Atopic Dermatitis and Eczema Symptoms & Causes

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In-Depth

If your child has atopic dermatitis, you’ve probably struggled with how you can stop her skin from itching and causing painful irritation. At Children’s Hospital Boston’s Atopic Dermatitis Center, within the Division of Allergy and Immunology,  we help you every step of the way. We understand that you may want to learn more about your child’s atopic dermatitis in order to fully understand the condition and get her the most appropriate treatment.   

What is atopic dermatitis?

Atopic dermatitis is a chronic and relapsing inflammatory condition of the skin. Children with atopic dermatitis often have skin barrier dysfunction which causes dry, itchy, scaly skin. They can also have associated environmental and food allergies.  Of children who have atopic dermatitis, 65 percent show signs in the first year of life and 90 percent show signs within the first five years. Half of all affected children improve between ages 5 and 15. Parents with atopic dermatitis are more likely to have children with atopic dermatitis.

What triggers it?

The main triggers of atopic dermatitis are dry skin, irritants, stress, allergies, infection and heat/sweating. It’s important to note that these are triggers that worsen the symptoms of atopic dermatitis, and don’t necessarily cause atopic dermatitis.

Is my child at risk for having atopic dermatitis?

Children with a family history of allergies, asthma and atopic dermatitis are more likely to have atopic dermatitis.  In research studies, mutations in skin barrier genes such as filaggrin are commonly associated with atopic dermatitis.

What does it look like?

Atopic dermatitis often causes itching which leads to scaly, bumpy, red and/or swollen skin. If chronic scratching occurs, the skin becomes thickened and or hardened. It manifests on different parts of the body depending on the person’s age. In older children and adults, atopic dermatitis tends to appear on the creases of the arms and the back of the knees. In infants, it affects the face, trunk and extremities

How serious is it?

Atopic dermatitis is not a life-threatening condition. The usual cause for concern is a severe skin infection.

Is it curable?

It is not curable, but with proper treatment and medication, the disease can be well controlled.

Is atopic dermatitis the same thing as eczema?

Physicians often use the terms eczema and atopic dermatitis interchangeably because most cases of eczema are caused by atopic dermatitis. Eczema is a general term for dry flaky inflamed skin, which can sometimes be caused by something other than atopic dermatitis.

How does atopic dermatitis relate to food allergies?

About 25 percent of children with atopic dermatitis have a food allergy.

Who does atopic dermatitis mostly affect?

Atopic dermatitis usually affects babies or very young children, but it sometimes lasts until adolescence or adulthood.

What happens if my child doesn’t stop itching affected areas?

Prolonged itching of the skin can lead to lichenification, which means the skin becomes thick and leathery. Intense itching may break the skin, and lead to infections and or permanent scars. While atopic dermatitis is not a life-threatening condition, many patients with atopic dermatitis have an underlying skin barrier defect that requires them to take special care of their skin for their whole lives.

What impact can climate have on atopic dermatitis?

Extreme levels of dry climate, or hot and humid climates can trigger atopic dermatitis. For example, the cold dry air of winter in New England can trigger an outbreak of atopic dermatitis as well as the heat and humidity of summer. We recommend that parents find ways to help their child avoid exposure to extreme weather, such as using air conditioners in summertime.

What can children do to help reduce their atopic dermatitis while playing sports?

Sports equipment can be an irritant to areas affected by atopic dermatitis. Wearing moisture wicking clothes, taking a bath right after sports and taking medicine can help.

Triggers and Symptoms

What triggers atopic dermatitis?

  • stress
  • allergies
  • sweating
  • certain soaps, cleaners or detergents
  • long, hot baths or showers
  • rapid changes in temperature
  • low humidity
  • wool or man-made fabrics or clothing
  • dust or sand
  • cigarette smoke
  • certain foods, such as eggs, milk, fish, soy or wheat
  • bacterial skin infection or colonization

What parts of the body are affected?

  • The part or parts of the body affected by atopic dermatitis tends to change as a child ages. In infants and young children, it's usually the face, trunk and extremities. In older children and adults, atopic dermatitis tends to appear on the creases if the arms and back of the legs.

What are the symptoms of atopic dermatitis?

  • dry, scaly skin
  • small bumps
  • redness and swelling of the skin
  • a thickening and hardening of the skin
  • raw and sensitive skin

When should my child see a doctor about her atopic dermatitis?

  • child is irritable and uncomfortable
  • child has trouble sleeping
  • rash spreads
  • child has a fever
  • child has pus or yellow crusts from affected areas

FAQ

Q: What is atopic dermatitis?

A: Atopic dermatitis is a chronic and relapsing inflammatory condition of the skin. Children with atopic dermatitis often have skin barrier dysfunction which causes dry, itchy, scaly skin. They can also have associated environmental and food allergies.  Usually it affects babies and young children, but sometimes it can last until adolescence or adulthood.

Q: Why is it a cause for concern, other than being itchy and uncomfortable?

A: Severe atopic dermatitis can make it very hard for your child to enjoy school and play. Too much scratching or itching can lead to a severe skin infection.  Additionally, the discomfort of atopic dermatitis can ruin sleep, which can affect your child.

Q: Can other children contract my child’s atopic dermatitis?

A:No. Atopic dermatitis is not contagious; however, if an allergen is a source of your child’s atopic dermatitis, it is important to avoid it.

Q: If my child has atopic dermatitis, will he be OK?

A: Although there is no cure for atopic dermatitis, it can be treated with bathing, emollients, prescription ointments and other treatments. Many children with atopic dermatitis get better as they grow older.

Q: Can stress cause atopic dermatitis?

A: No. Stress does not cause atopic dermatitis, however it can worsen the symptoms.

Q: Can atopic dermatitis leave permanent scars?

A: Yes. If your child suffers from a chronic case of atopic dermatitis and itches excessively, this can lead to permanent scarring.

Q: Can atopic dermatitis affect my child’s mood?

A: Yes. Atopic dermatitis is very uncomfortable, and can limit your child’s sleep, which may impact her mood, just as anyone would be affected by a lack of sleep.

Q: Can my child still swim in chlorinated pools?                             

A: Yes. Prolonged exposure to chlorine can make your child’s atopic dermatitis worse. However, if your child applies fragrance-free, hypoallergenic sunscreen before swimming, and quickly rinses off and applies moisturizer after getting out of the pool, her atopic dermatitis should not be aggravated.

Q: Should my child bathe daily even if he has atopic dermatitis?

A: Yes. It’s important for your child to bathe daily, moisturize and hydrate the skin afterward.

Q: If I prevent my child from being exposed to allergens, will her atopic dermatitis go away?

A:Most children have an underlying skin disorder, and their atopic dermatitis will not go away even if you limit exposure to allergens.

Q: What’s the difference between eczema and atopic dermatitis?

A:Physicians often use the terms eczema and atopic dermatitis interchangeably because most cases of pediatric eczema are caused by atopic dermatitis. Eczema is a general term for inflamed, itchy skin, which can sometimes be caused by something other than atopic dermatitis.  

Questions to ask your child’s doctor

After your child is diagnosed with atopic dermatitis, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

Lots of parents find it helpful to jot down questions as they arise- that way, when you talk to your child’s doctors you can be sure that all of your questions are answered. If your child is old enough, you may want to suggest that she writes down what she wants to ask her health care provider too.

  • How could the medication or treatments interact with my child’s current medication regiments?
  • How could creams or ointments interact with other creams or sprays, such as suntan lotion or bug repellent?
  • Are there any dietary restrictions my child needs to follow while taking atopic dermatitis medications?
  • What treatments and medications are covered by my insurer?
  • What are some things I can do to help my child’s itching and scratching?
  • How can I find out if any of the products, substances and foods around the house triggers my child’s atopic dermatitis?
  • How will atopic dermatitis impact my child’s social life?
  • What resources are available to help my child cope with the stress of having atopic dermatitis?
  • How could atopic dermatitis impact my child’s experience in the classroom?
  • How will Children’s Hospital Boston coordinate with my child’s school nurse to continue care at school?
    Managing food allergies at home
     About 25 percent of children with severe atopic dermatitis have food allergies. As many athletes know, having a game plan is crucial to winning. In managing allergies, it’s even more important. Learn new strategies for helping your child manage and cope with food allergies. Join the discussion on Children’s Thriving blog.
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