Atopic Dermatitis (Eczema)
What is atopic dermatitis?
Atopic dermatitis (also called eczema) is a skin problem that causes intense itching and a red, raised rash. In severe cases, the rash develops clear fluid-filled blisters. The rash is not contagious. You can't catch it from others. People with this condition seem to have very sensitive immune systems that are likely to react to things that cause allergies. The immune system is the body's way of fighting infection.
There is no cure for atopic dermatitis. But you may be able to control it with care at home.
What causes it?
The cause of atopic dermatitis isn't clear. Most people who have it have a personal or family history of allergies. The skin inflammation that causes the atopic dermatitis rash is considered a type of allergic response. It can be triggered by allergens, harsh soaps, temperature changes, stress, and excessive washing.
What are the symptoms?
Atopic dermatitis starts with very itchy, dry skin. The skin becomes red and irritated by scratching. Little blisters may appear and ooze fluid or crust over. A recurring rash can become tough and thick from constant scratching. The areas most often affected are the face, scalp, neck, arms, and legs.
How is it diagnosed?
A doctor can usually tell if you have atopic dermatitis by doing an exam and asking questions about your health. Your doctor may recommend allergy testing. If a specific allergen is triggering your atopic dermatitis, you and your doctor will discuss how to remove it from your diet or environment.
How is atopic dermatitis treated?
Atopic dermatitis is usually treated with medicines that are put on your skin (topical medicines). Gentle skin care, including using plenty of moisturizer, is also important. Early medical treatment may keep your symptoms from getting worse. If the topical medicines don't help, your doctor may prescribe other treatments, such as pills, phototherapy, or injections.
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Things that trigger a flare-up of atopic dermatitis
The itching and rash of atopic dermatitis can be triggered by:
- Allergens, such as dust mites, pollen, molds, or animal dander.
- Harsh soaps or detergents, rubbing the skin, and wearing wool.
- Workplace irritants, such as fumes and chemicals.
- Weather changes, especially dry and cold.
- Temperature changes, such as a suddenly higher temperature. This may bring on sweating, which can cause itching.
- Stress. Emotions such as frustration or embarrassment may lead to more itching and scratching.
- Certain foods. This can include eggs, peanuts, milk, soy, or wheat products, if you are allergic to them. But experts don't agree on this as a cause.
- Excessive washing. This can lead to drier skin and more itching.
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.
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 how bad it is.
- Breastfeed your baby for at least 6 months if possible.
Breastfeeding can boost your baby's immune system.
- Talk with your doctor when you are ready to give your child solid foods.
Ask if your child should avoid foods that often cause food allergies, such as eggs, peanuts, milk, soy, and wheat.
Atopic dermatitis starts with dry skin that is often very itchy. Scratching causes the dry skin to become red and irritated (inflamed). Tiny bumps that look like little blisters may appear and ooze fluid or crust over. This can happen when the skin is rubbed or scratched or if a skin infection is present.
These symptoms may come and go. Over time, a recurring rash can become tough and thick from constant scratching.
Atopic dermatitis may be mild, moderate, or severe. 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 the inside of the elbows.
Atopic dermatitis is most common in babies and children. The condition may affect how children feel about themselves. If others can see the rash, a child may feel self-conscious. Most children outgrow it. But some teens and adults continue to have problems with it, though usually not as bad as when they were children.
Health problems caused by atopic dermatitis
There are some other health problems that can happen when you have atopic dermatitis.
Atopic dermatitis can cause problems with sleep. The itching caused by it, especially during flares, can make it hard to fall asleep or to get good sleep.
Skin infections can happen more often in people who have it. The skin may become red and warm, and a fever may develop. Skin infections are treated with antibiotics.
One type of skin infection is eczema herpeticum. It happens when atopic dermatitis is infected with the herpes simplex virus. The rash will likely blister 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.
When to Call a Doctor
Call your doctor if you or your child has atopic dermatitis and:
- Itching makes you or your child irritable.
- Itching is interfering with daily activities or with sleep.
- There are crusting or oozing sores, severe scratch marks, widespread rash, severe discoloration of the skin, or a fever that is accompanied by a rash.
- Painful cracks form on the hands or fingers.
- Atopic dermatitis on the hands interferes with daily school, work, or home activities.
- Signs of an infection develop. These may include:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the area.
- Pus draining from the area.
- A fever.
Exams and Tests
A doctor can usually tell if you have atopic dermatitis. To do this, he or she will do a physical exam and ask questions about your past health.
Your doctor may recommend allergy testing to find out what might be causing your condition. 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 you make changes in your diet.
If a certain allergen is thought to be a trigger for your atopic dermatitis, you and your doctor will discuss it. You will discuss how to remove it from your diet or environment while you closely observe and record your symptoms.
Allergy tests can be done by an allergist (immunologist) or dermatologist.
Treatment for atopic dermatitis depends on how severe your rash is. It's usually treated with medicines that are put on your skin (topical medicines) and with moisturizers.
Getting medical treatment early may keep your symptoms from getting worse.
- Topical medicines are usually creams, gels, or ointments. They include:
- Steroids. These reduce itching and help the rash heal.
- An ointment called crisaborole (Eucrisa). This can help the rash heal and can reduce itching and redness.
- Calcineurin inhibitors. These also reduce itching and help the rash heal. They are used to treat moderate and severe atopic dermatitis.
- Moisturizers—especially skin barrier repair moisturizers—can help. They can reduce the itching, keep your rash from getting worse, and help your rash heal.
If topical medicines don't help, your doctor may prescribe other treatments. These may include pills, phototherapy, or injections. Your doctor may also talk to you about bleach baths and wet wraps.
- Use moisturizer at least twice a day.
- If your doctor prescribes a cream, use it as directed. If your doctor prescribes other medicine, take it exactly as directed.
- Wash the affected area with warm (not hot) water only. Soap can make dryness and itching worse. Pat dry.
- Apply a moisturizer after bathing. Use a cream such as Cetaphil, Lubriderm, or Moisturel that does not irritate the skin or cause a rash. Apply the cream while your skin is still damp after lightly drying with a towel.
- Use cold, wet cloths to reduce itching.
- Keep cool, and stay out of the sun.
- If itching affects your sleep, ask your doctor if you can take an antihistamine that might reduce itching and make you sleepy, such as diphenhydramine (Benadryl). Be safe with medicines. Read and follow all instructions on the label.
- Control scratching. Keep your fingernails trimmed and smooth to prevent damage to the skin when you scratch it. Wearing cotton mittens or gloves can help you stop scratching.
- Try to avoid things that trigger your rash. These may include things like allergens, such as pollen or animal dander. Harsh soaps, scratchy clothes, stress, and some foods are other examples.
Medicines are used to help control itching and heal the rash caused by atopic dermatitis. Topical medicines are applied directly to the skin. Options include:
- Corticosteroids. They are the most common and effective treatment. But they can cause skin to shrink or change texture.
- Crisaborole (Eucrisa). This ointment is used to treat mild-to-moderate atopic dermatitis. It works well to heal the skin and relieve symptoms such as itching and redness.
- Calcineurin inhibitors. These medicines include pimecrolimus cream (Elidel) and tacrolimus ointment (Protopic). They work well to treat atopic dermatitis. But they can weaken the body's immune system.
Corticosteroids and calcineurin inhibitors are strong medicines. They shouldn't be used for long periods of time. Carefully follow your doctor's directions.
Other medicines that may be prescribed include:
- Antibiotic, antiviral, or antifungal medicines, if the rash gets infected.
- Antihistamines, to treat the itch.
- Cyclosporine, dupilumab (Dupixent), or interferon. They're used for adults if other treatment doesn't help.
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