Atopic dermatitis

Last reviewed: 1 Sep 2023

Last updated: 04 Apr 2023

Atopic dermatitis commonly presents with dry, itchy skin.

Typically there is erythema, scaling, vesicles, or lichenification in skin flexures.

Diagnosis is primarily clinical.

First-line treatment is with emollients and topical corticosteroids.

Other options that may be used in patients unresponsive to first-line therapy include topical calcineurin inhibitors, phototherapy, biologic agents, or immunomodulatory agents.

Definition

Atopic dermatitis is an inflammatory skin condition characterized by dry, pruritic skin with a chronic relapsing course. It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% to 20% of children. Patients often have a personal or family history of other atopic diseases such as asthma or allergic rhinitis. Food allergies may occur at increased rates in this population. Atopic dermatitis can be described as acute or chronic. Acute atopic dermatitis is used to describe a flare-up of symptoms. Chronic is used to describe the condition when the patient develops signs of chronic inflammation (e.g., lichenification).

History and exam

Key diagnostic factors

pruritus
xerosis (dry skin)
sites of skin involvement

More key diagnostic factors

Other diagnostic factors

erythema
scaling
vesicles
papules
keratosis pilaris
excoriations
lichenification
hypopigmentation

Other diagnostic factors

Risk factors

filaggrin gene mutation
age <5 years
family history of atopic dermatitis
allergic rhinitis
asthma
active and passive exposure to smoke
female sex
African-American ethnicity

More risk factors

Diagnostic investigations

1st investigations to order

clinical diagnosis

More 1st investigations to order

Investigations to consider

IgE levels
skin-prick testing
oral food challenge
trial elimination diet
patch testing
skin biopsy

More investigations to consider

Treatment algorithm

ACUTE

acute flare

ONGOING

chronic or relapsing disease (nonrefractory)

refractory chronic or relapsing disease

Contributors

Authors

Adelaide A. Hebert, MD

Professor & Director of Pediatric Dermatology

Clinical Specialist

Department of Dermatology and Pediatrics

University of Texas Health Sciences Center at Houston

Houston

Disclosures

AAH serves on the board of the International Hyperhidrosis Society and the American Academy of Dermatology; consults for Pfizer, Galderma, LaRoche Posay, Arcutis, Incyte, Vyne, Varrica, Beiersdorf, Aslan, and Ortho Dermatologics; has undertaken or is undertaking contractual research for Pfizer, Galderma, Ortho Dermatologics, Aslan, Leo, Mayne, Arcutis, Incyte, Verrica, Novan, Brickell, and Almirall; is on the data safety monitoring boards for GSK, Regeneron, and Sanofi; and is on the speakers' bureaux for Pfizer, Almirall, and Galderma.

Kavina Patel, MD

Dermatology Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

Disclosures

KP declares that she has no competing interests.

Matthew Dallo, MD

Clinical Research Fellow

Department of Dermatology

University of Texas Health Science Center at Houston

Houston

Disclosures

MD declares that he has no competing interests.

Eugenio G. Galindo, MD

Dermatology Clinical Research Fellow

UTHealth McGovern Medical School

Houston

Disclosures

EGG declares that he has no competing interests.

Acknowledgements

Dr Adelaide A. Hebert, Dr Kavina Patel, Dr Matthew Dallo, and Dr Eugenio G. Galindo would like to gratefully acknowledge Dr Quoc-Bao D. Nguyen, Dr Mary D. DarConte, Dr Christina M. Gelbard, and Dr Daniel A. Grabella, previous contributors to this topic.

Disclosures

QNN, MDD, CMG, and DAG declare that they have no competing interests.

Peer reviewers

Amor Khachemoune, MD

Assistant Professor

New York University School of Medicine

Disclosures

AK declares that he has no competing interests.

John English, MBBS, FRCP

Consultant Dermatologist

Department of Dermatology

Queen's Medical Centre

Nottingham University Hospitals

Nottingham

Disclosures

JE declares that he has no competing interests.

Differentials
- Seborrheic dermatitis
- Irritant contact dermatitis
- Allergic contact dermatitis
More Differentials
Guidelines
- Guidelines of care for the management of atopic dermatitis. Section 2. Management and treatment of atopic dermatitis with topical therapies
- Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children
More Guidelines
Patient leaflets
Eczema
More Patient leaflets
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Atopic dermatitis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

acute flare

chronic or relapsing disease (nonrefractory)

refractory chronic or relapsing disease

Contributors

Authors

Adelaide A. Hebert, MD

Disclosures

Kavina Patel, MD

Disclosures

Matthew Dallo, MD

Disclosures

Eugenio G. Galindo, MD

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Amor Khachemoune, MD

Disclosures

John English, MBBS, FRCP

Disclosures

Differentials

Guidelines

Patient leaflets

Log in or subscribe to access all of BMJ Best Practice

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