About Atopic Dermatitis

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What is AD?

Atopic dermatitis or AD is a common and chronic (long-term) disease that causes the skin to become itchy, inflamed, and irritated. Those with light skin will also have red, dry patches of skin. In those with darker skin tones, this redness may be hard to see and will tend to appear darker brown, purple, or gray in color. 1,2

AD, which is often referred to as eczema, is not contagious, so it can't spread from one person to another. 1

AD symptoms can come and go. There will be times when: 1

Your symptoms get worse, called flares
Your symptoms improve or your skin clears up completely, called remission

What causes AD and who gets it?

Your skin has many functions. It serves as a barrier to shield your body against heat, light, injury, and infection. It also helps control your body temperature and prevent water loss. 3

While the exact cause of AD is not known, it may be caused by a variety of factors such as genes or triggers in your environment. An irregular immune response within the skin is also thought to play a role. Doctors know the symptoms are related to changes in the outer layer of your skin, causing it to lose moisture. When this happens, your skin becomes dry, leading to damage and inflammation. The inflammation makes you feel very itchy and can lead you to scratch, which makes the damage to your skin worse. 1

AD usually first appears in babies and children, though some people develop it in adulthood. Both males and females can get AD. In the U.S., black children tend to develop AD more often than white children. The number of people with AD has increased over the past few decades. 4

What factors increase a person's risk of AD?

Genes

There are two ways genetics may increase a person's risk of AD. 1,4,5

Having a family history of atopic disease, especially AD, has been shown to be the strongest risk factor for developing AD.
Certain genes help keep the outer layer of your skin healthy. Sometimes these genes change, or "mutate". This can change your skin barrier, making it dry and more sensitive, and lead to AD.

About Atopic Dermatitis

Other factors

Having a family history of hay fever, asthma, or food allergies 1,4
Having an overactive immune system which leads to inflammation in the skin 1
Being exposed to things in the environment such as: 1,4
Very hot and cold temperatures
Air pollution
Ultraviolet radiation from the sun and other sources
Tobacco smoke

What are the signs and symptoms of AD?

The most common symptom is itching, which can be severe. Other common symptoms include: 1,2

Discolored patches of dry skin that may look red, brown, purple, or gray depending on your skin tone
Thick, hard patches of skin
Rashes or bumps that ooze clear fluid or bleed when scratched

Though rashes can occur anywhere on the body, what they look like, and their location tend to vary depending on age. 1

Babies. In babies and young children, AD tends to be widespread on the body and involve the head, face, cheeks, arms, legs, and trunk. The diaper area may rarely be involved. 1,5

Children. As children age, AD is usually more limited to the arms and legs, mainly in the bends of the knees and elbows. Rashes may also be present on the lower legs, feet, neck, and around the eyes. The skin may also be thickened from repeated scratching. 4,5

Teens and adults. AD can be widespread and include localized rashes most commonly on the hands, feet, around the eyes, and in the bends of the knees and elbows. 1,5

What are AD Triggers?

Anything that irritates the skin can lead to a flare or make your AD worse. These are called triggers. Some common triggers for AD include: 1,4,6

Dry skin
Stress
Sweating
Perfumes
Clothes made of scratchy materials like wool
Household cleaners, laundry detergent, dish soap
Shampoo, bubble bath, body wash, hand soap

How is AD diagnosed?

To diagnose AD your doctor may: 1

Ask about your medical and family history of AD and other conditions and issues related to AD
Examine your skin and rash
Order blood tests or even a skin biopsy (a sample of skin to be examined under a microscope) of the rash to check for other possible causes of your condition

Your doctor may need to see you several times or schedule follow-up visits to get an accurate diagnosis based on the nature of your condition. The types of doctors that can diagnose and treat AD include: 1

A primary care physician, such as a family doctor, internist, or pediatrician
A dermatologist, which is a doctor that specializes in treating conditions of the skin, hair, and nails
An allergist, a doctor that specializes in treating allergies and problems with the immune system

When choosing a doctor, it's important that you find one who is an expert in diagnosing and treating AD.

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Atopic dermatitis: in depth. Reviewed November 2022. Accessed May 15, 2023. https://www.niams.nih.gov/health-topics/atopic-dermatitis/advanced
Kaufman B, Alexis A. Eczema in skin of color: what you need to know. National Eczema Association. Published September 2, 2022. Accessed May 15, 2023. https://nationaleczema.org/blog/eczema-in-skin-of-color/
UC San Diego Health. Anatomy of the skin. Reviewed April 1, 2023. Accessed May 15, 2023. https://myhealth.ucsd.edu/Search/85,P01336
Ständer S. Atopic dermatitis. N Eng J Med. 2021;384:1136-1143. doi:10.1056/NEJMra2023911
Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers. 2018;4:1-20. doi:10.1038/s41572-018-0001-z
National Eczema Association. Eczema causes and triggers. Accessed May 15, 2023. https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/