Atopic Dermatitis

Atopic dermatitis, often called atopic eczema, is a common skin condition that typically causes dry, scaly, itchy, inflamed skin. The condition is particularly common in children under 5 years old, but may persist into later life. Atopic dermatitis is also known as infantile atopic dermatitis or baby eczema when it affects infants and young children.

Treatment typically involves keeping the skin moist and using creams or medications to soothe inflammation. Many children with atopic dermatitis will find that the condition improves over time, and that the symptoms of the condition disappear by adolescence. Some people, however, will experience atopic eczema into adulthood.

The symptoms of atopic dermatitis will usually appear before the age of 5. Typical symptoms of the condition include: 1

• Itchiness of the skin, which may intensify at nighttime
• Patches of red, inflamed skin
• Small bumps on the skin
• Skin flaking

Atopic dermatitis is usually confined to one area of the body, though it can affect multiple areas in severe cases. Areas of skin which are near skin creases – such as the elbows, wrists, back of the knees and neck – are the most commonly affected areas. In infants, the face is the most commonly affected area.

Thickened skin or scars can develop from scratching or rubbing. If the affected area becomes infected, thick, yellow pus, as well as redness and crusting may appear.

The symptoms experienced, as well as the severity and duration of a flare-up, will differ from person to person.

If you think you or a loved one might have atopic dermatitis, try using Ada  to find out more about your symptoms.

The causes of atopic dermatitis are not yet fully understood. What is known is that the lipid (oily) barrier of skin is diminished in people with the condition and that substances, or cytokines, released by cells in the immune system may be a factor. The reason why these things affect some people and not others is unknown, however. 2

There is a genetic element to atopic dermatitis. If both parents have the condition, a child stands roughly an 80 percent chance of inheriting it themselves; if only one parent has the condition, this figure drops to 60 percent. 2

Atopic dermatitis is a common condition, especially in children younger than 5 years old. It is uncommon to experience a first episode in adulthood.

People with atopy – a predisposal to allergic conditions such as hay fever and allergic asthma, for example, tend to have a slightly higher chance of developing atopic dermatitis. Other factors that are known to trigger the condition include:

• Skin dryness
• Heat
• Perspiration
• Irritating substances, such as certain clothing or chemicals
• Emotional or physical stress
• Skin infections

A doctor or dermatologist will usually diagnose atopic dermatitis based on the symptoms and an examination of the affected skin. Skin or blood tests are not usually necessary to reach a diagnosis.

There is no cure for atopic dermatitis, meaning treatment is aimed at managing the symptoms. In many cases, symptoms will naturally improve with age.

The two main treatment methods for atopic dermatitis are: 1 2 3

• Emollients, or moisturizers
• Steroid creams and ointments (topical steroids)

Treatment for atopic dermatitis aims to reduce the number and severity of flare-ups by reducing skin irritation and promoting skin health.

Emollients are lotions, creams, ointments and bathing additives that help to prevent the skin from becoming dry, one of the key characteristics of atopic dermatitis. Keeping the skin moist helps to protect the skin from various irritants, which reduces the number of flare-ups experienced.

Depending on the severity of the condition, emollients may need to be applied between two and several times per day. They are most effective when applied directly after bathing – within three minutes – and should be applied liberally. 4 The most effective emollients are generally thick and contain little water, though a doctor, dermatologist or pharmacist will be able to advise on the best variety for each person.

Good to know: It is advisable to manage atopic dermatitis using products which have been specifically recommended for the use of people with the condition. Many commercial skincare products contain perfumes, and/or other chemicals which could irritate sensitive skin.

Steroid creams and ointments, otherwise known as topical steroids, are used to reduce skin inflammation. They come in various strengths, from mild to very potent, with the stronger varieties being more effective at treating inflammation but with a greater risk of side-effects. Possible side-effects include a mild stinging when applied, and, more rarely, thinning of the skin, skin discoloration, acne and increased hair growth. 3

For this reason, the long-term regular use of topical steroids is not recommended, and a course of this type of medication will typically need to be used for between 7 and 14 days. Commonly, a mild steroid will first be prescribed, followed by a stronger variety if the flare-up does not clear up within three to seven days. The cream or ointment will usually need to be applied liberally once or twice per day. In very severe cases, a short-course of steroid tablets may be prescribed to help manage symptoms when topical steroids have proven ineffective.

Additional treatment methods for atopic dermatitis include: 1 3

• Antihistamine tablets; sometimes used to help manage the itching associated with atopic dermatitis. They can be very effective but tend to cause drowsiness in some people.
• Ultraviolet light therapy; generally only recommended for people who have not responded to other treatment methods due to the expense as well as the possible risk of skin cancer.
• Immunosuppressive drugs; sometimes used in severe cases when no other treatment methods have proven effective. Can cause serious side-effects, including an increased risk of infection.
• Wet dressings can be used to hydrate and soothe the skin during a flare-up.

Identifying and avoiding triggers that may cause symptoms to worsen can help in preventing episodes of atopic dermatitis.

Triggers to avoid may include:

• Hot, dry environments
• Perspiration
• Certain chemicals and solutions, such as detergents, perfumes and cosmetics
• Wool or synthetic clothing

Once triggers have been identified, a person’s doctor or dermatologist will be able to help with devising methods of avoiding them.

Other methods of preventing atopic dermatitis from worsening include blotting the skin dry instead of rubbing after bathing as well as ensuring the fingernails of children are kept short to prevent wounds from scratching.

The skin of people with atopic dermatitis is susceptible to infection. This infection can be both bacterial and viral in origin.

Skin that has become cracked as a result of atopic dermatitis is prone to bacterial infection. If infected, the usual symptoms of the condition may become more severe and treatments may cease to be effective.

Additional signs and symptoms of a bacterial skin infection include: 5

• Fluid seeping from the skin
• A yellowish crust over the skin
• The development of small yellow-white spots on the affected area of skin
• Swollen and/or painful skin
• High temperature
• Generally feeling unwell

Seek medical attention if any of these signs or symptoms appear. Antibiotics will typically be prescribed to treat the infection.

People with atopic dermatitis are also susceptible to viral infections, particularly the herpes simplex virus. This can lead to a condition known as atopic dermatitis with eczema herpeticum. 6

Symptoms of atopic dermatitis with eczema herpeticum include: 5

• Rapidly worsening areas of painful dermatitis
• Clusters of fluid-filled blisters which may burst to leave shallow open sores
• High temperature
• Generally feeling unwell

Atopic dermatitis with eczema herpeticum requires urgent medical treatment. Contact a doctor immediately if any of the signs or symptoms appear.

Q: Do I need to see a specialist?
A: In most cases, a general practitioner will be capable of diagnosing and treating atopic dermatitis. However, if the usual treatment methods prove ineffective, it is not clear what is causing the condition and/or the dermatitis is particularly severe, the affected person may be recommended to a dermatologist, a specialist skin doctor. A dermatologist will be able to give additional support, including helping to identify any triggers and devising alternative treatment methods. 3

Q: Are there any home treatment methods for atopic dermatitis?
A: There are several ways in which to treat the symptoms of atopic dermatitis at home. These include using wet dressings – a piece of clothing or bandage soaked in water – to help keep the skin moist, bathing regularly – no more than once daily unless otherwise advised – and the use of over-the-counter emollients.

• Atopic eczema
• Atopic rash