Atopic dermatitis (eczema)
is an itchy inflammation of your skin. It's a long-lasting (chronic)
condition that may be accompanied by asthma or hay fever. Eczema is most
often seen in infants and children, but it can continue into adulthood
or first appear later in life.
Eczema may affect any area, but it classically appears on your arms and
behind the knees. It tends to flare periodically and then subside. The
cause of atopic dermatitis, or eczema, is unknown, but it may result
from a malfunction in the body's immune system.
Self-care measures, such as avoiding soaps or other irritants and
applying creams or ointments, can help relieve itching. See your doctor
if your symptoms distract you from your daily routines or prevent you
Signs and symptoms of atopic dermatitis (eczema) include:
* Red to brownish-gray colored patches
* Itching, which may be severe, especially at night
* Small, raised bumps, which may leak fluid and crust over when scratched
* Thickened, cracked or scaly skin
* Raw, sensitive skin from scratching
Though the patches can occur anywhere, they most often appear on the
hands and feet, in the front of the bend of the elbow, behind the knees,
and on the ankles, wrists, face, neck and upper chest. Atopic
dermatitis can also affect the skin around your eyes, including your
eyelids. Scratching can cause redness and swelling around the eyes.
Sometimes, rubbing or scratching in this area causes patchy loss of
eyebrow hair and eyelashes.
Atopic dermatitis most often begins in childhood before age 5 and may
persist into adulthood. For some, it flares periodically and then
subsides for a time, even up to several years. Itching may be severe,
and scratching the rash can make it even itchier. Breaking this
itch-scratch cycle can be challenging.
Factors that worsen atopic dermatitis
Most people with atopic dermatitis also have Staphylococcus aureus
bacteria growing on their skin. The staph bacteria multiply and can
worsen symptoms, increasing the severity of the disease.
Other factors that can worsen signs and symptoms of atopic dermatitis include:
* Long, hot baths or showers
* Dry skin
* Rapid changes in temperature
* Low humidity
* Solvents, cleaners, soaps or detergents
* Wool or man-made fabrics or clothing
* Dust or sand
* Cigarette smoke
* Certain foods, such as eggs, milk, fish, soy or wheat
When atopic dermatitis occurs in infants, it's called infantile eczema.
This condition may continue into childhood and adolescence.
Infantile eczema often involves an oozing, crusting rash, mainly on the
face and scalp, but it can occur anywhere. After infancy, the rash
becomes dryer and tends to be red to brown-gray in color. In
adolescence, the skin may be scaly or thickened and easily irritated.
The intense itching may continue.
When to see a doctor
See your doctor if:
* You're so uncomfortable that you're losing sleep or are distracted from your daily routines
* Your skin is painful
* You suspect your skin is infected
* You've tried self-care steps without success
If you suspect your child has atopic dermatitis or you notice the above signs and symptoms, see your child's doctor.
The exact cause of atopic dermatitis (eczema) is unknown, but is likely
due to a combination of dry, irritated skin together with a malfunction
in the body's immune system. Stress and other emotional disorders can
worsen atopic dermatitis, but they don't cause it.
Atopic dermatitis often occurs along with allergies and frequently runs
in families in which other family members have asthma or hay fever.
Sometimes children who have signs and symptoms of atopic dermatitis
later develop asthma or hay fever.
Complications of atopic dermatitis (eczema) include:
* Neurodermatitis. Prolonged itching and scratching may increase the
intensity of the itch, possibly leading to neurodermatitis (lichen
simplex chronicus). Neurodermatitis is a condition in which an area of
skin that's frequently scratched becomes thick and leathery. The patches
can be raw, red or darker than the rest of your skin. Persistent
scratching can also lead to permanent scars or changes in skin color.
* Skin infections. Sometimes, scratching can break the skin and
cause open sores and fissures that can become infected. A milder form of
infection is impetigo, usually due to staphylococcal infection. Having
atopic dermatitis predisposes you to this infection.
* Eye complications. Severe atopic dermatitis can also cause eye
complications, which may lead to permanent eye damage. When these
complications occur, itching in and around the eyelids becomes severe.
Signs and symptoms of eye complications also include eye watering and
inflammation of the eyelid (blepharitis) and the lining of the eyelid
(conjunctivitis). If you suspect complications with your eyes, see your
Preparing for your appointment
You're likely to start by first seeing your family doctor or a primary
care doctor. However, in some cases when you call to set up an
appointment, you may be referred directly to a specialist in skin
Because appointments can be brief, and because there's often a lot to
cover, it's a good idea to be well prepared for your appointment. Here's
some information to help you get ready for your appointment, and what
to expect from your doctor.
What you can do
* Write down your signs and symptoms, when they occurred and how
long they lasted. Also, it may help to write down any factors that
triggered or worsened your symptoms, such as soaps or detergents,
cigarette smoke, sweating, or long, hot showers.
* Make a list of all medications, including vitamins, herbs and
over-the-counter drugs, that you're taking. Even better, take the
original bottles and a written list of the dosages and directions.
* Write down questions to ask your doctor. Don't be afraid to ask
questions or to speak up when you don't understand something your doctor
List your questions from most important to least important in case your
time with your doctor runs out. For atopic dermatitis, some basic
questions you might ask your doctor include:
* What might be causing the signs and symptoms?
* Are tests needed to confirm the diagnosis?
* What treatment approach do you recommend, if any?
* Is this condition temporary or chronic?
* Can I wait to see if the condition goes away on its own?
* What are the alternatives to the primary approach that you're suggesting?
* What skin care routines do you recommend to improve my symptoms?
What to expect from your doctor
Your doctor is likely to ask you several questions. Being ready to
answer them may reserve time to go over any points you want to discuss
more. Your doctor may ask:
* When did you first begin experiencing symptoms?
* How often do you experience these symptoms?
* Have your symptoms been continuous or occasional?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?
* Do you or any family members have asthma or allergies?
Tests and diagnosis
There is no test to diagnose atopic dermatitis (eczema). Instead, it's
typically diagnosed based on an examination of your skin and a review of
your medical history. Your doctor will ask about the frequency and
severity of the inflammation and how long you've had the symptoms.
Treatments and drugs
Treatments for atopic dermatitis (eczema) aim to reduce inflammation,
relieve itching and prevent future flare-ups. Over-the-counter
(nonprescription) anti-itch creams, along with other self-care measures,
may help control mild atopic dermatitis.
Although atopic dermatitis is related to allergies, eliminating
allergens is rarely helpful in clearing the condition. Occasionally,
items that trap dust — such as feather pillows, down comforters,
mattresses, carpeting and drapes — can worsen the condition. Allergy
shots usually aren't successful in treating atopic dermatitis and might
even make the condition worse.
* Corticosteroid creams or ointments. Your doctor may recommend
prescription corticosteroid creams or ointments to ease scaling and
relieve itching. Some low-potency corticosteroid creams are available
without a prescription, but you should always talk to your doctor before
using any topical corticosteroid. Side effects of long-term or repeated
use can include skin irritation or discoloration, thinning of the skin,
infections, and stretch marks on the skin.
* Antibiotics. You may need antibiotics if you have a bacterial skin
infection or an open sore or fissure caused by scratching. Your doctor
may recommend taking antibiotics for a short time to treat an infection
or for longer periods of time to reduce bacteria on your skin and to
prevent recurrent infections.
* Oral antihistamines. If itching is severe, oral antihistamines may
help. Diphenhydramine (Benadryl, others) can make you very sleepy and
may be helpful at bedtime. If your skin cracks open, your doctor may
prescribe mildly astringent wet dressings to prevent infection.
* Oral corticosteroids. For more severe cases, your doctor may
prescribe a short-course of oral corticosteroids, such as prednisone, to
reduce inflammation and to control symptoms. These medications are
effective but can't be used long term because of potential serious side
effects, which include cataracts, loss of bone mineral (osteoporosis),
muscle weakness, decreased resistance to infection, high blood pressure
and thinning of the skin.
* Immunomodulators. A class of medications called immunomodulators,
such as tacrolimus (Protopic) and pimecrolimus (Elidel), affects the
immune system and may help maintain normal skin texture and reduce
flares of atopic dermatitis. This prescription-only medication is
approved for children over the age of 2 and for adults. Due to possible
concerns about the effect of these medications on the immune system when
used for prolonged periods of time, the Food and Drug Administration
recommends that Elidel and Protopic be used only when other treatments
have failed, or if someone can't tolerate other treatments.
Light therapy (phototherapy)
As the name suggests, this treatment uses natural or artificial light.
The simplest and easiest form of phototherapy involves exposing your
skin to controlled amounts of natural sunlight. Other forms of light
therapy include the use of artificial ultraviolet A (UVA) or ultraviolet
B (UVB) light either alone or in combination with medications.
Though effective, long-term light therapy has many harmful effects,
including premature skin aging and an increased risk of skin cancer. For
these reasons, it's important to consult your doctor before using light
exposure as treatment for atopic dermatitis. Your doctor can advise you
on possible advantages and disadvantages of light exposure in your
Treatment for infantile eczema includes identifying and avoiding skin
irritations, avoiding extreme temperatures, and using bath oils,
lotions, creams or ointments to lubricate your baby's skin.
See your baby's doctor if these measures don't improve the rash or if
the rash looks infected. Your baby may need a prescription medication to
control the symptoms or to treat the infection. Your doctor may
recommend an oral antihistamine to help lessen the itch and to cause
drowsiness, which may be helpful for nighttime itching and discomfort.
Lifestyle and home remedies
To help reduce itching and soothe inflamed skin, try these self-care measures:
* Try to identify and avoid triggers that worsen the inflammation.
Rapid changes of temperature, sweating and stress can worsen the
condition. Avoid direct contact with wool products, such as rugs,
bedding and clothes, as well as harsh soaps and detergents.
* Apply an anti-itch cream or calamine lotion to the affected area. A
nonprescription hydrocortisone cream, containing at least 1 percent
hydrocortisone, can temporarily relieve the itch. A nonprescription oral
antihistamine, such as diphenhydramine (Benadryl, others), may be
helpful if itching is severe.
* Avoid scratching whenever possible. Cover the itchy area if you
can't keep from scratching it. Trim nails and wear gloves at night.
* Apply cool, wet compresses. Covering the affected area with
bandages and dressings can help protect the skin and prevent scratching.
* Take a warm bath. Sprinkle the bath water with baking soda,
uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is
made for the bathtub (Aveeno, others). Or, add 1/2 cup (118 milliliters)
of bleach to a 40 gallon (151 liter) bathtub filled with warm water.
The diluted bleach bath is thought to kill bacteria that grow on the
* Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body.
* Moisturize your skin. Use an oil or cream to seal in moisture
while your skin is still damp from a bath or shower. Pay special
attention to your legs, arms, back and the sides of your body. If your
skin is already dry, consider using a lubricating cream.
* Use a humidifier. Hot, dry indoor air can parch sensitive skin and
worsen itching and flaking. A portable home humidifier or one attached
to your furnace adds moisture to the air inside your home. Portable
humidifiers come in many varieties. Choose one that meets your budget
and any special needs. And be sure to keep your humidifier clean to ward
off bacteria and fungi.
* Wear cool, smooth-textured cotton clothing. Avoid clothing that's
rough, tight, scratchy or made from wool. This will help you avoid
irritation. Also, wear appropriate clothing in hot weather or during
exercise to prevent excessive sweating.
Many alternative therapies — including chamomile, evening primrose oil,
witch hazel extract and borage seed oil — have been touted as possible
ways to treat atopic dermatitis (eczema). However, there's no conclusive
evidence that any of these alternative therapies are effective.
If you're considering dietary supplements or other alternative therapy
to treat atopic dermatitis, consult your doctor. He or she can help you
weigh the pros and cons of specific alternative therapies.
Avoiding dry skin may be one factor in helping prevent future bouts of
dermatitis. These tips can help you minimize the drying effects of
bathing on your skin:
* Bathe less frequently. Most people who are prone to atopic
dermatitis don't need to bathe daily. Try going a day or two without a
shower or bath. When you do bathe, limit yourself to 15 to 20 minutes,
and use warm, rather than hot, water. Using a bath oil also may be
* Use only certain soaps or synthetic detergents. Choose mild soaps
that clean without excessively removing natural oils. Deodorant and
antibacterial soaps may be more drying to your skin. Use soap only on
your face, underarms, genital areas, hands and feet. Use clear water
* Dry yourself carefully. Brush your skin rapidly with the palms of
your hands, or gently pat your skin dry with a soft towel after bathing.
* Moisturize your skin. Moisturizers provide a seal over your skin
to keep water from escaping. Thicker moisturizers work best, such as
over-the-counter brands Cetaphil, Vanicream and Eucerin. You may also
want to use cosmetics that contain moisturizers. If your skin is
extremely dry, you may want to apply an oil, such as baby oil, while
your skin is still moist. Oil has more staying power than moisturizers
do and prevents the evaporation of water from the surface of your skin.