No one likes having dry, scaly, or itchy skin. And though it may seem like a problem that comes and goes, perhaps with cold or dry weather, or simply a sign for the need to moisturize, it may also be a sign of a medical condition called atopic dermatitis.
Atopic dermatitis is the most common type of eczema. More than 30 million Americans have some form of eczema, which can cause skin to become dry, red, and itchy. Eczema is a broad term that healthcare providers use to describe a general group of conditions that may cause red, inflamed, and itchy skin. Atopic dermatitis—considered a severe form of eczema—is a chronic (long-lasting), non-contagious inflammatory skin disease marked by periodic flares. It is characterized by significant itching that can be worse at night and disrupt sleep.
Atopic dermatitis causes patches of rash commonly located on the face, inside the elbows and behind the knees, and on the hands and feet, but it can appear anywhere on the body. And while there is no cure for the condition, atopic dermatitis can be managed with treatment and lifestyle changes.
Who gets it?
Atopic dermatitis most often occurs in babies and children. Childhood atopic dermatitis may go away or improve with age, but in some cases the condition persists into adulthood. It’s rare for an adult to get atopic dermatitis. In fact, 90% of people get it before the age of 5.
Though its cause is not fully understood, the condition may run in families. It also may be seen in those who suffer from asthma or hay fever or in those who have family members who have these conditions.
The signs of atopic dermatitis may look different in infants, children and adults, and may affect various parts of your body from time to time. It is common to see a rash or patches of skin that look red, raised, or open and oozing with crusting sores on the skin.
Infants up to 6 months old tend to initially get patches on the face, cheeks, chin, forehead, and scalp. In babies 6 to 12 months old, patches frequently appear on the elbows and knees. You may notice them rubbing against bedding or carpeting to scratch the itch.
In toddlers 2 to 5 years old, patches may appear in the creases of the elbows and knees, or on the wrists, ankles, and hands. They can also appear on the skin around the mouth and eyelids.
Children 5 years and older may have patches in the folds of the knees or elbows. There may also be red, itchy patches behind the ears or on the feet. In some children, patches appear only on the hands. In some children, atopic dermatitis may seem to go away for a period of time, only to come back later in life when hormones, stress, or the use of irritating skin care products or cosmetics may cause the disease to flare again.
In adults, atopic dermatitis may look different from childhood atopic dermatitis. Rashes are often seen in the elbow and knee creases as well as the neck. The skin may be very dry, scaly, thick, and dark, and constantly itchy.
How it can impact life
One of the most bothersome symptoms of atopic dermatitis is the itch. It can be mild, moderate, or in some cases more severe. Sometimes the itch may be so bad that a person may scratch his or her skin until it bleeds. This can make the rash even worse, even leading to an increased risk of infection. This continuous circle of inflammation and itching is known as the “itch-scratch cycle.”
Itching may affect sleep for both the person with atopic dermatitis and their family members. In adults, having atopic dermatitis may lead to feelings of anger and embarrassment, disrupt their work and home lives, and limit what they can eat and drink. Children with the condition may face bullying and isolation. In addition, their symptoms can interfere with their sleep, leading to problems with their mood and overall well-being.
“One of the great challenges in people who have any skin disease is that it’s often clearly visible or difficult to conceal. It’s not like high blood pressure or heart disease, which are not readily visible on the skin or apparent to others. People with atopic dermatitis or other skin disorders also have to deal with the self-consciousness, embarrassment, or stigmatism related to the appearance of their skin.”
Mark Levenberg, DO, FAAD
How it’s diagnosed
In order to make a diagnosis of atopic dermatitis, your healthcare provider will look at your skin (or your child’s skin) and ask questions about your personal and family history. If you or a family member has atopic dermatitis, talk with a healthcare professional about a possible treatment plan. A variety of management approaches may be needed over time.
“It’s far more than just dry and itchy skin. This condition can have lasting impacts both physically and psychologically as well. It’s a complicated disease that may require a long-term approach to management and significant patient education. When patients are fully educated on their disease itself and treatment options, only then can they make the most informed treatment decisions for their benefit. Having an ongoing, partnership with a physician is very important in this regard.”
Mark Levenberg, DO, FAAD
What else you can do about it
Getting the right diagnosis and discussing a management plan with a healthcare provider is key to managing atopic dermatitis. Good skin care is also important to help manage atopic dermatitis. Here are some things you can do to take care of your skin to help manage the condition:
- Wear soft, breathable clothing and avoid itchy fabrics like wool.
- To help reduce dryness, apply a moisturizer to damp skin immediately after bathing; short, cooler baths are better than long, hot ones.
- Keep your fingernails short and cover your hands during sleep to avoid scratching your rash and skin. This may help decrease the chance of infections caused by scratching.
- Avoid detergents with fragrances, as well as chemicals and solvents; use non-soap liquid cleansers instead of regular soap.
- Watch for signs of infection.
It’s also important to talk with your healthcare provider to help identify triggers for atopic dermatitis that may affect you. It can also be helpful to get support from others who are living with atopic dermatitis.
Dr. Mark Levenberg is a Board-certified Dermatologist and Medical Director in US Medical Affairs at Pfizer Inc.