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Atopic dermatitis

Definition

Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly and itchy rashes. It is also called eczema.

Other forms of eczema include:

Alternative Names

Infantile eczema; Dermatitis - atopic; Eczema

Causes

Atopic dermatitis is due to a skin reaction (similar to an allergy) in the skin. The reaction leads to ongoing swelling and redness. People with atopic dermititis may be more sensitive because their skin lacks certain proteins.

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 allergies 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 following can make atopic dermatitis symptoms worse:

Symptoms

Skin changes may include:

The type and location of the rash can depend on the age of the person:

Intense itching is common. 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 follows as a result of scratching.

Exams and Tests

Your health care provider will look at your skin and do a physical exam. You may need a skin biopsy to confirm the diagnosis or rule out other causes of dry, itchy skin.

Diagnosis is based on:

Allergy skin testing may be helpful for people with:

Treatment

SKIN CARE AT HOME

Daily skin care may cut down on the need for medicines.

To help you avoid scratching your rash or skin:

Keep your skin moist by using ointments (such as petroleum jelly), creams, or lotions 2 to 3 times a day. Choose skin products that do not contain alcohol, scents, dyes, and other chemicals. A humidifier to keep home air moist will also help.

Avoid things that make symptoms worse, such as:

When washing or bathing:

MEDICATIONS

At this time, allergy shots are not used to treat atopic dermatitis.

Antihistamines taken by mouth may help with itching or allergies. You can often buy these medicines without a prescription.

Atopic dermatitis is usually treated with medicines placed directly on the skin or scalp. These are called topical medicines:

Wet-wrap treatment with topical corticosteroids may help control the condition, but may lead to an infection.

Other treatments that may be used include:

Outlook (Prognosis)

Atopic dermatitis lasts a long time. You can control it by treating it, avoiding irritants, and by keeping your skin well-moisturized.

In children, the condition often starts to go away around age 5 to 6, but flare-ups will often occur. In adults, the problem is generally a long-term or returning condition.

Atopic dermatitis may be harder to control if it:

Possible Complications

Some complications of atopic dermatitis that may occur are:

When to Contact a Medical Professional

Call  your health care provider if:

Prevention

Children who are breast-fed until age 4 months may be less likely to get atopic dermatitis.

If a child is not breast-fed, using a formula that contains processed cow milk protein (called partially hydrolyzed formula) may cut down on the chances of developing atopic dermatitis.

References

Ascroft DM, Chen LC, Garside R, Stein K, Williams HC. Topical pimecrolimus for eczema. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005500. http://www.ncbi.nlm.nih.gov/pubmed/?term=Ascroft+DM%2C+Chen+LC%2C+Garside+R%2C+Stein+K%2C+Williams+HC.+Topical+pimecrolimus+for+eczema.+Cochrane+Database+Syst+Rev.+2007+Oct+17%3B(4)%3ACD005500

Atopic Dermatitis. Alvero R, Ferri FF, Fort GG, et al, eds. In: Ferri's Clinical Advisor 2015. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2014:section I.

Atopic Dearmatitis, Eczema, and Noninfectious Immunodeficiency Disorders. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 5.

Bath-Hextall FJ, Delamere FM, Williams HC. Dietary exclusions for established atopic eczema. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD005203. http://www.ncbi.nlm.nih.gov/pubmed/?term=Bath-Hextall+FJ%2C+Delamere+FM%2C+Williams+HC.+Dietary+exclusions+for+established+atopic+eczema

Boguniewicz M, Leung DYM. Atopic Dermatitis. In: Adkinson NF Jr, Bochner BS, Burks AW, et al, eds. Middleton's Allergy: Principles and Practice. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2013:chap 34.

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. http://www.ncbi.nlm.nih.gov/pubmed/?term=Lewis-Jones+S%2C+Mugglestone+MA%3B+Guideline+Development+Group.+Management+of+atopic+eczema+in+children+aged+up+to+12+years%3A+summary+of+NICE+guidance.+BMJ.+2007%3B335%3A1263-1264


Review Date: 11/12/2014
Reviewed By: Richard J. Moskowitz, MD, dermatologist in private practice, Mineola, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional 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. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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