Illness and Conditions - Illnesses & Conditions
Atopic Dermatitis (Eczema)
What is atopic dermatitis?
Atopic dermatitis , sometimes called eczema, is a skin problem that causes dry skin, intense itching, and then a red, raised rash. It's most common in babies and children. It cannot be spread from person to person.
Some children with atopic dermatitis outgrow it or have milder cases as they get older. Also, a person may get atopic dermatitis as an adult. For some people, atopic dermatitis may be a long-lasting (chronic) skin problem that requires more than one treatment.
What causes atopic dermatitis?
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.
Things that may make atopic dermatitis worse include:
What are the symptoms?
The main symptom of atopic dermatitis is itching, followed by rash. The rash is red and patchy. It may be long-lasting (chronic) or may come and go (recurring). Tiny bumps that look like little blisters may appear and ooze fluid or crust over. Scratching can cause the sores to become infected. Over time, a recurring rash can lead to tough and thickened skin.
Mild atopic dermatitis affects a small area of skin, isn't very itchy, and usually goes away with moisturizer. Severe atopic dermatitis covers a large area of skin that is very itchy and doesn't go away with moisturizer.
People tend to get the rash on different parts of the body, depending on their age. Common sites include the face, neck, arms, and legs. Rashes in the groin area are rare.
How is atopic dermatitis diagnosed?
A doctor can usually tell if you have atopic dermatitis by doing a physical exam and asking questions about your past health.
Your doctor may advise allergy testing to find the things that trigger the rash. Allergy tests can be done by an allergist (immunologist) or dermatologist.
How is it treated?
Mild atopic dermatitis can be treated at home.
But if your symptoms are bothering you and aren't getting better, see your doctor. Getting medical treatment early may keep your symptoms from getting worse.
In severe cases, your doctor may prescribe pills or give you a shot to stop the itching. Or you may get ultraviolet (UV) light treatment at a clinic or doctor's office.
Frequently Asked Questions
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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 allergic response.
Itching and rash can be triggered by many things, including:
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 becomes less frequent and improves as you get older.
Atopic dermatitis causes repeated attacks of itching and rash that can become quite severe. It is most common in babies and children. Some children outgrow it. But many people, especially teens and adults, continue to have relapses or to have the condition, although not as severely. 2 Also, a person may get atopic dermatitis as an adult.
The condition may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.
Some people who have atopic dermatitis get patches of lighter skin. This most often happens on the face, upper arms, or shoulders. Chronic scratching or rubbing of the skin can also lighten or darken skin color. When the condition has been successfully controlled, skin color returns to normal over time.
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 antibiotics.
Eczema herpeticum results when atopic dermatitis is infected with the herpes simplex virus. This is the virus that causes cold sores and genital herpes . In this condition, the rash blisters 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.
What Increases Your Risk
The major risk factor for atopic dermatitis is having a family history of the condition. You are also at risk if family members have asthma, allergic rhinitis , or other allergies.
When To Call a Doctor
Call your doctor if you or your child has atopic dermatitis and:
Who to see
For the diagnosis and treatment of atopic dermatitis, consult with a:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
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 eliminate 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 preventive care. Most of the time, rash and itching can be controlled within 3 weeks.
For more serious rashes, you will need to see your doctor for treatment. These rashes include:
Getting medical treatment early may keep your symptoms from getting worse.
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.
What to think about
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 severity:
Home treatment for atopic dermatitis includes taking care of your skin and avoiding things that irritate it.
Take care of your skin
Control itching and scratching
Avoid sun and stress
Medicines for 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 control.
Topical medicines, such as creams or ointments, are applied directly to the skin. Other medicines, such as oral corticosteroids or antihistamines, are taken as pills.
Other treatment for atopic dermatitis includes light therapy and complementary therapies.
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).
Too much sun exposure and light treatment (such as with UVA or UVB treatments) increases your risk of skin cancer.
Complementary or alternative treatments
Complementary or alternative treatments may be helpful for treating atopic dermatitis. Some small studies showed benefit from these treatments. But there isn't clear scientific evidence to show that they help. Examples of complementary and alternative treatments for atopic dermatitis include:
If you are interested in these treatments, talk to your doctor. Ask about the treatments' use, their effectiveness, and any possible interactions related to other medicines you are taking.
Other Places To Get Help
Last Revised: April 17, 2012
Leung DYM, et al. (2008). Atopic dermatitis (atopic eczema). In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 1, pp. 146–158. New York: McGraw-Hill.
Boguniewicz M, Leung DYM (2009). Atopic dermatitis. In N Franklin Addison Jr et al., eds., Middleton's Allergy Principles and Practice, 7th ed., vol. 2, pp. 1083–1103. Philadelphia: Mosby Elsevier.
U.S. Food and Drug Administration (2006). FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. FDA News. Available online: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm153941.htm.
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