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:
- Allergens, such as
dust mites or
- Harsh soaps or
- Weather changes, especially dry and cold.
- An allergic reaction to certain foods, such as
eggs, peanuts, milk, wheat, fish, or soy products.
- Skin infection.
What are the symptoms?
Atopic dermatitis starts with dry skin that is often very itchy. Scratching causes the dry skin to
become red and irritated (inflamed). Infection often occurs. Tiny bumps that look like little blisters may appear and ooze fluid or crust over. These symptoms—dryness, itchiness, scratching, and inflammation—may come and go. Over time, a recurring rash can lead to tough and thickened
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 certain parts of the body,
depending on their age. Common sites for babies include the scalp and face (especially on the cheeks), the front of the knees, and the back of the elbows. In children, common areas include the neck, wrists, legs, ankles, the creases of elbows or knees, and between the buttocks. In adults, the rash often appears in the creases of the elbows or knees and on the nape of the neck.
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.
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.
- Moisturize often to treat and prevent dry skin. Thicker creams and ointments, like petroleum jelly, work better than thinner lotions.
- Avoid things that trigger rashes, such as harsh soaps and
detergents, dander, and any other things you are allergic to.
Control scratching. You may want to cover the rash with a bandage to keep from
- Putting mittens or cotton socks on your baby's hands may prevent
him or her from scratching.
- Wearing cotton gloves at night may help older children and adults. (Moisturize hands first before putting on the gloves.)
- Use medicine prescribed by your
- Bathe with lukewarm or warm (not hot) water. Soak for about 10 minutes. Use soap or shampoo at the end so that you aren't sitting in soapy water.
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
Learning about atopic dermatitis:
- What is atopic dermatitis?
- What causes it?
- Can I prevent it?
- What are the symptoms?
- What happens in atopic dermatitis?
- What increases my risk for getting it?
- Who is affected by atopic dermatitis?
- Who can diagnose atopic dermatitis?
- How is it diagnosed?
- How is atopic dermatitis treated?
- What medicines will I need to take?
Living with atopic dermatitis:
- What can I do to treat atopic dermatitis at home?
- When should I call my doctor?
- How often will I need to see my doctor?
- How can I take care of my skin?
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
| ||Atopic Dermatitis: Taking Care of Your Skin|
| ||Stress Management: Breathing Exercises for Relaxation|
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
rash can be triggered by many things,
Allergens, such as dust mites, pollen, molds, or
- 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. Lying under blankets, entering a warm room, or going from a
warm shower into colder air can all cause itching.
- Stress. Emotions such as frustration or embarrassment may lead to more itching and scratching.
- Certain foods, such as
eggs, peanuts, milk, soy, or wheat products, if you are allergic to them. Up to 40% of children with
moderate to severe atopic dermatitis also have some type of
food allergy.1 But experts don't agree on whether foods can cause atopic dermatitis.
washing. Repeated washing dries out the top layer of skin. This can lead to drier
skin and more itching, especially in the winter months when humidity is
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:
- Develop fluid-filled sores that can ooze fluid
or crust over. This can happen when the skin is rubbed or scratched or if a
skin infection is present. This is known as an acute (sudden or of short
duration), oozing rash.
- Be scaly and dry, red, and itchy. This is known as a subacute
(longer duration) rash.
- Become tough and thick from constant
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.
- Babies (2 months to 2 years): The rash is often crusted or oozes fluid. It's most commonly seen during the winter months as dry, red patches on the cheeks .
- Children (2 years to 11 years): The rash is usually dry. But it may go through stages from an oozing rash to a red, dry rash that causes the skin to thicken. This thickened skin is called lichenification. It often occurs after the rash
For adolescents and adults, atopic dermatitis often 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
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.
The major risk factor for
atopic dermatitis is having a family history of the
condition. You are also at risk if family
allergic rhinitis, or other allergies.
Call your doctor if you or your
atopic dermatitis and:
- Itching makes you or your child irritable.
- Itching is interfering with daily activities or with
- 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.
cracks form on the hands or fingers.
- Atopic dermatitis on the
hands interferes with daily school, work, or home activities.
of bacterial infection develop. These include:
- Increased pain, swelling, redness,
tenderness, or heat.
- Red streaks extending from the
- A discharge of pus.
- A fever of
100.4 °F (38 °C) or higher with
no other cause.
Who to see
For the diagnosis and treatment of atopic dermatitis,
consult with a:
- Family medicine doctor.
- Nurse practitioner.
- Physician assistant.
food or other allergies are suspected to be a factor
in atopic dermatitis, you can see an
allergist (immunologist) for specialized evaluation.
For more information, see the topic
To prepare for your appointment, see the topic Making the Most of Your Appointment.
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 remove 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:
- An oozing rash, with fluid-filled sores that ooze fluid or crust over. You may have a skin infection.
- A scaly, dry, red, and itchy rash.
- Areas of thickened skin (lichenified skin).
For severe rashes, talk to your doctor about using bleach baths and wet wraps.
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:
topical corticosteroids or
oral corticosteroids. These may be used when the rash
covers large areas of the body. They may also be used when complications occur, such as skin
- A bandage or dressing that is wrapped around
the affected skin. This covers open sores and prevents contact with
- Exposure to
ultraviolet (UV) light, with or without other
medicine, at a clinic or doctor's office. Options include
psoralen plus ultraviolet light therapy (PUVA).
- Cyclosporine or
interferon. These are sometimes used in adults if other
treatment doesn't work.
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
- If possible, breast-feed your baby for at least
6 months. Breast-feeding can boost your baby's
- When you are
ready to give your child solid foods, talk with your doctor. Ask if your
child should avoid foods that often cause
food allergies, such as eggs, peanuts, milk, soy, and
Home treatment for
atopic dermatitis includes taking care of your skin and avoiding things that irritate it.
Take care of your skin
- Keep your skin hydrated through
bathing in warm (not hot) water and applying moisturizer right afterwards.
- Atopic Dermatitis: Taking Care of Your Skin
- Avoid things that irritate a rash or make it worse, such as soaps that dry the skin, perfumes, and scratchy clothing or
- Avoid possible
allergens that cause a rash or make a rash worse, such as dust mites,
animal dander, and certain
Control itching and scratching
- Keep your
fingernails trimmed and filed smooth to help prevent damaging the skin when
you scratch it.
- Use protective dressings to keep from rubbing the
affected area. Put mittens or cotton socks on your baby's hands to help prevent
him or her from scratching the area.
- Try coal tar preparations. When applied to the skin, they may
help reduce itching. But if your itching gets worse after using coal tar, stop using it.
Avoid sun and stress
- Exposure to natural sunlight can be helpful for atopic dermatitis, but it is important to avoid sunburn. Too much sun, sweating, and/or getting too hot also can irritate the skin. When you use a sunscreen, choose one for sensitive skin.
- Reduce stress to help your skin and keep rashes from getting worse. Try relaxation techniques, behavior modification, or biofeedback. Massage therapy is also helpful, especially in children.
- Stress Management: Breathing Exercises for Relaxation
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
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.
- Topical corticosteroids are the most common and
effective treatment for atopic dermatitis. They are
used until the rash clears.
- Calcineurin inhibitors
are topical immunosuppressants—medicines that weaken your body's
immune system. The U.S. Food and Drug Administration
(FDA) recommends caution when prescribing or using Elidel (pimecrolimus) cream
and Protopic (tacrolimus) ointment because of a potential cancer risk.3 The FDA also stresses that these medicines only be used as
directed and only after trying other treatment options. These medicines
aren't approved for children younger than 2 years of age.
- Antihistamines are often used to treat atopic dermatitis itch. They can also help you
sleep when severe night itching is a problem. But histamines aren't always
involved in atopic dermatitis itch, so these medicines may not help all people. Don't give antihistamines to
your child unless you've checked with the doctor first.
- Oral corticosteroids are used in severe cases when the rash covers large areas of the
body or when complications occur.
- Cyclosporine or
interferon is sometimes used in adults if other
treatment doesn't help.
Antibiotic, antiviral, or antifungal medicines are
used if the rash gets infected. Skin that has been broken down by scratching and inflammation can become
- Coal tar applied to the
skin may help reduce itching. But this medicine should not be used on skin that is very irritated, because it can make your skin problem worse. Tar preparations are sometimes used to control the condition
after a stronger medicine has successfully improved atopic dermatitis.
Other treatment for
atopic dermatitis includes light therapy and
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).
- Phototherapy uses UVA, UVB, or a
combination of UVA and UVB.
- Psoralen plus ultraviolet light therapy (PUVA) uses UVA light along with psoralen medicines, which
make the skin more sensitive to UV light.
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:
- Dietary supplements of
essential fatty acids (EFAs), such as fish oil or evening primrose oil.
- Creams that are put on the skin. These creams contain St. John's wort or vitamin B12.
- Chinese herbal therapy. But herbal therapies may also contain substances that may cause liver or heart problems.
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.
|American Academy of Dermatology|
|Web Address: ||www.aad.org|
|National Eczema Association (U.S.)|
|Web Address: ||www.nationaleczema.org|
- Allergic Rhinitis
- Asthma in Children
- Asthma in Teens and Adults
- Complementary Medicine
- Food Allergies
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:
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:
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
Other Works Consulted
Berger TG (2012). Dermatologic disorders. In SJ McPhee, MA Papadakis, eds., 2012 Current Medical Diagnosis and Treatment, 51st ed., pp. 93–163. New York: McGraw-Hill.
Bieber T (2008). Mechanisms of disease: Atopic dermatitis. New England Journal of Medicine, 358(14): 1483–1494.
Greer FR, et al. (2008). 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, 121(1): 183–191. Also available online: http://pediatrics.aappublications.org/content/121/1/183.full.
Habif TP (2010). Atopic dermatitis. In Clinical Dermatology, A Color Guide to Diagnosis and Therapy, 5th ed., pp. 154–180. Edinburgh: Mosby Elsevier.
Habif TP, et al. (2011). Atopic dermatitis. In Skin Disease: Diagnosis and Treatment, 3rd ed., pp. 71–76. Edinburgh: Saunders.
Krakowski AC, et al. (2008). Management of atopic dermatitis in the pediatric population. Pediatrics, 122(4): 812–824.
Schmitt J, et al. (2011). Eczema, search date May 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
Stevens SR, et al. (2008). Eczematous disorders,
atopic dermatitis, and ichthyoses. In EG Nabel, ed.,
ACP Medicine, section 2, chap. 4. Hamilton, ON: BC Decker.
|By: ||Healthwise Staff ||Current as of: March 12, 2014|
|Medical Review: ||Adam Husney, MD - Family Medicine|
Amy McMichael, MD - Dermatology