What is atopic dermatitis?
Atopic dermatitis (AD) is a chronic skin condition characterized by patches of dry, inflamed, and itchy skin. The exact cause of AD isn’t well understood. One factor may be an overproduction of cells in your immune system that promote inflammation.
AD often starts in childhood and tends to flare up periodically. During flare-ups, people with AD often scratch the affected area. This scratching can lead to more skin inflammation and make symptoms worse.
Currently, there’s no cure for AD. Treatment involves avoiding triggers, making lifestyle changes, and taking medications to ease symptoms.
Keep reading to learn more about AD, including what it looks like, causes, treatments, and potential complications.
If you’re living with atopic dermatitis, you’re not alone. Rakhi was diagnosed over 30 years ago. Hear her story.
Atopic dermatitis vs. eczema
AD is often called eczema, a word that refers to a broader group of skin conditions. “Dermatitis” relates to conditions of the skin and “atopic” refers to diseases caused by allergic reactions.
As an atopic disease, AD falls under the same classification as:
What are the types of atopic dermatitis?
All types of eczema cause itchiness and redness, but AD is the most severe and chronic. Other types of eczema include:
- Hand eczema. Hand eczema affects only your hands and is often caused by frequent contact with irritating chemicals.
- Contact dermatitis.Contact dermatitis is skin irritation caused by contact with certain irritants.
- Dyshidrotic eczema. Dyshidrotic eczema is a type of eczema that develops only on your fingers, your palms, and the soles of your feet.
- Neurodermatitis (lichenification).Neurodermatitis is characterized by thickened patches of skin due to repeated rubbing or scratching.
- Nummular eczema.Nummular eczema is a chronic condition that causes spots about the size of coins that are often itchy.
- Stasis dermatitis.Stasis dermatitis is a type of skin irritation that develops in people with poor circulation, typically in the lower legs.
Doctors and researchers are working to better understand how eczema works and why it affects so many people. There’s currently no known cure for this common condition.
What are the symptoms of atopic dermatitis?
The primary symptom of AD is dry, itchy skin that often turns into a red rash during flare-ups.
Many different physical and internal factors can trigger an eczema flare-up. The resulting inflammation causes increased blood flow and the urge to itch.
Eczema flares are part of the agonizing itch-scratch cycle. It’s hard to fight the physical and psychological elements that drive this cycle. Scratching feels good at the time but can lead to more inflammation and even skin infections.
AD has different symptoms depending on a person’s age.
Symptoms in infants
Symptoms in infants can include:
- dry, itchy, scaly skin
- a rash on the scalp or cheeks
- a rash that may bubble and weep clear fluid
Infants with these symptoms may have trouble sleeping due to itchy skin. Infants with AD may also develop skin infections from scratching.
Symptoms in children
Symptoms in children can include:
- a rash in the creases of the elbows, knees, or both
- scaly patches of skin at the site of the rash
- lightened or darkened skin spots
- thick, leathery skin
- extremely dry and scaly skin
- rashes on the neck and face, especially around the eyes
Symptoms in adults
Adults with AD tend to have skin that’s extremely dry and scaly. In a 2021 survey published by the Eczema Society of Canada, 71 percent of people with moderate or severe AD rated their itch as a 7 out of 10 or higher.
According to the American Academy of Dermatology Association, adults tend to get AD in different places than children. Commonly affected areas include:
- backs of the knees
- crooks of the elbows
- back of the neck
Adults are also more likely to have symptoms around their eyes.
Adults who had AD as children may have discolored or leathery patches of skin that are easily irritated. Some people who had AD in childhood may not have symptoms for many years until they return later in adulthood.
What does atopic dermatitis look like?
Areas affected with AD may be lighter or darker than the rest of your skin. During flare-ups, AD often appears as rashes in the crooks of your elbows and knees. Here are some examples of what AD may look like:
What causes atopic dermatitis?
The exact cause of AD is unknown. AD isn’t contagious, so you can’t give the rash to someone else.
The basic understanding of AD is that inflammation results from a misdirected immune reaction. This immune reaction causes too many inflammatory cells in your skin, and these cause many of AD’s symptoms.
People with AD tend to have dry skin because of an altered skin barrier. AD skin is more prone to water loss and the entry of irritants. This all leads to the development of red, itchy rashes.
AD flare-ups can have various triggers, but common lifestyle and environmental triggers include:
- long, hot showers or baths
- cold, dry weather
- soaps, detergents, and cleaners
- wool and synthetic fabrics
- physical irritants (dirt, sand, smoke)
- allergens (pollen, dander, dust)
- strenuous exercise
Who is at risk for atopic dermatitis?
In the United States, about 7.2 percent of adults and 11.6 percent of children are thought to have eczema or skin allergies., according to the Centers for Disease Control and Prevention (CDC). It affects people of all ethnicities, but the CDC data suggests the African American children have the highest rates.
An estimated 17.8 million people have AD, most of whom are undiagnosed. About 10 to 30 percent of children and 2 to 10 percent of adults in developed countries have AD, per 2021 research. AD in childhood about 80 percent of the time.
There seems to be a genetic component to AD. People with AD typically have a family member affected by the condition, and changes to the filaggrin gene have been linked as a risk factor for AD.
People with AD are also more likely to have other atopic conditions, such as allergies or asthma.
AD can lead to cracked and broken skin that puts you at risk of bacterial or viral infections, especially if you scratch the affected areas.
Some types of infections, such as the viral infection eczema herpeticum, can be serious. Signs of this condition include:
- painful eczema that gets worse quickly
- fluid-filled blisters that break and leave open sores
- feeling feverish, shivering, or feeling generally unwell
It’s important to seek medical attention if you think you may have eczema herpeticum.
Some people with AD may have poor self-confidence if they feel self-conscious about their skin. If itching is severe, AD can lead to poor sleep quality that may have a negative impact on mood, concentration, and behavior.
How is atopic dermatitis treated?
There’s no known cure for AD. Finding the right treatment is important to help reduce itching and discomfort. Reducing itching reduces stress and helps prevent excessive scratching that can lead to skin infections.
Treatment options vary, from home remedies and skin care routine changes to over-the-counter (OTC) skin care products and prescription medications.
It can be difficult to keep from scratching, but it’s important to avoid the temptation because it can make the affected area worse.
The best preventive measure is to moisturize your skin. This improves the function of the skin barrier. Healthier skin will become inflamed less often, and it provides a better barrier against allergens and irritants.
Bathing and moisturizing each day is the simplest way to hydrate your skin. It’s important to apply a type of moisturizer called an emollient within minutes of bathing. Emollients create a protective layer over your skin that traps moisture.
Pain relievers like Tylenol or ibuprofen can help you manage your discomfort and inflammation.
Antihistamines can help relieve itchiness, and some antihistamines contain sedatives to aid sleep. Some oral antihistamines that may be used to treat AD include:
Topical corticosteroids like hydrocortisone can help reduce inflammation and itchiness. They come in forms such as:
It’s important not to go above the dosage listed on the label or recommended by a medical professional to avoid side effects.
A doctor may prescribe more powerful corticosteroids than those available OTC to help you manage inflammation and itchiness.
In rare cases, your doctor may prescribe oral corticosteroids for 5 to 7 days. These tablets come with a higher risk of side effects and are generally avoided.
An injected biologic medication called dupilumab has been approved by the Food and Drug Administration (FDA) to treat AD that you can’t manage with other prescription therapies. It works by reducing the release of signaling molecules, called interleukins, that promote inflammation.
Your doctor may also prescribe medicated bandages or wet wraps to apply over affected areas to keep your skin moist and prevent itchiness.
When should you see a doctor?
You should see a primary care physician or a dermatologist to receive your initial diagnosis. A doctor can help you create an effective treatment plan and understand your triggers.
If AD is affecting your life, it’s also a good idea to speak with a doctor to develop a management plan.
Also, call a doctor right away if you see signs of a skin infection, such as:
- pain, swelling, tenderness, or heat around the rash
- red streaks extending from the rash
- discharge from the skin
If you need help finding a primary care doctor, then check out our FindCare tool here.
Can you prevent atopic dermatitis?
It’s not entirely clear why some people develop AD, and there’s currently no known way to prevent it from developing. But keeping your skin moist and forming an understanding of what causes your AD to flare up can help you minimize your symptoms.
Triggers commonly include stress and certain food allergies. Common food allergies include:
Certain irritants that come into contact with your skin can also cause your symptoms to flare up. These irritants often include:
- cigarette smoke
- dust or sand
- soaps, detergents, cleaning supplies
- synthetic fibers
By learning your triggers and taking good care of your skin, you can reduce the frequency and severity of your AD flare-ups. Even if your first treatment plan doesn’t work, there are many different things you can try. You and a doctor can work together to find a combination that works for you and your skin.