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What Is Atopic Dermatitis?

Updated on June 10, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Kelly Crumrin

KEY TAKEAWAYS:
  • Atopic dermatitis is a chronic, severe type of eczema.

  • There is a strong association between atopic dermatitis, asthma, and allergies including hay fever.

  • Atopic dermatitis usually develops in young children and may last lifelong.

  • Many people with atopic dermatitis have trouble sticking to the treatment their doctor prescribes.

  • Having a good daily skin care regimen can help control atopic dermatitis and decrease the need for medication.

The word atopic comes from the ancient Greek words "a topos," literally “without place,” but in context meaning “unusual.” Ironically, atopic dermatitis is anything but unusual. In fact, atopic dermatitis is the most common type of eczema, affecting as many as 13 percent of children and 10 percent of adults in the United States.

Every type of eczema causes redness, scales, and itchy skin, and all eczema involves skin inflammation resulting from overactivation of the immune system. People with eczema tend to have a defective or “leaky” skin barrier that causes dry skin and lets in irritants and allergens.

Atopic dermatitis is considered a severe and long-lasting type of eczema. For many with atopic dermatitis, the condition has a significant impact on quality of life and can pose a substantial economic burden.

What Sets Atopic Dermatitis Apart From Other Eczema Types?

Different types of eczema have different triggers, symptoms, and treatments. If you have atopic dermatitis, gaining a better understanding of your skin condition can be a good first step to improving it.

Atopic dermatitis is more likely to be chronic and recurrent than other types of eczema. Some researchers believe atopic dermatitis is part of the “atopic triad” or “atopic march,” a genetic tendency to also develop asthma and allergic rhinitis (hay fever), food allergies, or other allergic conditions. In contrast, a review of existing studies on contact dermatitis have not found conclusive evidence of a genetic link or increased risk factors based on family history.

This chart shows a few key differences between atopic dermatitis and contact dermatitis, another common type of eczema.Unfortunately, it is possible to have more than one type of eczema at the same time. If your eczema worsens or fails to improve while correctly using treatments prescribed for atopic dermatitis, you may have contact dermatitis in addition to atopic dermatitis. It is possible to develop a contact allergy to medications for atopic dermatitis.

What Makes Atopic Dermatitis Challenging to Treat?

Atopic dermatitis is a chronic skin disease, and research indicates it is likely lifelong. Atopic dermatitis can be confusing because it is also episodic and intermittent — there may be years between flares. However, in people with atopic dermatitis, even skin that appears normal shows impaired skin barrier function and evidence of allergic and inflammatory changes.

The good news is that there are many new medications for atopic dermatitis recently approved by the U.S. Food and Drug Administration (FDA) or in late stages of development. There are more options available for the treatment of atopic dermatitis now than ever before.

The bad news is that people living with atopic dermatitis often have trouble with treatment adherence, as it often involves daily treatments. Treatment adherence is defined as taking all prescribed medicines as directed for the length of time necessary. Adherence may be better for oral or injected medications than for topical treatments (applied directly to the skin).

Some common reasons for not adhering to atopic dermatitis treatment include:

  • Difficulty affording treatment
  • Unclear instructions from doctors
  • Complex treatment regimens with multiple medications and steps
  • Concerns about the risk and side effects of medications, especially topical corticosteroids (also called topical steroids)

Some people use their atopic dermatitis medication incorrectly, then decide it is not working. This sometimes results in switching to a more powerful medication when it is not really needed.

If you have difficulty affording your prescribed atopic dermatitis medication, taking medications as directed, or sticking to the schedule for phototherapy treatments, discuss these issues openly with your doctor. They may be able to recommend ways to overcome these obstacles. Your dermatologist, allergist, or family doctor can also help you weigh the risks and benefits of each medication if you are concerned about safety.

Think Long Term, Act Daily

There are steps you can take each day to preserve your skin barrier and keep your skin its healthiest. Sticking to a good skin care regimen every day can help control atopic dermatitis and decrease the need for medications.

Basic skin care tips for people with atopic dermatitis include:

Bathing

  • Skip the long, hot shower. Bathe once daily for no more than five or 10 minutes in cool or lukewarm water.
  • Use a nonsoap cleanser — they are gentler on the skin. During a flare, skip cleansers altogether. Always avoid antiseptic cleansers, and cleansers with fragrance or dyes.
  • Rinse soaps and shampoos off thoroughly.
  • If you have crusting lesions or recurrent skin infections associated with your atopic dermatitis, consider adding a small amount of bleach to your bath. Bleach baths should only be taken once or twice a week.

Moisturizing

  • Apply lotions or moisturizers with a high oil content immediately after bathing — within three minutes — to lock in moisture.
  • Use moisturizers without fragrance or dyes.
  • Moisturize your hands after every time you wash or come into contact with water.

Environment

  • Choose soft, loose, full-sleeved clothing that will not irritate the skin.
  • If you live in a dry climate, consider using a humidifier. In hot, sweaty weather, try to stay in air-conditioned areas or near a fan.
  • Regular vacuuming, damp dusting, and mopping can help keep down dust mite populations. Dust mites are a common irritant for people with atopic dermatitis.
  • Avoid swimming in chlorinated pools during flare-ups. Limit swimming and water exposure if it seems to irritate your skin.

Find Your Team

MyEczemaTeam is the social network for people with eczema and their loved ones. Here, more than 36,000 members from around the world come together to swap stories and advice, discuss daily life with eczema, and meet others who understand the diagnosis.

Do you have atopic dermatitis? Share your experience in the comments below or by posting on MyEczemaTeam.

References

  1. Atopic: Definition of Atopic by Lexico. Lexico. Retrieved from https://www.lexico.com/en/definition/atopic. Accessed November 2019.
  2. What is atopic dermatitis and how can I tell if I have it? National Eczema Association. Retrieved from https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis/. Accessed November 2019.
  3. Levenberg, M. E. (2019, April 17). The Challenge of Managing Atopic Dermatitis in the United States. Retrieved from http://www.ahdbonline.com/issues/2019/april-2019-vol-12-no-2/2759-the-challenge-of-managing-atopic-dermatitis-in-the-united-states.
  4. Types of Eczema. (n.d.). Retrieved from https://nationaleczema.org/eczema/types-of-eczema/. Accessed November 2019.
  5. How to use baths to manage your eczema. National Eczema Association. Retrieved from https://nationaleczema.org/eczema/treatment/bathing/. Accessed November 2019.
  6. Eczema Symptoms & Causes. National Eczema Association. Retrieved from https://nationaleczema.org/eczema/. Accessed November 2019.
  7. Abuabara, K., Margolis, D. J., & Langan, S. M. (2017). The Long-Term Course of Atopic Dermatitis. Dermatologic Clinics, 35(3), 291–297. doi: 10.1016/j.det.2017.02.003
  8. Atopic Dermatitis (Eczema): AAAAI. American Academy of Allergy, Asthma & Immunology. Retrieved from https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/atopic-dermatitis-(eczema). Accessed November 2019.
  9. Contact Dermatitis: American Academy of Dermatology. Retrieved from https://www.aad.org/contact-dermatitis. Accessed November 2019.
  10. Atopic Dermatitis: Causes: American Academy of Dermatology. Retrieved from https://www.aad.org/diseases/eczema/atopic-dermatitis-causes/. Accessed November 2019.
  11. Contact Dermatitis: Diagnosis & Treatment: American Academy of Dermatology. Retrieved from https://www.aad.org/diseases/eczema/contact-dermatitis-treatment. Accessed November 2019.
  12. Think About Contact Dermatitis in Atopic Dermatitis Patients: American Academy of Dermatology. Retrived from https://www.aaaai.org/global/latest-research-summaries/New-Research-from-JACI-In-Practice/Think-about-Contact-Dermatitis-in-Atopic-Dermatiti. Accessed November 2019.
  13. Adherence to treatment. (n.d.). Retrieved from https://medical-dictionary.thefreedictionary.com/adherence to treatment. Accessed November 2019.
  14. Dhar S, Parikh D, Rammoorthy R, Srinivas S, Sarkar R, Inamadar A, Shah M, Banerjee R, Kanwar AJ, Mendiratta V, George R, Gulati R. Atopic dermatitis: General care of the skin. Indian J Paediatr Dermatol 2017;18:176-9



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Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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