Atopic dermatitis, often referred to as eczema, is a chronic (long-lasting) disease that causes inflammation, redness, and irritation of the skin. It is a common condition that usually begins in childhood; however, anyone can get the disease. Atopic dermatitis is not contagious, so it cannot be spread from person to person.

Atopic dermatitis causes the skin to become extremely itchy. Scratching leads to further redness, swelling, cracking, “weeping” clear fluid, crusting, and scaling. In most cases, there are periods of time when the disease is worse, called flares, followed by periods when the skin improves or clears up entirely, called remissions.

Researchers do not know what causes atopic dermatitis, but they do know that genes, the immune system, and the environment play a role in the disease. Depending on the severity and location of the symptoms, living with atopic dermatitis can be hard. Treatment can help control symptoms. For many people, atopic dermatitis improves by adulthood, but for some, it can be a lifelong illness.

Atopic dermatitis (also known as atopic eczema) is a disorder characterized by inflammation of the skin (dermatitis). The condition usually begins in early infancy, and it often disappears before adolescence. However, in some affected individuals the condition continues into adulthood; in others, it does not begin until adulthood. Hallmarks of atopic dermatitis include dry, itchy skin and red rashes that come and go. The rashes can occur on any part of the body, although the pattern tends to be different at different ages. In affected infants, the rashes commonly occur on the face, scalp, hands, and feet. In children, the rashes are usually found in the bend of the elbows and knees and on the front of the neck. In adolescents and adults, the rashes typically occur on the wrists, ankles, and eyelids in addition to the bend of the elbows and knees. Scratching the itchy skin can lead to oozing and crusting of the rashes and thickening and hardening (lichenification) of the skin. The itchiness can be so severe as to disturb sleep and impair a person's quality of life.

The word "atopic" indicates an association with allergies. While atopic dermatitis is not always due to an allergic reaction, it is commonly associated with other allergic disorders: up to 60 percent of people with atopic dermatitis develop asthma or hay fever (allergic rhinitis) later in life, and up to 30 percent have food allergies. Atopic dermatitis is often the beginning of a series of allergic disorders, referred to as the "atopic march." Development of these disorders typically follows a pattern, beginning with atopic dermatitis, followed by food allergies, then hay fever, and finally asthma. However, not all individuals with atopic dermatitis will progress through the atopic march, and not all individuals with one allergic disease will develop others.

Individuals with atopic dermatitis have an increased risk of developing other conditions related to inflammation, such as inflammatory bowel disease, rheumatoid arthritis, and hair loss caused by a malfunctioning immune reaction (alopecia areata). They also have an increased risk of having a behavioral or psychiatric disorder, such as attention-deficit/hyperactivity disorder (ADHD) or depression.

In a particular subset of individuals with atopic dermatitis, the immune system is unable to protect the body from foreign invaders such as bacteria and fungi (which is known as immunodeficiency). These individuals are prone to recurrent infections. Most also have other allergic disorders, such as asthma, hay fever, and food allergies.

Atopic dermatitis can also be a feature of separate disorders that have a number of signs and symptoms, which can include skin abnormalities and immunodeficiency. Some such disorders are Netherton syndrome; immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome; and severe dermatitis, multiple allergies, metabolic wasting (SAM) syndrome.

Atopic dermatitis is a common disorder that affects 10 to 20 percent of children and 5 to 10 percent of adults.

You’ve probably had a rash at some point or another, whether from poison ivy or the chickenpox or something more unusual. Why does your skin break out in red blotches like that? More important, is there anything you can do about it?

We often think of the skin as a barrier—it keeps the insides of our bodies in, and it keeps the outside world out. But our skin is also filled with special cells of the immune system. These cells protect the skin and body against viruses, bacteria and other threats. Whenever these cells detect a suspicious substance, they begin a chain reaction in the skin that leads to inflammation. The medical name for this reaction is dermatitis. But it’s more commonly known as a rash.

There are many different types of dermatitis, and each has a distinct set of treatments. Sometimes the skin’s immune cells react to something that directly touches the skin. Other times, the immune system flares in the skin because of a whole-body infection or illness.

The symptoms of these different types of rashes often overlap. “Itching is a common symptom for all these problems,” says Dr. Stephen I. Katz, director of NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases. Many rashes are red, painful, and irritated. Some types of rash can also lead to blisters or patches of raw skin. While most rashes clear up fairly quickly, others are long lasting and need to be cared for over long periods of time.

Eczema, or atopic dermatitis, is a dry, red, itchy rash that affects up to 1 in 5 infants and young children. It often improves over time, although it can last into adulthood or start later in life. In this condition, the water-tight barrier between skin cells gets weak, which lets moisture out and other things in. That’s why people with atopic dermatitis have to moisturize their skin, and they’re more susceptible to skin infections.

Researchers have recently identified specific genes that are involved in maintaining the skin barrier. People with certain versions of these genes are more likely to get atopic dermatitis.

“The skin is the outermost sentinel for fighting off bacteria and noxious agents,” says Katz. “If the barrier is broken somehow, you can become more allergic to things.”

A skin allergy, or allergic contact dermatitis, produces a red, itchy rash that sometimes comes with small blisters or bumps. The rash arises when the skin comes in contact with an allergen, a usually harmless substance that the immune system attacks. Allergens trigger allergic reactions. Allergens can come from certain soaps, creams and even pets.

Your immune system might not react the first time you encounter an allergen. But over time, your immune system can become sensitive to the substance. As a result, your next contact may lead to inflammation and an allergic rash.

“The most common form of dermatitis that is seen anywhere is an allergic contact dermatitis to nickel,” says Katz. “Why? Because of ear piercing.” Many inexpensive earrings are made of nickel, and over time, wearing nickel earrings can cause an allergic reaction to the metal.

Other common causes of allergic dermatitis are poison oak and poison ivy. The stems and leaves of these plants produce a chemical that’s likely to cause allergies. If you touch one of them, wash your skin as soon as possible. The chemical can also remain in clothing for a long time, so it’s important to wash any clothes or shoes—or even pets—that come into contact with these plants.

Mild cases of allergic contact dermatitis usually disappear after a few days or weeks. But if the rash persists, is extremely uncomfortable or occurs on the face, it’s important to see a physician. A doctor can prescribe medications that will tone down the immune reaction in the skin. This eases swelling and itching and will protect your eyes and face.

The immune cells of the skin can also produce rashes when they react to invading germs—like bacteria, fungi and viruses. Bacterial and viral infections within your body can cause your skin to break out in spots as well. The chickenpox virus, for example, can cause itchy spots in children. Years later, in older adults, the same virus may reappear as shingles, bringing a painful rash and high fever. Vaccines can prevent several rash-causing diseases, including chickenpox, shingles and measles.

Certain drugs, including antibiotics like amoxicillin, may also cause itchy skin rashes. If you’re allergic to a drug, a rash can be the first sign of a serious reaction. As with other allergies, a reaction to a drug may not occur the first time you take it. It could show up after several uses. Not all drug rashes are due to an allergy, however. If you break out in itchy spots after starting a new drug prescription, contact your doctor right away.

While most rashes get better with time, some can last a lifetime. Psoriasis, a condition where skin cells build up into thick red patches, tends to run in families. “It’s a complex genetic disease, in that there’s not one gene that causes psoriasis but many,” says Katz. Even though none of these genes alone has a great effect on the disease, knowing which genes are involved can help researchers design potential new treatments. Other long-term diseases that can produce rashes include autoimmune diseases, such as lupus, and some forms of cancer.

If you notice an itchy or painful rash on your skin, think twice before going to the drugstore and getting some cream if you don’t know the cause. “The creams that you buy can produce problems that make your original problem even worse,” Katz says. Because rashes can be caused by many different things—bacteria, viruses, drugs, allergies, genetic disorders, and even light—it’s important to figure out what kind of dermatitis you have.

“If you have any significant rash, you should see a dermatologist,” says Katz. A dermatologist, or skin doctor, is specially trained to figure out what’s causing a rash and help you get the right treatment.

Your skin is your protection. It’s not just the covering that keeps your body in; it’s also your first line of defense against germs and chemicals. Take care of your skin so your skin can take care of you.

Call Your Doctor If …

• Your rash is so uncomfortable or painful it interferes with daily activities or sleep.
• The rash is on your face.
• Your rash looks worrisome or seems infected.
• You break out in a rash after taking a new medication.
• Your rash lasts for several days.

Atopic dermatitis is a common disease and usually appears during infancy and childhood. For many children, atopic dermatitis goes away before the teenage years. However, some children who develop atopic dermatitis may continue to have symptoms as teens and adults. Occasionally, for some people, the disease first appears during adulthood.

The chance of developing atopic dermatitis is higher if there is a family history of atopic dermatitis, hay fever, or asthma. In addition, research shows that atopic dermatitis is more common in non-Hispanic black children and that women and girls tend to develop the disease slightly more often than men and boys.

No one knows what causes atopic dermatitis; however, researchers know that changes in the protective layer of the skin can cause it to lose moisture. This can cause the skin to become dry, leading to damage and inflammation in the skin. New research suggests that inflammation directly triggers sensations of itch which in turn cause the patient to scratch. This leads to further damage of the skin as well as increased risk for infection with bacteria.

Researchers do know that the following may contribute to the changes in the skin barrier, which critically regulates moisture:

• Changes (mutations) in genes.
• Problems with the immune system.
• Exposure to certain things in the environment.

Genetics

The chance of developing atopic dermatitis is higher if there is a family history of the disease, which suggests that genetics may play a role in the cause. Recently, researchers found changes to genes that control a specific protein and help our bodies maintain a healthy layer of skin. Without the normal levels of this protein, the skin barrier changes, allowing moisture to escape and exposing the skin immune system to the environment, leading to atopic dermatitis.

Researchers continue to study genes to better understand how different mutations cause atopic dermatitis.

Immune System

The immune system normally helps to fight off illness, bacteria, and viruses in your body. Sometimes, the immune system becomes confused and overactive, which can create inflammation in the skin, leading to atopic dermatitis.

Environment

Environmental factors may trigger the immune system to change the protective barrier of the skin allowing more moisture to escape, which can lead to the atopic dermatitis. These factors may include:

• Exposure to tobacco smoke.
• Certain types of air pollutants.
• Fragrances and other compounds found in skin products and soaps.
• Excessively dry skin.

The genetics of atopic dermatitis are not completely understood. Studies suggest that several genes can be involved in development of the condition. In very rare cases, atopic dermatitis is caused by inherited mutations in a single gene. One such gene is the CARD11 gene. The protein produced from this gene turns on signaling pathways involved in the development and function of immune system cells called lymphocytes. Mutations in the CARD11 gene lead to production of an altered CARD11 protein that does not function normally. These changes impair pathway signaling, and as a result, certain lymphocytes called T cells do not develop or function properly. The number of these cells is normal, but their response to foreign invaders such as bacteria and fungi is diminished. The T cell abnormalities lead to a weakened immune system and recurrent infections, which are common in people with CARD11-associated atopic dermatitis.

It is not clear how the immune dysfunction caused by CARD11 gene mutations leads to skin rashes and allergic disorders in affected individuals. Atopic dermatitis is not initially caused by an allergic reaction, although sometimes substances that can cause allergic reactions (allergens) are thought to contribute to flare-ups of the rashes.

In contrast to rare cases caused by CARD11 gene mutations, most cases of atopic dermatitis are thought to occur due to a combination of genetic and environmental factors (such as living with a pet). Several common genetic variations may be involved, each contributing only a small amount to the risk of developing atopic dermatitis. The strongest of these associations is with the FLG gene, which is altered in 20 to 30 percent of people with atopic dermatitis compared with 8 to 10 percent of the general population without atopic dermatitis.

The FLG gene provides instructions for making a protein called profilaggrin, which is important for the structure of the outermost layer of skin. Proteins derived from profilaggrin help create a strong barrier to keep in water and keep out foreign substances, including toxins, bacteria, and allergens. These proteins also are part of the skin's "natural moisturizing factor," which helps maintain hydration of the outermost layer of skin.

Variations in the FLG gene lead to production of an abnormally short profilaggrin protein that cannot be processed to produce the other profilaggrin-related proteins. The resulting shortage can impair the barrier function of the skin. Impairment of the skin's barrier function contributes to development of allergic disorders, including atopic dermatitis. Research suggests that without a properly functioning barrier, allergens are able to get into the body through the skin, triggering a reaction. In addition, a lack of natural moisturizing factor allows excess water loss through the skin, which can lead to dry skin.

Variations in many other genes are likely associated with development of atopic dermatitis, although most of these genes have not been identified or definitively linked to the disorder. Researchers suspect these genes are involved in the skin's barrier function or in the function of the immune system. However, not everyone with a mutation in FLG or another risk-associated gene develops atopic dermatitis; exposure to certain environmental factors also contributes to the development of the disorder. Studies suggest that these exposures trigger epigenetic changes to the DNA. Epigenetic changes modify DNA without changing the DNA sequence. They can affect gene activity and regulate the production of proteins, which may influence the development of allergies in susceptible individuals.

Syndromes with atopic dermatitis as one of several features are caused by mutations in other genes.

Normal Function

The CARD11 gene provides instructions for making a protein involved in the function of immune system cells called lymphocytes, particularly certain types called T cells and B cells. These cells identify foreign substances such as bacteria, viruses, and fungi and defend the body against infection. When T or B cells recognize a foreign substance, the CARD11 protein is turned on (activated) and attaches (binds) to two other proteins, BCL10 and MALT1, to form the CBM signalosome complex. This complex in turn activates other protein complexes called nuclear factor-kappa-B (NF-κB) and mTOR complex 1 (mTORC1), which are important for cellular signaling. NF-κB and mTORC1 signaling direct the development and function of T and B cells so they can support an immune response against foreign invaders.

Health Conditions Related to Genetic Changes

Atopic dermatitis

At least five CARD11 gene mutations have been identified in people with a skin disorder called atopic dermatitis (also known as atopic eczema). This condition is characterized by dry, itchy skin and red rashes. The word "atopic" indicates an association with allergies. While atopic dermatitis is not always due to an allergic reaction, it is commonly associated with other allergic disorders. People with atopic dermatitis caused by CARD11 gene mutations often have additional allergic disorders, such as asthma and environmental (such as pollen) or food allergies. Many of these individuals also have recurrent infections due to problems with the immune system (immunodeficiency).

Atopic dermatitis is generally thought of as a complex condition that is influenced by multiple genetic and environmental factors, which each contribute only a small amount to the overall risk of developing the condition. However, CARD11 gene mutations appear to cause atopic dermatitis without other factors. These mutations likely account for only a small percentage of cases of the condition.

A mutation in one of the two copies of the CARD11 gene in each cell is sufficient to cause atopic dermatitis. These mutations result in the production of an altered protein that does not function normally. The altered protein produced from the mutated copy of the gene interferes with the normal protein produced from the non-mutated copy of the gene (such mutations are described as "dominant-negative"), so the amount of functioning CARD11 protein in cells is reduced. These genetic changes are thought to prevent formation of the CBM signalosome complex, impairing signaling by NF-κB and mTORC1. Without these signals, T cells do not develop or function properly. The number of these cells is normal, but their response to foreign invaders is diminished, leading to recurrent infections.

It is not clear how the immune dysfunction caused by CARD11 gene mutations leads to atopic dermatitis and allergic disorders. Atopic dermatitis is not initially caused by an allergic reaction, although sometimes substances that can cause allergic reactions (allergens) are thought to contribute to flare-ups of the rashes.

Omenn syndrome

MedlinePlus Genetics provides information about Omenn syndrome

Other disorders

CARD11 gene mutations can cause other immune system disorders. At least 3 mutations in the gene have been found to cause a type of severe combined immunodeficiency (SCID) known as immunodeficiency 11. SCID is a group of disorders characterized by an almost total lack of immune protection from foreign invaders. Immunodeficiency 11 is characterized by recurrent severe infections in the respiratory tract, particularly pneumonia caused by a fungus known as Pneumocystis jirovecii. Immunodeficiency 11 occurs when both copies of the CARD11 gene are mutated. The mutations are described as "loss of function" because they lead to production of an abnormally short, nonfunctional CARD11 protein. The lack of CARD11 function diminishes T cells' ability to fight foreign invaders, despite normal numbers of the cells, leading to recurrent infections. Individuals with immunodeficiency 11 do not appear to have an increased risk of atopic dermatitis (described above) or allergies.

At least four mutations in the CARD11 gene cause another immune cell disorder called B-cell expansion with NF-κB and T-cell anergy (BENTA). This condition is characterized by an excess of immune system cells called B cells (B-cell lymphocytosis), an increased risk of B-cell lymphoma, and susceptibility to infection. The mutations that cause BENTA are inherited and occur in one copy of the CARD11 gene. Like those involved in B-cell and T-cell cancers (described above), the genetic changes that cause BENTA are "gain-of-function" mutations; they lead to production of an altered CARD11 protein that is always turned on, resulting in constant NF-κB signaling. Overactive NF-κB promotes the proliferation of B cells, which can lead to B-cell lymphoma. These abnormal cells, however, cannot respond to infections. T cells are also abnormal and unable to fight foreign invaders (a phenomenon known as anergy). These immune cell problems lead to the increased risk of infection in people with BENTA.

Cancers

Mutations in the CARD11 gene are also associated with cancers of B cells (primarily diffuse large B-cell lymphoma) and T cells (adult T-cell leukemia/lymphoma). These mutations are not inherited; instead, they arise during a person's lifetime and are found only in B or T cells that give rise to cancer. These genetic changes are called "gain-of-function" mutations because they lead to production of an altered CARD11 protein that is always turned on, even without recognition of foreign substances by the B or T cell. As a result, NF-κB is constantly activated. Unregulated NF-κB signaling allows these cells to grow and divide without control, contributing to the development of cancer.

Other Names for This Gene

• bcl10-interacting maguk protein 3
• BENTA
• BIMP3
• CARD-containing MAGUK protein 1
• carma 1
• CARMA1
• caspase recruitment domain-containing protein 11
• IMD11
• IMD11A
• PPBL

Genomic Location

Normal Function

The FLG gene provides instructions for making a large protein called profilaggrin, which is found in cells that make up the outermost layer of skin (the epidermis). Profilaggrin is cut (cleaved) to produce multiple copies of the filaggrin protein, which is important for the structure of the epidermis. The profilaggrin molecule can contain 10, 11, or 12 copies of the filaggrin protein, depending on the genetics of the individual. Further processing of the filaggrin protein produces other molecules that play a role in hydration of the skin.

The epidermis acts as a barrier to help minimize water loss and protect the body from foreign substances, including toxins, bacteria, and substances that can cause allergic reactions (allergens), such as pollen and dust mites. Filaggrin plays an important role in the skin's barrier function. It brings together structural proteins in the outermost skin cells to form tight bundles, flattening and strengthening the cells to create a strong barrier. In addition, processing of filaggrin proteins leads to production of molecules that are part of the skin's "natural moisturizing factor," which helps maintain hydration of the skin. These molecules also maintain the correct acidity (pH) of the skin, which is another important aspect of the barrier.

Health Conditions Related to Genetic Changes

Alopecia areata

MedlinePlus Genetics provides information about Alopecia areata

Atopic dermatitis

Mutations in the FLG gene are strongly associated with a skin disorder called atopic dermatitis (also known as atopic eczema). This condition is characterized by dry, itchy skin and red rashes. Twenty to 30 percent of people with atopic dermatitis have an FLG gene mutation compared with 8 to 10 percent of the general population without atopic dermatitis.

Having a mutation in this gene only increases the risk of developing atopic dermatitis. Not everyone with an FLG gene mutation will develop the disorder. Other genes and environmental factors contribute to atopic dermatitis. Individuals with a mutation in both copies of the FLG gene are at greater risk of developing atopic dermatitis than those with a mutation in only one copy of the gene. The condition is typically more severe in people with two mutated copies.

In addition to FLG gene mutations, the number of filaggrin proteins produced from each profilaggrin molecule is associated with development of atopic dermatitis; individuals with genetic instructions for producing 10 copies are at greater risk of developing the disorder than those with instructions for producing 11 or 12 copies.

Approximately 40 mutations in the FLG gene have been identified in people with atopic dermatitis. These mutations lead to production of an abnormally short profilaggrin molecule that cannot be cleaved to produce filaggrin proteins. The resulting shortage of filaggrin can impair the barrier function of the skin. Further, a lack of filaggrin leads to a shortage of natural moisturizing factor, which allows excess water to be lost through the skin and causes dry skin in affected individuals.

Research suggests that the impairment of the skin's barrier function caused by a shortage of filaggrin contributes to development of allergic disorders. Atopic dermatitis is not initially caused by an allergic reaction, although sometimes substances that can cause allergic reactions (allergens) are thought to contribute to flare-ups of the rashes. In addition, people with atopic dermatitis have an increased likelihood of developing other allergic disorders, including asthma, hay fever, and food allergies. (The tendency to develop allergic disorders is known as atopy.)

Other disorders

More than 40 FLG gene mutations have been found to cause a relatively common skin disorder called ichthyosis vulgaris, which is characterized by dry, scaly skin, particularly during the winter when humidity in the air is low. Affected individuals can also have unusually prominent creases on the palms of their hands and soles of their feet (palmar and plantar hyperlinearity) and an increased risk of allergic disorders, including atopic dermatitis (described above).

Typically, individuals with a mutation in one copy of the FLG gene are mildly affected; they may have symptoms only seasonally, or they may never have obvious skin problems. Individuals with two mutated copies of the gene have more severe symptoms that may be present year-round.

Some of the mutations associated with atopic dermatitis are also found in people with ichthyosis vulgaris. As in atopic dermatitis, the mutations lead to production of an abnormally short profilaggrin molecule that cannot be cleaved to produce filaggrin proteins. A lack of filaggrin and the molecules produced from its processing lead to the dry, scaly skin characteristic of ichthyosis vulgaris. Impairment of the skin's barrier function likely contributes to the development of allergic diseases in some people with ichthyosis vulgaris.

Individuals with FLG gene mutations have an increased risk of developing asthma, but only if they also have atopic dermatitis. FLG gene mutations also increase the risk of hay fever, food allergies, and skin sensitivity to nickel, regardless of whether the person has atopic dermatitis. Additional factors, such as living with a cat and smoking tobacco products, may increase the risk of atopic dermatitis and asthma, respectively, in people with ichthyosis vulgaris.

Other Names for This Gene

• ATOD2
• epidermal filaggrin

Genomic Location

Allergic disorders tend to run in families; having a parent with atopic dermatitis, asthma, or hay fever raises the chances a person will develop atopic dermatitis.

When caused by CARD11 gene mutations, atopic dermatitis has an autosomal dominant inheritance pattern, which means one copy of the altered CARD11 gene in each cell is sufficient to cause the disorder.

Similarly, when associated with FLG gene mutations, risk of the condition follows an autosomal dominant pattern; a mutation in one copy of the FLG gene is sufficient to increase the risk of the disorder. Individuals with two altered copies of the FLG gene are more likely to develop the disorder and can have more severe signs and symptoms than individuals with a single altered copy.

When atopic dermatitis is associated with other genetic factors, the inheritance pattern is unclear. While CARD11 gene mutations appear to cause the condition without other contributing factors, people with changes in the FLG gene or another atopic dermatitis-associated gene inherit an increased risk of this condition, not the condition itself. Not all people with this condition have a mutation in a risk-associated gene, and not all people with a variation in a risk-associated gene will develop the disorder.

The most common symptom of atopic dermatitis is itching, which can be severe. Other common symptoms include:

• Red, dry patches of skin.
• Rashes that that may ooze, weep clear fluid, or bleed when scratched.
• Thickening and hardening of the skin.

The symptoms can flare in multiple areas of the body at the same time and can appear in the same locations and in new locations. The appearance and location of the rash vary depending on age; however, the rash can appear anywhere on the body.

Infants

During infancy and up to 2 years of age, it is most common for a red rash, which may ooze when scratched, to appear on the:

• Face.
• Scalp.
• Area of skin around joints that touch when the joint bends.

Some parents worry that the infant has atopic dermatitis in the diaper area; however, the condition rarely appears in this area.

Childhood

During childhood, usually 2 years of age to puberty, it is most common for a red thickened rash, which may ooze or bleed when scratched, to appear on the:

• Elbows and knees, usually in the bend.
• Neck.
• Ankles.

Teens and Adults

During the teenage and adult years, it is most common for a red to dark brown scaly rash, which may bleed and crust when scratched, to appear on the:

• Hands.
• Neck.
• Elbows and knees, usually in the bend.
• Skin around the eyes.
• Ankles and feet.

Other common skin features of atopic dermatitis include:

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

In addition, people with atopic dermatitis often have other conditions, such as:

• Asthma and allergies, including food allergies.
• Other skin diseases, such as ichthyosis, which causes dry, thickened skin.
• Depression or anxiety.
• Sleep loss.

Researchers continue to study why having atopic dermatitis as a child can lead to the development of asthma and hay fever later in life.

Complications of atopic dermatitis can happen. They include:

• Bacterial skin infections that can worsen from scratching. These are common and may make the disease harder to control.
• Viral skin infections.
• Sleep loss that can lead to behavior issues in children.
• Hand eczema (hand dermatitis).
• Eye problems such as:
  • Conjunctivitis (pink eye), which causes swelling and redness in the inside of your eyelid and the white part of your eye.
  • Blepharitis, which causes general inflammation and redness of your eyelid.

Diagnosing atopic dermatitis may include the following:

• Giving the doctor your or your child’s medical history, including:
  • Your family history of allergies.
  • Whether you also have diseases such as hay fever, asthma, or food allergies.
  • Sleep problems.
  • Foods that seem to trigger hives.
  • Previous treatments for skin-related symptoms.
  • Use of steroids or other medications.
  • Exposure to irritants, such as:
    • Soaps and detergents.
    • Some perfumes and cosmetics.
    • Cigarette smoke.
• Examining your skin and the rash.
• Ordering laboratory tests, such as:
  • Blood tests to check for other causes of the rash.
  • Skin biopsy of the rash or lesion.

Your doctor may need to see you or your child several times to make an accurate diagnosis and to determine if symptoms are from other diseases and conditions or from atopic dermatitis.

The goals for treating atopic dermatitis include:

• Manage and control dry skin.
• Contain skin inflammation.
• Control itching.
• Promote healing.
• Prevent infections.
• Prevent flares.

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

• Location and type of rash, including the severity of the itching.
• Triggers that are unique to you or your child, to avoid exposure and prevent potential flares.
• The skin’s response to specific treatments, to identify which treatments seem to work best.

Treatments usually include a combination of therapies and can include:

• Medications. Your doctor may prescribe one or more of the following medications to treat atopic dermatitis, depending on the severity of the disease and your or your child’s age:
  • Moisturizing creams can help restore the skin barrier.
  • Corticosteroid creams and ointments help to decrease inflammation and are commonly used to treat diseases affecting the skin. Doctors do not usually prescribe oral corticosteroids to treat atopic dermatitis because after stopping the normal dose, atopic dermatitis can flare or rebound and be more severe than before.
  • Calcineurin inhibitors applied to the skin decrease inflammation and help prevent flares.
  • Phosphodieterase-4 inhibitors, a topical cream, can help with inflammation when the symptoms do not respond to other treatments.
  • Pills that reduce the abnormal immune response can be used but are reserved for more severe disease, and they require close monitoring.
  • Biologic medication, which is given by an injection just under the skin, blocks specific functions of the immune system to help control and manage atopic dermatitis. At this time, biologic medications are only approved to treat adults and adolescents with the condition.
• Skin care. Keeping the skin hydrated by applying moisturizers immediately after bathing to hold the water in your skin is important when treating atopic dermatitis. Your doctor will recommend how often you or your child should bathe and the type of moisturizer you should use. In some cases, doctors may recommend the following skin care for AD:
  • A diluted bleach bath twice a week to help treat AD and prevent infections. It is important to follow your doctor’s specific instructions when taking a bleach bath. You should not use this treatment without first talking to your doctor.
  • Wet wrap therapy to help increase moisture in the skin when the condition is persistent. However, only use wet wraps after speaking with your doctor.
• Phototherapy. If the atopic dermatitis is severe, widespread, and has not responded to other treatments, your doctor may recommend the use of ultraviolet A or B light waves to treat symptoms.

If you or your child develops skin infections from atopic dermatitis, your doctor may recommend additional topical or oral antibiotic treatments.

It is important to use skin treatments as directed and follow up with your doctor regularly to make sure the treatment plan is working.

Atopic dermatitis, or eczema, is an inflammatory skin disease. It can cause dry, itchy skin and rashes. It’s also linked to increased risk for asthma, hay fever, and food allergies.

Eczema is most common in children. Many outgrow eczema, but some continue to have symptoms as teens and adults. Medications and skin treatments can help manage eczema symptoms. However, they may be costly and often need to be applied multiple times each day.

The causes of eczema are unclear. Research suggests that the skin’s microbiome—the community of bacteria and other microbes living on the skin—plays a key role. Studies have shown that people with eczema often have a different balance of bacteria than those with healthy skin. Researchers have been testing whether beneficial bacteria might help treat eczema.

Results in mice and cell models suggested that the bacterium Roseomonas mucosa, taken from healthy human skin, could improve eczema. Researchers led by Dr. Ian A. Myles of NIH’s National Institute of Allergy and Infectious Diseases (NIAID) launched a clinical trial to test R. mucosa therapy in people with eczema. In 2018, the team published positive results in 10 adults and five children.

To test whether R. mucosa therapy might benefit younger children, who are most likely to have eczema, the team expanded the study by enrolling 15 additional children, some as young as 3 years old. Findings appeared in Science Translational Medicine on September 9, 2020.

For four months, children or their caregivers sprayed a solution containing live R. mucosa onto areas of skin with eczema. The solution was applied twice weekly for three months and then every other day for an additional month. The researchers gradually increased the dose of live R. mucosa for most of the children enrolled in the study.

Seventeen of the 20 children had a greater than 50% improvement in their eczema symptoms following treatment. The scientists also found increases in the skin’s barrier function—its ability to seal in moisture and keep out allergens. Most children needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following the therapy. These benefits continued after finishing treatment, and R. mucosa strains remained on the skin for up to eight months.

The researchers also studied how R. mucosa therapy improves eczema symptoms. They found that treated skin had more microbial diversity and reduced levels of Staphylococcus aureus, a bacterium known to worsen eczema.

The skin of people with eczema is usually deficient in certain lipids, or oils. The scientists studied a specific class of lipids produced by R. mucosa strains taken from healthy skin. Using cell cultures and mouse models of eczema, they found that these lipids can induce skin repair and promote turnover of skin tissue. Children in the study had increased levels of these lipids on their skin after treatment with R. mucosa.

“Most children in the study experienced substantial improvements in their skin and overall wellbeing following R. mucosa therapy. Encouragingly, the therapeutic bacteria stayed on the skin and continued to provide benefit after therapy stopped,” Myles says. “These results support a larger study to further assess the safety and effectiveness of this experimental treatment by comparing it with a placebo.”

The following health care providers may diagnose and treat atopic dermatitis:

• Dermatologists, who specialize in conditions of the skin, hair, and nails. You may want to find a dermatologist that specializes in treating atopic dermatitis.
• Allergists, who specialize in treating allergies.
• Primary health care providers, including family doctors, internists, or pediatricians.

Depending on the location and severity of the atopic dermatitis, living with the condition can be hard. Here are some tips to help control atopic dermatitis.

• Caring for skin. Following a daily skin care routine is important and helps prevent flares. Skin care can include:
  • Taking lukewarm baths to cleanse and moisturize the skin without drying it excessively. Limit baths to once a day.
  • Using mild unscented bar soap or non-soap cleanser.
  • Patting the skin dry after bathing and not allowing it to get too dry before moisturizing (avoid rubbing or brisk drying).
  • Using a moisturizer to seal in the water that has been absorbed into the skin during bathing. Use cream and ointments and avoid lotions with high water or alcohol content, which can cause burning.
  • Protecting the skin from irritants and rough clothing, such as wool.
• Talking to your doctor about potential food allergies.
• Managing stress. Using stress management and relaxation techniques can help lower your stress and decrease the likelihood of flares. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial.
• Preventing skin irritations. Try to avoid scratching or rubbing, which irritates the skin, increases inflammation, and can increase itchiness. Keep your child’s fingernails short to help reduce scratching.
• Seeking counseling. If you are feeling overwhelmed, embarrassed, or anxious about the condition, seek counseling with a mental health professional.
• Maintaining level indoor temperatures. Try keeping the inside of your home at a cool, stable temperature and consistent humidity levels. Avoid situations where overheating may occur. This may help prevent flares.
• Getting restful sleep. If you or your child is unable to get restful sleep at night because of itching and scratching, talk to your doctor about options to better control the atopic dermatitis.
• Avoiding exposure to the smallpox vaccine. Anyone with atopic dermatitis should not receive a smallpox vaccine. If you have atopic dermatitis and you receive the smallpox vaccine, you are more likely to develop a serious complication to the vaccine, even if your condition is mild or not active at the time of the shot. In addition, you should avoid being around others who have recently received the vaccine. Talk to your doctor about your risks before anyone in your household receives the vaccine.

Eczema: What is it?

Also known as “atopic dermatitis,” eczema is an inflammatory skin condition that affects roughly 30% of Americans, mostly children and adolescents. Those with eczema experience dry, itchy skin that can leak clear fluid when scratched. Eczema is not contagious, but those who have eczema may be particularly at risk for bacterial, viral, and fungal skin infections. Flare-ups can arise unexpectedly, and oftentimes frequent treatments are needed. Trying to manage this condition can be quite hard and emotional for patients and caregivers.

The exact cause of eczema is unclear, but environment, genetics, and the immune system can all be causes. Eczema often is associated with allergic diseases like asthma, hay fever, and food allergies. Children with siblings are less likely to develop eczema than only children. People who live in urban areas and those with higher socioeconomic status also appear more likely to develop the disease. Eczema in young children, especially in infants, is a major risk factor for the development of food allergies, particularly allergies to peanuts.

The Food and Drug Administration (FDA) has recently approved new treatments for eczema. Speak with your dermatologist to learn more about what treatment options might be available for you.

Winter and Eczema

Though eczema flare-ups can occur at any time of year, many experience flare-ups in the winter. Cold air, wind, and a decrease in humidity dry out everybody’s skin, which can trigger a flare-up for those with eczema. Here are some tips to beat back those winter flares.

• Use a humidifier
• Moisturize right after you get out of the shower - petroleum jelly or thicker creams are better
• Avoid scented lotions or laundry detergents
• Avoid very hot showers
• Cover up as much skin as possible when going outside in the cold, dry air
• If you know you’re going to sweat, wear quick-drying fabric
• Avoid wearing wool, nylon, polyester, or spandex
• Ask your doctor about prescription therapy if symptoms persist