What Is Atopic Dermatitis (Eczema)?

Medically Reviewed by Poonam Sachdev on July 24, 2024
Written by Lori M. King, PhD
11 min read

Eczema is a group of medical conditions that cause inflammation in your skin. There are several types of eczema, with atopic dermatitis being the most common type.

Atopic dermatitis is a long-term (chronic) condition that causes inflammation and irritation of your skin. While it usually begins in childhood, it can start at any age. And since it's a long-term condition, it may go away for a while and then return.

There are two types of atopic dermatitis:

Extrinsic. This type is triggered by allergies. If you have this type, your doctor will find high levels of antibodies in your blood. Also, you will likely have other people in your family with atopic dermatitis. This is the most common type; about 73%-88% of people with atopic dermatitis have this type.

Intrinsic. This is not caused by allergies. Your doctor probably won't be able to find antibodies in your blood. This is less common; only about 12%-27% of people with atopic dermatitis have this type.

Atopic eczema vs. contact dermatitis

Both atopic dermatitis and contact dermatitis are types of eczema. The symptoms are very similar, and it can be hard to tell them apart. But atopic dermatitis is usually caused by a combination of factors, such as your genes, your immune system, and your environment. Most people with atopic dermatitis get it first when they are kids and they may also have hay fever or asthma. They may get symptoms anywhere on their skin or scalp, and they'll likely have flare-ups throughout their life.

In contrast, contact dermatitis is caused by irritation or allergy to something specific. So, you will usually have symptoms only where the irritant or allergen touches your skin. The symptoms tend to go away once you figure out what's irritating your skin and stop using it. You may have a rash with clear borders, especially if an irritant is causing your problems. Most people get contact dermatitis for the first time as adults.

The most common symptom of atopic dermatitis is itching, which can be severe. You may also have:

  • Red and dry patches of skin. If you have a darker skin tone, you may have darker or lighter patches where you have skin inflammation. 
  • Rashes that may bleed when scratched, release clear fluid, or ooze.
  • Thickened, discolored, and hardened skin caused by repeated scratching.

View a slideshow to see what eczema looks like.

You may get flare-ups in multiple places at once, or in the same or new places over time. How the rashes look and where they appear tends to vary by age.

Other symptoms include:

  • An extra fold of skin under your eye, known as a Dennie-Morgan fold
  • Darkening of the skin under your eyes
  • Extra skin creases on the palms of your hands and soles of your feet

Atopic dermatitis is a chronic condition, which means it lasts a long time. It may flare up and then go away for a while before it comes back. Most people will have their first signs of eczema between the ages of 2 months and 5 years. For many people who develop it as a child, it goes away when they're teenagers. But some people will have it for life.

Many people with atopic dermatitis also have other medical conditions, such as:

  • Asthma and allergies, including food allergies
  • Other skin conditions
  • Depression or anxiety
  • Trouble sleeping

What does baby eczema look like?

Infants and children up to 2 years old typically get a rash with bumps and swollen skin that may ooze or crust. It's commonly found on their

  • Face
  • Scalp
  • Skin around joint folds where the skin touches

Babies with lighter skin tones may have a pink or red rash. Babies with darker skin tones may have dark brown, gray, or purple rashes with small bumps and extremely dry skin.

Atopic dermatitis rash patterns in children

Children aged two and older, including teenagers, typically have a thickened rash, which may ooze or bleed on their:

  • Bends of their elbows and knees
  • Neck
  • Ankles

Atopic dermatitis rash patterns in teens and adults

Teens and adults will typically have a scaly red or dark brown rash, which may bleed and crust over on their:

  • Hands
  • Knees
  • Bends of their elbows and knees
  • Skin around the eyes
  • Ankles and feet

Scalp atopic dermatitis symptoms

Atopic dermatitis can affect your scalp at any age. Your scalp may be itchy, dry, and inflamed. Your scalp may become infected, especially if you scratch it and break the skin.

When you have atopic dermatitis, changes in the protective layer of your skin can make it lose moisture more quickly than usual. This makes your skin dry and leads to damage and inflammation in your skin. New research suggests that this inflammation triggers itchy sensations, making you want to scratch. Scratching causes further damage to your skin and an increased risk for bacterial infection. However, doctors aren't sure what starts the whole process that causes your skin to lose moisture.

It's likely caused by several different factors, including:

Your genes. Atopic dermatitis tends to run in families. Researchers have found some changes to genes that help your body maintain a healthy layer of skin. Without the normal levels of this protein, your skin barrier changes, which makes your skin lose moisture. This makes your skin's immune system more vulnerable to pollutants, irritants, and allergens in your environment. About 70% of people with atopic dermatitis have close relatives either with atopic dermatitis or asthma and hay fever.

Your environment. Pollutants, irritants, and allergens in your environment can further make changes in your skin's moisture levels. Such factors may include:

  • Air pollutants, such as tobacco smoke
  • Irritants, such as fragrances in your skin care products
  • Allergens in your environment, such as dust mites

Also, if you live in the city or a dry or cooler climate, you may have an increased risk of developing atopic dermatitis.

Your immune system. Sometimes, your immune system becomes confused and overactive. This can make the inflammation in your skin worse.

Atopic dermatitis isn't contagious. You can't catch it or give it to someone else. Learn more about the causes of atopic dermatitis.

Is atopic dermatitis an autoimmune condition?

The answer to this question is complicated because some experts say it is and some say it isn't. However, the current expert consensus is that it is not an autoimmune condition.

Your immune system does play a role in your development of atopic dermatitis. We know this because suppressing your immune system can help relieve your symptoms. But your immune system isn't the only factor that contributes to your condition. In atopic dermatitis, your immune system doesn't attack a specific target in your body. In contrast, with type 1 diabetes, which is an autoimmune condition, your immune system cells specifically attack the insulin-producing cells of your pancreas. Atopic dermatitis seems more like an immune system malfunction rather than an "immunity" to your own tissues.

Triggers vary between people. But common triggers include:

  • Irritants, such as soaps and detergents, including shampoo, dish-washing liquid, and bubble bath
  • Environmental factors, such as cold, dry, or damp weather
  • Exposure to allergens, such as dust mites, animal dander, pollen, or mold
  • Food allergies, such as allergies to cow's milk, eggs, soy, peanuts, and wheat
  • Wool or synthetic materials worn close to your skin
  • Hormonal changes. People who are assigned female at birth (AFAB), for instance, may have worse symptoms during pregnancy or right before their period
  • Skin infections

View a slideshow to see top eczema triggers to avoid.

Some people also say their symptoms get worse when they're:

  • In dry or dusty air
  • Stressed
  • Sweaty
  • Too hot
  • Too cold

If your doctor thinks you may have atopic dermatitis, they’ll usually start by asking you about your medical history and doing a physical exam of your rash and the rest of your skin.

In particular, they will likely ask about:

  • Your family history of allergies
  • Your personal history of hay fever, asthma, or food allergies
  • Any foods that seem to trigger hives
  • Exposure to irritants, such as soaps and detergents, perfumes, cosmetics, and tobacco smoke
  • Previous treatments for skin-related symptoms
  • Use of steroids or other medications
  • Sleep problems

Your doctor may also suggest testing with blood tests or a skin biopsy. Learn more about how atopic dermatitis is diagnosed.

Your doctor will work with you to develop a treatment plan based on:

  • The location and type of your rash, including how itchy it is
  • What triggers your flare-ups
  • How your skin responds to certain treatments

Treatments may include:

Medications, such as:

  • Steroid creams and ointments that help reduce inflammation of your skin
  • Calcineurin inhibitor creams and ointments to reduce inflammation and help prevent flares
  • Phosphodiesterase-4 inhibitor creams, which can help control inflammation if your symptoms don't respond to other treatments
  • Oral medicines such as Janus kinase (JAK) inhibitors, which stop your skin cells from sending out signals that cause inflammation
  • Injectable biologic medications to block some immune system functions and help control your symptoms

Skin care recommendations, such as:

  • Particular moisturizing skin creams to help restore your skin's protective barrier
  • A regimen of applying moisturizing creams right after your bath to help hold the moisture in your skin
  • If your doctor says it's okay, a diluted bleach bath twice per week or wet wrap therapy. Follow your doctor's advice because you can make your symptoms worse if you dry your skin out too much.

Phototherapy for people with severe or widespread rashes that don't respond to other medicines or skin care regimens. Phototherapy is treatment with ultraviolet A or B light.

If you develop an infection from scratching, your doctor may also prescribe antihistamines to control itching and antibiotics to treat the infection.

You can't cure eczema, but your doctor may suggest some medication for your symptoms. These might include steroid creams or ointments for mild flares or steroid pills for more severe cases.

You can do a few things at home to help control your flares, such as:

Take good care of your skin, including:

  • Only take one bath or shower a day, and use lukewarm water to keep from drying your skin out too much.
  • When you bathe, use mild, unscented bar soap or non-soap cleanser.
  • Pat your skin dry after bathing (in particular, avoid rubbing or brisk drying), and don't allow it to get too dry before moisturizing. Avoid scratching, which further irritates your skin.
  • Use a moisturizer to seal in the moisture your skin absorbs when you bathe. Avoid lotions with high water or alcohol content. Instead, use cream and ointments, which are thicker and better at locking in moisture than lotions.
  • Protect your skin from irritants and rough clothing, such as wool.

Manage your stress levels

Use stress management and relaxation techniques to help lower your stress level. This can reduce the likelihood of having a flare. Lean on your family, friends, medical team, and support groups or organizations when you need to help manage your stress levels.

Maintain a level indoor temperature

Keep your home at a cool, stable temperature and consistent humidity levels. You want to avoid situations where you may become overheated. This may help prevent flares.

Take steps to get restful sleep

If you or your child have trouble sleeping because of itching and scratching, talk to your doctor about options to better control your symptoms. For instance, you may need to take an antihistamine before bed to calm your itching so you can rest.

People with atopic dermatitis may develop other, related medical conditions, such as skin infections and psychological complications.

Skin infections

Atopic dermatitis can cause your skin to become cracked and broken. This increases the risk that you will get an infection with bacteria or viruses. If you scratch a lot, your risk of getting an infection is higher.

What is atopic dermatitis eczema herpeticum?

This is when you get infected with herpes simplex virus (HSV), which causes cold sores, through breaks in your skin. Symptoms include:

  • Painful patches of eczema that may get worse very quickly
  • Groups of fluid-filled blisters that break open and leave small, shallow open sores on your skin
  • Fever and chills, and a general feeling of being unwell

If you think you have eczema herpeticum, go see your doctor as soon as possible. It can be a very serious infection. You will need to get a prescription for an antiviral medicine, such as aciclovir, to treat it.

Psychological complications

  • Teasing and bullying. Children with atopic dermatitis may get teased or bullied over their skin condition. This can make school very difficult for them and may negatively affect their self-esteem.
  • Falling self-confidence. Both adults and children can have negative impacts on their self-confidence from skin conditions. But it can be particularly bad for children. This can make it hard for them to socialize.
  • Trouble sleeping. This can make it hard to concentrate and may negatively affect your or your child's moods and behavior.

If you have negative psychological complications from your atopic dermatitis, talk to your doctor. They may suggest you go for counseling or join a support group.

Read more on the complications of eczema.

You can’t really prevent atopic dermatitis, but you can take steps to reduce your risk of flare-ups, such as:

Avoid your triggers. Figure out what triggers your flare-ups and try to avoid them. Your doctor can help you figure out strategies for this.

Take care of your skin. It's key to keep your skin moisturized. 

When you bathe, use warm, not hot, water. Use mild soaps or non-soap cleaners, such as castile bar soaps. Avoid deodorant or antibacterial soaps because these can really dry your skin out. If you're taking a bath, try using some colloidal oatmeal to help lock moisture in your skin and soothe inflamed, itchy skin. Colloidal oatmeal is finely ground oatmeal made specifically for bathing. Soak for less than 10 minutes, then pat dry. 

Apply moisturizer while your skin is still damp (within 3 minutes after you get out of the bath or shower). Moisturize at least twice daily with creams, oils, sprays, ointments, or a combination of these. Look for products that have no perfumes or dyes that could irritate your skin.

Know more about how to prevent atopic dermatitis flare-ups.

In addition to avoiding your triggers and taking good care of your skin, here are some self-care tips for living with atopic dermatitis:

  • Keep your or your child's nails short and smooth to prevent from tearing your skin if you scratch. You can also try wearing cotton gloves at night if you can't keep yourself from scratching while you sleep.
  • Use a humidifier in your house, especially in the winter, when indoor heating can make the air really dry and dehydrating.
  • Use laundry detergent for people with sensitive skin. Also, avoid using fabric softener and dryer sheets, which can fill your clothes with irritants.
  • Buy clothes without tags or cut tags out of your clothes.
  • Wash new clothes before you wear them. New clothes often have fabric finishers and dyes that can irritate your skin.

Atopic dermatitis is the most common form of eczema. It causes inflammation and irritation of your skin. The most common symptom of atopic dermatitis is severe itching, but you may also have dry skin, red, dark, or pale patches of skin, and thickened, discolored, and hardened skin from scratching. It's not an autoimmune condition, but most people with it have a family history of the condition, as well as exposure to irritants, allergens, or pollution. One of the best ways to care for yourself is to know what triggers your flares and avoid these things. Also, keep your skin moisturized with dye-free, fragrance-free creams and ointments.

How can atopic dermatitis be cured?

There's currently no cure for atopic dermatitis. Some people who get it when they're children grow out of it eventually, and sometimes it gets less severe over time. Managing your symptoms can decrease the severity of your flares. For instance, moisturizing your skin twice a day with non-irritating creams and ointments can go a long way in reducing the number of flare-ups you get.