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The cause of
atopic dermatitis isn't clear, but it affects your skin's ability to hold moisture. Your skin becomes dry, itchy, and easily irritated.
Most people who have atopic dermatitis
have a personal or family history of allergies, such as hay fever (allergic rhinitis) or asthma.
Atopic dermatitis starts with dry skin that is often very itchy. Scratching causes the dry skin to
become red and irritated (inflamed). Infection often occurs. Tiny bumps that look like little blisters may appear and ooze fluid or crust over. These symptoms—dryness, itchiness, scratching, and inflammation—may come and go. Over time, a recurring rash can lead to tough and thickened
Mild atopic dermatitis affects a small area of skin and may be itchy once in a while. Moderate and severe atopic dermatitis cover larger areas of skin and are itchy more often. And at times the itch may be intense.
People tend to get the rash on certain parts of the body,
depending on their age. Common sites for babies include the scalp and face (especially on the cheeks), the front of the knees, and the back of the elbows. In children, common areas include the neck, wrists, legs, ankles, the creases of elbows or knees, and between the buttocks. In adults, the rash often appears in the creases of the elbows or knees and on the nape of the neck.
A doctor can
usually tell if you have atopic dermatitis by doing a physical exam and asking
questions about your past health.
may advise allergy testing to find the things that trigger the rash. Allergy
tests can be done by an allergist (immunologist) or dermatologist.
Atopic dermatitis is usually treated with medicines that are put on your skin (topical medicines). Gentle skin care, including using plenty of moisturizer, is also important.
Getting medical treatment early may keep your symptoms from getting worse.
If the topical medicines don't help, your doctor may prescribe other treatments, such as pills or phototherapy.
Learning about atopic dermatitis:
Living with atopic dermatitis:
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The cause of
atopic dermatitis isn't known. But most people who have it have a personal or family history of allergies, such as
hay fever (allergic rhinitis). The skin
inflammation that causes the atopic dermatitis rash is
considered a type of
rash can be triggered by many things,
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:
How bad your symptoms are depends on how large an area of
skin is affected, how much you scratch the rash, and whether the rash gets infected.
The areas most often affected are the face, scalp, neck, arms, and legs. The rash is also common in areas that bend, such as the back of the knees and inside of the elbows. Rashes in the groin or diaper area are rare. There may be age-related differences in the way the rash looks and behaves.
For adolescents and adults, atopic dermatitis often improves as you get older.
Atopic dermatitis is most common
in babies and children. Most children outgrow it. But some teens and adults continue to have problems with it, though it's usually not as bad as when they were children.
The condition may affect how children feel about themselves. If others can see the rash, a child may feel self-conscious and may need to be reassured.
Atopic dermatitis can cause problems with sleep. The itching caused by atopic dermatitis, especially during flares, can make it hard for children to fall asleep or to get good sleep.
Skin infections can happen more often in people with atopic dermatitis. The skin may become red
and warm, and a fever may develop. Skin infections are treated with
One type of skin infection is eczema herpeticum. It happens when atopic dermatitis is infected with the
herpes simplex virus. The rash will likely blister
and may begin to bleed and crust. You may also have a high fever. This is a
serious infection, so contact your doctor right away.
The major risk factor for
atopic dermatitis is having a family history of the
condition. You are also at risk if family
allergic rhinitis, or other allergies.
Call your doctor if you or your
atopic dermatitis and:
For the diagnosis and treatment of atopic dermatitis,
consult with a:
food or other allergies are suspected to be a factor
in atopic dermatitis, you can see an
allergist (immunologist) for specialized evaluation.
For more information, see the topic
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.
Your doctor may recommend
allergy testing to find out what might be causing your atopic dermatitis. Allergy testing is most helpful for people
with atopic dermatitis who also have respiratory allergies or asthma.
Testing can also help find out if certain foods, such as eggs or nuts, are making the condition worse. Talk with your doctor about testing for allergies before making dietary changes.
If a specific allergen is
thought to trigger your atopic dermatitis, you and your doctor will discuss how
to remove it from your diet or environment while
closely observing and recording your symptoms.
Treatment for atopic dermatitis depends on the type of rash you have. Most mild cases can be treated at home with moisturizers—especially skin barrier repair moisturizers—and gentle skin care. Most of the time, rash and itching can be controlled within 3 weeks.
Your doctor may talk to you about bleach baths and wet wraps. He or she will give you directions on how to use these treatments.
For rashes that don't get better with medicines or moisturizers, treatment may include:
For itching, treatment may include antihistamines. Also, taking baths with colloidal oatmeal (such as Aveeno) or applying wet dressings to the rash for 30 minutes several times a day may help.
In severe cases, hospitalization may be needed. A short
stay in the hospital can quickly control the condition.
Counseling may 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.
If your baby is at risk for atopic dermatitis because you or other family members
have it or other allergies, these steps may help prevent a rash or reduce its
Home treatment for
atopic dermatitis includes taking care of your skin and avoiding things that irritate it.
atopic dermatitis are used to help control itching and heal the rash. 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, you will need to use medical
treatment to prevent the itch-scratch-rash cycle from getting out of
Topical medicines, such as creams or ointments, are applied directly to the skin.
Both corticosteroids and calcineurin inhibitors are strong medicines, so be sure to follow carefully your doctor's directions. They shouldn't be used for long periods of time, so use them only as long as your doctor says. And any skin that has these medicines on it shouldn't be covered with any material that keeps air from getting to your skin, unless your doctor tells you to.
Other medicines include:
Other treatment for
atopic dermatitis includes light therapy and
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). Phototherapy uses UVA, UVB, or a
combination of UVA and UVB.
Too much sun exposure and light treatment (such as with
UVA or UVB treatments) increases your risk of skin cancer.
Complementary medicine may be helpful for treating atopic dermatitis. Some small studies showed benefit from using probiotics. But there isn't strong scientific evidence to show that they help.
Talk with your doctor about any complementary health practice that you would like to try or are already using. Your doctor can help you manage your health better if he or she knows about all of your health practices.
Other Works Consulted
Berger TG (2012). Dermatologic disorders. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 93–163. New York: McGraw-Hill.
Bieber T (2008). Mechanisms of disease: Atopic dermatitis. New England Journal of Medicine, 358(14): 1483–1494.
Greer FR, et al. (2008). Effects of early nutritional interventions on the development of atopic disease in infants and children: The role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics, 121(1): 183–191. Also available online: http://pediatrics.aappublications.org/content/121/1/183.full.
Habif TP (2010). Atopic dermatitis. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 154–180. Edinburgh: Mosby Elsevier.
Habif TP, et al. (2011). Atopic dermatitis. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 71–76. Edinburgh: Saunders.
Krakowski AC, et al. (2008). Management of atopic dermatitis in the pediatric population. Pediatrics, 122(4): 812–824.
Schmitt J, et al. (2011). Eczema, search date May 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Stevens SR, et al. (2008). Eczematous disorders, atopic dermatitis, and ichthyoses. In EG Nabel, ed., ACP Medicine, section 2, chap. 4. Hamilton, ON: BC Decker.
ByHealthwise StaffPrimary Medical ReviewerAdam Husney, MD - Family MedicineSpecialist Medical ReviewerAmy McMichael, MD - Dermatology
Current as ofFebruary 5, 2016
Current as of:
February 5, 2016
Adam Husney, MD - Family Medicine & Amy McMichael, MD - Dermatology
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