, which can occur after long-term irritation and scratching
The type and location of the rash can depend on the age of the person:
- In children younger than age 2, the rash may begin on the face, scalp, hands, and feet. The rash is often itchy and forms blisters that ooze and crust over.
- In older children and adults, the rash is more often seen on the inside of the knees and elbow. It can also appear on the neck, hands, and feet.
- In adults, the rash may be limited to the hands, eyelids, or genitals.
- Rashes may occur anywhere on the body during a bad outbreak.
Intense itching is common. Itching may start even before the rash appears. Atopic dermatitis is often called the "itch that rashes" because the itching starts, and then the skin rash follows as a result of scratching.
Exams and Tests
Your health care provider will look at your skin and do a physical exam. You may need a skin biopsy to confirm the diagnosis or rule out other causes of dry, itchy skin.
Diagnosis is based on:
- How your skin looks
- Your personal and family history
Allergy skin testing may be helpful for people with:
- Hard-to-treat atopic dermatitis
- Other allergy symptoms
- Skin rashes that form only on certain areas of the body after exposure to a specific chemical
Your provider may order cultures for infection of the skin. If you have atopic dermatitis, you may get infections easily.
Treatment
SKIN CARE AT HOME
Daily skin care may cut down on the need for medicines.
To help you avoid scratching your rash or skin:
- Use a moisturizer, topical steroid cream, or other medicine your provider prescribes.
- Take antihistamine medicines by mouth to reduce severe itching.
- Keep your fingernails cut short. Wear light gloves during sleep if nighttime scratching is a problem.
Keep your skin moist by using ointments (such as petroleum jelly), creams, or lotions 2 to 3 times a day. Choose skin products that do not contain alcohol, scents, dyes, and other chemicals. A humidifier to keep home air moist will also help.
Avoid things that make symptoms worse, such as:
- Foods, such as eggs, that may cause an allergic reaction in a very young child (always talk to your provider first)
- Irritants, such as wool and lanolin
- Strong soaps or detergents, as well as chemicals and solvents
- Sudden changes in body temperature and stress, which may cause sweating
- Triggers that cause allergy symptoms
When washing or bathing:
- Expose your skin to water for as short a time as possible. Short, cooler baths are better than long, hot baths.
- Use gentle body washes and cleansers instead of regular soaps.
- Do not scrub or dry your skin too hard or for too long.
- Apply lubricating creams, lotions, or ointment to your skin while it is still damp after bathing. This will help trap moisture in your skin.
MEDICINES
At this time, allergy shots are not used to treat atopic dermatitis.
Antihistamines taken by mouth may help with itching or allergies. You can often buy these medicines without a prescription.
Atopic dermatitis is usually treated with medicines placed directly on the skin or scalp. These are called topical medicines:
- You will probably be prescribed a mild corticosteroid cream or ointment at first (such as hydrocortisone). You may need a stronger medicine if this does not work.
- Medicines called topical immunomodulators (TIMs) may be prescribed for anyone over 2 years old. Ask your provider about concerns over a possible cancer risk with the use of these medicines.
- Creams or ointments that contain coal tar or anthralin may be used for thickened areas.
- Barrier repair creams containing ceramides may be used.
Wet-wrap treatment with topical corticosteroids may help control the condition. But, it may lead to an infection.
Other treatments that may be used include:
- Antibiotic creams or pills if your skin is infected
- Drugs that suppress the immune system
- Targeted biologic medicines that are designed to affect parts of the immune system involved in atopic dermatitis
- Phototherapy, a treatment in which your skin is carefully exposed to ultraviolet (UV) light
- Short-term use of systemic steroids (steroids given by mouth or through a vein)
Outlook (Prognosis)
Atopic dermatitis lasts a long time. You can control it by treating it, avoiding irritants, and by keeping your skin well-moisturized.
In children, the condition often starts to go away around age 5 to 6, but flare-ups will often occur. In adults, the problem is generally a long-term or returning condition.
Atopic dermatitis may be harder to control if it:
- Begins at an early age
- Involves a large amount of the body
- Occurs along with allergies and asthma
- Occurs in someone with a family history of eczema
Possible Complications
Complications of atopic dermatitis include:
- Infections of the skin caused by bacteria, fungi, or viruses
- Permanent scars
- Side effects from long-term use of medicines to control eczema
When to Contact a Medical Professional
Contact your provider if:
- Atopic dermatitis does not get better with home care
- Symptoms get worse or treatment does not work
- You have signs of infection (such as fever, redness, or pain)
Prevention
Children who are breastfed until age 4 months may be less likely to get atopic dermatitis.
If a child is not breastfed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may cut down on the chances of developing atopic dermatitis.
References
American Academy of Dermatology Association website. Eczema types: atopic dermatitis overview.
Boguniewicz M, Leung DYM. Atopic dermatitis. In: Burks AW, Holgate ST, O'Hehir RE, et al, eds. Middleton's Allergy: Principles and Practice. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 33.
Dinulos JGH. Atopic dermatitis. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 5.
McAleer MA, O'Regan GM, Irvine AD. Atopic dermatitis. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 12.
Moon M, Guerrero AM, Li X, Koch E, Gehris RP. Dermatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis' Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 8.
Version Info
Last reviewed on: 11/18/2022
Reviewed by: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
