Atopic Dermatitis

What is atopic dermatitis?

Atopic dermatitis is a chronic skin condition that can come and go for years or throughout life. It is the most common type of eczema. Eczema is the name for a group of inflammatory skin conditions. Atopic dermatitis can also overlap with other types of eczema.

In people with atopic dermatitis, the immune system becomes disordered and overactive. This triggers inflammation that damages the skin barrier, leaving it dry and prone to itching and rashes. People with severe atopic dermatitis are also at higher risk for food allergy, asthma and allergic rhinitis (also known as hay fever), a triangulation of conditions that commonly co-occur known as the atopic march.¹

What does atopic dermatitis look like?

Atopic dermatitis often appears as an itchy rash or dry, scaly patches on the skin that may appear red, purple, brown or grayish hue depending on skin tone. Symptoms commonly appear on the face, inside the elbows or behind the knees. However, atopic dermatitis can appear anywhere on the body, and for some it can be widespread. Skin can become dry and discolored, and repeated scratching can cause thickening and hardening — a process called lichenification.

View images of atopic dermatitis

Who gets atopic dermatitis?

Atopic dermatitis is the most common form of eczema, affecting more than 9.6 million children under the age of 18^2–4 and about 16.5 million adults in the United States.⁵

While it can occur at any age, atopic dermatitis typically begins in childhood, usually in the first six months of a baby’s life. Even though it’s a common form of eczema, it can also be severe and long-lasting. When you or your child have atopic dermatitis, it may improve at times; but at other times, it may get worse. In some children, symptoms may taper off as they grow up, while other children will have atopic dermatitis flares into adulthood.

People who have asthma and/or hay fever or who have family members who do, are more likely to develop atopic dermatitis.

Learn more about the seven types of eczema

Is atopic dermatitis contagious?

No, atopic dermatitis is not contagious. You cannot catch it or spread it to others.

What is the difference between eczema and atopic dermatitis?

While the two terms are often used interchangeably, they aren’t exactly the same thing. Eczema is a term for the general skin condition where a trigger causes an adverse reaction in an affected area. This reaction can include itching, blisters, dry skin and other symptoms. Atopic dermatitis is the most common type of eczema and is usually caused by a genetic predisposition to the skin condition.

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What causes atopic dermatitis?

While the exact cause is unknown, people develop atopic dermatitis because of a combination of genes and a trigger. People with atopic dermatitis tend to have an overactive immune system that, when triggered, responds by producing inflammation. It is the inflammation that causes itchy, painful skin symptoms. Research also shows that some people with atopic dermatitis have a mutation in the gene responsible for filaggrin. Filaggrin helps our bodies maintain a healthy protective barrier on the very top layer of the skin. Without enough filaggrin, moisture can escape and bacteria, viruses and more can enter. This is why many people with atopic dermatitis have very dry skin that’s prone to infection.

What are common atopic dermatitis triggers and how do I prevent flares?

Healthcare providers and people with eczema often refer to something that aggravates their atopic dermatitis as a “trigger.” By knowing what bothers your skin, you can help prevent symptom flares. But identifying triggers can be difficult. A flare can appear some time after exposure to an irritant or allergen. This lag time can make it challenging to nail down a particular trigger. Some common atopic dermatitis triggers include:

• Scratchy clothing
• Sweat
• Humidity
• Changing temperatures
• Harsh skincare routines
• Products with fragrances
• Stress

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What are the symptoms of atopic dermatitis?

Common symptoms of atopic dermatitis include:

• Significant itch in affected areas — itch may affect sleep, ability to focus at work or school, or result in intense scratching that causes skin to bleed
• Inflamed skin (which can look pink, red, purple, brown or gray depending on skin tone) that can also be painful to touch
• Dry, scaly skin or skin that oozes clear fluid
• Thickened skin and light or dark patches in areas previously affected

Itch is the most common symptom of atopic dermatitis, followed by skin redness and sleep loss.^6–8. Atopic dermatitis can also have a significant impact on quality of life and mental health depending on the severity of symptoms.

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How is atopic dermatitis diagnosed?

Atopic dermatitis is typically diagnosed during a doctor visit. This may include a visit with a primary care physician, a dermatologist and/or an allergist. Atopic dermatitis is often diagnosed with a physical examination of the symptoms based on appearance and duration. Other methods of diagnosis include a skin biopsy where a sample of the skin is taken for lab testing to rule out other skin conditions. There are no laboratory tests to confirm a diagnosis of atopic dermatitis.

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How do you manage atopic dermatitis?

For atopic dermatitis daily management, it is important to establish a regular skincare routine that includes bathing and moisturizing to retain moisture and repair the skin barrier. Moisturized skin helps control flares by combating dryness and keeping out irritants and allergens.

Whether you have mild or severe atopic dermatitis, basic atopic dermatitis care includes:

• Bathing with a gentle cleanser
• Frequent moisturizing to lock moisture into the skin to help repair the skin barrier

Moisturizers may lower the chance of a flare by preventing dryness and blocking irritants and allergens. (People with eczema often refer to their symptoms acting up as a “flare” or “flare-up.”) In addition to these basics, there are various treatment options available, including:

• Over-the-counter medicines like hydrocortisone
• Topical prescription medications that are applied to the skin
• Biologic prescription medicines, which are given by injection
• Oral prescription medications, which are taken by mouth in the form of a pill
• Phototherapy, which is prescribed and a form of ultraviolet light treatment
• Complementary and alternative therapies like acupuncture or traditional Chinese medicine

It’s important to discuss your treatment options with your doctor to assess what works best for you. You may need to use more than one treatment option to best control atopic dermatitis symptoms.

What treatments and medications are available for atopic dermatitis?

Depending on severity of symptoms and age, atopic dermatitis treatments include lifestyle changes, over-the-counter (OTC) and natural remedies, prescription topical medications, which are applied to the skin; biologics, given by injection; immunosuppressants, usually taken by mouth in the form of a pill; and phototherapy, a form of ultraviolet light treatment. It’s important to discuss your treatment options with your doctor to assess what works best for you.

Learn more about available treatments for eczema

Does atopic dermatitis go away?

With the right treatment options, your atopic dermatitis flare-up can go away. However, the actual condition can last a long time and atopic dermatitis is considered chronic. Usually, someone gets this condition when they are a young child and it can follow them through to adulthood. Other times, it goes away as children grow up.

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Dr. Peter Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University, discusses diet and eczema, including how researchers have uncovered a new understanding of the connection between eczema and food allergies.

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If you have atopic dermatitis, do you have an increased risk of developing other health conditions?

Yes, people with atopic dermatitis have an increased risk of developing other conditions that can impact physical and mental health, such as skin infections, autoimmune conditions, asthma, allergies, anxiety and depression.

People with atopic dermatitis can get rashes anywhere on the body that can ooze fluid and bleed when scratched, making skin vulnerable to infection. People with atopic dermatitis also have an increased amount of Staphylococcus aureus (or “staph”) bacteria living on the skin, which can increase the risk of infection.⁹

Additionally, some people with atopic dermatitis have a mutation of the gene responsible for creating filaggrin. Filaggrin is a protein that helps our bodies maintain a healthy, protective barrier on the very top layer of the skin. Without enough filaggrin to build a strong skin barrier, moisture can escape and bacteria, viruses and more can enter. This is why many people with atopic dermatitis have very dry skin and an increased risk for skin infections.

Is atopic dermatitis an autoimmune disease?

No, atopic dermatitis is not an autoimmune disease.

An autoimmune disease is a condition in which the immune system attacks the body’s own healthy tissues. In some cases, atopic dermatitis can be considered an “immune-driven” condition. This means that the immune system does play a role in atopic dermatitis, and treatments that suppress the immune system can help manage symptoms. However, while overactive or dysregulated immune functions contribute to atopic dermatitis, they aren’t attacking a specific target in the body, the way, for instance, immune cells destroy the insulin-producing cells of the pancreas in type 1 diabetes. Environmental factors and skin barrier defects also play large roles in atopic dermatitis.

While atopic dermatitis is not an autoimmune disorder, there have been recent reports in scientific literature about links between the immune disturbance that drives atopic dermatitis and development of other diseases that are autoimmune, including dermatological, gastrointestinal and rheumatological diseases.^10,11

Does atopic dermatitis cause allergies and/or asthma?

People with atopic dermatitis often also have food/environmental allergies and asthma. The term “atopic” means a form of allergy in which a hypersensitivity reaction may occur in a part of the body that is not in contact with the allergen. Considerable research has been done to investigate all forms of atopic diseases and how they may be linked together. One concept is that disruption of the skin barrier in atopic dermatitis leads to allergen sensitization in the skin, which can trigger inflammation at other epithelial (skin-like) body surfaces, including in the gastrointestinal tract (food allergy), upper respiratory tract (allergic rhinitis, also known as “hay fever”) and the lower respiratory tract (asthma).¹² While these other conditions are not always present in people with atopic dermatitis, it has been long thought that atopic dermatitis can be the first of these related diseases to arise, followed by a “march” toward the other diseases. This is known as the “atopic march.”

Does atopic dermatitis affect mental health?

Yes, atopic dermatitis can significantly affect your quality of life. This includes managing physical symptoms, like itch, as well as burdens related to emotional, social and psychological impacts on life. Here are some of the ways atopic dermatitis can impact mental health:

Mental impact:

• Adults with atopic dermatitis have a two-and-a-half to three-fold higher risk for anxiety or depression that increases with disease severity.^5,13–15
• Children and adolescents with atopic dermatitis are two to six times more likely to have depression, anxiety or attention deficit/hyperactivity disorder (ADHD) than children without atopic dermatitis.^16–20
• Childhood atopic dermatitis also has a significant impact on the emotional and social well-being of parents and caregivers.^6,21,22

Sleep disturbances: Itching and sleep disturbance are most often cited by patients and caregivers as the greatest causes of disease burden in atopic dermatitis, regardless of disease severity.^5,23 Sleep deprivation is a common side effect of eczema, as the itch/scratch cycle can prevent a good night’s sleep. Inadequate sleep can impact academic, social and/or work life.

Social impact: People, especially children, may feel singled out for being different, which is exacerbated when the disease limits their ability to participate in certain activities, such as sports, without causing a flare. People with atopic dermatitis must also cope with a general lack of understanding of atopic dermatitis from their peers, along with the unfounded fear that atopic dermatitis is contagious. (Atopic dermatitis is not contagious.)

Family impact: Atopic dermatitis can also impact family life. Medical visits, time-consuming treatments and alternative sleeping arrangements to manage symptoms can impact everyone in a family, including caregivers, siblings and children.

Primary care providers, mental health professionals and other healthcare providers can provide advice on how to manage the stress and other emotional effects that may be associated with atopic dermatitis.

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