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Atopic dermatitis

Published Oct. 28, 2020
• Reviewed by a UI Health Care Provider
on Oct. 1, 2020

Overview

Atopic dermatitis is a long-term (chronic) skin disorder that involves scaly, red, and itchy rashes. It is a type of eczema.

Causes

People with atopic dermatitis may be more sensitive because their skin lacks certain structure that help keep the skin's barrier to water. The weakened barrier can cause an allergic reaction in the skin. The reaction leads to ongoing itching, swelling and redness. Atopic dermatitis occurs most commonly in infants and children. Many people outgrow it during childhood.

People with atopic dermatitis often have other allergic diseases like asthma and/or seasonal allergies.  People with atopic dermatitis often test positive to allergy testing. However, atopic dermatitis is not caused by allergies.

The following can make atopic dermatitis symptoms worse:

  • Allergies to pollen, mold, dust mites, or animals
  • Cold and dry air
  • Infections
  • Contact with irritants and chemicals and rough materials, such as wool
  • Dry skin
  • Emotional stress
  • Perfumes or dyes added to skin lotions or soaps

Symptoms

  • Itching can start 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.
  • Blisters with oozing and crusting
  • Raw, dry, scaly, red, bumpy skin
  • Thickened or leather-like areas, which can occur after long-term irritation and scratching

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

  • Infants: face, scalp, hands, and feet. The rash is often itchy and forms blisters that ooze and crust over.
  • Children and adults:  inside of the knees and elbow, neck, hands, and feet.
  • Rashes may occur anywhere on the body during a bad outbreak, but tend to spare areas that are harder to itch such as the groin and middle of the back.

Exams and tests

Diagnosis is based on:

  • Skin exam
  • Your personal and family history
  • Sometimes a skin biopsy is used to confirm the diagnosis or rule out other causes of eczema.

Allergy skin prick and patch testing may be helpful for people with:

  • Hard-to-treat atopic dermatitis
  • Skin rashes that form only on certain areas of the body after exposure to a specific substance.

Treatment

  • Moisturizer or topical steroid cream. Daily skin care may cut down on the need for stronger medicines.
  • Antihistamines to reduce itching.

When washing or bathing:

  • Short and cool baths are best.
  • Use gentle body washes and cleansers.
  • Apply lubricating creams, lotions, or ointment while your skin is still damp after bathing. Good options include Cerave, Vanicream, Aquaphor, Vasaline. This will help trap moisture in your skin.

Other options:

  • Wet-wrap treatment
  • Antibiotic creams or pills if your skin is infected
  • Drugs that suppress the immune system
  • Targeted biologic medicines that are designed to target specific parts of the allergy immune system.
  • Phototherapy,  or ultraviolet (UV) light therapy.
  • Short courses of oral steroids

Additional trusted resources: