Atopic Dermatitis/Eczema

What is atopic dermatitis or eczema?

Atopic dermatitis, commonly referred to as eczema, is a hereditary skin disorder characterized by inflammation, such as a rash, that causes extreme itching and discomfort. Flare-ups of eczema, called exacerbations, lead the affected person to scratch which can cause broken skin, swelling, redness and what is called “weeping” of clear fluid from the affected area.

The term “atopic” refers to a group of diseases that are usually inherited such as asthma, hay fever, or food allergies. So, if there is anyone in the family such as a parent or grandparent who suffers from one or more of these disorders, you or your child’s likelihood of developing atopic dermatitis is much higher.

Types of Eczema (Dermatitis)

What causes eczema?

Atopic dermatitis or eczema is closely associated with a malfunction of the body’s immune system. Doctors have recently discovered that among individuals that suffer from atopic dermatitis/eczema there is commonly found an increased amount of a certain cytokine (protein) that is essential to the normal function of the immune system and an increased amount of cytokines that induce allergic reactions. Essentially, the immune system is fooled into attacking the skin and causing inflammation even when an infection is not present.

At one point physicians believed that eczema was an emotional disorder. Now doctors are more informed and realize that although the exact cause, other than genetic heredity, is unknown, eczema or atopic dermatitis is a medical disorder. Changes in a person’s life that cause stress such as changes in employment, divorce, loss of a loved one, moving, sudden unrelated illness, etc., can definitely exacerbate the condition but are not the cause of the disorder.

Skin Features of Atopic Dermatitis

How is eczema diagnosed?

Diagnosis is mainly visual and may take several visits to your physician to determine if atopic dermatitis/eczema is actually the problem. Typically the patient will exhibit extremely dry, itchy skin with inflamed patches usually behind the knees, on the inner fold of the elbow, or on the face. The more the patient scratches the area in response to itching, the worse the appearance of the affected area will be – especially if affected by secondary infections. Your primary care physician may refer you to a dermatologist (skin specialist) or an allergist for further observation and testing. Most eczema patients are affected from infancy, but it may seem to improve by 18 months.


Typical Progression of Atopic Dermatitis/Eczema

Age Manifestation
6-12 weeks Patchy facial rash which can progress to red, scaling, oozing skin; May become infected
Crawling stage Exposed areas like inner and outer parts of arms and legs may be affected
18 months Condition may seem to improve but there is an increased risk of developing extremely dry skin or hand eczema later on
Early Childhood – Preteen Papules form that become hard and scaly when scratched on areas behind the knees and crooks of the elbows; around the mouth, on wrists, ankles and hands.  Licking of inflamed lips makes the condition worse leading to cracking and possibly infection.  May go into remission only to return at the onset of puberty.

Some patients may develop eczema later in life between their 30s and 60s but most cases start in early childhood.

Major and Minor Features of Atopic Dermatitis