Atopic Dermatitis (Eczema)

Atopic dermatitis (eczema) is a condition that makes your skin red and itchy. It’s common in children but can occur at any age.

Atopic dermatitis is long lasting (chronic) and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever.

No cure has been found for atopic dermatitis. But treatments and self-care measures can relieve itching and prevent new outbreaks. For example, it helps to avoid harsh soaps and other irritants, apply medicated creams or ointments, and moisturize your skin.

See your doctor if your atopic dermatitis symptoms distract you from your daily routines or prevent you from sleeping.

Symptoms

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

  • Itching, which may be severe, especially at night
  • Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and, in infants, the face and scalp
  • Small, raised bumps, which may leak fluid and crust over when scratched
  • Thickened, cracked, dry, scaly skin
  • Raw, sensitive, swollen skin from scratching

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

Factors that worsen atopic dermatitis

Most people with atopic dermatitis also have Staphylococcus aureus bacteria on their skin. The staph bacteria multiply rapidly when the skin barrier is broken and fluid is present on the skin. This in turn may worsen symptoms, particularly in young children.

Factors that can worsen atopic dermatitis signs and symptoms include:

  • Dry skin, which can result from long, hot baths or showers
  • Scratching, which causes further skin damage
  • Bacteria and viruses
  • Stress
  • Sweat
  • Changes in heat and humidity
  • Solvents, cleaners, soaps and detergents
  • Wool in clothing, blankets and carpets
  • Dust and pollen
  • Tobacco smoke and air pollution
  • Eggs, milk, peanuts, soybeans, fish and wheat, in infants and children

Atopic dermatitis is related to allergies. But eliminating allergens is rarely helpful in clearing the condition. Occasionally, items that trap dust — such as feather pillows, down comforters, mattresses, carpeting and drapes — can worsen the condition.

Causes

The exact cause of atopic dermatitis (eczema) is unknown. Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is likely related to a mix of factors:

  • Dry, irritable skin, which reduces the skin’s ability to be an effective barrier
  • A gene variation that affects the skin’s barrier function
  • Immune system dysfunction
  • Bacteria, such as Staphylococcus aureus, on the skin that creates a film that blocks sweat glands
  • Environmental conditions

Risk Factors

Factors that put people at increased risk of developing the condition include:

  • A personal or family history of eczema, allergies, hay fever or asthma
  • Being a health care worker, which is linked to hand dermatitis

Risk factors for children include:

  • Living in urban areas
  • Being African-American
  • Having parents with a high level of education
  • Attending child care
  • Having attention-deficit/hyperactivity disorder (ADHD)

Complications

Complications of atopic dermatitis (eczema) include:

  • Asthma and hayfever. Eczema sometimes precedes these conditions.
  • Chronic itchy, scaly skin. A skin condition called neurodermatitis (lichen simplex chronicus) starts with a patch of itchy skin. You scratch the area, which makes it even itchier. Eventually, you may scratch simply out of habit. This condition can cause the affected skin to become discolored, thick and leathery.
  • Skin infections. Repeated scratching that breaks the skin can cause open sores and cracks. These increase your risk of infection from bacteria and viruses, including the herpes simplex virus.
  • Eye problems. Signs and symptoms of eye complications include severe itching around the eyelids, eye watering, inflammation of the eyelid (blepharitis) and inflammation of the eyelid (conjunctivitis).
  • Irritant hand dermatitis. This especially affects people whose work requires that their hands are often wet and exposed to harsh soaps, detergents and disinfectants.
  • Allergic contact dermatitis. This condition is common in patients with atopic dermatitis. Many substances can cause an allergic skin reaction, including corticosteroids, drugs often used to treat people with atopic dermatitis.
  • Sleep problems. The itch-scratch cycle can cause you to awaken repeatedly and decrease the quality of your sleep.
  • Behavioral problems. Studies show a link between atopic dermatitis and attention-deficit/hyperactivity disorder, especially if a child is also losing sleep.

Treatments

There are a variety of different treatments available, which can be applied individually or in combination with each other. These range from emollients for use in the bath or shower, medicinal moisturisers to relieve acute itchiness and weak topical steroids or immunosuppressants for severe cases. These steroids are applied externally to the skin and reduce inflammation and itching without causing skin thinning, enabling the skin to heal more effectively.

Successful treatment typically results in full elimination of eczema symptoms and therefore relief from existing discomfort and irritation.