Atopic Dermatitis/Eczema
What is Atopic Dermatitis/Eczema?
Atopic dermatitis is a chronic inflammatory skin condition that causes red, itchy, and dry patches. It is also known as eczema, though eczema can describe several types of skin inflammation. Atopic dermatitis affects the skin barrier, which normally protects against irritants, allergens, and moisture loss. When this barrier breaks down, the skin becomes vulnerable to infection and inflammation.
This condition often begins in childhood but can persist or develop in adulthood. It typically affects the hands, feet, face, and the folds of the elbows and knees. Many people with atopic dermatitis also have other atopic conditions like asthma, hay fever, or food allergies. These conditions share a common thread of immune system overreaction.
Atopic dermatitis results from a combination of genetic factors, immune dysfunction, and environmental triggers. The immune system releases inflammatory chemicals that damage skin cells and cause itching. Understanding the root causes through testing can help identify what drives inflammation in your body. This knowledge makes it possible to address triggers rather than just treating symptoms.
Symptoms
- Intense itching, especially at night
- Red or brownish patches on skin
- Dry, cracked, or scaly skin
- Small raised bumps that may leak fluid when scratched
- Thickened or leathery skin from repeated scratching
- Raw or sensitive skin from scratching
- Skin infections from bacteria entering broken skin
- Sleep problems due to itching
Symptoms can flare up for weeks or months and then improve. Some people experience mild symptoms while others have severe flares that affect daily life. Children may develop symptoms on the face and scalp first.
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Causes and risk factors
Atopic dermatitis develops when the skin barrier does not function properly. This can result from genetic variations that affect skin proteins like filaggrin. When the barrier is weak, moisture escapes and irritants enter more easily. The immune system then overreacts to these triggers, releasing inflammatory chemicals that worsen the condition. Imbalances in fatty acids like arachidonic acid can contribute to both barrier dysfunction and inflammation.
Common risk factors include family history of eczema, asthma, or allergies. Environmental triggers such as harsh soaps, fragrances, wool fabrics, dust mites, pet dander, and certain foods can cause flares. Stress, temperature changes, and sweating may also worsen symptoms. Food sensitivities, particularly to dairy, eggs, nuts, and wheat, can trigger inflammation in some people. Understanding your personal triggers helps you avoid flares and manage the condition better.
How it's diagnosed
Doctors diagnose atopic dermatitis primarily through physical examination and medical history. They look for characteristic rash patterns and ask about symptom timing and triggers. There is no single definitive test, but blood work can reveal underlying inflammation and nutrient imbalances that contribute to the condition.
Blood tests measuring fatty acid balance, including arachidonic acid, help identify inflammation patterns in your body. Arachidonic acid is a fatty acid that affects both skin barrier health and inflammatory responses. Testing this marker can reveal imbalances that drive skin inflammation. Rite Aid offers add-on testing for arachidonic acid at Quest Diagnostics locations nationwide. This testing helps you understand the root causes driving your skin condition rather than just treating surface symptoms.
Treatment options
- Moisturize skin multiple times daily with fragrance-free creams or ointments
- Use gentle, fragrance-free cleansers and avoid hot water
- Apply topical corticosteroids during flares to reduce inflammation
- Try topical calcineurin inhibitors for sensitive areas like the face
- Take antihistamines to reduce itching, especially at night
- Address fatty acid imbalances through diet or supplementation
- Identify and avoid personal triggers like certain foods or fabrics
- Use wet wrap therapy for severe flares
- Consider phototherapy for moderate to severe cases
- Try biologic medications if other treatments fail
- Manage stress through meditation, exercise, or counseling
- Keep nails short to minimize skin damage from scratching
Need testing for Atopic Dermatitis/Eczema? Add it to your panel.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
Eczema is a general term for several types of skin inflammation. Atopic dermatitis is the most common type of eczema. The terms are often used interchangeably, though eczema can also refer to contact dermatitis, dyshidrotic eczema, and other conditions. Atopic dermatitis specifically involves immune system dysfunction and often runs in families with allergies or asthma.
Blood tests alone cannot diagnose atopic dermatitis, but they reveal underlying inflammation and imbalances. Testing arachidonic acid levels helps identify fatty acid imbalances that contribute to skin barrier problems and inflammation. These insights guide treatment by addressing root causes. Your doctor makes the diagnosis based on symptoms, physical exam, and lab results together.
Flares happen when triggers irritate already sensitive skin or activate the immune system. Common triggers include dry air, harsh soaps, fragrances, wool or synthetic fabrics, dust mites, and pet dander. Stress, sweating, temperature changes, and certain foods can also cause flares. Tracking your symptoms helps identify your personal triggers so you can avoid them.
No, atopic dermatitis is not contagious. You cannot catch it from someone else or spread it through contact. However, scratched skin can become infected with bacteria like staph, which can spread. The condition results from genetic factors and immune dysfunction, not from germs that pass between people.
Arachidonic acid is a fatty acid that plays two roles in atopic dermatitis. Your body needs it to build healthy cell membranes, including skin cells. However, too much arachidonic acid gets converted into inflammatory chemicals that worsen eczema symptoms. Testing helps determine if you have an imbalance that needs addressing through diet or supplements.
Diet changes help some people with atopic dermatitis reduce inflammation and flares. Common trigger foods include dairy, eggs, nuts, soy, and wheat, though triggers vary by person. Balancing omega-3 and omega-6 fatty acids may reduce inflammation. An elimination diet under medical guidance can help identify your specific food triggers.
Many children see improvement or complete resolution as they grow older. About half of children with atopic dermatitis improve significantly by their teen years. However, some people continue to have symptoms into adulthood or develop milder symptoms later. Early management and trigger avoidance may improve long-term outcomes.
See a doctor if over-the-counter treatments do not help within a few weeks. Seek immediate care if you notice signs of infection like increased redness, warmth, pus, fever, or red streaks spreading from the rash. Also see a doctor if eczema interferes with sleep or daily activities. Blood testing can reveal underlying imbalances driving your symptoms.
Topical steroids are safe when used correctly under medical guidance. Use the lowest strength that controls your symptoms and apply only during flares. Prolonged use of strong steroids can thin the skin or cause other side effects. Your doctor can recommend a treatment plan that balances effectiveness with safety, including steroid-free options for maintenance.
Yes, stress is a common trigger for atopic dermatitis flares. Stress hormones can activate immune cells and increase inflammation in the body. This creates a cycle where eczema causes stress, which then worsens the eczema. Managing stress through relaxation techniques, exercise, adequate sleep, and counseling can help reduce flare frequency and severity.