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Atopic Dermatitis - a Chronic Relapsing Skin Disease

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Atopic Dermatitis - a Chronic Relapsing Skin Disease

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Atopic dermatitis is a chronic disease, which usually manifests for the first time in infancy or childhood. But, it usually improves with age. Let us discuss in detail about atopic dermatitis.

Written by

Dr. Suvash Sahu

Medically reviewed by

iCliniq medical review team

Published At December 5, 2016
Reviewed AtMarch 8, 2023

What Is Atopic Dermatitis?

Atopic dermatitis is endogenous eczema (eczema due to internal causes) characterized by extreme itchiness and recurrent symmetric eczematous dermatitis. This chronic eczema is one of the atopic conditions, and together with asthma and hay fever, it has a heritable tendency. Certain environmental factors like winter, inhaled allergens, and particular food may aggravate this disease in a specific subset of patients. The involvement of a site depends on the age of the patients. Its clinical course and features vary with age and are easily aggravated by secondary infections. Herpes simplex virus infection can cause a severe rash called Kaposi varicelliform eruption in children with atopic eczema.

What Causes Atopic Dermatitis?

Genetic variation in the skin, which results in the inability of the skin to retain moisture, results in atopic dermatitis. Moisture is essential for the skin to protect against irritants, allergens, and other environmental factors.

What Are the Clinical Features of Atopic Dermatitis?

Symptoms of atopic dermatitis include the following:

  • Itching that may be intense at night.

  • Tiny, elevated bumps on the skin that cracks open and releases fluids upon scratching.

  • Skin dryness.

  • Patches range from red to brownish-gray in color and are commonly seen on the upper chest, ankles, feet, arms, eyelids, wrists, neck, elbows, face, scalp, etc.

  • Scratching results in thin, raw, sensitive, and swollen skin.

  • Skin becomes thick, scaly, and has a cracked appearance.

Three distinct patterns of atopic dermatitis have been recognized depending on the patient's age:

  • Atopic dermatitis in infancy.

  • Childhood phase.

  • Adult phase.

Atopic Dermatitis in Infancy (Infantile Eczema):

Atopic dermatitis in babies begins after the age of 3 months. Lesions are intensively itchy papules and vesicles, which soon discharge serous fluids. Lesions begin on the face but can involve the rest of the body. But, usually, there is sparing of the diaper area, and secondary infection is common.

Childhood Phase:

Dry, leathery, and extremely itchy, raised areas (plaques), mainly on the elbow and knee flexors. Sometimes, a reversed (extensor) pattern may be seen.

Adult Phase:

Lesions are very itchy and lichenified; they look like tree bark. It involves the cubital (front of the elbow), popliteal fosse (back of the knee), and sometimes the neck. A low-grade involvement may be seen in the rest of the body. Discoid patterns (coin-shaped) of eczema may be seen.

What Increases the Risk Of Developing Atopic Dermatitis?

Family history or personal history of Hay fever, eczema, asthma, or allergy.

How is Atopic Dermatitis Diagnosed?

Visual examination is done to diagnose atopic dermatitis, which is accompanied by medical history. If needed, patch skin tests can be taken to rule out other skin conditions. Also, it is essential to look for potential allergens.

What Is the Treatment of Atopic Dermatitis?

General Measures:

  • Avoid triggering factors that provoke itching.

  • Avoid irritants, which may trigger itching, like woolen clothes, chemicals, etc.

  • Avoid excessive cleaning or degreasing of the skin and use mild soaps or cleaning lotions.

  • Avoidance measures include reduced contact with house dust mites using barriers on mattresses and quilts, thorough and regular vacuuming of rooms, avoiding the use of carpets, and use of anti-mite sprays.

Topical Therapy:

Moisturizers- Emollients are used to alleviate the itching due to dry skin. Emollients can be added to the bath or applied directly to the skin.

Topical Steroids -These are used for localized exudative lesions and sometimes in combination with topical or systemic antibiotics to prevent secondary infections if any. Topical macrolactam immunomodulators like Tacrolimus and Pimecrolimus are the latest topical agents for atopic dermatitis.

Systemic Therapy:

Systemic antibiotics are used in patients with extensive infected lesions. Systemic steroids with the availability of potent topical steroids and systemic corticosteroids have reduced eczema substantially.


The sedating ones are used regularly to overcome the itching and are of great value in whom sleep is interrupted.

Counseling and Psychotherapy:

Not only can stress aggravate atopic dermatitis, but the severely affected child is also a source of stress for the whole family. Counseling is an integral part of the treatment. Counseling parents for do’s and don’ts when the patient is a child will help them lead a stress-free life. Adolescents with atopic dermatitis should be well-advised that this disease often improves or goes into remission with age. They should avoid occupations such as car mechanics, engineering, hairdressing, or nursing.

What are the Complications Of Atopic Dermatitis?

  1. Asthma and Hay Fever: Atopic dermatitis is often followed by allergy and hay fever and is seen in more than 50% of children above the age of 13.

  2. Skin Infections: Repetitive scratching causes the pores to open and gives a cracked appearance, increasing the chance of bacterial and viral infection, particularly herpes simplex infection.

  3. Problems With Sleep: Disturbances in the sleep pattern are seen with the presence of the itch-scratch cycle.

  4. Neurodermatitis: Itching is associated with neurodermatitis, which gradually increases the intensity of itching resulting in thick, scaly, leathery, and discolored skin.

  5. People exposed to soaps, irritants, and detergents and those who work in damp areas develop irritant contact dermatitis.

  6. Allergic Contact Dermatitis.

Prevention of atopic dermatitis

How Can We Prevent Atopic Dermatitis?

  • Identifying the triggering factors and avoiding them.

  • Using a moisturizer for your skin at least twice daily.

  • Gently pat dry the skin after bathing with a soft towel and applying moisturizer while still moist.

  • Avoiding bactericidal and deodorant soaps, which reduce the moisture content of the skin, and using only mild soaps.

  • Taking a bleach bath.

  • Showering for only 5 to 10 minutes with warm water instead of using hot water for bathing.


Atopic dermatitis is not a contagious condition, and people with these skin conditions should not be treated with shame. In addition to medical treatment, psychological therapy is needed to help them lead happy and peaceful lives.

Frequently Asked Questions


What Can Cause Atopic Dermatitis?

Atopic dermatitis is the inflammatory condition of the skin. The common causes of atopic dermatitis are allergens, hereditary or environmental factors. In many children, food allergens play a role in causing atopic dermatitis. When it is due to hereditary, genetic mutations can affect the skin and make it lose its capacity to retain moisturize.


What are the treatment options for Atopic Dermatitis?

- Moisturize your skin twice a day.
- Apply topical corticosteroid creams.
- Apply an anti-itching cream to the affected area.
- Take an allergy or anti-itching medication.
- Wet wrap therapy.
- Phototherapy.
- Do not scratch.
- Apply bandages to avoid scratching.
- Use mild soaps.
- Take a warm bath.
- Use a humidifier.
- Wear loose and cotton garments.


How Does Atopic Dermatitis Look?

Atopic dermatitis looks like small red bumpy, scaly, or swollen with cracked skin, which is often itchy. Clear fluids may come out of the bumps, and these bumps can dry and form a crust.


How Long Does It Take for Atopic Dermatitis to Heal?

Atopic dermatitis can often last for weeks, months, or even years. It may occur in children younger than 12 months, and may last for their lifetime, or with occasional flare-ups, or improve with age.


Can Atopic Dermatitis Go Away Completely?

There is no cure for atopic dermatitis, but self-care measures and proper treatment can relieve itching and further complications. The rashes in atopic dermatitis tend to flare-up or go away, but it will come back again.


What Food Should You Avoid When You Have Atopic Dermatitis?

The foods you should avoid when you have atopic dermatitis are:
- Eggs.
- Dairy products.
- Citrus fruits.
- Wheat or gluten.
- Soy.
- Tomatoes.
- Spices such as cinnamon, cloves, and vanilla.
- Nuts.


Can Atopic Dermatitis Be Itchy?

Atopic dermatitis can cause extreme itching and the skin looks very dry. The more you scratch, the more red, swollen, and sore, it will become. Scratching also results in new bumps or lesions.


What Are the Triggering Factors of Atopic Dermatitis?

The factors that trigger atopic dermatitis are:
- Strong soaps and detergents.
- Some fabrics, like scratchy materials or wool.
- Perfumes, skincare products, and makeup.
- Pollen and mold.
- Animal dander.
- Tobacco smoke.
- Anger and stress.
- Dry winter air or low humidity.
- Long and hot showers or baths.
- Dry skin.
- Sweating.
- Skin infections or dehydrated skin.
- Certain hormones.
- Sand or dust.
- Certain foods like eggs, wheat, dairy products, soy, and nuts.


How Can Atopic Dermatitis Be Treated in Adults?

When atopic dermatitis does not respond to local over-the-counter medications, it needs proper treatment with the physician's help. It cannot be cured completely but can be controlled with appropriate treatment. The following are the treatment options for atopic dermatitis:
1. Topical corticosteroid creams and ointments.
2. Tacrolimus and Pimecrolimus ointments.
3. Crisaborole.
4. Dupilumab.
5. Oral antibiotics.
6. Antihistamines.
7. Phototherapy.
8. Systemic corticosteroids.


Can Atopic Dermatitis Spread From One Person to Another?

Atopic dermatitis is not contagious, meaning, your skin is not infected or unclean. You will not spread the condition if someone touches the affected skin. It can be well treated and managed with various treatment options and medications.


How Can Atopic Dermatitis in the Face Be Treated?

The face skin can be rehydrated with emollients like petroleum jelly and topical steroids to reduce inflammation and itching. As scratching due to itching can worsen the condition and give way to new outbreaks, itching should be treated with antihistamines.


How to Get Rid of Atopic Dermatitis Naturally?

The natural methods to get rid of atopic dermatitis are:
- Application of coconut oil to moisturize the skin and protect from bacteria, sunflower oil to reduce inflammation, and Cardiospermum oil to relieve itching.
- Different types of baths, like oatmeal baths, baking soda baths, bleach baths, vinegar baths, and bath-oil baths can also be used.


Can a Child Outgrow Atopic Dermatitis?

Some children may outgrow atopic dermatitis and gradually improve as they grow, but others may take it to adulthood. Many are better by the age of 3, and others may have occasional troubles.
Dr. Suvash Sahu
Dr. Suvash Sahu



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