Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes.
Atopic dermatitis is due to a hypersensitivity reaction (similar to an allergy) in the skin, which leads to long-term swelling and redness (inflammation) of the skin. People with atopic dermititis may lack certain proteins in the skin, which leads to greater sensitivity.
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 allergic conditions such as asthma, hay fever, or eczema. People with atopic dermatitis often test positive to allergy skin tests.
However, atopic dermatitis is not caused by allergies. The condition tends to get worse when the person is exposed to certain triggers.
The following can make atopic dermatitis symptoms worse:
Typical skin changes may include:
Both the type of rash and where the rash appears can depend on the age of the patient:
Itching, which is sometimes intense, almost always occurs. 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 appears from the scratching.
A physical exam will be done. A skin biopsy can be done to confirm the diagnosis or rule out other causes of dry, itchy skin.
Diagnosis is based on the:
Allergy skin testing may be helpful for people with:
SKIN CARE AT HOME
Taking care of your skin at home may reduce the need for medications.
Avoid scratching the rash or skin:
Keep the skin moist (called lubricating or moisturizing the skin). Use ointments (such as petroleum jelly), creams, or lotions 2 - 3 times a day. Moisturizers should be free of alcohol, scents, dyes, fragrances, or other chemicals. A humidifier in the home will also help.
Avoid anything that makes your symptoms worse. This may include:
When washing or bathing:
At this time, allergy shots are not used to treat atopic dermatitis, although there is evidence that they may benefit certain adults with atopic dermatitis.
Antihistamines taken by mouth may help with itching or if you have allergies. Often you can buy them without a prescription.
Most causes of atopic dermatitis are treated with medications that are placed directly on the skin or scalp (called topical medicines):
Wet-wrap treatment with topical corticosteroids has been shown effective for atopic dermatitis, although it can have side effects such as infection.
Other treatments that may be used include:
Atopic dermatitis is a long-term condition, but you can control it with treatment, by avoiding irritants, and by keeping the skin well-moisturized.
In children, the condition often clears beginning at around age 5 - 6, but flare-ups will often occur. In adults, it is generally a long-term or returning condition.
Atopic dermatitis may be harder to control if it:
Call for an appointment with your health care provider if:
Studies have shown that children who are breast-fed until age 4 months are less likely to get atopic dermatitis.
If the child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may decrease the chances of developing atopic dermatitis.
Infantile eczema; Dermatitis - atopic; Eczema
Excema and hand dermatitis. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 3.
Atopic dermatitis. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 5.
Greer FR, Sicherer SH, Burks, W and the Committee on Nutrition and Section on Allergy and Immunology. 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. 2008;121:183-191.
Lewis-Jones S, Mugglestone MA; Guideline Development Group. Management of atopic eczema in children aged up to 12 years: summary of NICE guidance. BMJ. 2007;335:1263-1264.
Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500.
Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005203.
Reviewed by: Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Notice: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 1997-2012, A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.