Atopic Dermatitis (Eczema)

What Is Atopic Dermatitis (Eczema)?

Atopic dermatitis is a red, itchy rash common in infants and children. It’s estimated that eczema affects 11 percent of children in the United States. Atopic dermatitis is often the first sign that a child may develop food allergies, asthma, or allergic reactions to airborne substances such as pollen and animal dander that affect their nose and eyes.    

What Causes Atopic Dermatitis?

A combination of factors — including genetics, environmental conditions, defects in the immune system, and breakdown of the skin barrier — is responsible for atopic dermatitis. 

The skin is the body’s largest organ. It helps the body retain moisture and protects it from bacteria, irritants, and allergens.

Some eczema is related to a genetic variation that affects the skin’s ability to perform its protective role. Often, a patient will have a personal or family history of eczema, allergies, hay fever, or asthma.

What Are the Signs and Symptoms of Eczema?

Atopic dermatitis (eczema) signs and symptoms include:

• Dry skin.
• Itching, which may be severe, especially at night (contributing to disrupted sleep).
• Red patches on the skin of the hands, wrists, ankles, feet, neck and upper chest, eyelids, in the bend of the elbows and knees, and, in infants, the face and scalp.
• Small, raised bumps, which may leak fluid (serum) and crust over when scratched.
• Thickened, cracked, scaly skin.
• Skin that is raw, sensitive, and swollen from scratching.

How Is Atopic Dermatitis (Eczema) Diagnosed?

The physician will do a physical exam and take a complete medical history, since other family members may also have atopic dermatitis, asthma, food allergies, or hay fever.

He or she may order blood tests or skin tests.

What Treatment is Available for Atopic Dermatitis (Eczema)?

A variety of options can help:

• First, try to identify the triggers that cause flares (bouts) of eczema, and have your child avoid them as best you can. Triggers may include some of the following: detergents and soaps, perspiration, stress, dust mites, and seasonal pollen. Certain foods may cause flares in some proportion of infants and children who have moderate to severe disease. Parents should ask their doctor if it would be beneficial to test their child for food allergies.
• The first line of treatment is topical cortisone, in a strength prescribed by your doctor. These are available in foam, cream, ointment, and lotion forms.
• Phototherapy may be prescribed. This involves standing in a booth and being exposed to narrowband ultraviolet B (UVB) light. In some circumstances, broadband UVB phototherapy, PUVA (Psoralen and UVA), and UVA1 may be used. Phototherapy helps about 70 percent of people who have eczema by reducing itching, soothing the inflammation, increasing production of vitamin D, and boosting the skin’s ability to fight bacteria. Treatment sessions extend for several months, and it may take a month or two to begin seeing results.
• Anyone older than six years who has moderate to severe eczema may be treated with injections of dupilumab (Dupixent), the first monoclonal antibody therapy to be developed for atopic dermatitis.

How Can I Prevent Eczema Flares?

These steps may help prevent flares and reduce drying of the skin: 

• Apply moisturizer twice daily.
• Limit baths and showers to 15 minutes or less, and avoid hot water. 
• Use gentle soaps that are free of additives such as fragrance.
• Gently pat skin dry and apply moisturizer immediately.
• Take a bleach bath, which prevents skin infections by decreasing bacteria. Add 1/4 to 1/2 cup of household bleach (such as Clorox regular, not concentrated) to a bathtub filled with warm water. Soak from the neck down for 10 minutes or so, then rinse. Take bleach baths no more than twice weekly.

Biological Therapies for Asthma and Allergic Diseases

Biologic therapies target specific inflammatory pathways involved in the pathogenesis of allergic diseases such as asthma and atopic dermatitis (or eczema).

To tailor to the medical needs of each patient with allergic disease(s), we offer monoclonal (or biological) therapies for patients with asthma and atopic dermatitis (eczema) or other allergic diseases whose disease is not adequately controlled with usual medications.

Learn about treatment at Brown University Health for more pediatric asthma and allergy conditions