HEALTH TOPICS

Atopic Dermatitis
IN-DEPTH
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Overview of Atopic Dermatitis

Atopic dermatitis, often referred to as eczema, is a chronic (long-lasting) disease that causes
inflammation, redness, and irritation of the skin. It is a common condition that usually begins in
childhood; however, anyone can get the disease at any age. Atopic dermatitis is not contagious, so it
cannot be spread from person to person.

Atopic dermatitis causes the skin to become extremely itchy. Scratching leads to further redness,
swelling, cracking, “weeping” clear fluid, crusting, and scaling. In most cases, there are periods of time
when the disease is worse, called flares, followed by periods when the skin improves or clears up
entirely, called remissions.

Researchers do not know what causes atopic dermatitis, but they do know that genes, the immune
system, and the environment play a role in the disease. Depending on the severity and location of the
symptoms, living with atopic dermatitis can be hard. Treatment can help control symptoms. For many
people, atopic dermatitis improves by adulthood, but for some, it can be a lifelong illness.

Who Gets Atopic Dermatitis?

Atopic dermatitis is a common disease and usually appears during infancy and childhood. For many
children, atopic dermatitis goes away before the teenage years. However, some children who develop
atopic dermatitis may continue to have symptoms as teens and adults. Occasionally, for some people,
the disease first appears during adulthood.

The chance of developing atopic dermatitis is higher if there is a family history of atopic dermatitis, hay
fever, or asthma. In addition, research shows that atopic dermatitis is more common in non-Hispanic
black children and that women and girls tend to develop the disease slightly more often than men and
boys do.

Symptoms of Atopic Dermatitis

The most common symptom of atopic dermatitis is itching, which can be severe. Other common
symptoms include:
 Red, dry patches of skin.
Rashes that that may ooze, weep clear fluid, or bleed when scratched.
Thickening and hardening of the skin.

The symptoms can flare in multiple areas of the body at the same time and can appear in the same
locations and in new locations. The appearance and location of the rash vary depending on age;
however, the rash can appear anywhere on the body. Patients with darker skin tones often experience
darkening or lightening of the skin in areas of skin inflammation.

Infants
During infancy and up to 2 years of age, it is most common for a red rash, which may ooze when
scratched, to appear on the:

Face.
Scalp.
Area of skin around joints that touch when the joint bends.

Some parents worry that the infant has atopic dermatitis in the diaper area; however, the condition
rarely appears in this area.

Childhood
During childhood, usually 2 years of age to puberty, it is most common for a red thickened rash, which
may ooze or bleed when scratched, to appear on the:

Elbows and knees, usually in the bend.

Neck.
Ankles.

Teens and Adults

During the teenage and adult years, it is most common for a red to dark brown scaly rash, which may
bleed and crust when scratched, to appear on the:

Hands.
Neck.
Elbows and knees, usually in the bend.
Skin around the eyes.
Ankles and feet.

Other common skin features of atopic dermatitis include:

An extra fold of skin under the eye, which is known as a Dennie-Morgan fold.
 Darkening of the skin beneath the eyes.
Extra skin creases on the palms of the hands and soles of the feet.

In addition, people with atopic dermatitis often have other conditions, such as:

Asthma and allergies, including food allergies.

Other skin diseases, such as ichthyosis, which causes dry, thickened skin.
Depression or anxiety.
Sleep loss.

Researchers continue to study why having atopic dermatitis as a child can lead to the development of
asthma and hay fever later in life.

Complications of atopic dermatitis can happen. They include:

Bacterial skin infections that can worsen from scratching. These are common and may make the
disease harder to control.
Viral skin infections like warts or cold sores.
Sleep loss that can lead to behavior issues in children.
Hand eczema (hand dermatitis).
Eye problems such as:
Conjunctivitis (pink eye), which causes swelling and redness in the inside of your eyelid and the
white part of your eye.
Blepharitis, which causes general inflammation and redness of your eyelid.

Causes of Atopic Dermatitis

No one knows what causes atopic dermatitis; however, researchers know that changes in the
protective layer of the skin can cause it to lose moisture. This can cause the skin to become dry,
leading to damage and inflammation in the skin. New research suggests that inflammation directly
triggers sensations of itch which in turn cause the patient to scratch. This leads to further damage of
the skin as well as increased risk for infection with bacteria.

Researchers do know that the following may contribute to the changes in the skin barrier, which helps
control moisture:

Changes (mutations) in genes.

Problems with the immune system.
Exposure to certain things in the environment.

Genetics
The chance of developing atopic dermatitis is higher if there is a family history of the disease, which
suggests that genetics may play a role in the cause. Recently, researchers found changes to genes
that control a specific protein and help our bodies maintain a healthy layer of skin. Without the normal
levels of this protein, the skin barrier changes, allowing moisture to escape and exposing the skin
immune system to the environment, leading to atopic dermatitis.

Researchers continue to study genes to better understand how different mutations cause atopic
dermatitis.

Immune System
The immune system normally helps to fight off illness, bacteria, and viruses in your body. Sometimes,
the immune system becomes confused and overactive, which can create inflammation in the skin,
leading to atopic dermatitis.

Environment
Environmental factors may trigger the immune system to change the protective barrier of the skin
allowing more moisture to escape, which can lead to the atopic dermatitis. These factors may include:

Exposure to tobacco smoke.

Certain types of air pollutants.
Fragrances and other compounds found in skin products and soaps.
Excessively dry skin.

Diagnosis of Atopic Dermatitis

Diagnosing atopic dermatitis may include the following:

Giving the doctor your or your child’s medical history, including:

Your family history of allergies.
Whether you also have diseases such as hay fever, asthma, or food allergies.
Sleep problems.
Foods that seem to trigger hives.
Previous treatments for skin-related symptoms.
Use of steroids or other medications.
Exposure to irritants, such as:
Soaps and detergents.
Some perfumes and cosmetics.
Cigarette smoke.
 Examining your skin and the rash.
Ordering laboratory tests, such as:
Blood tests to check for other causes of the rash.
Skin biopsy of the rash or lesion.

Your doctor may need to see you or your child several times to make an accurate diagnosis and to
determine if symptoms are from other diseases and conditions or from atopic dermatitis.

Treatment of Atopic Dermatitis

The goals for treating atopic dermatitis include:

Manage and control dry skin.

Reduce skin inflammation.
Control itching.
Promote healing.
Prevent infections.
Prevent flares.

Your doctor will work with you to develop a treatment plan based on the:

Location and type of rash, including the severity of the itching.

Triggers that are unique to you or your child, to avoid exposure and prevent potential flares.
The skin’s response to specific treatments, to identify which treatments seem to work best.

Treatments usually include a combination of therapies and can include:

Medications. Your doctor may prescribe one or more of the following medications to treat atopic
dermatitis, depending on the severity of the disease and your or your child’s age:
Moisturizing creams can help restore the skin barrier.
Corticosteroid creams and ointments help to decrease inflammation and are commonly used to
treat diseases affecting the skin. Doctors do not usually prescribe oral corticosteroids to treat
atopic dermatitis because after stopping the normal dose, atopic dermatitis can flare or rebound
and be more severe than before.
Calcineurin inhibitors applied to the skin decrease inflammation and help prevent flares.
Phosphodieterase-4 inhibitors, a topical cream, can help with inflammation when the symptoms
do not respond to other treatments.
Pills that reduce the abnormal immune response can be used but are reserved for more severe
disease, and they require close monitoring. These include janus kinase (JAK) inhibitors, which
 send messages to specific cells to stop inflammation from inside the cell.
Biologic medication, which is given by an injection just under the skin, blocks specific functions
of the immune system to help control and manage atopic dermatitis.

Skin care. Keeping the skin hydrated by applying moisturizers immediately after bathing to hold the
water in your skin is important when treating atopic dermatitis. Your doctor will recommend how
often you or your child should bathe and the type of moisturizer you should use. In some cases,
doctors may recommend the following skin care for AD:
A diluted bleach bath twice a week to help treat AD. It is important to follow your doctor’s specific
instructions when taking a bleach bath. You should not use this treatment without first talking to
your doctor.
Wet wrap therapy to help increase moisture in the skin when the condition is persistent.
However, only use wet wraps after speaking with your doctor.

Phototherapy. If the atopic dermatitis is severe, widespread, and has not responded to cream and
ointment treatments, your doctor may recommend the use of ultraviolet A or B light waves to treat
symptoms.

If you or your child develops skin infections from atopic dermatitis, your doctor may recommend
additional topical or oral antibiotic treatments.

It is important to use skin treatments as directed and follow up with your doctor regularly to make sure
the treatment plan is working.

Who Treats Atopic Dermatitis?

The following health care providers may diagnose and treat atopic dermatitis:

Dermatologists, who specialize in conditions of the skin, hair, and nails. You may want to find a
dermatologist that specializes in treating atopic dermatitis.
Allergists, who specialize in treating allergies.
Primary health care providers, including family doctors, internists, or pediatricians.

Living With Atopic Dermatitis

Depending on the location and severity of the atopic dermatitis, living with the condition can be hard.
Here are some tips to help control atopic dermatitis.

Caring for skin. Following a daily skin care routine is important and helps prevent flares. Skin care
can include:
 Taking lukewarm baths to cleanse and moisturize the skin without drying it excessively. Limit
baths to once a day.
Using mild unscented bar soap or non-soap cleanser.
Patting the skin dry after bathing and not allowing it to get too dry before moisturizing (avoid
rubbing or brisk drying).
Using a moisturizer to seal in the water that has been absorbed into the skin during bathing. Use
cream and ointments and avoid lotions with high water or alcohol content, which can cause
burning.
Protecting the skin from irritants and rough clothing, such as wool.

Talking to your doctor about potential food allergies.

Managing stress. Using stress management and relaxation techniques can help lower your stress
and decrease the likelihood of flares. Developing a network of support that includes family, friends,
health professionals, and support groups or organizations can be beneficial.
Preventing skin irritations. Try to avoid scratching or rubbing, which irritates the skin, increases
inflammation, and can increase itchiness. Keep your child’s fingernails short to help reduce
scratching.
Seeking counseling. If you are feeling overwhelmed, embarrassed, or anxious about the
condition, seek counseling with a mental health professional.
Maintaining level indoor temperatures. Try keeping the inside of your home at a cool, stable
temperature and consistent humidity levels. Avoid situations where overheating may occur. This
may help prevent flares.
Getting restful sleep. If you or your child is unable to get restful sleep at night because of itching
and scratching, talk to your doctor about options to better control the atopic dermatitis.
Avoiding exposure to the smallpox vaccine. Anyone with atopic dermatitis should not receive a
smallpox vaccine. If you have atopic dermatitis and you receive the smallpox vaccine, you are more
likely to develop a serious complication to the vaccine, even if your condition is mild or not active at
the time of the shot. In addition, you should avoid being around others who have recently received
the vaccine. Talk to your doctor about your risks before anyone in your household receives the
vaccine.

Research Progress Related to Atopic Dermatitis

The NIAMS Dermatology Branch conducts clinical and basic research of the skin and skin diseases,
including topics such as:

The skin as an organ that is part of our immune system.

The causes, diagnosis, and treatment of skin diseases, particularly inflammatory skin diseases.
 The human microbiome and its influence in healthy people and those with atopic dermatitis.

Additional areas of research on atopic dermatitis, include:

Genetics. Although atopic dermatitis runs in families, the role of genetics remains unclear.
Scientists have also found that the disease is associated with mutations in certain genes that
normally help form a protective skin barrier.
Skin development and maintenance. Discoveries about how the body creates and maintains skin
will help us understand why the skin barrier breaks down.
Understanding itch. Researchers are studying how the nervous system and the immune system
communicate to cause the inflammation, itch, and pain seen in atopic dermatitis.
Immune system imbalance. Researchers continue to study links between atopic dermatitis and
autoimmune diseases, including exploring factors that play a role in the immune response causing
inflammation like that seen in atopic dermatitis.
Itching. Many recent studies demonstrate that specific proteins associated with inflammation in the
skin stimulate sensory nerves to trigger sensations of itch. These factors are being targeted in new
and emerging treatments for atopic dermatitis.

For More Info

U.S. Food and Drug Administration
Toll free: 888-INFO-FDA (888-463-6332)
Website: https://www.fda.gov

Drugs@FDA at https://www.accessdata.fda.gov/scripts/cder/daf. Drugs@FDA is a searchable catalog

of FDA-approved drug products.

Centers for Disease Control and Prevention, National Center for Health Statistics
Website: https://www.cdc.gov/nchs

National Institute of Allergy and Infectious Diseases

Website: https://www.niaid.nih.gov/diseases-conditions/eczema-atopic-dermatitis

American Academy of Dermatology

Website: https://www.aad.org

American Academy of Allergy, Asthma, and Immunology

Website: https://www.aaaai.org

National Eczema Association

Website: https://www.nationaleczema.org
Food Allergy Research & Education
Website: https://www.foodallergy.org

If you need more information about available resources in your language or other languages, please
visit our webpages below or contact the NIAMS Information Clearinghouse at
NIAMSInfo@mail.nih.gov. You can also find a variety of information from organizations that are
NIAMS Coalition Members.

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