Eczema (Atopic Dermatitis)

What is atopic dermatitis?

Atopic dermatitis is a long-term (chronic) skin condition. It causes itchy skin. It’s a very common condition. It’s more common in babies and children, but also occurs in adults. It usually first appears between ages 3 to 6 months.

What causes atopic dermatitis?

The exact cause of atopic dermatitis is not known. But some factors are linked to it, such as:

• Genes. Allergies and eczema run in families.

• The immune system. An immune system that isn’t fully developed may affect the protective ability of the skin.

• External factors. These include winter weather, dry, hot temperatures and lack of skin moisturizing.

Who is at risk for atopic dermatitis?

A child has a greater chance of having atopic dermatitis if he or she has:

• Family members with atopic dermatitis

• Allergies

What are the symptoms of atopic dermatitis?

Symptoms may come and go, or occur most or all of the time. Any area of the body may be affected. In babies, symptoms usually affect the face, neck, scalp, elbows, and knees. In children, symptoms usually affect the skin inside the elbows, on the back of the knees, the sides of the neck, around the mouth, and on the wrists, ankles, and hands.

Symptoms can occur a bit differently in each child. They can include:

• Dry, scaly skin

• Severe itching

• Redness and swelling

• Thickened skin

• Small, raised bumps that may become crusty and leak fluid if scratched

• Rough bumps on the face, upper arms, and thighs

• Darkened skin of eyelids or around the eyes

• Skin changes around the mouth, eyes, or ears

Make sure your child sees his or her healthcare provider for a diagnosis.

How is atopic dermatitis diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask if you or other family members have atopic dermatitis, asthma, or nasal allergies such as hay fever or allergic rhinitis. He or she will also ask about allergy symptoms in your child. The healthcare provider will examine your child, looking for signs of atopic dermatitis. There is no specific test for atopic dermatitis. Testing is usually not needed, but it may be done if allergies are suspected. E.g. About one third of small children with severe eczema have food allergies. Tests may include:

• Blood tests. Your child’s blood may be checked for levels of immunoglobulin E (IgE). IgE is released by the body's immune system. It’s high in most children with allergies and with atopic dermatitis. Other blood tests may be done too.

• Skin tests. Skin tests may be done to check for allergies or other skin conditions.

How is atopic dermatitis treated?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. There is no cure for atopic dermatitis. The goals of treatment are to reduce itching and inflammation, add moisture, and prevent infection.

Treatment of atopic dermatitis includes:

• Staying away from irritants, as advised by your child's healthcare provider

• Regular bathing with luke warm water or wash as advised by the healthcare provider. At times bleach baths may be recommended.

• Keeping your child's fingernails short and covering eczema areas by clothing or dressings, to help prevent scratching that can cause skin irritation and infection

• Using moisturizing regimens advised by the healthcare provider

Your child's healthcare provider may also prescribe medicines. They may be used alone or together. The following are most commonly used to treat atopic dermatitis:

• Corticosteroid cream or ointment. The cream or ointment is applied to the skin. This is to help lessen itching and swelling. 

• Antibiotic medicine. Liquid or pills may be taken by mouth to treat infection.

• Antihistamine. This medicine may be taken before sleep to help decrease itching and improve sleep. It comes in liquid or pills and is taken by mouth. 

• Calcineurin inhibitor cream or ointment. Cream or ointment is applied to the skin. This is to help lessen itching and swelling.

• Phototherapy (light therapy). Light therapy may be done in the healthcare provider's office or at home.

• Immunomodulatory medicine. This is a liquid or pill taken by mouth that affects the immune system. It may be used when other treatments do not work well. This medicine may have side effects. Your child will have regular blood tests to check for side effects.

What are possible complications of atopic dermatitis?

Can atopic dermatitis be prevented?

Living with atopic dermatitis

There is no cure for atopic dermatitis. But it will usually get better or go away as your child gets older. There may be times when your child has few or no symptoms. And he or she may have times when symptoms get worse. This is called a flare-up. To help prevent flare-ups, make sure your child:         

• Avoids triggers. Common triggers include irritants (such as wool, soap, or chemicals), allergens if diagnosed by your healthcare provider, and stress. 

• Doesn’t scratch the skin. Try to keep your child from scratching. It can cause worse symptoms and infection.

• Always has short fingernails. Trim or file your child’s nails to keep them short and prevent scratching.

• Takes warm baths or showers, not hot. Followed by application of a moisturizer on damp skin.

• Uses moisturizers. Apply creams or ointments immediately after bathing.

• Wears soft clothing. Don’t dress your child in wool or other rough fabric.

• Keeps cool. Try to keep your child as cool as possible. Getting hot and sweating can make him or her more uncomfortable.

• Doesn’t get the smallpox vaccine. It’s not a common vaccine, but people with atopic dermatitis should not receive the smallpox vaccine.

Talk with your child's healthcare provider about other ways to help your child’s skin condition.  

When should I call my child’s healthcare provider?

Call the healthcare provider if your child has:

• Symptoms that get worse

• Signs of a skin infection, such as increased redness, warmth, swelling, or fluid

• New symptoms

Key points about atopic dermatitis

• Atopic dermatitis is a long-term (chronic) skin condition. It is more common in babies and children, but also occurs in adults.

• A child with allergies or family members with allergies or atopic dermatitis has a higher chance of having atopic dermatitis.

• Itching, dryness, and redness are common symptoms.

• The goals of treatment are to reduce itching and inflammation of the skin, increase moisture, and prevent infection.

• Avoiding triggers is important in managing the condition.

• It usually gets better or goes away as a child gets older.

Next steps

• Before your visit, write down questions you want answered.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Online Medical Reviewers:

• Freeborn, Donna, PhD, CNM, FNP
• Holloway, Beth, RN, M.Ed.
• Kirsi Järvinen-Seppo, M.D., Ph.D.