Atopic dermatitis

  • Overview

    Atopic dermatitis: Overview

    Also called: Eczema

    This is a common skin disease in children. It is so common that people have given it a few names:

    • Eczema (name most people use)
    • Dermatitis
    • Atopic (a-top-ic) eczema
    • Atopic dermatitis

    To avoid confusion, we’ll use the medical term atopic dermatitis.

    Children often get atopic dermatitis (AD) during their first year of life. If a child gets AD during this time, dry and scaly patches appear on the skin. These patches often appear on the scalp, forehead, and face. These patches are very common on the cheeks.

    No matter where it appears, AD is often very itchy. Infants may rub their skin against bedding or carpeting to relieve the itch.

    In children of all ages, the itch can be so intense that a child cannot sleep. Scratching can lead to a skin infection.

    Because atopic dermatitis can be long lasting, it is important to learn how to take care of the skin. Treatment and good skin care can alleviate much of the discomfort.

    Atopic dermatitis: A guide for patients

    Meet four people who have atopic dermatitis and dermatologist Jenny E. Murase, MD, FAAD.  Dr. Murase will explain why we get atopic dermatitis and the benefits of treatment.  You’ll also hear inspiring tips from World Champion softball pitcher Jennie Finch, who lives with atopic dermatitis. To watch the entire video, visit the Atopic dermatitis video library.

    Atopic dermatitis
  • Symptoms

    Atopic dermatitis: Signs and symptoms

    Atopic dermatitis (AD) looks different in infants, children, and adults. The following gives you the signs (what you see) and symptoms (what you feel) for each age group.


    AD can begin early. A child may be 2 or 3 months old when AD begins. When AD begins early, it often causes:

    • A rash that appears suddenly and:
      • makes the skin dry, scaly, and itchy.
      • forms on the scalp and face, especially on the cheeks (can appear on other areas of the body).
      • can bubble up, then ooze and weep fluid.
      • causes itching that may come and go.
    • Rubbing against bedding, carpeting, and other things in order to scratch the itch.
    • Trouble sleeping.
    • Skin infections, common due to rubbing and scratching.

    Parents often worry that their babies are getting AD in the diaper area. A babies rarely gets AD in his or her diaper area. The skin stays too moist for AD.

    Atopic dermatitis: This 6-year-old boy has atopic dermatitis in the creases of his elbows and on his feet — common places for AD to appear in children.


    When AD begins between 2 years of age and puberty, the child often has these signs and symptoms:

    • A rash that often begins in the creases of the elbows or knees. Other common places for the rash to appear are the neck, wrists, ankles, and/or crease between the buttocks and legs.

    • Itchy, scaly patches where the rash appeared.

    In time, the skin with AD can:

    • Get bumpy, looking like permanent goose bumps.
    • Lighten (or darken) where AD appears.
    • Thicken, turning leathery to protect itself from constant scratching.
    • Develop knots (only on the thickened skin).
    • Itch all the time (only on the thickened skin).
    Atopic dermatitis: This 7-year-old girl says the thickened skin on the back of her knees is always dry and always itches.

    The thickened skin can itch even when the AD is not flaring.

    When talking about the thickened skin, your dermatologist may use the word lichenification. This word means thickened skin.

    Atopic dermatitis: Adults who have AD often have darker patches and scaly skin, as does this 30-year-old woman.


    It is rare for adults to get AD. Most people (90%) get AD before age 5. About half (50%) of people who get AD during childhood continue to have milder signs and symptoms of AD as an adult. When an adult has AD, it often looks different from the AD of childhood. For adults, AD often:

    • Appears in the creases of the elbows or knees and nape of neck.
    • Covers much of the body.
    • Can be especially noticeable on the neck and face.
    • Can be especially bad around the eyes.
    • Causes very dry skin.
    • Causes non-stop itch.
    • Causes scaly skin — more scaly than in infants and children.
    • Leads to skin infections.

    If a person has had AD for years, patches of skin may be thick and darker than the rest of the skin (or lighter). Thickened skin can itch all the time.

    Atopic dermatitis: Years of scratching caused permanently thickened skin on this woman’s hand and wrist. This skin always itches.

    Adults who had AD as a child and no longer have AD can have the following:

    • Extremely dry skin.
    • Skin that is easily irritated.
    • Hand eczema.
    • Eye problems (eczema on eyelids, cataracts).


    Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

    Atopic dermatitis

  • Causes

    Atopic dermatitis: Who gets and causes

    Who gets atopic dermatitis?

    Around the world, between 10% and 20% of children have AD. About 1% to 3% of adults have AD. People of all skin colors get AD.

    Most people (90%) get AD before their 5th birthday. AD rarely starts when a person is an adult.

    AD is much more common today than it was 30 years ago. Dermatologists are not sure why. They do know that some children have a greater risk of getting AD. The following seem to increase a child’s risk of getting AD:

    • Family members have AD, asthma, or hay fever: Does the child’s mother or father have AD? Does a parent have asthma or hay fever? A family history of these diseases remains the strongest risk factor. If one or both parents have AD or an allergic condition, the child is much more likely to get AD. Some children get all 3 diseases. Asthma and hay fever usually appear before the age of 30. People often have asthma and hay fever for life.

    • Where child lives: Living in a developed country, city (especially one with higher levels of pollution), or a cold climate seems to increase the risk. For example, Jamaican children living in London are twice as likely to develop AD as those who live in Jamaica.

    • Gender: Females are slightly more likely than males to get AD.

    • Mother’s age when child born: When the mother gives birth to the child later in her childbearing years, a child is more likely to get AD.

    • Social class: AD seems more common in higher social classes.


    What causes atopic dermatitis?

    Researchers are still studying what causes AD. Through their studies, they have learned that AD:

    • Is not contagious: There is no need to worry about catching it or giving it to someone.

    • Runs in families: People who get AD usually have family members who have AD, asthma, or hay fever. This means that genes play a role in causing AD.
      • Children are more likely to develop AD if one or both parents have AD, asthma, or hay fever.
      • About half (50%) of the people with severe AD (covers a large area of the body or is very troublesome) will get asthma and about two-thirds (66%) will get hay fever.

    Can certain foods cause atopic dermatitis?

    Foods do not cause AD. But some studies suggest that food allergies can make AD worse. Children who have AD often have food allergies to these foods — milk and foods that contain milk (e.g., yogurt and cheese), nuts, and shellfish.

    Before you stop feeding your child any foods, talk about this with your child’s dermatologist. Children need certain foods to grow and develop normally.

    Researchers continue to study what causes this complex disease. They believe that many things interact to cause AD. These things include our genes, where we live, and the way our immune system works.

    Atopic dermatitis
  • Treatment

    Atopic dermatitis: Diagnosis and treatment

    How do dermatologists diagnose atopic dermatitis?

    To diagnose atopic dermatitis (AD), a dermatologist begins by looking at the child’s skin. The dermatologist will look for a rash. The dermatologist also will ask questions. It is important for the dermatologist to know whether the child has itchy skin. The dermatologist also needs to know whether blood relatives have had AD, asthma, or hay fever.

    Sometimes a dermatologist will perform a patch test. This medical test is used to find allergies. It involves placing tiny amounts of allergens (substances that cause allergies for some people) on the child’s skin. The dermatologist will check the skin for reactions. Checks are often done after a few hours, 24 hours, and 72 hours. Studies suggest that some allergens can make AD worse.

    How do dermatologists treat atopic dermatitis?

    Treatment cannot cure AD, but it can control AD. Treatment is important because it can:

    • Prevent the AD from getting worse.
    • Calm the skin, relieving pain and itch.
    • Reduce emotional stress.
    • Prevent infections.
    • Stop the skin from thickening. Thickened skin often itches all the time — even when the AD is not flaring.

    A treatment plan often includes medicine, skin care, and lifestyle changes. Skin care and lifestyle changes can help prevent flare-ups. Many patients receive tips for coping. Doing all of this may seem bothersome, but sticking to the plan can make a big difference.

    A dermatologist will create a treatment plan tailored to the patient’s needs. Medicine and other therapies will be prescribed as needed to:

    • Control itching.
    • Reduce skin inflammation (redness and swelling). 
    • Clear infection. 
    • Loosen and remove scaly lesions.
    • Reduce new lesions from forming.


    Studies have found that when AD develops in an infant or young child, the child tends to get better with time. For some children, the condition completely disappears by age 2.

    About half (50%) of the children who get AD will have it as an adult. The good news is that the AD often becomes milder with age.

    There is no way to know whether the AD will go away or be a lifelong disease. This makes treatment very important. Treatment can stop the AD from getting worse. Treatment also helps to relieve the discomfort.

    Atopic dermatitis
  • Tips

    Atopic dermatitis: Tips for managing

    Most children’s eczema does not have a clear cause, such as an allergy, but most eczema will improve with good skin care. These tips from dermatologists can reduce the severity and frequency of your child's flare-ups.

    Coping with atopic dermatitis

    Learn tips to reduce your atopic dermatitis symptoms. To watch this video, visit the Atopic dermatitis video library.

    Bathing tips

    • Bathe your child in warm — not hot — water.
    • Limit your child’s time in the bath to 5 or 10 minutes.
    • Use cleanser only when needed and make sure the cleanser is mild and fragrance-free. Do not use bubble bath. 
      • If your child’s eczema is frequently infected, twice-weekly bleach baths may be beneficial. Discuss this option with your child’s dermatologist.
    • After bathing, gently pat your child’s skin partially dry.
    • If your child has medicine that you apply to the skin, apply medicine when your child’s skin is almost dry and use the medicine as directed. 
    • Apply moisturizer on top of the medicine and to the rest of your child’s skin.

    Tips for choosing a moisturizer

    • When selecting a moisturizer, consider choosing a thick cream or ointment.
    • Some children do better with fragrance-free products, so consider petroleum jelly — an inexpensive, fragrance-free product that works well for many children. 
    • When selecting a product, “trial and error” sampling of different types may help to identify the best moisturizer for your child.

    Tips to ease discomfort

    • For best results, apply moisturizer at least twice a day. This prevents dryness and cracking. It also can decrease the need for eczema medications.
    • If your child has severe itching and scratching, ask your child’s dermatologist about wet wrap therapy. This can reduce swelling and lessen the desire to scratch.
    • Keep your child’s fingernails short and smooth. This decreases the likelihood that scratching will puncture the skin. Putting cotton gloves on your child’s hands at night may help prevent scratching during sleep.
    • Keep temperature and humidity levels comfortable. Avoid situations in which the air is extremely dry, or where your child may sweat and overheat. This is the most common trigger of the itch/scratch cycle.

    Clothes-washing tips

    • Using a laundry detergent made for sensitive skin may be beneficial. Scented fabric softener or dryer sheets may contribute to irritation.
    • Only use the recommended amount of detergent.
    • Use enough water for adequate rinsing.
    • Buy clothes without tags because tags can rub against the skin, causing irritation. 
    • Wash your child’s new clothes before wearing. This will remove excess dyes and fabric finishers, which can irritate the skin.

    Good skin care is a key part of gaining control of your child’s eczema. If skin care has not been a regular part of your child’s treatment, you should make an appointment for your child to see a dermatologist.

    Are the shots that treat hay fever and other allergies useful?

    Allergy shots have not proven helpful for AD. Shots may even make AD worse. There is an exception. If the shots treat a patient's lung allergies, the skin may get better. Before trying allergy shots, be sure to talk with a dermatologist.

    Support groups and other resources:

    National Eczema Association
    Offers support groups and telephone support for people living with atopic dermatitis

    Other resources from the American Academy of Dermatology:

    Coping with atopic dermatitis
    This video explains tips to reduce your atopic dermatitis symptoms.

    Camp Discovery
    The American Academy of Dermatology's free summer camp exclusively for kids living with a chronic (long-lasting) skin disease.

    Eczema: Itchy Skin
    Written especially for kids to help them understand why their skin itches and what they can do to feel better.

    Eczema: Bleach bath therapy
    If your child has eczema and gets frequent skin infections, a dermatologist may recommend bleach bath therapy. Be sure to follow these important steps for giving a bleach bath.

    Atopic dermatitis
  • Bleach baths

    Atopic dermatitis: Bleach bath therapy

    If your child’s dermatologist recommends bleach baths, follow these important steps for giving a bleach bath:

    1. Use regular strength – 6 percent – bleach for the bath. Do not use concentrated bleach.

    2. Use a measuring cup or measuring spoon to add the bleach to the bath. Adding too much bleach to the bath can irritate your children’s skin. Adding too little bleach may not help.

    3. Measure the amount of bleach before adding it to the bath water. For a full bathtub of water, use a half cup of bleach. For a half-full tub of water, add a quarter cup of bleach. For a baby or toddler bathtub, add one teaspoon of bleach per gallon of water.

    4. Never apply bleach directly to your child’s eczema. While the tub is filling, pour the bleach into the water. Be sure to wait until the bath is fully drawn and bleach is poured before your child enters the tub.

    5. Talk with your dermatologist about how long your child should soak in the tub. Most dermatologists recommend a five- to 10-minute soak.

    6. Pat your child’s skin dry after the bath. If your child uses eczema medication, apply it immediately after the bath. Then moisturize your child’s skin.

    Talk with a board-certified dermatologist before beginning bleach bath therapy with your child. If you have questions or concerns about caring for your child’s eczema, you should make an appointment to see a dermatologist.

    Atopic dermatitis
  • Severe atopic dermatitis

    Can anything relieve severe atopic dermatitis?

    Carefully following a customized treatment plan often helps relieve severe AD.

    If you're living with severe atopic dermatitis (AD), relief is possible. With help from a board-certified dermatologist, you can get a treatment plan that will help you:

    • Follow an effective skin care plan
    • Avoid triggers
    • Use medication safely
    • Find and care for related diseases

    What exactly is severe AD?

    AD is the most common type of eczema. When this eczema becomes severe, a person has patches of skin that are red, swollen, and unbearably itchy. The patches of AD can weep fluids. Skin infections are common.

    Severe AD tends to impact a person’s quality of life. The intense itch can waken a child or adult from a sound sleep and keep the person awake for hours. This can make it hard for a child to focus at school. An adult may have trouble keeping up at work.

    Living with severe AD often means you cannot do many things. One woman equates having severe AD with being in prison. She desperately wants to pick up her grandchildren and swing them in the air, but her hands hurt too much to do that. She would enjoy having people over for dinner, but she cannot imagine anyone wanting to take a plate of food from someone who has bloody, flaky hands.

    Living with severe AD can take a toll on your mental health. Not being able to do many things and coping with the itch and pain can lead to depression and anxiety.

    How do dermatologists treat severe AD?

    Each patient with severe AD receives a personalized treatment plan.

    To create this plan, your dermatologist will want to know how long you’ve had AD, your response to past treatments, and your preferences for treating AD.

    Even for severe AD, treatment often begins with the basics — skin care, trigger management, and medication.

    For treatment to work, it’s equally important to find out if you have any other medical conditions. If you have an undiagnosed medical condition, it may prevent your AD treatment from working.

    Here’s what you can expect if you see a board-certified dermatologist for severe AD.

    Skin care builds a foundation for effective treatment

    Skin care plays an important role in helping the skin heal. A skin care plan for severe AD often includes baths and moisturizer.

    Baths and showers help to:

    • Hydrate extremely dry skin
    • Get rid of crusts and scales
    • Remove microscopic particles on the skin that may be irritating you or causing an allergic reaction

    If you have frequent skin infections, your dermatologist may prescribe bleach baths. Adding a small amount of bleach to your bath water can help reduce the bacteria on your skin.

    Bleach bath therapy

    Moisturizer helps trap water in your skin. Studies show that applying a moisturizer after bathing (within 3 minutes of getting out of the water) and frequently throughout the day can:

    • Reduce extremely dry skin
    • Lessen the itch and other symptoms
    • Reduce redness and swelling
    • Help heal cracks in the skin
    • Prevent thickening of the skin

    Researchers have found that using moisturizer frequently can reduce severe eczema. It may also reduce the need for medication.

    With so many moisturizers available, your choices can feel overwhelming. Your dermatologist can recommend moisturizers that work for you without irritating your skin.

    Why are baths and moisturizer so important when treating eczema?

    Trigger management can help prevent flare-ups

    A trigger is anything that aggravates your skin, causing new AD to appear or existing AD to worsen.

    Many things can trigger AD, including dry air, sweat, and stress. What triggers your AD may not trigger someone else’s AD. It’s also possible for your triggers to change.

    Knowing your triggers and avoiding them can help prevent AD from flaring. A board-certified dermatologist can help you find your triggers and offer tips for avoiding them.

    You’ll find information about common triggers at:

    Triggers: What can cause eczema to flare?

    Medication is often necessary to treat severe AD

    Patients with severe AD often need medication along with skin care and trigger avoidance to get relief.

    Medication that you apply to your skin may be part of your treatment plan. To increase how well this medication works, your dermatologist may recommend that you apply the medication and then cover your skin with a gauze bandage or wet pajamas.

    Only cover your skin if your dermatologist recommends it. For this to be safe and effective, proper technique is essential.

    For treatment to work, you must follow your treatment plan.


    If you have severe AD, stronger medication may be required. One option for treating severe AD is light treatments. Your dermatologist may call this phototherapy.

    For phototherapy to be effective, you must go to a treatment center 2 to 3 times per week for several weeks. For this reason, light treatments may not be a realistic option for some people.

    Another option may be to take medication that works throughout the body.

    You can learn more about treatment for AD at:

    Atopic dermatitis: Diagnosis, treatment, and outcome

    Finding an undiagnosed medical condition can make AD treatment effective

    If you have an undiagnosed medical condition, such as a skin allergy, your AD treatment plan may not work. That’s why board-certified dermatologists treat the whole person.

    A dermatologist can look for signs and symptoms of other conditions and refer you to other specialists as needed. This helps ensure you get the treatment you need to feel better.

    Severe AD often requires expertise

    A treatment plan for severe AD can have many parts. A board-certified dermatologist can tailor a treatment plan to meet your needs. While that may not completely eliminate severe AD, it can help you feel better.

    Image 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    Image 2: Getty Images

    Eichenfield LF, Tom WL, et al. “Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies.” J Am Acad Dermatol. 2014;71:116-32.

    Kalb RE and Weinberg JM. “Atopic dermatitis: New perspective on managing a chronic inflammatory disease.” Global Education Group and Integritas Communications. Released: July 1, 2017.

    Sidbury R, Davis DM, et al. “Guidelines of care for the management of atopic dermatitis Section 3. Management and treatment with phototherapy and systemic agents.” J Am Acad Dermatol. 2014;71:327-49.

    Simpson EL, Bruin-Weller M, et al. “When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council.” J Am Acad Dermatol. 2017 Oct;77:623-33.

    Thyssen JP, Skov L, et al. “Assessment of major comorbidities in adults with atopic dermatitis using the Charlson comorbidity index.” J Am Acad Dermatol. 2017;76:1088-92.