Atopic dermatitis is a term used to describe a skin condition. It causes itchy dry skin that becomes an inflamed red
raised rash when scratched. Typically, the rash will vary in severity, with times when the rash worsens (flares) and
other times when it is nearly non existent (remission). Atopic dermatitis almost always begins in childhood, and
often persists through adulthood.
Atopic dermatitis is sometimes called eczema. However, eczema actually refers to many different types of skin
condition, one of which is atopic dermatitis.
Who gets atopic dermatitis?
Atopic dermatitis can affect children and adults—but is more common in children than adults. Overall, 10-15% of
all children will suffer from this skin condition. 90% of children with atopic dermatitis will have symptoms before the
age of 5. About 60% of affected children will still have the condition as adults, although it is typically less severe at
that time. The condition is less likely to go away if the child has a history of hay fever, asthma, or if there is a family
history of atopic dermatitis. It is rare for atopic dermatitis to start after age 30.
What causes atopic dermatitis?
The cause is not known. It may be due to a combination of genetic and environmental factors.
It may be allergic related as the majority (70%) of people with atopic dermatitis has a family history of asthma,
allergic rhinitis (hay fever, or environmental allergies), or atopic dermatitis. About half of children with severe atopic
dermatitis will develop hay fever or asthma by the time they reach their teens.
A common misconception is that atopic dermatitis is caused by stress. Studies show that while stress can worsen
the rash, it is not the cause of the condition.
One thing that is clear is that itching is worsens the development of the rash of atopic eczema. The condition is often
called “the itch that rashes” because the more one scratches the worse the rash will become.
What are the symptoms of atopic dermatitis?
Typically, the skin will be dry and itchy. With scratching, the rash will worsen, resulting in red, scaly patches.
When more severe, the rash can result in oozing and crusting lesions. Over time, the skin can become thick or
leathery in appearance.
The rash tends to affect different parts of the body depending on the
age of the individual. In infants, the rash typically involves the cheeks.
Sometimes, it may involve the whole body, except for the diaper area.
In young children (ages 2-12), the most commonly affected area
are the folds of the arms, the wrists, the ankles and behind the knees.
In teenagers and adults, the rash often occurs on the hands,
the folds of the arms or knees, around the eyes, and in the groin.
What makes atopic dermatitis worse?
A dry environment will result in increased itching and flares of atopic dermatitis. This is why the condition often
worsens during the winter months. However summer can be difficult also, as sweating can also cause increased
itching. Stress can have a dramatic affect on atopic dermatitis as well.
The skin of individuals with atopic dermatitis is much more sensitive than normal skin. Substances such as wool,
cosmetics, perfumes, and detergents can result in skin irritation and worsening of atopic dermatitis. Even plain soap
can exacerbate the condition as it will remove the skin’s protective oil from the skin.
Environmental allergens such as dust mite, animals, and pollens can make atopic dermatitis worse, so it is worth
getting tested for these to find out if these could be exacerbating the problem.
Can foods make atopic dermatitis worse?
Yes...sometimes, more so in infants and young children. It is estimated food may be a trigger in 50% of children’s
atopic dermatitis. This is the result of a response by the immune system to the food. Usually, this is due to an
allergy to food. However, unlike regular food allergies, this type of food allergy is not life threatening—it only
causes worsening of the atopic dermatitis. The most common foods associated with eczema in children are eggs,
peanuts, milk, fish, soy, and wheat. Skin testing is usually preferred over blood testing (RAST) for the evaluation
of food allergies in infants and children with atopic dermatitis. This is because young children with eczema often have
highly elevated allergy (IgE) antibodies in their system, which appears to cause many false positive blood test results
What can I do to help improve my condition?
- Avoid scratching. This is very important as the more you scratch, the worse the rash will become, and the
higher the risk of a skin infection. Antihistamines such as Loratadine (Claritin), Cetirizine (Zyrtec), or
Benadryl can help reduce the sensation of itching.
- Put mittens or cotton socks on your baby’s hands to help prevent scratching. Even better, wet the socks at
night to keep the skin moisturized.
- Moisturize the skin. This cannot be emphasized enough. Atopic dermatitis will not get better unless the skin
is well moisturized. You should apply a moisturizer at least 5-6 times a day. The thicker the moisturizer the
better, as it will stay on longer (so use moisturizers that comes in tubs, not bottles). You may also want to try
Crisco shortening - it often works wonders.
- Avoid perfumes, harsh soaps and detergents, and fabric softeners as these will irritate the skin and make
- Avoid wool; use 100% cotton when possible.
- Avoid cigarettes
- Minimize stress
- See a board certified allergist to help figure out if foods or environmental allergies are triggers for you.
- Humidify the house in the winter (unless you are allergic to dust mites, which thrive in a humid environment).
- Antihistamines such as Benadryl, Atarax, Claritin, Allegra, and Zyrtec help minimize itching – discuss with your
doctor if it is OK for you to use them.
Daily bathing with lukewarm water is fine – bathing doesn’t dry the skin, it’s the evaporation of the water off your
skin after you get out which results in dry skin. The key what is done during, and after the bath.
- Minimize the use of soap. Definitely avoid scented soap.
- Avoid abrasive washcloths
- Pat the skin dry with a towel (don’t rub) and apply a thick moisturizer on the skin as quickly as possible to
trap the moisture in.
- Adding 1½ cup of mineral oil to the bath water can help keep the skin moisturized
- If the eczema is severe and you get recurrent skin infections, try adding bleach to the bath. Once or twice a
week, add about ¼ to ½ cup of regular household bleach to the bath (it give about the same concentration as
pool water) - this will help kill the bacteria on the skin which can make eczema worse. With this, limit the
bath to 10-15 minutes and keep the water out of the eyes, mouth, and hair.
What is Atopic Dermatitis?
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