Atopic dermatitis


  • Also known as atopic eczema
  • A chronic type of inflammatory skin disease affecting many children and adults
  • Occasionally accompanied by asthma and/or hay fever. Patients develop a cutaneous hyperreactivity to environmental triggers.
  • Cause is not known, but believed to be due to an interaction between susceptibility genes, the environment, defective skin barrier function, and immunologic responses.

Dermatitis Types

Clinical Features

Atopic dermatitits.jpg
Atopic dermatitis of the inside crease of the elbow.
  • Atopic personal or family history, worse in winter, dry weather
  • Erythema, crusts, fissures, pruritus, excoriations, lichenification


  • blisters, crusts, exfoliations
  • Face, scalp, trunk, extensor surfaces, sparing of diaper area
  • 1st few months of life, resolving by age 2
  • Differentiate from impetigo (which may occur alongside)


  • ~4-12 years old
  • Wrists, ankles, antecubital and popliteal fossae


  • >12 years old
  • Dryness, thickening in flexor surfaces including antecubital and popliteal fossae, neck, hands[1]

Differential Diagnosis

Neonatal Rashes


  • Clinical diagnosis
    • Dry skin, erythematous papular lesions
    • Face most commonly involved; nose and diaper areas spared

Neonatal atopic dermatitis vs. seborrhoeic dermatitis

Category Neonatal atopic dermatitis Neonatal seborrhoeic dermatitis
Presentation 1-2 months 2-6 months
Puritic (fussiness) Yes No


  • Identify and eliminate triggers:
    • Alcohol based products
    • Fragrances and astringents
    • Excessive bathing
    • Allergens
  • Reduce drying of skin
    • Avoid lotions (high water and low oil content)
  • Liberal application of emollients (vaseline) immediately after bath (<5 min, skin should be pat dry instead of rubbing) [2]
    • Alternatives include petroleum jelly and Aquaphor
    • If using steroids, apply emollients on top of steroids
  • Topical steroids
  • Avoid fluoridinated steroids to thin skin areas such as face, groin, or axilla
  • Consider doxepin for recalcitrant pruritus[3][4]
    • 25-50mg PO nightly
    • Or topical doxepin cream 5% QID


  • Outpatient


See Also

External Links


  1. Leung DYM, Sicherer SH. Atopic Dermatitis (Atopic Eczema). In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020:(Ch) 170.
  2. Fang J. Dermatology. In: The Harriet Lane Handbook. 20th ed. Philadelphia, PA: Elsevier; 2015
  3. Hercogova J. Topical anti-itch therapy. Dermatol Ther 18(4):341-3 (2005 Jul-Aug).
  4. Drake L, Cohen L, Gillies R, et al. Pharmakinetics of doxepin in subjects with pruritic atopic dermatitis. J Am Acad Dermatol 41(2):209-14 (1999 Aug).