Atopic Dermatitis

Atopic dermatitis (AD) is a chronic skin condition characterized by dry, itchy skin. AD is often referred to as eczema, a word that refers to a broader group of skin conditions. “Dermatitis” refers to a condition of the skin and “atopic” relates to diseases caused by allergic reactions.

As an atopic disease, AD is in the same classification as hay fever and asthma.

All types of eczema cause itching and redness, but AD is the most severe and chronic type of eczema. Other types of eczema include:

  • hand eczema
  • contact dermatitis, which occurs only when the skin makes contact with certain substances
  • dyshidrotic eczema, a blistering form of eczema that’s found only on the fingers, palms, and soles of the feet

Doctors and researchers are working to better understand how eczema works and why it affects so many people. There’s currently no known cure for this common disease.

The primary symptom of AD is dry, itchy skin that often turns into a red rash.

During a flare, AD becomes a red, itchy rash. Many different physical and internal factors can trigger an eczema flare-up. The resulting inflammation causes increased blood flow and the urge to itch.

Eczema flares are part of the agonizing itch-scratch cycle. It’s hard to fight the physical and psychological components that drive the itch-scratch cycle. Scratching feels good at the time but can lead to more inflammation and even skin infections.

AD presents different symptoms depending on a person’s age.

Symptoms in infants can include:

  • dry, itchy, scaly skin
  • a rash on the scalp or cheeks
  • a rash that may bubble and weep clear fluid

Infants with these symptoms may have trouble sleeping due to itchy skin. Infants with AD may also develop skin infections from scratching.

Symptoms in children can include:

  • a rash in the creases of the elbows, knees, or both
  • scaly patches of skin at the site of the rash
  • lightened or darkened skin spots
  • thick, leathery skin
  • extremely dry and scaly skin
  • rashes on the neck and face, especially around the eyes

Symptoms in adults can include:

Adults who had AD as children may have discolored skin that is easily irritated.

About 31 million people have eczema and 17.8 million people have AD.

Statistics from the National Eczema Association (NEA) show how common AD and eczema are. The prevalence of childhood AD is 10.7 percent in the United States. Approximately one in three children with AD has a moderate to severe form. For adults, the prevalence is as high as 10.2 percent.

According to the American Academy of Dermatology (AAD), 90 percent of people with AD get it before age 5. It’s rare that somebody will be diagnosed with AD if they didn’t have it as a child.

There seems to be a genetic component to AD. People with AD typically have a family member affected by AD, allergies, or asthma.

The exact cause of AD is unknown. AD isn’t contagious, so you can’t give the rash to someone else.

The basic understanding of AD is that inflammation results from the presence of too many inflammatory cells in the skin. There’s also evidence that people with AD have a compromised skin barrier compared to normal skin.

Because of the altered skin barrier, people with AD have drier skin. AD skin is more prone to water loss and the entry of irritants. This all leads to the development of red, itchy rashes.

You’ll need to learn what triggers your AD flare-ups, but common lifestyle and environmental triggers include:

  • long, hot showers or baths
  • scratching
  • sweat
  • heat
  • cold, dry weather
  • soaps, detergents, and cleaners
  • wool and synthetic fabrics
  • physical irritants (dirt, sand, smoke)
  • allergens (pollen, dander, dust)
  • strenuous exercise
  • stress
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There’s no known cure for AD. Finding the right treatment is important to help reduce itching and discomfort. Calming the skin reduces stress and helps prevent excessive scratching that leads to skin infections.

Treatment options vary from over-the-counter skin care, prescription medication, and lifestyle changes.

The best preventive measure is to moisturize the skin. This improves the function of the skin barrier. Healthier skin will become inflamed less often and provide a better barrier against allergens and irritants.

Bathing and moisturizing each day is the simplest way to hydrate your skin. It’s important to apply a moisturizer within minutes of bathing.

When should you see a doctor?

You should see your primary care physician or a dermatologist to receive your initial diagnosis. A doctor can help you create an effective treatment plan and help you understand your triggers.

If you’re feeling stressed due to AD or are losing sleep, speak with your doctor. Call your doctor right away if you see signs of a bacterial skin infection, such as:

  • pain, swelling, tenderness, or heat around the rash
  • red streaks extending from the rash
  • discharge from the skin
  • fever

By learning your triggers and taking good care of your skin, you can reduce the frequency and severity of AD flare-ups. Even if your first treatment plan doesn’t work, there are many different things you can try. You and your doctor can work together to find a combination that works for you and your skin.