Atopic Dermatitis Disease Summary

Quick Summary

Familial, chronic, relapsing inflammatory skin disease with intense itch and dry skin, often starting in infancy.

Clinical diagnosis using Hanifin and Rajka criteria with severity scoring, stepwise therapy from topical agents to systemic immunosuppressants and biologics, and proactive maintenance to reduce relapses.
Warning signs
  • Severe eczema or secondary skin infection may require hospitalization.
  • Eczema herpeticum or Kaposi’s varicelliform eruption requires hospital antivirals.
More details — Initial assessment · More details — Management

Initial assessment

  • Pruritus is predominant.
  • Pain is common from scratching or fissures.
  • Infants under two: facial red papules with oozing or crusting.
  • Diaper area is usually spared in infants.
  • Children two to twelve: flexural eczema with lichenification.
  • Adolescents and adults: face, neck, chest, and back involvement.
More details

Diagnosis

  • Diagnosis is clinical using history and skin findings.
  • Screen for allergens, infections, irritants, stress, and temperature.
  • Apply Hanifin and Rajka diagnostic criteria.
  • Require three or more major features.
  • Major feature: pruritus.
  • Major feature: typical morphology and distribution.
More details

Diagnostics (Lab Test and Imaging)

  • Consider serum total IgE testing.
  • IgE ≥500 IU/mL may indicate atopic dermatitis.
  • Use specific IgE tests or skin prick tests.
  • Monitor eosinophils, LDH, and TARC for progression.
  • Raised LDH may reflect tissue damage.
  • Routine FLG genetic testing is not recommended.
More details

Pharmacological management

  • Topical corticosteroids
    • First line for flares and relapse prevention.
    • Choose potency by site, severity, and age.
    • Avoid high potency on face, groin, axillae.
    • Intermittent one to two times weekly for maintenance.
    • Taper high potency to prevent rebound.
  • Topical calcineurin inhibitors
    • Steroid sparing for face, folds, anogenital areas.
    • Use in steroid atrophy or intolerance.
    • Effective in patients older than two years.
    • Improvement within three to seven days.
    • No proven causal link to cancer.
  • PDE‑4 inhibitors
    • Crisaborole for mild to moderate from three months.
    • Roflumilast for patients six years and older.
    • Early itch improvement may occur.
    • Consider apremilast in refractory disease.
  • Systemic immunosuppressants and corticosteroids
    • Ciclosporin short term for severe refractory disease.
    • Methotrexate, azathioprine, or mycophenolate are options.
    • Monitor TPMT with azathioprine.
    • Short‑term oral steroids for severe flares or bridge therapy.
  • Biologics and JAK inhibitors
    • Dupilumab from six months of age.
    • Tralokinumab from twelve years of age.
    • Lebrikizumab from twelve years and forty kilograms.
    • Nemolizumab from twelve years and thirty kilograms.
    • Oral JAKs include abrocitinib, baricitinib, upadacitinib.
    • Reassess baricitinib at eight weeks for response.
    • Topical ruxolitinib for patients twelve years and older.
    • Tapinarof approved from two years of age.
  • Adjuncts and infection management
    • Sedating oral antihistamines can aid sleep.
    • Non sedating antihistamines have variable itch benefit.
    • Topical antihistamines may cause contact dermatitis.
    • Treat localized bacterial lesions with topical antibiotics.
    • Use oral antibiotics for widespread infection.
    • Consider antifungals for head and neck involvement.
    • Hospital antivirals for eczema herpeticum.
More details

Indications for surgery / procedural interventions

  • Use potent steroids under occlusion for resistant plaques.
  • Clear clinical infections before anti‑inflammatory therapy.
  • Treat reservoirs such as nose and groin.
  • For molluscum, consider KOH, cantharidin, or tretinoin.
  • Consider cryotherapy or curettage for molluscum.
  • Avoid combining ciclosporin with UV light therapies.
More details

Follow up / Monitoring

  • Use proactive maintenance on commonly flaring sites.
  • Class II or III steroids one to two times weekly.
  • Tacrolimus two to three times weekly for maintenance.
  • Track severity with EASI, SCORAD, and POEM.
  • Use QoL tools such as DLQI and CDLQI.
  • Reassess baricitinib at eight weeks for response.
More details — Follow up · More details — Scoring

Special situations

  • Infants under two: cheeks and chin with oozing and crusting.
  • Children two to twelve: flexural distribution and lichenification.
  • Adolescents and adults: face, neck, chest, and back involvement.
  • Adult new‑onset without childhood history is unusual.
  • Hand dermatitis in adults from irritant exposures.
More details

Overview

Atopic dermatitis is a kind of dermatitis that has specific characteristics that you can know more in the Introduction section.

Atopic dermatitis is one of the most common dermatological diseases affecting millions worldwide. It can affect both children and adults. More information about the prevalence of this disease in the Epidemiology section.

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There are many causes of atopic dermatitis. The Etiology section enumerated these causes. The Pathophysiology section discussed the development of this skin disease.

History and Physical Examination

Among 34 countries, it has been found that pain is the second most common symptom after pruritus. To know more, see the Clinical Presentation section.

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Diagnosis

In order to diagnose atopic dermatitis, the Hanifin and Rajka criteria in the Diagnostic Criteria section is used. In this section you will also learn how to assess the disease severity.

The Laboratory Tests and Ancillaries section discuss what tests can be done to help with the diagnosis of atopic dermatitis.

There are several diseases that can mimic atopic dermatitis and the Differential Diagnosis section has enumerated them.

Management

One of the goals of therapy is to reduce the symptoms to know more about the goals of therapy. See the Principles of Therapy section for further details.

Various topical and systemic therapies are recommended for the treatment of atopic dermatitis, such as corticosteroids, calcineurin inhibitors, phosphodiesterase type-4 (PDE-4) inhibitors, immunosuppressants, etc.  The Pharmacological Therapy section contains a more extensive discussion on these treatment options.

There are Lifestyle Modifications (eg avoidance of trigger factors, skin care) and preventive measures that can be done in order to manage atopic dermatitis. These are discussed in the Prevention and Lifestyle Modifications sections.

Educating the patient or caregiver about the disease is also an important aspect in the management of atopic dermatitis. Refer to the Patient Education section for further details.  

The sections of Other Therapy and Proactive Therapy discusses about the available options for the management of atopic dermatitis such as wet wrap therapy, phototherapy and immunoadsorption.

Frequently Asked Questions

How is atopic dermatitis initially assessed?
Initial assessment should define symptom pattern, itch severity, sleep disturbance, flare frequency, trigger exposure, treatment history, and impact on quality of life. Clinical examination should document lesion morphology, distribution, extent, excoriations, lichenification, signs of infection, and features suggesting alternative diagnoses. Age of onset, personal or family atopy, and occupational or environmental aggravators are also important in guiding diagnosis and management. Read more
What clinical features support the diagnosis?
Diagnosis is primarily clinical and is supported by chronic or relapsing eczematous dermatitis with pruritus, typical age-related distribution, xerosis, and personal or family history of atopy. Infantile disease often affects the face and extensor surfaces, while older children and adults more often have flexural involvement. Lichenification, excoriations, and sleep-disrupting itch are common. Clinicians should also consider mimics when the presentation is atypical. Read more
When are tests needed for atopic dermatitis?
Routine laboratory testing is not required for typical atopic dermatitis. Investigations are reserved for atypical, severe, treatment-refractory, or diagnostically uncertain cases, or when contact dermatitis, infection, immunodeficiency, or other inflammatory dermatoses are suspected. Patch testing may be useful when allergic contact dermatitis is a concern. Skin swabs or other targeted studies may be appropriate if secondary infection is suspected clinically. Read more
What is the mainstay of treatment?
Treatment is built on regular emollient use, trigger avoidance, and anti-inflammatory therapy during flares. Topical corticosteroids are commonly used according to disease severity, body site, and patient age. Topical calcineurin inhibitors may be used for sensitive areas or maintenance in selected patients. Escalation to phototherapy or systemic therapy is considered for moderate-to-severe disease that remains uncontrolled despite optimized topical care. Read more
How should patients be followed up?
Follow-up should assess disease control, itch, sleep, adherence, treatment technique, adverse effects, and frequency of flares. Clinicians should review emollient use, potency and duration of topical anti-inflammatory therapy, and signs of infection or treatment complications. Patients with persistent, extensive, or severe disease may need closer review and treatment escalation. Education on self-management and early flare recognition helps reduce relapse and improve long-term control. Read more