What Is Atopic Dermatitis?

Atopic dermatitis (AD), the most common type of eczema, is a chronic and recurring skin condition. Itchy rashes, inflamed skin patches that “weep” when scratched, and dry or leathery skin are classic signs of the skin condition.

The cause of AD is unknown, but there are many contributing factors and triggers for the skin condition. While AD can go away in some individuals, it is a lifelong condition for others. It cannot be prevented or cured, but treatment options are available to reduce symptoms and prevent flare-ups.

Atopic Dermatitis Symptoms

If a person has AD, their symptoms may include:

• Areas of bumpy skin, especially on the back of the arms or front of the thighs
• Ear discharge or bleeding
• Crusting, oozing blisters
• Raw skin areas
• Skin color changes and inflammation
• Widespread dry skin

Symptoms can also vary depending on the phase of AD. For acute phases of the condition, a person may have patches or plaques of skin that are itchy, red, thick, and scaly. The patches may look dry, thick, and leathery in chronic phases.

What Causes Atopic Dermatitis?

The exact cause of AD remains unknown. However, some factors that might play a role in a person developing atopic dermatitis include:

• Environmental factors
• Genetics
• Immune system
• Problems with a person's skin barrier

For example, triggers that may make AD symptoms worse include:

• Allergies
• Colds or the flu
• Dry skin or drying out the skin with frequent water contact in baths, showers, or swimming
• Emotional stress
• Irritant, chemical, and rough material (e.g., wool) contact with the skin
• Perfumes and dyes in lotions or soaps
• Temperature changes or extreme temperature exposure

Risk Factors

Some individuals are more likely to develop AD. For example, people with family members who have AD or allergy-based conditions like asthma have a higher risk of developing AD. Additionally, living in areas with polluted air or dry, cool climates may increase the risk of AD.

How Is Atopic Dermatitis Diagnosed?

If you think you have eczema, a healthcare provider will likely examine your skin and ask about your medical history. They'll also want to know about family and personal history of allergies and symptoms to help determine if you have AD. Diagnostic testing may include:

• Allergy skin testing: Providers use this test to determine what allergens are responsible for allergic reactions. The testing might involve intradermal skin testing, patch testing, or skin prick or scratch testing.
• Skin biopsy: A skin biopsy is when a provider takes a small skin sample for examination. The provider will numb the skin before scraping or removing the sample.

Treatments for Atopic Dermatitis

The main purposes of treating AD are to ease symptoms, reduce flare-ups, and keep AD from getting worse. There are a variety of treatments, from prescriptive options to home care options.

Skin Care

Taking care of your skin can help with AD. This includes:

• Applying thick moisturizers without scents at least twice daily
• Bathing in warm water for shorter periods of time and only using mild, fragrance-free cleansers
• Having an environment with a comfortable temperature and humidity level
• Keeping your nails short and smooth to prevent scratching and skin punctures
• Wearing clothing that doesn't include irritating fabrics like wool, polyester, or nylon

Topical Medications

A dermatologist may prescribe medications that you apply directly to the skin. These medications may include:

• Corticosteroid creams or ointments
• Crisaborole ointment
• Janus kinase (JAK) inhibitors, like ruxolitinib cream—used in moderate-to-severe AD cases
• Topical calcineurin inhibitors (TCIs), like pimecrolimus cream or tacrolimus ointment—used when steroids don't work well

Systemic Medications

While topical medications target certain areas of the skin, system medications help reduce symptoms by working throughout the body. Dermatologists may prescribe:

• Abrocitinib or upadacitinib, which are JAK inhibitors
• Dupilumab or Tralukinumab—an injectable biologic, or a medicine type with an organic origin, that helps reduce inflammation

Trigger Management

Knowing what triggers create an AD flare-up and avoiding them is beneficial for getting symptom relief. Everyone's AD triggers are different; see a dermatologist if you need help figuring out your triggers.

Light Therapy

Light therapy is a treatment that uses special bulbs or a laser. This may be an option for individuals who need stronger treatment. A person may complete two to three weekly sessions of light therapy over the course of a few weeks to months.

How To Prevent Atopic Dermatitis

Researchers haven't determined a way to prevent AD. However, the treatments above are good ways to prevent AD flare-ups. Other ways to prevent flare-ups include:

• Avoiding too much heat or sweat when possible
• Being gentle with your skin while you shower or bathe
• Limiting contact with things that may be irritating to your skin
• Using moisturizer daily
• Wearing gloves to protect your hands

Complications

If you have atopic dermatitis, there's a possibility of developing the following complications:

• Bacterial, fungal, or viral skin infections
• Permanent scars, though these are rare. Temporary pigmentary alteration is more common.
• Side effects following long-term eczema medication use

When To Contact a Healthcare Provider

If you have questions or concerns about your skin, speak with a healthcare provider or dermatologist. You'll also want to see a provider for:

• Atopic dermatitis that does not improve with home treatments
• Ineffective treatment
• Signs of infections like fever, pain, or redness
• Worsened symptoms

Living With Atopic Dermatitis

Atopic dermatitis can be a chronic or permanent condition. For some individuals, it will take a long time to improve and eventually disappear. For other people, they may have the skin condition for life.

Cases of AD that began earlier in life or involve many places on the body might be hard to treat. The same can be true of cases where people have also been diagnosed with allergies and asthma or have a family history of eczema. However, following your treatment plan can provide the best way to keep your symptoms under control.