The Medical Dermatology program at Massachusetts General Hospital is a full-service dermatology practice that provides care for all skin, hair and nail conditions.
The Massachusetts General Hospital Contact Dermatitis & Occupational Dermatology Clinic is a referral-based specialty clinic with over 30 years of experience diagnosing and treating allergic reactions of the skin.
The Khosrow Momtaz Phototherapy Center at Massachusetts General Hospital has been at the forefront of ultraviolet radiation therapy for chronic skin conditions for more than 30 years.
What is atopic dermatitis?
Atopic dermatitis is a chronic skin disorder. It causes dry, itchy, scaly patches on the skin, often on the face and scalp in babies. It’s most common in infants or very young children. Most will show signs of the condition in the first year of life. Symptoms may last until the teens or adulthood. It rarely starts in adulthood. Atopic dermatitis is not contagious.
Atopic dermatitis tends to run in families. This suggests a genetic link. It’s also associated with asthma and allergies, which are immune hypersensitivity disorders.
Treatment for this condition is aimed at calming the skin inflammation, decreasing the itching, and preventing infections. Good skin care and medicine to control itching and infection are used.
Atopic dermatitis is often called eczema.
What causes atopic dermatitis?
The exact cause of atopic dermatitis is not known. It runs in families, which suggests a genetic link. It’s also linked to asthma and allergies. There is likely an alteration of the proteins in the skin that leads to atopic dermatitis.
Certain triggers can make atopic dermatitis worse. For example, stress, hot or cold temperature, dry conditions, certain fabrics, or detergents can cause a flare-up.
What are the symptoms of atopic dermatitis?
The area of the body affected by atopic dermatitis may change with age. In infants and young children, it usually affects the face, outside of the elbows, and on the knees. In older children and adults, it tends to be on the hands and feet, the arms, on the back of the knees, and the folds of the elbows.
Symptoms are slightly different for each person. Common symptoms include:
- Dry, scaly patches on the skin
- Small bumps that open and weep when scratched
- Redness and swelling of the skin
- A thickening of the skin (with chronic eczema)
- Scratch marks on the skin
Too much rubbing and scratching can tear the skin and lead to infection.
The symptoms of atopic dermatitis may look like other skin conditions. Always talk with your healthcare provider for a diagnosis.
How is atopic dermatitis diagnosed?
Your healthcare provider will ask about your health history and whether you have allergies or asthma. He or she will also ask about any family history of dermatitis, allergies, or asthma.
A healthcare provider can often diagnose atopic dermatitis by examining your skin. You may also have a patch test. This is used to find allergies by placing small amounts of allergens on the skin and watching for a response. A skin biopsy may also be done to rule out other causes of the rash.
How is atopic dermatitis treated?
Factors such as your age, overall health, and health history will help your healthcare provider find the best treatment for you.
There is no cure for atopic dermatitis. The goals of treatment are to reduce itching and inflammation of the skin, to keep the skin moist, and to prevent infection.
Your healthcare provider may also prescribe medicines in severe cases. The following are commonly used to treat atopic dermatitis:
- Antihistamines. These medicines are taken by mouth. They may help to ease itching. Some examples include diphenhydramine and hydroxyzine. They may cause drowsiness. Some newer antihistamines available don’t cause drowsiness.
- Steroid creams. These are put on the skin to help ease inflammation, itching, and swelling. Many topical steroids are available in various strengths. If overused, they can cause skin thinning and discoloration.
- Systemic corticosteroids. These medicines ease inflammation, which can relieve itching. They are used for severe cases. They are available as a pill, liquid, or shot. These steroids have serious side effects from the long-term use. So they are only used for a short time to stop a flare-up.
- Oral antibiotics. These medicines kill bacteria that cause infections. Scratching the affected skin can bring bacteria to the area. This can lead to infection. Always take the antibiotic exactly as prescribed until it is all gone.
- Oral cyclosporine. This medicine has been used for years to treat atopic dermatitis that doesn’t respond to other treatments. It was first developed to prevent rejection after organ transplantation. It suppresses the immune system. This stops it from overreacting. This helps prevent flare-ups. It’s available as a capsule or liquid. It has many side effects that should be considered carefully.
- Phototherapy. Two types are used to treat atopic dermatitis: ultraviolet (UV) light therapy and PUVA (chemophototherapy). Light therapy uses UV light of specific wavelengths to target the immune system. It stops the responses that lead to inflammation. Phototherapy may be used along with other treatment. There are risks and benefits of light therapy. Weigh these risks with your healthcare provider.
- Topical immunomodulator. Also known as topical calcineurin inhibitors. They are put on the skin to change the immune response.
- Methotrexate. An immunosuppressive medicine that can be used to manage atopic dermatitis long term. However, it can potentially harm the liver.
- Barrier restoration creams. Similar to moisturizers, but they help repair the skin as well as provide moisture.
What are the complications of atopic dermatitis?
Complications of atopic dermatitis include:
- Dry skin that is easily irritated
- Skin infections
- Eye problems such as eyelid dermatitis or cataracts
- Difficulty in personal, family, and/or work relationships
Can atopic dermatitis be prevented?Because the cause of atopic dermatitis is not known, there is no known way to prevent it. But avoiding triggers may reduce flare-ups.
Living with atopic dermatitis
The following steps can help manage atopic dermatitis:
- Avoid triggers
- Take brief baths or showers using lukewarm water.
- Practice good skin care.
- Prevent infections.
- Don’t use harsh soaps. Ask your healthcare provider to recommend a brand.
- Dress in light clothes. Sweating can make atopic dermatitis worse.
- Use a good moisturizer at least once a day. Ask your healthcare provider to recommend a brand.
- Avoid scratching the affected area.
- Minimize stress.
- Make lifestyle changes that prevent flare-ups.
- Avoid skin products that have fragrances and dyes
When should I call my healthcare provider?Tell your healthcare provider if your symptoms get worse or you have new symptoms.
Key points about atopic dermatitis
- Atopic dermatitis is commonly called eczema.
- It’s an inherited and chronic skin disorder that is most common in infants or very young children.
- Atopic dermatitis causes dry, scaly, red skin that has red bumps that open and weep when scratched.
- It’s important to find and avoid things that make atopic dermatitis worse. Triggers include stress, high or low temperatures, bacterial infections, fabrics such as wool, and detergents.
- The goals of treatment are to reduce itching and inflammations of the skin, to keep the skin moisturized, and prevent infection.
Next stepsTips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions