Atopic Dermatitis 101

What is atopic dermatitis?

Atopic dermatitis (AD) is a severe form of eczema, which is an umbrella term used to describe a group of conditions that result in itchy, red, and irritated skin. It is a chronic, inflammatory disease that results in red, itchy patches on the skin that can crack and weep. Atopic dermatitis falls into a category of diseases called atopic meaning allergic reaction. It is usually diagnosed and treated by a dermatologist or an allergist.

What are the symptoms of atopic dermatitis?

Symptoms of atopic dermatitis include dry, itchy skin that typically appears on the face, inside of elbows or behind knees. However, AD can appear anywhere on the body. Skin may be scaly, bumpy and leathery, or broken, depending on what part of the body is affected.

People with atopic dermatitis are more prone to skin infections and herpes. When it appears on the eyelids and around the eyes, it can result in cataracts, darkening of the skin, and an extra fold of skin under the eye.

Who gets atopic dermatitis?

Atopic dermatitis usually starts in childhood, but can affect people of any age. People with eczema often also develop asthma and/or hay fever, or are related to someone with these allergic conditions. Children may grow out of AD, however, it can affect some people throughout their lives.

At least 18 million people in the U.S. have atopic dermatitis.

What causes atopic dermatitis?

We don't know exactly what causes atopic dermatitis but it is believed that genes and environmental factors play a role. People with AD in childhood may go on to develop asthma or hay fever.

What are common atopic dermatitis triggers?

Atopic dermatitis can appear, or are up, when a person is exposed to something in his or her environment. This is commonly called a trigger. Known triggers for atopic dermatitis include exposure to allergens such as pollen, pet dander or peanuts, or by stress, dry skin and infection. Skin irritants such as some fabrics, soaps and household cleaners may also trigger an atopic dermatitis flare.

How is atopic dermatitis treated?

There is no cure for AD but there are many effective treatments. Flares can be treated with topical steroids, topical calcineurin inhibitors (TCIs) and phototherapy. Systemic drugs such as methotrexate, cyclosporine and mycophenolate mofetil are also used to control flares. New research on what causes atopic dermatitis has spurred the development of new drugs, with more than 40 currently in the clinical trial pipeline.

Systemic and topical treatments in the pipeline include the first biologic drug for adults with moderate-to-severe atopic dermatitis, and a non-steroid topical cream for mild-to-moderate AD patients age 2 and up. Complementary and alternative treatments for atopic dermatitis that are shown to work include biofeedback, meditation and hypnosis. There is evidence that Chinese herbs and certain supplements, such as probiotics, may provide relief from symptoms of atopic dermatitis. In additional to treatments, it is important to have a regular schedule of care that includes bathing with a gentle cleanser and moisturizing to lock water into the skin.

What are some best practices for bathing and moisturizing?

Daily moisturizing and bathing are an important part of managing atopic dermatitis. Here are some tips to remember:

  • Take at least one bath or shower daily
  • Bathe or shower in lukewarm, not hot, water for 10 to 15 minutes
  • Avoid scrubbing
  • Use gentle cleanser, not soap, that is dye and fragrance- free
  • During flare-ups, limit use of cleansers
  • Moisturize within three minutes of bathing or showering Use a high oil content moisturizer to improve hydration
  • Moisturize hands every time you wash them or they come into contact with water
  • Schedule bathing and moisturizing before bed to help skin retain moisture
  • If using a prescription topical medication, apply as directed before moisturizing

How can atopic dermatitis affect people's social and emotional life?

The physical effects of atopic dermatitis are evident: dry, itchy, red, and inflamed skin. The emotional effects are not as obvious. People, especially children, may feel singled out for being different, which is exacerbated when the disease limits important activities, such as sports. People with atopic dermatitis must also cope with the lack of understanding from others, along with the unfounded fear that atopic dermatitis is contagious.

Atopic dermatitis can also impact family life. Medical visits, time-consuming treatments and alternate sleeping arrangements to manage symptoms affects everyone in the family. 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.

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

Are people with atopic dermatitis likely to develop other conditions?

There is growing evidence to show that people with atopic dermatitis are more likely to have other serious conditions such as depression, heart disease, ADHD and epilepsy. These are called comorbid conditions. Talk to your doctor about how your atopic dermatitis might impact other areas of your life.