What is atopic dermatitis?
Atopic dermatitis is a long-term skin disorder characterized by a red, scaly, and itchy rash. It is the most common form of eczema. Contact dermatitis, dyshidrotic eczema, nummular eczema, and seborrheic dermatitis are the other forms of eczema.
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.
What causes atopic dermatitis?
What exactly causes atopic dermatitis is not known. Researchers believe an immune reaction in the skin causes it. When a substance from inside or outside the body triggers the immune system, it over-reacts and produces inflammation. It is this inflammation that causes the skin to become red, rashy and itchy.
Researchers also believe that a combination of genetics and other factors are involved.
People with atopic dermatitis may be more sensitive because their skin lacks specific proteins that maintain the skin’s barrier to water.
What are the symptoms of atopic dermatitis?
The main symptoms of atopic dermatitis are an itchy, scaly, and red rash on the skin. Intense itching is the common symptom. Itching may start even before the rash appears. Atopic dermatitis appears typically on the cheeks, arms, and legs, but can appear anywhere on the body.
The following symptoms (skin changes) occur due to atopic dermatitis:
- 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.
How is atopic dermatitis diagnosed?
Your doctor will look at your skin and perform a physical exam. The doctor may suspect atopic dermatitis based on how your skin looks, your personal and family history. The doctor may do a skin biopsy to confirm the diagnosis or rule out other causes of dry, itchy skin.
The doctor may do allergy skin testing in people with hard-to-treat atopic dermatitis, other allergy symptoms, or skin rashes that form only on specific areas of the body after exposure to a particular chemical.
The doctor may order cultures for infection of the skin. If you have atopic dermatitis, you may get infections easily.
How is atopic dermatitis treated?
Depending on the severity of the symptoms, atopic dermatitis is treated with topical medications, phototherapy, or immunosuppressant medications.
Initially, the doctor may prescribe the following medications:
- Mild cortisone (steroid) cream or ointment. May prescribe a stronger medicine if this does not work.
- Topical immunomodulators (TIMs) for anyone over 2 years old.
- Creams or ointments that contain coal tar or anthralin to be used for thickened areas.
- Barrier repair creams containing ceramides.
The doctor may prescribe the following other treatments:
- Antibiotic creams or pills if your skin is infected
- Drugs that suppress the immune system
- Phototherapy, a medical treatment in which your skin is carefully exposed to ultraviolet (UV) light
- Short-term use of systemic steroids (oral or intravenous)
The doctor may recommend the following skin care measures to cut down on the need for medicines.
- Use a moisturizer, topical steroid cream, or other medicine your provider prescribes.
- Take oral antihistamine medicines 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.
- A humidifier to keep home air moist.
When washing or bathing:
- Expose your skin to water for as short a time as possible. Quick, more cooling baths are better than long, hot baths.
- Use gentle body washes and cleansers instead of regular soaps.
- Don’t 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.
Avoid the following things that can make your symptoms worse:
- 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
This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.