Atopic dermatitis

This article is about the most common type of eczema. For other types and related skin conditions, see Dermatitis.

Atopic dermatitis
Other namesAtopic eczema, infantile eczema, prurigo Besnier, allergic eczema, neurodermatitis[1]
Atopic dermatitis of the inside crease of the elbow
SpecialtyDermatology, Clinical Immunology and Allergy
SymptomsItchy, red, swollen, cracked skin[2]
ComplicationsSkin infections, hay fever, asthma[2]
Usual onsetChildhood[2][3]
CausesUnknown[2][3]
Risk factorsFamily history, living in a city, dry climate[2]
Diagnostic methodBased on symptoms after ruling out other possible causes[2][3]
Differential diagnosisContact dermatitis, psoriasis, seborrheic dermatitis[3]
TreatmentAvoiding things that worsen the condition, daily bathing followed by moisturising cream, steroid creams for flares[3] Humidifier
Frequency~20% at some time[2][4]

Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin.[2] AD is also often called simply eczema but the same term is also used to refer to dermatitis, the larger group of skin conditions.[2][5] AD results in itchy, red, swollen, and cracked skin.[2] Clear fluid may come from the affected areas, which can thicken over time.[2]

Atopic dermatitis affects about 20% of people at some point in their lives.[2][4] It is more common in younger children.[3] Females are affected slightly more often than males.[6] Many people outgrow the condition.[3]

While the condition may occur at any age, it typically starts in childhood, with changing severity over the years.[2][3] In children under one year of age, the face and limbs and much of the body may be affected.[3] As children get older, the areas on the insides of the knees and folds of the elbows and around the neck are most commonly affected.[3] In adults, the hands and feet are commonly affected.[3] Scratching the affected areas worsens the eczema and increases the risk of skin infections.[2] Many people with atopic dermatitis develop hay fever or asthma.[2]

The cause is unknown but believed to involve genetics, immune system dysfunction, environmental exposures, and difficulties with the permeability of the skin.[2][3] If one identical twin is affected, the other has an 85% chance of having the condition.[7] Those who live in cities and dry climates are more commonly affected.[2] Exposure to certain chemicals or frequent hand washing makes symptoms worse.[2] While emotional stress may make the symptoms worse, it is not a cause.[2] The disorder is not contagious.[2] A diagnosis is typically based on the signs, symptoms and family history.[3]

Treatment involves avoiding things that make the condition worse, enhancing the skin barrier through skin care and treating the underlying skin inflammation. Moisturising creams are used to make the skin less dry and prevent AD flare-ups. Anti-inflammatory corticosteroid creams are used to control flares-ups.[3] Creams based on calcineurin inhibitors (tacrolimus or pimecrolimus) may also be used to control flares if other measures are not effective.[2][8] Certain antihistamine pills might help with itchiness.[3] Things that commonly make it worse include house dust mite, stress and seasonal factors.[9] Phototherapy may be useful in some people.[2] Antibiotics (either by mouth or topically) are usually not helpful unless there is secondary bacterial infection or the person is unwell.[10] Dietary exclusion does not benefit most people and it is only needed if food allergies are suspected.[11] More severe AD cases may need systemic medicines such as cyclosporin, methotrexate, dupilumab or baricitinib.

Other names of the condition include "infantile eczema", "flexural eczema", "prurigo Besnier", "allergic eczema", and "neurodermatitis".[1]

  1. ^ a b Williams HC (October 2000). "Epidemiology of atopic dermatitis". Clinical and Experimental Dermatology. 25 (7). Cambridge University Press: 522–529. doi:10.1046/j.1365-2230.2000.00698.x. ISBN 978-0-521-57075-6. PMID 11122223. S2CID 31546363. Archived from the original on 2015-06-19.
  2. ^ a b c d e f g h i j k l m n o p q r s t u v "Handout on Health: Atopic Dermatitis (A type of eczema)". National Institute of Arthritis and Musculoskeletal and Skin Diseases. May 2013. Archived from the original on 30 May 2015. Retrieved 19 June 2015.
  3. ^ a b c d e f g h i j k l m n o Tollefson MM, Bruckner AL (December 2014). "Atopic dermatitis: skin-directed management". Pediatrics. 134 (6): e1735–e1744. doi:10.1542/peds.2014-2812. PMID 25422009.
  4. ^ a b Thomsen SF (2014). "Atopic dermatitis: natural history, diagnosis, and treatment". ISRN Allergy. 2014: 354250. doi:10.1155/2014/354250. PMC 4004110. PMID 25006501.
  5. ^ Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, et al. (May 2004). "Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003". The Journal of Allergy and Clinical Immunology. 113 (5): 832–836. doi:10.1016/j.jaci.2003.12.591. PMID 15131563.
  6. ^ "Atopic Dermatitis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 2019. Retrieved 29 August 2022.
  7. ^ Williams H (2009). Evidence-Based Dermatology. John Wiley & Sons. p. 128. ISBN 978-1-4443-0017-8. Archived from the original on 2017-09-08.
  8. ^ Carr WW (August 2013). "Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations". Paediatric Drugs. 15 (4): 303–310. doi:10.1007/s40272-013-0013-9. PMC 3715696. PMID 23549982.
  9. ^ Langan SM, Williams HC (September 2006). "What causes worsening of eczema? A systematic review". The British Journal of Dermatology. 155 (3): 504–514. doi:10.1111/j.1365-2133.2006.07381.x. PMID 16911274. S2CID 43247714.
  10. ^ Ong PY, Boguniewicz J, Chu DK (May 2023). "Skin Antiseptics for Atopic Dermatitis: Dissecting Facts From Fiction". The Journal of Allergy and Clinical Immunology. In Practice. 11 (5): 1385–1390. doi:10.1016/j.jaip.2023.01.012. PMID 36702247. S2CID 256222372.
  11. ^ Oykhman P, Dookie J, Al-Rammahy H, de Benedetto A, Asiniwasis RN, LeBovidge J, et al. (October 2022). "Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis". The Journal of Allergy and Clinical Immunology. In Practice. 10 (10): 2657–2666.e8. doi:10.1016/j.jaip.2022.06.044. PMID 35987995. S2CID 250710625.