Atopic Dermatitis

TH

Atopic
Dermatitis
(A type of eczema)
U.S. Department of Health and
HANDOUT ON HEAL
Human Services
National Institutes of Health
National Institute of Arthritis and
Musculoskeletal and Skin Diseases

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This booklet is not copyrighted. Readers are
encouraged to duplicate and distribute as many
copies as needed.
Additional copies of this booklet are available
from the National Institute of Arthritis and
Musculoskeletal and Skin Diseases, NIAMS/National
Institutes of Health, 1 AMS Circle, Bethesda, Maryland
20892-3675, and on the NIAMS Web site at http://
www.niams.nih.gov/hi/topics/dermatitis/index/html.

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Table of Contents
Defining Atopic Dermatitis ............................................ 3
Incidence and Prevalence of Atopic Dermatitis ............. 4
Cost of Atopic Dermatitis............................................... 6
Causes of Atopic Dermatitis........................................... 6
Symptoms of Atopic Dermatitis ..................................... 9
Stages of Atopic Dermatitis........................................... 11
Diagnosing Atopic Dermatitis ....................................... 12
Factors that Make Atopic Dermatitis Worse ................. 15
Treatment of Atopic Dermatitis..................................... 18
Atopic Dermatitis and Quality of Life .......................... 24
Atopic Dermatitis and Vaccination
Against Smallpox .......................................................... 25
Current Research ........................................................... 27
Hope for the Future ....................................................... 31
Additional Resources..................................................... 32

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Types of Eczema (Dermatitis) ........................................ 5
Skin Features Associated With Atopic Dermatitis ......... 8
Major and Minor Features of Atopic Dermatitis........... 14
Common Irritants .......................................................... 16
Treating Atopic Dermatitis in Infants and Children...... 22
Tips for Working With Your Doctor..............................26
Controlling Atopic Dermatitis ....................................... 28

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Atopic Dermatitis
This booklet is for people who have atopic dermatitis
(often called “eczema”), parents and caregivers of
children with atopic dermatitis, and others interested in
learning more about the disease. The booklet describes
the disease and its symptoms and contains information
about diagnosis and treatment as well as current
research efforts supported by the National Institute of
Arthritis and Musculoskeletal and Skin Diseases
(NIAMS) and other components of the Department of
Health and Human Services’ National Institutes of
Health (NIH). It also discusses issues such as skin care
and quality of life for people with atopic dermatitis. If
you have further questions after reading this booklet, you
may wish to discuss them with your doctor or your
child’s pediatrician.
A topic dermatitis is a chronic (long-lasting) disease
that affects the skin. It is not contagious; it cannot be
passed from one person to another. The word “dermatitis”
means inflammation of the skin. “Atopic” refers to a
group of diseases where there is often an inherited
tendency to develop other allergic conditions, such as
asthma and hay fever. In atopic dermatitis, the skin
becomes extremely itchy. Scratching leads to redness,
swelling, cracking, “weeping” clear fluid, and finally,
crusting and scaling. In most cases, there are periods of
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time when the disease is worse (called exacerbations or
flares) followed by periods when the skin improves or
clears up entirely (called remissions). As some children
with atopic dermatitis grow older, their skin disease
improves or disappears altogether,
although their skin often remains dry
and easily irritated. In others, atopic
dermatitis continues to be a significant
problem in adulthood.
Although atopic
Atopic dermatitis is often referred to
as “eczema,” which is a general term
dermatitis may
for the several types of inflammation
of the skin. Atopic dermatitis is the
occur at any age,
most common of the many types of
eczema. Several have very similar
it most often
symptoms. Types of eczema are
described in the box on page 5.
begins in infancy
and childhood.
A topic dermatitis is very common.
It affects males and females and
accounts for 10 to 20 percent of all
visits to dermatologists (doctors who
specialize in the care and treatment of
skin diseases). Although atopic dermatitis may occur at
any age, it most often begins in infancy and childhood.
Scientists estimate that 65 percent of patients develop
symptoms in the first year of life, and 90 percent develop
symptoms before the age of 5. Onset after age 30 is less
common and is often due to exposure of the skin to harsh
or wet conditions. Atopic dermatitis is a common cause
of workplace disability. People who live in cities and in
dry climates appear more likely to develop this condition.
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Types of Eczema (Dermatitis)
?
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
?
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
?
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
?
Neurodermatitis: scaly patches of the skin on the
head, lower legs, wrists, or forearms caused by a
localized itch (such as an insect bite) that become
intensely irritated when scratched
?
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
?
Seborrheic eczema: yellowish, oily, scaly patches
of skin on the scalp, face, and occasionally other
parts of the body
?
Stasis dermatitis: a skin irritation on the lower
legs, generally related to circulatory problems
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Although it is difficult to identify exactly how many
people are affected by atopic dermatitis, an estimated 20
percent of infants and young children experience
symptoms of the disease. Roughly 60
percent of these infants continue to
have one or more symptoms of atopic
dermatitis in adulthood. This means
that more than 15 million people in the
More than
United States have symptoms of the
disease.
15 million people
in the U.S. have
In a recent analysis of the health
symptoms
insurance records of 5 million
Americans under age 65, medical
of atopic
researchers found that approximately
2.5 percent had atopic dermatitis.
Annual insurance payments for
dermatitis.
medical care of atopic dermatitis
ranged from $580 to $1,250 per
patient. More than one-quarter of each
patient’s total health care costs were
for atopic dermatitis and related conditions. The
researchers project that U.S. health insurance companies
spend more than $1 billion per year on atopic dermatitis.
T he cause of atopic dermatitis is not known, but the
disease seems to result from a combination of genetic
(hereditary) and environmental factors.
Children are more likely to develop this disorder if one or
both parents have had it or have had allergic conditions
like asthma or hay fever. While some people outgrow skin
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symptoms, approximately three-fourths of children with
atopic dermatitis go on to develop hay fever or asthma.
Environmental factors can bring on symptoms of atopic
dermatitis at any time in individuals who have inherited
the atopic disease trait.
Atopic dermatitis is also associated
with malfunction of the body’s
immune system: the system that
recognizes and helps fight bacteria
Atopic dermatitis
and viruses that invade the body.
Scientists have found that people with
is also
atopic dermatitis have a low level of a
cytokine (a protein) that is essential to
associated with
the healthy function of the body’s
immune system and a high level of
malfunction of
other cytokines that lead to allergic
reactions. The immune system can
the body’s
become misguided and create
inflammation in the skin even in the
absence of a major infection. This can
immune system.
be viewed as a form of autoimmunity,
where a body reacts against its own
tissues.
In the past, doctors thought that atopic dermatitis was
caused by an emotional disorder. We now know that
emotional factors, such as stress, can make the condition
worse, but they do not cause the disease.
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Skin Features Associated
With Atopic Dermatitis
?
Atopic pleat (Dennie-Morgan fold): an extra
fold of skin that develops under the eye
?
Cheilitis: inflammation of the skin on and
around the lips
?
Hyperlinear palms: increased number of skin
creases on the palms
?
Hyperpigmented eyelids: eyelids that have
become darker in color from inflammation or
hay fever
?
Ichthyosis: dry, rectangular scales on the skin
?
Keratosis pilaris: small, rough bumps,
generally on the face, upper arms, and thighs
?
Lichenification: thick, leathery skin resulting
from constant scratching and rubbing
?
Papules: small raised bumps that may open
when scratched and become crusty and
infected
?
Urticaria: hives (red, raised bumps) that may
occur after exposure to an allergen, at the
beginning of flares, or after exercise or a
hot bath
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Document Outline

• Table of Contents
  • Defining Atopic Dermatitis
  • Incidence and Prevalence of Atopic Dermatitis
  • Cost of Atopic Dermatitis
  • Causes of Atopic Dermatitis
  • Symptoms of Atopic Dermatitis
  • Stages of Atopic Dermatitis
  • Diagnosing Atopic Dermatitis
  • Factors that Make Atopic Dermatitis Worse
  • Treatment of Atopic Dermatitis
  • Atopic Dermatitis and Quality of Life
  • Atopic Dermatitis and VaccinationAgainst Smallpox
  • Current Research
  • Hope for the Future
  • Additional Resources
  • Information Boxes
    • Types of Eczema (Dermatitis)
    • Skin Features Associated With Atopic Dermatitis
    • Major and Minor Features of Atopic Dermatitis
    • Common Irritants
    • Treating Atopic Dermatitis in Infants and Children
    • Tips for Working With Your Doctor
    • Controlling Atopic Dermatitis

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