Atopic dermatitis is a chronic (long-lasting) disease that
affects the skin. The word dermatitis means inflammation of the skin.
Atopic refers to a group of diseases that are hereditary (that is, run
in families) and often occur together, including asthma, allergies such
as hay fever, and atopic dermatitis.
In atopic dermatitis, the skin becomes extremely itchy and inflamed,
causing redness, swelling, cracking, weeping, crusting, and scaling.
Atopic dermatitis most often affects infants and young children, but it
can continue into adulthood or first show up later in life. In most
cases, there are periods of time when the disease is worse, called
exacerbations or flares, followed by
periods when the skin improves or clears up entirely, called
remissions. Many children with atopic dermatitis will experience a
permanent remission of the disease when they get older, although their
skin often remains dry and easily irritated. Environmental factors can
bring on symptoms of atopic dermatitis at any time in the lives of
individuals who have inherited the atopic disease trait.
Atopic dermatitis is often referred to as eczema, which is a general
term for the many types of dermatitis. Atopic dermatitis is the most
common of the many types of eczema. Several have very similar symptoms.
Atopic dermatitis is very common. It affects males and females
equally and accounts for 10 to 20 percent of all referrals to
dermatologists (doctors who specialize in the care and treatment of
skin diseases). Atopic dermatitis occurs most often in infants and
children and its onset decreases substantially with age.
The cause of atopic dermatitis is not known, but the disease seems
to result from a combination of genetic (hereditary) and environmental
factors. Evidence suggests the disease is associated with other
so-called atopic disorders such as hay fever and asthma, which many
people with atopic dermatitis
also have. In addition, many children who outgrow the symptoms of
atopic dermatitis go on to develop hay fever or asthma. Although one
disorder does not cause another, they may be related, thereby giving
researchers clues to understanding atopic dermatitis.
Types of Eczema (Dermatitis)
- Atopic dermatitis: a chronic skin disease characterized by itchy, inflamed skin.
- Contact eczema: a localized reaction that includes redness,
itching, and burning where the skin has come into contact with an
allergen (an allergy-causing substance) or with an irritant such as an
acid, a cleaning agent, or other chemical. - Allergic contact eczema (dermatitis): a red, itchy, weepy
reaction where the skin has come into contact with a substance that the
immune system recognizes as foreign, such
as poison ivy or certain preservatives in creams and lotions. - Seborrheic eczema: yellowish, oily, scaly patches of skin on the scalp, face, and occasionally other parts of the body.
- Nummular eczema: coin-shaped patches of irritated skin most
common on the arms, back, buttocks, and lower legs that may be crusted,
scaling, and extremely itchy. - Neurodermatitis: scaly patches of skin on the head, lower
legs, wrists, or forearms caused by a localized itch (such as an insect
bite) that becomes intensely irritated when
scratched. - Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems.
- Dyshidrotic eczema: irritation of the skin on the palms of hands and soles of the feet characterized by clear, deep blisters that itch and burn.
Symptoms vary from person to person. The most common symptoms are
dry, itchy skin; cracks behind the ears; and rashes on the cheeks,
arms, and legs. The itchy feeling is an important factor in atopic
dermatitis, because scratching and rubbing in response to itching
worsen the skin inflammation characteristic of this disease. People
with atopic dermatitis seem to be more sensitive to itching and feel
the need to scratch longer in response. They develop what is referred
to as the itch-scratch cycle: The extreme itchiness of the skin causes
the person to scratch, which in turn worsens the itch, and so on.
Itching is particularly a problem during sleep, when conscious control
of scratching decreases and the absence of other outside stimuli makes
the itchiness more noticeable.
The skin of a person with atopic dermatitis loses too much moisture
from the epidermal layer, allowing the skin to become very dry and
reducing its protective abilities. In addition, the patient's skin is
very susceptible to recurring infections, such as staphylococcal and
streptococcal bacterial skin infections and warts, herpes simplex, and
molluscum contagiosum (skin disorders caused by a viruses).
Allergens are substances from foods, plants, or animals that inflame
the skin because the immune system overreacts to the substance.
Inflammation occurs even when the person is exposed to small amounts of
the substance for a limited time. Some examples of allergens are pollen
and dog or cat dander (tiny particles from the animal's skin or hair).
When people with atopic
dermatitis come into contact with an irritant or allergen they are
sensitive to, inflammation-producing cells come into the skin from
elsewhere in the body. These cells release chemicals that cause itching
and redness. As the person scratches and rubs the skin in response,
further damage occurs.
Some doctors and scientists believe that certain foods act as
allergens and may trigger atopic dermatitis or cause it to become
worse. Other researchers think that food allergens play a role in only
a limited number of cases of atopic dermatitis, primarily in infants
and children. An allergic reaction to food can cause skin inflammation
(generally hives), gastrointestinal symptoms (vomiting, diarrhea),
upper respiratory tract symptoms (congestion, sneezing), and wheezing.
The most common allergenic (allergy-causing) foods are eggs, peanuts,
milk, fish, soy products, and wheat.
Corticosteroid creams and ointments are the most frequently used
treatment. Sometimes over-the-counter preparations are used, but in
many cases the doctor will prescribe a stronger corticosteroid cream or
ointment. The doctor will take into account the patient's age, location
of the skin to be treated, severity of the symptoms, and type of
preparation (cream or ointment) when prescribing a medication.
Sometimes the base used in certain brands of corticosteroid creams and
ointments is irritating for a particular patient.
Some treatments reduce specific symptoms of the disease. Antibiotics
to treat skin infections may be applied directly to the skin in an
ointment, but are usually more effective when taken by mouth. Certain
antihistamines that cause drowsiness can reduce nighttime scratching
and allow more restful sleep when taken at bedtime.
There are no specific therapeutic modalities for complete control of
atopic dermatitis. Management must be individualized to improve
morbidity (itching and scratching) with the goal to allow most patients
to function in a normal productive manner.
Several experimental treatments are being evaluated that attempt to
replace substances that are deficient in people with atopic dermatitis.
Evening primrose oil is a substance rich in gamma-linolenic acid, one
of the fatty acids that is decreased in the skin of people with atopic
dermatitis. Studies to date using evening primrose oil have yielded
contradictory results. Clinical trials with another substance, a
dietary fatty acid supplement called eicosapentenoic acid, have
resulted in only slight improvement. There is also a great deal of
interest in the use of Chinese herbs and herbal teas to treat the
disease. Studies to date do show some benefit, but not without concerns
about toxicity and the risks of suppression of the immune system.
Treatment may include the following:
Oral ketotifen (a mast cell stabilizer)
Caffeine administered topically, 10% to 30% in petrolatum or water-in-oil base
Vitamins :- A, B Complex (high Potency), B6, Biotin, C
Minerals :- Chelated Multi Minerals, Zinc Magnesium
Food Supplements :-Nutritional Yeast, Lecithin, Linseed Oil, Rutin & Bioflavonoids, Linoleic acid, g -Linoleic acids
Herbs :- Evening Primrose Oil, Dandelion, Echinacea, Milk Thistle
The herbs/nutrients mentioned above reflect the major nutritional
supplements that may help the condition. Please do remember however
that nutritional supplementation is an adjunct to medical treatment and
in no way replaces medical treatment.
- Handout on Health: Atopic Dermatitis - National Institute of
Arthritis and Musculoskeletal and Skin Diseases - National Institutes
of Health
NIAMS gratefully acknowledges the assistance of Alan Moshell, M.D.,
NIAMS, NIH; Jon Hanifin, M.D., Oregon Health Sciences University,
Portland, Oregon; Amy Paller, M.D., Children's Hospital of Chicago,
Chicago, Illinois; Donald Leung, M.D., Ph.D., National Jewish Medical
Center, Denver, Colorado; and Kevin Cooper, M.D., Case Western Reserve
University, University Hospitals of Cleveland, Cleveland, Ohio, in the
preparation and review of this publication.
Additional Resources
National Eczema Association
1221 SW Yamhill, Suite 303
Portland, OR 97205
(503) 228-4430
This is a national, patient-oriented association devoted to eczema. It
publishes a newsletter and an eight-page brochure on atopic dermatitis,
provides educational materials, offers resource services for people
with atopic dermatitis, and provides referrals to atopic dermatitis
research centers.
