Atopic dermatitis (eczema)

What is it?

According to NIAMS: a chronic (long-term) disease that makes the skin inflamed, irritated and very itchy; it is a common condition that usually begins in childhood, and in many people it may clear before adolescence, while in others it continues into adulthood or appears later. MedlinePlus calls it the most common form of eczema (which is also called dermatitis).

According to NIAID it is “the most common chronic inflammatory skin disease”, affecting 10 to 30% of children and 2 to 10% of adults in the United States, and severe forms can greatly affect quality of life. The NHS states that it is not contagious and cannot be cured permanently, but its symptoms can be controlled.

Causes

“No one knows what causes atopic dermatitis” (NIAMS). Doctors think dry skin leads to skin damage and inflammation, and changes in genes and an immune system disorder in which it becomes overactive may take part, along with environmental factors such as tobacco smoke, skin products, soaps and air pollutants. MedlinePlus states that the cause is unclear and may combine genetic and environmental factors, and NIAID states that the causes are unclear.

Triggers of flares according to the NHS: soaps, laundry detergents, some fabrics and pets, pollen, house dust mites and some foods, heat and changes in temperature, skin infections, and stress and hormonal changes. MedlinePlus adds irritants such as perfumes, fabrics and lotions.

Risk factors

According to NIAMS: likelihood rises with a family history of eczema, hay fever or asthma, and rates are higher in Black non-Hispanic children. The NHS notes that having one or both parents affected, and family members with asthma or hay fever, are risk factors.

Symptoms

“The most common symptom is itching, which can be severe” (NIAMS). The skin becomes dry and may show red to dark brown patches and a rash that may ooze clear fluid or bleed when scratched, and the skin may thicken and harden. The NHS describes the skin as dry, cracked, scaly or thickened, with colour changes, and it may blister or bleed; most often on the elbows, knees and hands, and in infants and young children on the face.

Associated conditions according to NIAMS: asthma and allergies (including food allergy), other skin diseases such as ichthyosis, depression or anxiety, and lack of sleep. NIAID states that eczema increases susceptibility to bacterial, viral and fungal skin infections.

How is it diagnosed?

According to NIAMS, the doctor reviews medical history (family allergy, asthma, hay fever, food allergy, sleep problems and triggers), examines the skin and rash, may request blood tests or a skin biopsy, and an accurate diagnosis may need more than one visit. This page does not cover detailed diagnostic criteria.

Treatment

The treatment categories usually used are listed here; this is not a prescription. The doctor chooses the plan according to each person's condition; do not change any medicine or dose without a specialist.

Treatment categories mentioned in NIAMS (chosen by the doctor according to the case): skin creams and moisturisers, corticosteroid creams and ointments, calcineurin inhibitors, phosphodiesterase-4 (PDE-4) inhibitors, tablets that suppress the immune response (JAK inhibitors), an injected biologic medicine, ultraviolet light therapy, and antibiotics when infection occurs. The NHS mentions emollients and topical corticosteroid creams, with dressings and special medicines for severe cases.

Daily care according to NIAMS: lukewarm baths and gentle cleansers, patting the skin dry and moisturising immediately, avoiding alcohol-based products, keeping nails short and avoiding scratching, keeping the home cool and steady in temperature, and managing stress. The NHS advises emollients at least twice a day instead of soap, and warns against changing the diet without medical advice. NIAMS urges consulting the doctor before diluted bleach baths or wet-wrap dressings.

Complications

NIAID states that eczema increases susceptibility to skin infection, and the NHS lists warning signs: skin that is blistered, flaky, weeping fluid or has pus-filled spots, or rapid deterioration, or a high temperature. NIAMS advises avoiding exposure to the smallpox vaccine and seeing the doctor before a family member receives it (according to the source).

Prevention

MedlinePlus says avoiding triggers (irritants such as soaps, fabrics and lotions, stress, and allergens such as food, pollen and animals) helps prevent flares. NIAID states that prevention and treatment research is ongoing. This page does not cover proven ways to prevent the disease from developing in the first place.

Living with it

According to NIAMS: regular follow-up is needed to assess how well treatment works, seek psychological support when feeling overwhelmed, discuss food allergy with the doctor, and use the doctor if itching disrupts sleep. MedlinePlus describes it as often long-term with varying severity, and it may improve or clear as children grow.

Common questions