Eczema (Atopic Dermatitis)
What is atopic dermatitis?
Atopic dermatitis is a long-term (chronic) skin condition. It causes itchy skin. It’s
a very common condition. It’s more common in babies and children, but also occurs
in adults. It usually first appears between ages 3 to 6 months.
What causes atopic dermatitis?
The exact cause of atopic dermatitis is not known. But some factors are linked to
it, such as:
Genes. Allergies and eczema run in families.
The immune system. An immune system that isn’t fully developed may affect the protective ability of
External factors. These include winter weather, dry, hot temperatures and lack of skin moisturizing.
Who is at risk for atopic dermatitis?
A child has a greater chance of having atopic dermatitis if he or she has:
What are the symptoms of atopic dermatitis?
Symptoms may come and go, or occur most or all of the time. Any area of the body may
be affected. In babies, symptoms usually affect the face, neck, scalp, elbows, and
knees. In children, symptoms usually affect the skin inside the elbows, on the back
of the knees, the sides of the neck, around the mouth, and on the wrists, ankles,
Symptoms can occur a bit differently in each child. They can include:
Dry, scaly skin
Redness and swelling
Small, raised bumps that may become crusty and leak fluid if scratched
Rough bumps on the face, upper arms, and thighs
Darkened skin of eyelids or around the eyes
Skin changes around the mouth, eyes, or ears
Make sure your child sees his or her healthcare provider for a diagnosis.
How is atopic dermatitis diagnosed?
The healthcare provider will ask about your child’s symptoms and health history. He
or she may also ask if you or other family members have atopic dermatitis, asthma,
or nasal allergies such as hay fever or allergic rhinitis. He or she will also ask
about allergy symptoms in your child. The healthcare provider will examine your child,
looking for signs of atopic dermatitis. There is no specific test for atopic dermatitis.
Testing is usually not needed, but it may be done if allergies are suspected. E.g.
About one third of small children with severe eczema have food allergies. Tests may
Blood tests. Your child’s blood may be checked for levels of immunoglobulin E (IgE). IgE is released
by the body's immune system. It’s high in most children with allergies and with atopic
dermatitis. Other blood tests may be done too.
Skin tests. Skin tests may be done to check for allergies or other skin conditions.
How is atopic dermatitis treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also
depend on how severe the condition is. There is no cure for atopic dermatitis. The
goals of treatment are to reduce itching and inflammation, add moisture, and prevent
Treatment of atopic dermatitis includes:
Staying away from irritants, as advised by your child's healthcare provider
Regular bathing with luke warm water or wash as advised by the healthcare provider.
At times bleach baths may be recommended.
Keeping your child's fingernails short and covering eczema areas by clothing or dressings,
to help prevent scratching that can cause skin irritation and infection
Using moisturizing regimens advised by the healthcare provider
Your child's healthcare provider may also prescribe medicines. They may be used alone
or together. The following are most commonly used to treat atopic dermatitis:
Corticosteroid cream or ointment. The cream or ointment is applied to the skin. This is to help lessen itching and
Antibiotic medicine. Liquid or pills may be taken by mouth to treat infection.
Antihistamine. This medicine may be taken before sleep to help decrease itching and improve sleep.
It comes in liquid or pills and is taken by mouth.
Calcineurin inhibitor cream or ointment. Cream or ointment is applied to the skin. This is to help lessen itching and swelling.
Phototherapy (light therapy). Light therapy may be done in the healthcare provider's office or at home.
Immunomodulatory medicine. This is a liquid or pill taken by mouth that affects the immune system. It may be
used when other treatments do not work well. This medicine may have side effects.
Your child will have regular blood tests to check for side effects.
What are possible complications of atopic dermatitis?Atopic dermatitis can cause thickened skin, bacterial skin infection, and other allergy-related
skin inflammation (allergic dermatitis). It can also cause poor sleep because of intense
itching. And it can lead to depression. Overuse of steroid creams can lead to thinning
of the skin and tissue beneath the skin.
Can atopic dermatitis be prevented?The skin condition is passed on from parents to children, so it may not be possible
to prevent it. But studies have found that the daily use of oil, cream, or ointment on
the skin of babies at risk may prevent it from developing.
Living with atopic dermatitis
There is no cure for atopic dermatitis. But it will usually get better or go away
as your child gets older. There may be times when your child has few or no symptoms.
And he or she may have times when symptoms get worse. This is called a flare-up. To
help prevent flare-ups, make sure your child:
Avoids triggers. Common triggers include irritants (such as wool, soap, or chemicals), allergens if
diagnosed by your healthcare provider, and stress.
Doesn’t scratch the skin. Try to keep your child from scratching. It can cause worse symptoms and infection.
Always has short fingernails. Trim or file your child’s nails to keep them short and prevent scratching.
Takes warm baths or showers, not hot. Followed by application of a moisturizer on damp skin.
Uses moisturizers. Apply creams or ointments immediately after bathing.
Wears soft clothing. Don’t dress your child in wool or other rough fabric.
Keeps cool. Try to keep your child as cool as possible. Getting hot and sweating can make him
or her more uncomfortable.
Doesn’t get the smallpox vaccine. It’s not a common vaccine, but people with atopic dermatitis should not receive the
Talk with your child's healthcare provider about other ways to help your child’s skin
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
Symptoms that get worse
Signs of a skin infection, such as increased redness, warmth, swelling, or fluid
Key points about atopic dermatitis
Atopic dermatitis is a long-term (chronic) skin condition. It is more common in babies
and children, but also occurs in adults.
A child with allergies or family members with allergies or atopic dermatitis has a
higher chance of having atopic dermatitis.
Itching, dryness, and redness are common symptoms.
The goals of treatment are to reduce itching and inflammation of the skin, increase
moisture, and prevent infection.
Avoiding triggers is important in managing the condition.
It usually gets better or goes away as a child gets older.
Next stepsTips to help you get the most from a visit to your child’s health care provider:
Before your visit, write down questions you want answered.
At the visit, write down the names of new medicines, treatments, or tests, and any
new instructions your provider gives you for your child.
If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.
Online Medical Reviewers:
- Freeborn, Donna, PhD, CNM, FNP
- Holloway, Beth, RN, M.Ed.
- Kirsi Järvinen-Seppo, M.D., Ph.D.