View source for Atopic dermatitis

{{Short description|Long-term form of skin inflammation}}
{{About|the most common type of eczema|other types and related skin conditions|Dermatitis}}
{{Use dmy dates|date=December 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition
| name            = Atopic dermatitis
| synonyms        = Atopic eczema, infantile eczema, prurigo Besnier, allergic eczema, neurodermatitis<ref name=Wil2000/>
| image           = Atopy2010.JPG
| caption         = Atopic dermatitis of the inside crease of the elbow
| field           = [[Dermatology]], [[Immunology|Clinical Immunology and Allergy]]
| symptoms        = [[pruritus|Itchy]], red, swollen, cracked skin<ref name=NIH2013/>
| complications   = [[Skin infection]]s, [[hay fever]], [[asthma]]<ref name=NIH2013/>
| onset           = Childhood<ref name=NIH2013/><ref name=Toll2014/>
| duration        =
| types           =
| causes          = Unknown<ref name=NIH2013/><ref name=Toll2014/>
| risks           = [[Family history (medicine)|Family history]], living in a city, dry climate<ref name=NIH2013/>
| diagnosis       = Based on symptoms after ruling out other possible causes<ref name=NIH2013/><ref name=Toll2014/>
| differential    = [[Contact dermatitis]], [[psoriasis]], [[seborrheic dermatitis]]<ref name=Toll2014/>
| prevention      =
| treatment       = Avoiding things that worsen the condition, daily bathing followed by [[moisturising cream]], [[corticosteroid|steroid]] creams for flares<ref name=Toll2014/> [[Humidifier]]
| medication      =
| prognosis       =
| frequency       = ~20% at some time<ref name=NIH2013/><ref name=Thom2014/>
| deaths          =
}}

<!-- Definition and symptoms -->
'''Atopic dermatitis''' ('''AD'''), also known as '''atopic eczema''', is a long-term type of inflammation of the skin.<ref name=NIH2013/> Atopic dermatitis is also often called simply '''eczema''' but the same term is also used to refer to [[dermatitis]], the larger group of skin conditions.<ref name="NIH2013" /><ref>{{cite journal |vauthors=Johansson SG, Bieber T, Dahl R, Friedmann PS, Lanier BQ, Lockey RF, Motala C, Ortega Martell JA, Platts-Mills TA, Ring J, Thien F, Van Cauwenberge P, Williams HC |date=May 2004 |title=Revised nomenclature for allergy for global use: Report of the Nomenclature Review Committee of the World Allergy Organization, October 2003 |journal=The Journal of Allergy and Clinical Immunology |volume=113 |issue=5 |pages=832–836 |doi=10.1016/j.jaci.2003.12.591 |pmid=15131563 | doi-access = free | title-link = doi }}</ref> Atopic dermatitis results in [[puritis|itchy]], red, swollen, and cracked skin.<ref name=NIH2013/> Clear fluid may come from the affected areas, which can thicken over time.<ref name=NIH2013>{{cite web|title=Handout on Health: Atopic Dermatitis (A type of eczema)|url=http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|access-date=19 June 2015|date=May 2013|url-status=live|archive-url=https://web.archive.org/web/20150530092344/http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|archive-date=30 May 2015}}</ref>

Atopic dermatitis affects about 20% of people at some point in their lives.<ref name=NIH2013/><ref name=Thom2014>{{cite journal | vauthors = Thomsen SF | title = Atopic dermatitis: natural history, diagnosis, and treatment | journal = ISRN Allergy | volume = 2014 | pages = 354250 | date = 2014 | pmid = 25006501 | pmc = 4004110 | doi = 10.1155/2014/354250 | doi-access = free | title-link = doi }}</ref> It is more common in younger children.<ref name=Toll2014/> Females are affected slightly more often than males.<ref>{{cite web |title=Atopic Dermatitis |url=https://www.niams.nih.gov/health-topics/atopic-dermatitis |website=National Institute of Arthritis and Musculoskeletal and Skin Diseases |access-date=29 August 2022 |date=September 2019}}</ref> Many people outgrow the condition.<ref name=Toll2014/>

While the condition may occur at any age, it typically starts in childhood, with changing severity over the years.<ref name="NIH2013" /><ref name="Toll2014" /> In children under one year of age, the face and limbs and much of the body may be affected.<ref name="Toll2014" /> As children get older, the areas on the insides of the knees and folds of the elbows and around the neck are most commonly affected.<ref name="Toll2014" /> In adults, the hands and feet are commonly affected.<ref name="Toll2014">{{cite journal | vauthors = Tollefson MM, Bruckner AL | title = Atopic dermatitis: skin-directed management | journal = Pediatrics | volume = 134 | issue = 6 | pages = e1735–e1744 | date = December 2014 | pmid = 25422009 | doi = 10.1542/peds.2014-2812 | doi-access = free | title-link = doi }}</ref> Scratching the affected areas worsens the eczema and increases the risk of [[skin infection]]s.<ref name="NIH2013" /> Many people with atopic dermatitis develop [[hay fever]] or [[asthma]].<ref name="NIH2013" />

<!-- Cause and diagnosis -->
The cause is unknown but is believed to involve [[genetics]], [[immune system]] dysfunction, environmental exposures, and difficulties with the [[Semipermeable membrane|permeability]] of the skin.<ref name="NIH2013" /><ref name="Toll2014" /> If one [[identical twin]] is affected, the other has an 85% chance of having the condition.<ref>{{cite book| vauthors = Williams H |title=Evidence-Based Dermatology|year=2009|publisher=John Wiley & Sons|isbn=978-1-4443-0017-8|pages=128|url=https://books.google.com/books?id=SbsQij5xkfYC&pg=PA128|url-status=live|archive-url=https://web.archive.org/web/20170908181020/https://books.google.com/books?id=SbsQij5xkfYC&pg=PA128|archive-date=8 September 2017}}</ref> Those who live in cities and dry climates are more commonly affected.<ref name="NIH2013" /> Exposure to certain chemicals or frequent hand washing makes symptoms worse.<ref name="NIH2013" /> While [[Psychological stress|emotional stress]] may make the symptoms worse, it is not a cause.<ref name="NIH2013" /> The disorder is not [[contagious disease|contagious]].<ref name="NIH2013" /> A diagnosis is typically based on the signs, symptoms and [[Family history (medicine)|family history]].<ref name="Toll2014" />

<!-- Prevention and treatment -->
Treatment involves avoiding things that make the condition worse, enhancing the skin barrier through skin care and treating the underlying skin inflammation. [[Moisturising cream]]s are used to make the skin less dry and prevent AD flare-ups. Anti-inflammatory [[corticosteroid]] creams are used to control flare-ups.<ref name="Toll2014" /> Creams based on [[calcineurin inhibitors]] (tacrolimus or pimecrolimus) may also be used to control flares if other measures are not effective.<ref name="NIH2013" /><ref name="Carr2013">{{cite journal | vauthors = Carr WW | title = Topical calcineurin inhibitors for atopic dermatitis: review and treatment recommendations | journal = Paediatric Drugs | volume = 15 | issue = 4 | pages = 303–310 | date = August 2013 | pmid = 23549982 | pmc = 3715696 | doi = 10.1007/s40272-013-0013-9 }}</ref> Certain [[antihistamine]] pills might help with itchiness.<ref name="Toll2014" /> Things that commonly make it worse include [[house dust mite]], [[Psychological stress|stress]] and seasonal factors.<ref>{{cite journal | vauthors = Langan SM, Williams HC | title = What causes worsening of eczema? A systematic review | journal = The British Journal of Dermatology | volume = 155 | issue = 3 | pages = 504–514 | date = September 2006 | pmid = 16911274 | doi = 10.1111/j.1365-2133.2006.07381.x | s2cid = 43247714 }}</ref> [[Phototherapy]] may be useful in some people.<ref name="NIH2013" /> Antibiotics (either by mouth or topically) are usually not helpful unless there is secondary bacterial infection or the person is unwell.<ref>{{cite journal | vauthors = Ong PY, Boguniewicz J, Chu DK | title = Skin Antiseptics for Atopic Dermatitis: Dissecting Facts From Fiction | journal = The Journal of Allergy and Clinical Immunology. In Practice | volume = 11 | issue = 5 | pages = 1385–1390 | date = May 2023 | pmid = 36702247 | doi = 10.1016/j.jaip.2023.01.012 | s2cid = 256222372 }}</ref> [[Elimination diet|Dietary exclusion]] does not benefit most people and it is only needed if food allergies are suspected.<ref>{{cite journal | vauthors = Oykhman P, Dookie J, Al-Rammahy H, de Benedetto A, Asiniwasis RN, LeBovidge J, Wang J, Ong PY, Lio P, Gutierrez A, Capozza K, Martin SA, Frazier W, Wheeler K, Boguniewicz M, Spergel JM, Greenhawt M, Silverberg JI, Schneider L, Chu DK | title = Dietary Elimination for the Treatment of Atopic Dermatitis: A Systematic Review and Meta-Analysis | journal = The Journal of Allergy and Clinical Immunology. In Practice | volume = 10 | issue = 10 | pages = 2657–2666.e8 | date = October 2022 | pmid = 35987995 | doi = 10.1016/j.jaip.2022.06.044 | s2cid = 250710625 }}</ref> More severe AD cases may need systemic medicines such as [[Ciclosporin|cyclosporin]], [[methotrexate]], [[dupilumab]] or [[baricitinib]].

Other names of the condition include "infantile eczema", "flexural eczema", "prurigo Besnier", "allergic eczema", and "neurodermatitis".<ref name="Wil2000">{{cite journal | vauthors = Williams HC | title = Epidemiology of atopic dermatitis | journal = Clinical and Experimental Dermatology | volume = 25 | issue = 7 | pages = 522–529 | date = October 2000 | pmid = 11122223 | doi = 10.1046/j.1365-2230.2000.00698.x | url = https://books.google.com/books?id=q8OZ4O_gjQUC&pg=PA10 | url-status = live | publisher = Cambridge University Press | isbn = 978-0-521-57075-6 | s2cid = 31546363 | archive-url = https://web.archive.org/web/20150619134904/https://books.google.ca/books?id=q8OZ4O_gjQUC&pg=PA10 | archive-date = 19 June 2015 | url-access = subscription }}</ref>

== Signs and symptoms ==
[[File:Child with Eczema (34034003933).jpg|thumb|Child with atopic dermatitis]]
Symptoms refer to the sensations that people with AD feel, whereas signs refers to a description of the visible changes that result from AD.[[File:Pattern of atopic eczema varies with age.png|thumb|The pattern of atopic eczema varies with age.]]The main symptom of AD is [[itch]]ing which can be intense. Some people experience burning or soreness or [[pain]].<ref name="NIH2013" />

People with AD often have a generally dry skin that can look greyish in people with darker skin tones of colour. Areas of AD are not well defined, and they are typically inflamed (red in a light coloured skin or purple or dark brown in people with dark skin of colour).<ref>{{cite journal | vauthors = Kaufman BP, Guttman-Yassky E, Alexis AF | title = Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment | journal = Experimental Dermatology | volume = 27 | issue = 4 | pages = 340–357 | date = April 2018 | pmid = 29457272 | doi = 10.1111/exd.13514 | s2cid = 3379280 | doi-access = free | title-link = doi }}</ref> Surface changes include:
* scaling cracking ([[skin fissure]]s)
* swelling ([[Edema|oedema]])
* scratch marks (excoriation)
* bumpiness ([[Papule|papulation]])
* oozing of clear fluid
* thickening of the skin ([[lichenification]]) where the AD has been present for a long time.<ref name="NIH2013" />

Eczema often starts on the cheeks and outer limbs and body in infants and frequently settles in the folds of the skin such as behind the knees, folds of the elbows, around the neck, wrists and under the buttock folds as the child grows.<ref>{{Cite book |url=https://www.worldcat.org/oclc/605909001 |title=Rook's Textbook of Dermatology |date=2010 |publisher=Wiley-Blackwell | vauthors = Rook A, Burns T |isbn=978-1-4443-1764-0 |edition=8th |location=Chichester, UK |chapter=Atopic dermatitis |oclc=605909001}}</ref> Any part of the body can be affected by AD.<ref>{{cite book | vauthors = Friedmann PS, Holden CA | chapter = Atopic Dermatitis |date= January 2004 | title = Rook's Textbook of Dermatology |pages=755–786 | veditors = Burns T, Breathnach S, Cox N, Griffiths C |place=Malden, Massachusetts, USA |publisher=Blackwell Publishing, Inc. |doi=10.1002/9780470750520.ch18 |isbn=978-0-470-75052-0 }}</ref>

Atopic dermatitis commonly affects the eyelids, where an extra prominent crease can form under the eyelid due to skin swelling known as [[Dennie–Morgan fold|Dennie-Morgan infraorbital folds]].<ref name="The infra-auricular fissure: a beds">{{cite journal | vauthors = Kwatra SG, Tey HL, Ali SM, Dabade T, Chan YH, Yosipovitch G | title = The infra-auricular fissure: a bedside marker of disease severity in patients with atopic dermatitis | journal = Journal of the American Academy of Dermatology | volume = 66 | issue = 6 | pages = 1009–1010 | date = June 2012 | pmid = 22583715 | doi = 10.1016/j.jaad.2011.10.031 }}</ref> Cracks can form under the ears which can be painful (infra-auricular fissure).<ref>{{cite journal | vauthors = Langan SM, Irvine AD, Weidinger S | title = Atopic dermatitis | journal = Lancet | volume = 396 | issue = 10247 | pages = 345–360 | date = August 2020 | pmid = 32738956 | doi = 10.1016/S0140-6736(20)31286-1 | s2cid = 220873055 }}</ref><ref name="The infra-auricular fissure: a beds"/>

The inflammation from AD often leaves "footprints" known as [[Postinflammatory hypopigmentation|postinflammatory pigmentation]] that can be lighter than the normal skin or darker. These marks are not scars and eventually go back to normal over a period of months providing the underlying AD is treated effectively.<ref>{{Cite web | vauthors = Lambert A |date=9 February 2021 |title=Skin pigmentation and eczema |url=https://eczema.org/information-and-advice/living-with-eczema/skin-pigmentation/ |access-date=6 April 2023 |website=National Eczema Society }}</ref>

People with AD often have dry and scaly skin that spans the entire body, except perhaps the diaper area, and intensely itchy red, splotchy, raised [[lesion]]s to form in the bends of the arms or legs, face, and neck.<ref name="AFP">{{cite journal | vauthors = Berke R, Singh A, Guralnick M | title = Atopic dermatitis: an overview | journal = American Family Physician | volume = 86 | issue = 1 | pages = 35–42 | date = July 2012 | pmid = 22962911 | url = http://www.aafp.org/afp/2012/0701/p35.pdf | url-status = live | archive-url = https://web.archive.org/web/20150906111528/http://www.aafp.org/afp/2012/0701/p35.pdf | archive-date = 6 September 2015 }}</ref><ref name="MSR">{{cite web |date=21 January 2014 |title=Atopic Dermatitis |url=http://emedicine.medscape.com/article/1049085-overview#showall |url-status=live |archive-url=https://web.archive.org/web/20140210011334/http://emedicine.medscape.com/article/1049085-overview#showall |archive-date=10 February 2014 |access-date=3 March 2014 |work=Medscape Reference |publisher=WebMD |vauthors=Kim BS |veditors=Fritsch P, Vinson RP, Perry V, Quirk CM, James WD}}</ref><ref>{{cite book |title=Encyclopedia of molecular mechanisms of diseases |vauthors=Brehler R |publisher=Springer |year=2009 |isbn=978-3-540-67136-7 | veditors = Lang F |location=Berlin |chapter=Atopic Dermatitis}}</ref><ref>{{cite journal | vauthors = Baron SE, Cohen SN, Archer CB | title = Guidance on the diagnosis and clinical management of atopic eczema | journal = Clinical and Experimental Dermatology | volume = 37 | issue = Suppl 1 | pages = 7–12 | date = May 2012 | pmid = 22486763 | doi = 10.1111/j.1365-2230.2012.04336.x | s2cid = 28538214 | doi-access = free | title-link = doi }}</ref><ref name="symp13">{{cite journal | vauthors = Schmitt J, Langan S, Deckert S, Svensson A, von Kobyletzki L, Thomas K, Spuls P | title = Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation | journal = The Journal of Allergy and Clinical Immunology | volume = 132 | issue = 6 | pages = 1337–1347 | date = December 2013 | pmid = 24035157 | doi = 10.1016/j.jaci.2013.07.008 | doi-access = free | title-link = doi }}</ref>

== Causes ==
The cause of AD is not known, although evidence indicates environmental, immunologic, bacterial<ref>{{Cite journal |last=Kedzierska |first=A. |last2=Kapińska-Mrowiecka |first2=M. |last3=Czubak-Macugowska |first3=M. |last4=Wójcik |first4=K. |last5=Kedzierska |first5=J. |date=December 2008 |title=Susceptibility testing and resistance phenotype detection in Staphylococcus aureus strains isolated from patients with atopic dermatitis, with apparent and recurrent skin colonization |url=https://pubmed.ncbi.nlm.nih.gov/18795934/ |journal=The British Journal of Dermatology |volume=159 |issue=6 |pages=1290–1299 |doi=10.1111/j.1365-2133.2008.08817.x |issn=1365-2133 |pmid=18795934}}</ref> and potential genetic factors.<ref name=GreyMaguiness2016>{{cite journal | vauthors = Grey K, Maguiness S | title = Atopic Dermatitis: Update for Pediatricians | journal = Pediatric Annals | volume = 45 | issue = 8 | pages = e280–e286 | date = August 2016 | pmid = 27517355 | doi = 10.3928/19382359-20160720-05 | type = Review }}</ref>

=== Pollution ===
Since 1970, the rates of atopic dermatitis in the US and UK have increased 3-6 fold.<ref name="wwwniaidnihgov-2023">{{Cite web |date=23 January 2023 |title=NIAID Researchers Identify Link Between Common Chemicals and Eczema {{!}} NIH: National Institute of Allergy and Infectious Diseases |url=https://www.niaid.nih.gov/news-events/researchers-identify-link-between-common-chemicals-and-eczema |access-date=23 November 2023 |website=www.niaid.nih.gov }}</ref> Even today, people who migrate from [[Developing country|developing nations]] before the age of 4 years to [[Developed country|industrialized nations]] experience a dramatic rise in the risk of atopic dermatitis and have an additional risk when living in [[Urban area|urbanized areas]] of the industrial nation.<ref name="Zeldin-2023">{{cite journal | vauthors = Zeldin J, Chaudhary PP, Spathies J, Yadav M, D'Souza BN, Alishahedani ME, Gough P, Matriz J, Ghio AJ, Li Y, Sun AA, Eichenfield LF, Simpson EL, Myles IA | title = Exposure to isocyanates predicts atopic dermatitis prevalence and disrupts therapeutic pathways in commensal bacteria | journal = Science Advances | volume = 9 | issue = 1 | pages = eade8898 | date = January 2023 | pmid = 36608129 | pmc = 9821876 | doi = 10.1126/sciadv.ade8898 | bibcode = 2023SciA....9E8898Z }}</ref> Recent work has shed light on these and other data strongly suggesting that early life industrial exposures may cause atopic dermatitis.<ref name="wwwniaidnihgov-2023" /><ref name="NBC News-2023">{{Cite web |date=26 March 2023 |title=Eczema's cause could be in the air we breathe |url=https://www.nbcnews.com/health/health-news/causes-eczema-air-breathe-new-science-suggests-rcna76427 |access-date=23 November 2023 |website=NBC News }}</ref> Chemicals such as [[Isocyanate|(di)isocyanates]] and [[xylene]] prevent the skin bacteria from producing [[ceramide]]-[[sphingolipid]] family [[lipid]]s.<ref name="wwwniaidnihgov-2023" /><ref name="NBC News-2023" /> Early life deficiency in these lipids predicts which children will go on to develop atopic dermatitis.<ref>{{cite journal | vauthors = Chaudhary PP, Myles IA, Zeldin J, Dabdoub S, Deopujari V, Baveja R, Baker R, Bengtson S, Sutton A, Levy S, Hourigan SK | title = Shotgun metagenomic sequencing on skin microbiome indicates dysbiosis exists prior to the onset of atopic dermatitis | journal = Allergy | volume = 78 | issue = 10 | pages = 2724–2731 | date = October 2023 | pmid = 37422700 | pmc = 10543534 | doi = 10.1111/all.15806 }}</ref><ref name="Berdyshev-2023">{{cite journal | vauthors = Berdyshev E, Kim J, Kim BE, Goleva E, Lyubchenko T, Bronova I, Bronoff AS, Xiao O, Kim J, Kim S, Kwon M, Lee S, Seo YJ, Kim K, Choi SJ, Oh SY, Kim SH, Yu SY, Hwang SY, Ahn K, Leung DY | title = Stratum corneum lipid and cytokine biomarkers at age 2 months predict the future onset of atopic dermatitis | journal = The Journal of Allergy and Clinical Immunology | volume = 151 | issue = 5 | pages = 1307–1316 | date = May 2023 | pmid = 36828081 | doi = 10.1016/j.jaci.2023.02.013 | s2cid = 255078763 }}</ref><ref>{{cite journal | vauthors = Rinnov MR, Halling AS, Gerner T, Ravn NH, Knudgaard MH, Trautner S, Goorden SM, Ghauharali-van der Vlugt KJ, Stet FS, Skov L, Thomsen SF, Egeberg A, Rosted AL, Petersen T, Jakasa I, Riethmüller C, Kezic S, Thyssen JP | title = Skin biomarkers predict development of atopic dermatitis in infancy | journal = Allergy | volume = 78 | issue = 3 | pages = 791–802 | date = March 2023 | pmid = 36112082 | doi = 10.1111/all.15518 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Yamamoto-Hanada K, Saito-Abe M, Shima K, Fukagawa S, Uehara Y, Ueda Y, Iwamura M, Murase T, Kuwano T, Inoue T, Ohya Y | title = mRNAs in skin surface lipids unveiled atopic dermatitis at 1 month | journal = Journal of the European Academy of Dermatology and Venereology | volume = 37 | issue = 7 | pages = 1385–1395 | date = July 2023 | pmid = 36897437 | doi = 10.1111/jdv.19017 | doi-access = free | title-link = doi }}</ref> These chemicals also directly activate an itch receptor in the skin known as [[TRPA1]].<ref>{{cite journal | vauthors = Yadav M, Chaudhary PP, D'Souza BN, Ratley G, Spathies J, Ganesan S, Zeldin J, Myles IA | title = Diisocyanates influence models of atopic dermatitis through direct activation of TRPA1 | journal = PLOS ONE | volume = 18 | issue = 3 | pages = e0282569 | date = 2023 | pmid = 36877675 | pmc = 9987805 | doi = 10.1371/journal.pone.0282569 | doi-access = free | title-link = doi | bibcode = 2023PLoSO..1882569Y }}</ref> The industrial manufacturing and use of both xylene and diisocyanates greatly increased starting in 1970, which greatly expanded the average exposure to these substances. For example, these chemicals are components of several exposures known to increase the risk of atopic dermatitis or worsen symptoms including: wildfires, [[Exhaust gas|automobile exhaust]], [[Wallpaper paste|wallpaper adhesives]], paints, non-latex foam furniture, cigarette smoke, and are elements of fabrics like [[polyester]], [[nylon]], and [[spandex]].<ref name="Zeldin-2023" /><ref name="wwwniaidnihgov-2023" /><ref name="NBC News-2023" />

===Climate===
Low [[humidity]], and low [[temperature]] increase the prevalence and risk of flares in people with atopic dermatitis.<ref>{{cite journal | vauthors = Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP | title = The effect of environmental humidity and temperature on skin barrier function and dermatitis | journal = Journal of the European Academy of Dermatology and Venereology | volume = 30 | issue = 2 | pages = 223–249 | date = February 2016 | pmid = 26449379 | doi = 10.1111/jdv.13301 | s2cid = 12378072 | doi-access = free | title-link = doi }}</ref>

=== Genetics ===
Genes that may contribute to AD are mainly those responsible for immune response (e.g. TH2 cytokine and JAK-STAT pathway genes) and skin barrier (e.g. filaggrin, claudin-1, loricrin).{{cn|date=January 2025}}

Immune response: Many people with AD have a family history or a personal history of [[atopy]]. Atopy is a term used to describe individuals who produce substantial amounts of [[Immunoglobulin E|IgE]]. Such individuals have an increased tendency to develop [[asthma]], [[Allergic rhinitis|hay fever]], [[Dermatitis|eczema]], [[Hives|urticaria]] and allergic rhinitis.<ref name="AFP" /><ref name="MSR" /> Up to 80% of people with atopic dermatitis have elevated total or allergen-specific IgE levels.<ref name="Stander" />

Skin barrier: About 30% of people with AD have mutations in the gene for the production of [[filaggrin]] (''FLG''), which increase the risk for early onset of atopic dermatitis and developing asthma.<ref name="ParkPak2016">{{cite journal | vauthors = Park KD, Pak SC, Park KK | title = The Pathogenetic Effect of Natural and Bacterial Toxins on Atopic Dermatitis | journal = Toxins | volume = 9 | issue = 1 | pages = 3 | date = December 2016 | pmid = 28025545 | pmc = 5299398 | doi = 10.3390/toxins9010003 | type = Review | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Irvine AD, McLean WH, Leung DY | title = Filaggrin mutations associated with skin and allergic diseases | journal = The New England Journal of Medicine | volume = 365 | issue = 14 | pages = 1315–1327 | date = October 2011 | pmid = 21991953 | doi = 10.1056/NEJMra1011040 | type = Review }}</ref> However, expression of filaggrin protein or breakdown products offer no predictive utility in atopic dermatitis risk.<ref name="Berdyshev-2023" />

People with atopic dermatitis also have decreased expression of [[Tight junction proteins|tight junction protein]] [[CLDN1|Claudin-1]], which deteriorates the [[Developmental bioelectricity|bioelectric]] barrier function in the epidermis.<ref name=":0">{{Cite journal |last=Benedetto De |first=Anna |date=2010 |title=Tight Junction Defects in Atopic Dermatitis |journal=Journal of Allergy and Clinical Immunology |volume=127 |issue=3 |pages=773–786 |doi=10.1016/j.jaci.2010.10.018 |pmid=21163515 |pmc=3049863 }}</ref>

=== Hygiene hypothesis ===
According to the [[hygiene hypothesis]], early childhood exposure to certain microorganisms (such as [[gut flora]] and [[helminth]] parasites) protects against [[allergy|allergic]] diseases by contributing to the development of the [[immune system]].<ref name="CleaningUpHygieneHypothesis">{{cite journal | vauthors = Scudellari M | title = News Feature: Cleaning up the hygiene hypothesis | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 7 | pages = 1433–1436 | date = February 2017 | pmid = 28196925 | pmc = 5320962 | doi = 10.1073/pnas.1700688114 | doi-access = free | title-link = doi | bibcode = 2017PNAS..114.1433S }}</ref> This exposure is limited in a modern "sanitary" environment, and the incorrectly developed immune system is prone to develop allergies to harmless substances.{{cn|date=January 2025}}

Some support exists for this hypothesis with respect to AD.<ref>{{cite journal | vauthors = Bieber T | title = Atopic dermatitis | journal = The New England Journal of Medicine | volume = 358 | issue = 14 | pages = 1483–1494 | date = April 2008 | pmid = 18385500 | doi = 10.1056/NEJMra074081 }}</ref> Those exposed to dogs while growing up have a lower risk of atopic dermatitis.<ref>{{cite journal | vauthors = Pelucchi C, Galeone C, Bach JF, La Vecchia C, Chatenoud L | title = Pet exposure and risk of atopic dermatitis at the pediatric age: a meta-analysis of birth cohort studies | journal = The Journal of Allergy and Clinical Immunology | volume = 132 | issue = 3 | pages = 616–622.e7 | date = September 2013 | pmid = 23711545 | doi = 10.1016/j.jaci.2013.04.009 | hdl-access = free | hdl = 2434/239729 }}</ref> Also, epidemiological studies support a protective role for helminths against AD.<ref name="epid">{{cite journal | vauthors = Flohr C, Mann J | title = New insights into the epidemiology of childhood atopic dermatitis | journal = Allergy | volume = 69 | issue = 1 | pages = 3–16 | date = January 2014 | pmid = 24417229 | doi = 10.1111/all.12270 | s2cid = 32645590 | doi-access = free | title-link = doi }}</ref> Likewise, children with poor hygiene are at a lower risk for developing AD, as are children who drink [[Raw milk|unpasteurized milk]].<ref name="epid" />

=== Allergens ===
In a small percentage of cases, atopic dermatitis is caused by sensitization to foods<ref name=diMauroBernardin2016>{{cite journal | vauthors = di Mauro G, Bernardini R, Barberi S, Capuano A, Correra A, De' Angelis GL, Iacono ID, de Martino M, Ghiglioni D, Di Mauro D, Giovannini M, Landi M, Marseglia GL, Martelli A, Miniello VL, Peroni D, Sullo LR, Terracciano L, Vascone C, Verduci E, Verga MC, Chiappini E | title = Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics | journal = The World Allergy Organization Journal | volume = 9 | pages = 28 | year = 2016 | pmid = 27583103 | pmc = 4989298 | doi = 10.1186/s40413-016-0111-6 | doi-access = free | title-link = doi | type = Review }}</ref> such as milk, but there is growing consensus that [[food allergy]] most likely arises as a result of skin barrier dysfunction resulting from AD, rather than food allergy causing the skin problems.<ref>{{cite journal | vauthors = Brough HA, Nadeau KC, Sindher SB, Alkotob SS, Chan S, Bahnson HT, Leung DY, Lack G | title = Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? | journal = Allergy | volume = 75 | issue = 9 | pages = 2185–2205 | date = September 2020 | pmid = 32249942 | pmc = 7494573 | doi = 10.1111/all.14304 }}</ref> Atopic dermatitis sometimes appears associated with [[celiac disease|coeliac disease]] and non-coeliac gluten sensitivity. Because a [[gluten-free diet]] (GFD) improves symptoms in these cases, [[gluten]] seems to be the cause of AD in these cases.<ref name="FasanoSapone2015">{{cite journal | vauthors = Fasano A, Sapone A, Zevallos V, Schuppan D | title = Nonceliac gluten sensitivity | journal = Gastroenterology | volume = 148 | issue = 6 | pages = 1195–1204 | date = May 2015 | pmid = 25583468 | doi = 10.1053/j.gastro.2014.12.049 | type = Review | doi-access = free | title-link = doi | quote = Many patients with celiac disease also have atopic disorders. About 30% of patients' allergies with gastrointestinal (GI) symptoms and mucosal lesions, but negative results from serologic (TG2 antibodies) or genetic tests (DQ2 or DQ8 genotype) for celiac disease, had reduced GI and atopic symptoms when they were placed on GFDs. These findings indicated that their symptoms were related to gluten ingestion. }}</ref><ref name="MansuetoSeidita2014">{{cite journal | vauthors = Mansueto P, Seidita A, D'Alcamo A, Carroccio A | title = Non-celiac gluten sensitivity: literature review | journal = Journal of the American College of Nutrition | volume = 33 | issue = 1 | pages = 39–54 | date = 2014 | pmid = 24533607 | doi = 10.1080/07315724.2014.869996 | hdl-access = free | type = Review | s2cid = 22521576 | hdl = 10447/90208 }}</ref> A diet high in fruits seems to have a protective effect against AD, whereas the opposite seems true for heavily [[Convenience food|processed foods]].<ref name="epid" />

Exposure to [[allergen]]s, either from food or the environment, can exacerbate existing atopic dermatitis.<ref>{{cite journal | vauthors = Williams H, Flohr C | title = How epidemiology has challenged 3 prevailing concepts about atopic dermatitis | journal = The Journal of Allergy and Clinical Immunology | volume = 118 | issue = 1 | pages = 209–213 | date = July 2006 | pmid = 16815157 | doi = 10.1016/j.jaci.2006.04.043 | url = http://eprints.nottingham.ac.uk/861/2/revised_final_rostrum.pdf | access-date = 5 February 2019 | url-status = dead | archive-url = https://web.archive.org/web/20180719092709/http://eprints.nottingham.ac.uk/861/2/revised_final_rostrum.pdf | archive-date = 19 July 2018 }}</ref> Exposure to [[House dust mite|dust mites]], for example, is believed to contribute to the risk of developing AD.<ref>{{cite journal | vauthors = Fuiano N, Incorvaia C | title = Dissecting the causes of atopic dermatitis in children: less foods, more mites | journal = Allergology International | volume = 61 | issue = 2 | pages = 231–243 | date = June 2012 | pmid = 22361514 | doi = 10.2332/allergolint.11-RA-0371 | doi-access = free | title-link = doi }}</ref>

=== Hard water ===
The prevalence of atopic dermatitis in children may be linked to the level of [[calcium carbonate]] or "[[Hard water|hardness]]" of household drinking water.<ref name=Sengupta2013>{{cite journal | vauthors = Sengupta P | title = Potential health impacts of hard water | journal = International Journal of Preventive Medicine | volume = 4 | issue = 8 | pages = 866–875 | date = August 2013 | pmid = 24049611 | pmc = 3775162 | type = Review }}</ref><ref name="JabbarLopez-2021">{{cite journal | vauthors = Jabbar-Lopez ZK, Ung CY, Alexander H, Gurung N, Chalmers J, Danby S, Cork MJ, Peacock JL, Flohr C | title = The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta-analysis | journal = Clinical and Experimental Allergy | volume = 51 | issue = 3 | pages = 430–451 | date = March 2021 | pmid = 33259122 | doi = 10.1111/cea.13797 | s2cid = 227245344 }}</ref> Living in areas with hard water may also play a part in the development of AD in early life. However, when AD is already established, using [[Water softening|water softeners]] at home does not reduce the severity of the symptoms.<ref name="JabbarLopez-2021" /><ref name="NIHR Evidence-2024" />

==Role of ''Staphylococcus aureus''==
Colonization of the skin by the bacterium ''[[Staphylococcus aureus|S. aureus]]'' is prevalent in those with atopic dermatitis.<ref>{{cite journal | vauthors = Goh CL, Wong JS, Giam YC | title = Skin colonization of ''Staphylococcus aureus'' in atopic dermatitis patients seen at the National Skin Centre, Singapore | journal = International Journal of Dermatology | volume = 36 | issue = 9 | pages = 653–657 | date = September 1997 | pmid = 9352404 | doi = 10.1046/j.1365-4362.1997.00290.x | s2cid = 3112669 }}</ref> Abnormalities in the skin barrier of persons with AD are exploited by ''S. aureus'' to trigger cytokine expression, thus aggravating the condition.<ref>{{cite journal | vauthors = Nakatsuji T, Chen TH, Two AM, Chun KA, Narala S, Geha RS, Hata TR, Gallo RL | title = Staphylococcus aureus Exploits Epidermal Barrier Defects in Atopic Dermatitis to Trigger Cytokine Expression | journal = The Journal of Investigative Dermatology | volume = 136 | issue = 11 | pages = 2192–2200 | date = November 2016 | pmid = 27381887 | pmc = 5103312 | doi = 10.1016/j.jid.2016.05.127 }}</ref>

However, atopic dermatitis is [[Non-communicable disease|non-communicable]] and therefore could not be directly caused by a highly [[Infection|infectious]] organism. Furthermore, there is insufficient evidence for the effectiveness of anti-staphylococcal treatments for treating ''S. aureus'' in infected or uninfected eczema.<ref name="George-2019">{{cite journal | vauthors = George SM, Karanovic S, Harrison DA, Rani A, Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, Williams HC | title = Interventions to reduce Staphylococcus aureus in the management of eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | date = October 2019 | pmid = 31684694 | pmc = 6818407 | doi = 10.1002/14651858.CD003871.pub3 | collaboration = Cochrane Skin Group }}</ref>

The role of ''S. aureus'' in skin irritation occurs via inflammation factors that induce [[itching]], which may damage the skin, further driving inflammation, and facilitating the growth of ''S. aureus'', thus promoting a chronic cycle.<ref>{{Cite journal |last1=Gallo |first1=Richard L. |last2=Horswill |first2=Alexander R. |date=May 2024 |title=Staphylococcus aureus: The Bug Behind the Itch in Atopic Dermatitis |journal=[[Journal of Investigative Dermatology]] |volume=144 |issue=5 |pages=950–953 |doi=10.1016/j.jid.2024.01.001|doi-access=free |pmid=38430083 }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}</ref>

==Pathophysiology==
Excessive [[type 2 inflammation]] underlies the pathophysiology of atopic dermatitis.<ref>{{cite journal | vauthors = Gandhi NA, Bennett BL, Graham NM, Pirozzi G, Stahl N, Yancopoulos GD | title = Targeting key proximal drivers of type 2 inflammation in disease | journal = Nature Reviews. Drug Discovery | volume = 15 | issue = 1 | pages = 35–50 | date = January 2016 | pmid = 26471366 | doi = 10.1038/nrd4624 | s2cid = 2421591 }}</ref><ref>{{cite journal | vauthors = Akdis CA, Arkwright PD, Brüggen MC, Busse W, Gadina M, Guttman-Yassky E, Kabashima K, Mitamura Y, Vian L, Wu J, Palomares O | title = Type 2 immunity in the skin and lungs | journal = Allergy | volume = 75 | issue = 7 | pages = 1582–1605 | date = July 2020 | pmid = 32319104 | doi = 10.1111/all.14318 | doi-access = free | title-link = doi }}</ref>

Disruption of the epidermal barrier is thought to play an integral role in the [[pathogenesis]] of AD.<ref name="Stander">{{cite journal | vauthors = Ständer S | title = Atopic Dermatitis | journal = The New England Journal of Medicine | volume = 384 | issue = 12 | pages = 1136–1143 | date = March 2021 | pmid = 33761208 | doi = 10.1056/NEJMra2023911 | s2cid = 232355341 }}</ref> Disruptions of the epidermal barrier allows allergens to penetrate the epidermis to deeper layers of the skin. This leads to activation of [[dendritic cell|epidermal inflammatory dendritic]] and [[innate lymphoid cell]]s which subsequently attracts [[T helper cell|Th2 CD4+ helper T cells]] to the skin.<ref name="Stander" /> This dysregulated Th2 inflammatory response is thought to lead to the eczematous lesions.<ref name="Stander" /> The Th2 helper T cells become activated, leading to the release of inflammatory cytokines including [[Interleukin 4|IL-4]], [[Interleukin 13|IL-13]] and [[IL-31]] which activate downstream [[Janus kinase|Janus kinase (Jak)]] pathways. The active Jak pathways lead to inflammation and downstream activation of [[plasma cells]] and [[B cells|B lymphocytes]] which release antigen specific [[IgE]] contributing to further inflammation.<ref name="Stander" /> Other CD4+ helper T-cell pathways thought to be involved in atopic dermatitis inflammation include the Th1, [[T helper 17 cell|Th17]], and Th22 pathways.<ref name="Stander" /> Some specific CD4+ helper T-cell inflammatory pathways are more commonly activated in specific ethnic groups with AD (for example, the Th-2 and Th-17 pathways are commonly activated in Asian people) possibly explaining the differences in phenotypic presentation of atopic dermatitis in specific populations.<ref name="Stander" />

Mutations in the filaggrin gene, ''FLG'', also cause impairment in the skin barrier that contributes to the pathogenesis of AD.<ref name="Stander" /> Filaggrin is produced by epidermal skin cells ([[keratinocytes]]) in the [[stratum corneum|horny layer]] of the epidermis. Filaggrin stimulates skin cells to release moisturizing factors and lipid matrix material, which cause adhesion of adjacent keratinocytes and contributes to the skin barrier.<ref name="Stander" /> A loss-of-function mutation of filaggrin causes loss of this lipid matrix and external moisturizing factors, subsequently leading to disruption of the skin barrier. The disrupted skin barrier leads to transdermal water loss (leading to the [[xerosis]] or dry skin commonly seen in AD) and antigen and allergen penetration of the epidermal layer.<ref name="Stander" /> Filaggrin mutations are also associated with a decrease in natural antimicrobial peptides found on the skin; subsequently leading to disruption of skin flora and bacterial overgrowth (commonly ''[[Staphylococcus aureus]]'' overgrowth or colonization).<ref name="Stander" />

Atopic dermatitis is also associated with the release of pruritogens (molecules that stimulate [[pruritus]] or itching) in the skin.<ref name="Stander" /> Keratinocytes, [[mast cell]]s, [[eosinophil]]s and [[T cell|T-cells]] release pruritogens in the skin; leading to activation of [[Group A nerve fiber|Aδ fibers]] and [[Group C nerve fiber]]s in the [[epidermis]] and [[dermis]] contributing to sensations of pruritus and pain.<ref name="Stander" /> The pruritogens include the Th2 cytokines IL-4, IL-13, IL-31, histamine, and various neuropeptides.<ref name="Stander" /> Mechanical stimulation from scratching lesions can also lead to the release of pruritogens contributing to the itch-scratch cycle whereby there is increased pruritus or itch after scratching a lesion.<ref name="Stander" /> Chronic scratching of lesions can cause thickening or [[lichenification]] of the skin or [[prurigo nodularis]] (generalized nodules that are severely itchy).<ref name="Stander" />

Another factor in the barrier failure and immunological dysregulation in people with atopic dermatitis may be due to decreases in [[Tight junction proteins|tight junction protein]] [[CLDN1|Claudin-1]]. Inhibiting Claudin-1 expression in human keratinocytes has been shown to both reduce [[tight junction]] function, as well as increase keratinocyte proliferation in vitro. It has also been discovered that this deteriorates the [[Developmental bioelectricity|bioelectric]] barrier function in the epidermis.<ref name=":0" />

== Diagnosis ==
Atopic dermatitis is typically [[Clinical diagnosis|diagnosed clinically]], meaning it is based on signs and symptoms alone, without special testing.<ref name="EichenfieldSec1">{{cite journal | vauthors = Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R | title = Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis | journal = Journal of the American Academy of Dermatology | volume = 70 | issue = 2 | pages = 338–351 | date = February 2014 | pmid = 24290431 | pmc = 4410183 | doi = 10.1016/j.jaad.2013.10.010 }}</ref> Several different criteria developed for research have also been validated to aid in diagnosis.<ref name="Brenninkmeijer-2008">{{cite journal | vauthors = Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI | title = Diagnostic criteria for atopic dermatitis: a systematic review | journal = The British Journal of Dermatology | volume = 158 | issue = 4 | pages = 754–765 | date = April 2008 | pmid = 18241277 | doi = 10.1111/j.1365-2133.2007.08412.x | s2cid = 453564 | doi-access = free | title-link = doi }}</ref> Of these, the UK Diagnostic Criteria, based on the work of Hanifin and [[Georg Rajka|Rajka]], has been the most widely validated.<ref name="Brenninkmeijer-2008" /><ref name="Williams-1994">{{cite journal | vauthors = Williams HC, Burney PG, Pembroke AC, Hay RJ | title = The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation | journal = The British Journal of Dermatology | volume = 131 | issue = 3 | pages = 406–416 | date = September 1994 | pmid = 7918017 | doi = 10.1111/j.1365-2133.1994.tb08532.x | s2cid = 37406163 }}</ref>
{| class="wikitable"
|+UK diagnostic criteria<ref name="Williams-1994" />
!People must have [[Itch|itchy skin]], or evidence of rubbing or scratching, plus three or more of:
|-
|Skin creases are involved – flexural dermatitis of fronts of [[ankle]]s, [[Cubital fossa|antecubital fossae]], [[popliteal fossa]]e, skin around eyes, or neck, (or cheeks for children under 10)
|-
|History of [[asthma]] or [[allergic rhinitis]] (or family history of these conditions if patient is a child ≤4 years old)
|-
|Symptoms began before age 2 (can only be applied to people ≥4 years old)
|-
|History of [[Xeroderma|dry skin]] (within the past year)
|-
|[[Dermatitis]] is visible on flexural surfaces (people ≥ age 4) or on the cheeks, forehead, and extensor surfaces (people < age 4)
|}
Other diseases that must be excluded before making a diagnosis include [[contact dermatitis]], [[psoriasis]], and [[seborrheic dermatitis]].<ref name="Toll2014" />

== Prevention ==
There are no established [[evidence-based medicine|clinical methods]] using dietary or [[topical medication|topical]] strategies to inhibit or prevent atopic dermatitis. Specific dietary plans during pregnancy and in early childhood, such as eating fatty fish (or taking [[Omega-3 fatty acid|omega-3]] supplements), are not effective.<ref>{{cite journal | vauthors = Trikamjee T, Comberiati P, D'Auria E, Peroni D, Zuccotti GV | title = Nutritional Factors in the Prevention of Atopic Dermatitis in Children | journal = Frontiers in Pediatrics | volume = 8 | pages = 577413 | date = 12 January 2021 | pmid = 33585361 | pmc = 7874114 | doi = 10.3389/fped.2020.577413 | doi-access = free | title-link = doi }}</ref> Taking [[probiotic]]s (for example [[Lacticaseibacillus rhamnosus|Lactobacillus rhamnosus]]'')'' during pregnancy and feeding probiotics to infants are strategies under research, with only preliminary evidence that they may be preventative.<ref>{{cite journal | vauthors = Sun S, Chang G, Zhang L | title = The prevention effect of probiotics against eczema in children: an update systematic review and meta-analysis | journal = The Journal of Dermatological Treatment | volume = 33 | issue = 4 | pages = 1844–1854 | date = June 2022 | pmid = 34006167 | doi = 10.1080/09546634.2021.1925077 }}</ref><ref>{{cite journal | vauthors = Voigt J, Lele M | title = Lactobacillus rhamnosus Used in the Perinatal Period for the Prevention of Atopic Dermatitis in Infants: A Systematic Review and Meta-Analysis of Randomized Trials | journal = American Journal of Clinical Dermatology | volume = 23 | issue = 6 | pages = 801–811 | date = November 2022 | pmid = 36161401 | pmc = 9576646 | doi = 10.1007/s40257-022-00723-x }}</ref>

Using [[Dermatitis#Moisturizers|moisturizers]] daily in infants during the first year of life does not help to prevent atopic dermatitis, and might even increase the risk of skin infections.<ref name="NIHR Evidence-2024">{{Cite report |url=https://evidence.nihr.ac.uk/collection/eczema-in-children-uncertainties-addressed/ |title=Eczema in children: uncertainties addressed |date=19 March 2024 |publisher=NIHR Evidence |doi=10.3310/nihrevidence_62438 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Kelleher MM, Phillips R, Brown SJ, Cro S, Cornelius V, Carlsen KC, Skjerven HO, Rehbinder EM, Lowe AJ, Dissanayake E, Shimojo N, Yonezawa K, Ohya Y, Yamamoto-Hanada K, Morita K, Axon E, Cork M, Cooke A, Van Vogt E, Schmitt J, Weidinger S, McClanahan D, Simpson E, Duley L, Askie LM, Williams HC, Boyle RJ | title = Skin care interventions in infants for preventing eczema and food allergy | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 11 | pages = CD013534 | date = November 2022 | pmid = 36373988 | pmc = 9661877 | doi = 10.1002/14651858.CD013534.pub3 | collaboration = Cochrane Skin Group }}</ref>

== Treatments ==
No cure for AD is known, although treatments may reduce the severity and frequency of flares.<ref name = AFP/> The most commonly used topical treatments for AD are topical corticosteroids (to get control of flare-ups) and [[Moisturizer|moisturisers]] (emollients) to help keep control.<ref>{{Cite web |title=What are Topical Treatments for Eczema and How Should They Be Used? |url=https://nationaleczema.org/eczema/treatment/topicals/ |access-date=22 June 2023 |website=National Eczema Association }}</ref> Clinical trials often measure the efficacy of treatments with a severity scale such as the [[SCORAD]] index or the [[Eczema Area and Severity Index]].<ref name="EichenfieldSec1" /><ref>{{cite journal | vauthors = Chopra R, Silverberg JI | title = Assessing the severity of atopic dermatitis in clinical trials and practice | journal = Clinics in Dermatology | volume = 36 | issue = 5 | pages = 606–615 | date = 2018 | pmid = 30217273 | doi = 10.1016/j.clindermatol.2018.05.012 | series = Atopic Dermatits: Part II | s2cid = 52277845 }}</ref>

=== Moisturisers ===
Daily basic care is intended to stabilize the barrier function of the skin to mitigate its sensitivity to irritation and penetration of allergens. Affected persons often report that improvement of skin hydration parallels with improvement in AD symptoms. [[Moisturizer|Moisturisers]] (or emollients) can improve skin comfort and may reduce disease flares.<ref>{{cite journal | vauthors = Ridd MJ, Roberts A, Grindlay D, Williams HC | title = Which emollients are effective and acceptable for eczema in children? | journal = BMJ | volume = 367 | pages = l5882 | date = October 2019 | pmid = 31649114 | doi = 10.1136/bmj.l5882 | s2cid = 204882682 | hdl = 1983/2c0e2127-710c-46a9-bd5c-89574b11c9ee | url = https://research-information.bris.ac.uk/en/publications/2c0e2127-710c-46a9-bd5c-89574b11c9ee | hdl-access = free }}</ref> They can be used as leave-on treatments, bath additives or [[soap substitute]]s. There are many different products but the majority of leave-on treatments (least to most greasy) are [[lotion]]s, [[Cream (pharmacy)|creams]], [[gel]]s or [[Topical medication|ointments]]. All of the different types of moisturisers are equally effective so people need to choose one or more products based on what suits them, according to their age, body site effected, climate/season and personal preference.<ref>{{cite journal | vauthors = Ridd MJ, Santer M, MacNeill SJ, Sanderson E, Wells S, Webb D, Banks J, Sutton E, Roberts A, Liddiard L, Wilkins Z, Clayton J, Garfield K, Barrett TJ, Lane JA, Baxter H, Howells L, Taylor J, Hay AD, Williams HC, Thomas KS | title = Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial | journal = The Lancet. Child & Adolescent Health | volume = 6 | issue = 8 | pages = 522–532 | date = August 2022 | pmid = 35617974 | doi = 10.1016/S2352-4642(22)00146-8 | hdl-access = free | s2cid = 249024141 | doi-access = free | title-link = doi | hdl = 1983/e4009d3c-127f-4aa9-bf71-e40401b33eee }}</ref> Non-medicated prescription moisturisers may also be no more effective than [[Over-the-counter drug|over-the-counter]] moisturisers.<ref name="Chu-2023a">{{cite journal | vauthors = Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L | title = Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials | journal = The Journal of Allergy and Clinical Immunology | volume = 152 | issue = 6 | pages = 1493–1519 | date = December 2023 | pmid = 37678572 | doi = 10.1016/j.jaci.2023.08.030 | s2cid = 261610152 | hdl = 10576/50632 | hdl-access = free }}</ref>

The use of emollient bath additives does not provide any additional benefits.<ref name="NIHR Evidence-2024" /><ref>{{Cite book |url=http://www.ncbi.nlm.nih.gov/books/NBK594326/ |title=Evidence reviews for adding bath emollients to the management of atopic eczema in children under 12 years: Atopic eczema in under 12s: diagnosis and management: Evidence review A |date=2023 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-5235-9 |series=NICE Evidence Reviews Collection |location=London |pmid=37616434}}</ref><ref>{{cite journal | vauthors = Santer M, Ridd MJ, Francis NA, Stuart B, Rumsby K, Chorozoglou M, Becque T, Roberts A, Liddiard L, Nollett C, Hooper J, Prude M, Wood W, Thomas KS, Thomas-Jones E, Williams HC, Little P | title = Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness | journal = BMJ | volume = 361 | pages = k1332 | date = May 2018 | pmid = 29724749 | pmc = 5930266 | doi = 10.1136/bmj.k1332 }}</ref>

===Medication===

==== Topical ====
Creams and ointments containing [[corticosteroid]]s applied directly on skin ([[Topical steroid|topical]]) are effective in managing atopic dermatitis.<ref name="Chu-2023a" /><ref name="Lax-2022">{{cite journal | vauthors = Lax SJ, Harvey J, Axon E, Howells L, Santer M, Ridd MJ, Lawton S, Langan S, Roberts A, Ahmed A, Muller I, Ming LC, Panda S, Chernyshov P, Carter B, Williams HC, Thomas KS, Chalmers JR | title = Strategies for using topical corticosteroids in children and adults with eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 3 | pages = CD013356 | date = March 2022 | pmid = 35275399 | pmc = 8916090 | doi = 10.1002/14651858.CD013356.pub2 | collaboration = Cochrane Skin Group }}</ref> Newer (second generation) corticosteroids, such as [[fluticasone propionate]] and [[Mometasone|mometasone furoate]], are more effective and safer than older ones. Strong and moderate corticosteroids work better than weaker ones. They are also generally safe and do not cause [[Steroid-induced skin atrophy|skin thinning]] when used intermittently to treat AD flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment).<ref>{{cite journal | vauthors = Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, Roberts A, Stuart B, Williams HC, Thomas KS | title = The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review | journal = Skin Health and Disease | volume = 3 | issue = 5 | pages = e268 | date = October 2023 | pmid = 37799373 | pmc = 10549798 | doi = 10.1002/ski2.268 }}</ref><ref name="Chu-2023a" /><ref>{{cite journal | vauthors = Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, Grindlay DJ, Muller I, Roberts A, Ahmed A, Williams HC, Thomas KS | title = Safety of topical corticosteroids in atopic eczema: an umbrella review | journal = BMJ Open | volume = 11 | issue = 7 | pages = e046476 | date = July 2021 | pmid = 34233978 | pmc = 8264889 | doi = 10.1136/bmjopen-2020-046476 }}</ref> Applying once daily is as effective as twice or more daily application.<ref name="Lax-2022" />

In addition to topical corticosteroids, topical [[calcineurin inhibitor]]s, such as [[tacrolimus]] or [[pimecrolimus]], are also recommended as first-line therapies for managing atopic dermatitis.<ref name="Chu-2023a" /><ref name="Chu-2024">{{cite journal | vauthors = Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AW, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK | title = Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations | journal = Annals of Allergy, Asthma & Immunology | volume = 132 | issue = 3 | pages = 274–312 | date = March 2024 | pmid = 38108679 | doi = 10.1016/j.anai.2023.11.009 | doi-access = free | title-link = doi }}</ref> Both tacrolimus and pimecrolimus are effective and safe to use in AD.<ref>{{cite journal | vauthors = Cury Martins J, Martins C, Aoki V, Gois AF, Ishii HA, da Silva EM | title = Topical tacrolimus for atopic dermatitis | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD009864 | date = July 2015 | pmid = 26132597 | pmc = 6461158 | doi = 10.1002/14651858.CD009864.pub2 }}</ref><ref>{{cite journal | vauthors = Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, MacDonald M, Wen A, Steen J, Levine M, Pyne L, Schneider L, Chu DK | title = Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis | journal = The Lancet. Child & Adolescent Health | volume = 7 | issue = 1 | pages = 13–25 | date = January 2023 | pmid = 36370744 | doi = 10.1016/S2352-4642(22)00283-8 | s2cid = 253470127 }}</ref> [[Crisaborole]], an inhibitor of [[Phosphodiesterase-4 inhibitor|PDE-4]], is also effective and safe as a topical treatment for mild-to-moderate AD.<ref>{{cite journal | vauthors = McDowell L, Olin B | title = Crisaborole: A Novel Nonsteroidal Topical Treatment for Atopic Dermatitis | journal = The Journal of Pharmacy Technology | volume = 35 | issue = 4 | pages = 172–178 | date = August 2019 | pmid = 34861031 | pmc = 6600556 | doi = 10.1177/8755122519844507 }}</ref><ref>{{Cite journal | vauthors = He Y, Liu J, Wang Y, Kuai W, Liu R, Wu J |date=6 February 2023 | veditors = Pimpinelli N |title=Topical Administration of Crisaborole in Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-Analysis |journal=Dermatologic Therapy |volume=2023 |pages=1–9 |doi=10.1155/2023/1869934 |issn=1529-8019| doi-access = free | title-link = doi }}</ref> [[Ruxolitinib]], a [[Janus kinase inhibitor]], has uncertain efficacy and safety.<ref name="Chu-2023a" /><ref name="Chu-2024" />

==== Systemic ====
When topical (on skin) treatments fail to control severe AD flares, medications taken by mouth (systemic treatment) can be used.<ref name="NIHR Evidence-2024" />

Conventional oral medications for AD include systemic [[Immunosuppressive drug|immunosuppressants]], such as [[ciclosporin]], [[methotrexate]], [[azathioprine]], and [[Mycophenolic acid|mycophenolate]].<ref name="Davis-2024">{{cite journal | vauthors = Davis DM, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Eichenfield LF, Frazer-Green L, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Sidbury R | title = Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies | journal = Journal of the American Academy of Dermatology | volume = 90 | issue = 2 | pages = e43–e56 | date = February 2024 | pmid = 37943240 | doi = 10.1016/j.jaad.2023.08.102 }}</ref><ref>{{cite journal | vauthors = Paolino A, Alexander H, Broderick C, Flohr C | title = Non-biologic systemic treatments for atopic dermatitis: Current state of the art and future directions | journal = Clinical and Experimental Allergy | volume = 53 | issue = 5 | pages = 495–510 | date = May 2023 | pmid = 36949024 | doi = 10.1111/cea.14301 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Flohr C, Rosala-Hallas A, Jones AP, Beattie P, Baron S, Browne F, Brown SJ, Gach JE, Greenblatt D, Hearn R, Hilger E, Esdaile B, Cork MJ, Howard E, Lovgren ML, August S, Ashoor F, Williamson PR, McPherson T, O'Kane D, Ravenscroft J, Shaw L, Sinha MD, Spowart C, Taams LS, Thomas BR, Wan M, Sach TH, Irvine AD | title = Efficacy and safety of ciclosporin versus methotrexate in the treatment of severe atopic dermatitis in children and young people (TREAT): a multicentre parallel group assessor-blinded clinical trial | journal = The British Journal of Dermatology | volume = 189 | issue = 6 | pages = 674–684 | date = November 2023 | pmid = 37722926 | doi = 10.1093/bjd/ljad281 }}</ref><ref name="NIHR Evidence-2024" /> [[Antidepressant]]s and [[naltrexone]] may be used to control pruritus (itchiness).<ref>{{cite journal | vauthors = Kim K | title = Neuroimmunological mechanism of pruritus in atopic dermatitis focused on the role of serotonin | journal = Biomolecules & Therapeutics | volume = 20 | issue = 6 | pages = 506–512 | date = November 2012 | pmid = 24009842 | pmc = 3762292 | doi = 10.4062/biomolther.2012.20.6.506 }}</ref>

Newer medications, such as [[Monoclonal antibody|monoclonal antibodies]] and [[Janus kinase inhibitor|JAK inhibitors]], are highly effective for managing atopic dermatitis, but modestly increase the risk of [[conjunctivitis]]. These include [[dupilumab]] (Dupixent), [[tralokinumab]] (Adtralza, Adbry), [[abrocitinib]] (Cibinqo), [[baricitinib]] (Olumiant) and [[upadacitinib]] (Rinvoq).<ref name="Davis-2024" /><ref name="Chu-2024" /><ref name="Chu-2023b">{{cite journal | vauthors = Chu AW, Wong MM, Rayner DG, Guyatt GH, Díaz Martinez JP, Ceccacci R, Zhao IX, McMullen E, Srivastava A, Wang J, Wen A, Wang FC, Brignardello-Petersen R, Izcovich A, Oykhman P, Wheeler KE, Wang J, Spergel JM, Singh JA, Silverberg JI, Ong PY, O'Brien M, Martin SA, Lio PA, Lind ML, LeBovidge J, Kim E, Huynh J, Greenhawt M, Gardner DD, Frazier WT, Ellison K, Chen L, Capozza K, De Benedetto A, Boguniewicz M, Smith Begolka W, Asiniwasis RN, Schneider LC, Chu DK | title = Systemic treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials | journal = The Journal of Allergy and Clinical Immunology | volume = 152 | issue = 6 | pages = 1470–1492 | date = December 2023 | pmid = 37678577 | doi = 10.1016/j.jaci.2023.08.029 | doi-access = free | title-link = doi }}</ref> Among monoclonal antibodies, [[dupilumab]] and [[tralokinumab]] are approved to treat moderate-to-severe eczema in the US and the EU.<ref name="FDA-Dupilumab">{{cite web |date=28 March 2017 |title=FDA approves new eczema drug Dupixent |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |url-status=dead |archive-url=https://web.archive.org/web/20170328204026/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |archive-date=28 March 2017 |access-date=29 March 2017 |publisher=US Food & Drug Administration}}</ref><ref>{{Cite web |date=17 September 2018 |title=Dupixent |url=https://www.ema.europa.eu/en/medicines/human/EPAR/dupixent |access-date=22 March 2023 |website=European Medicines Agency }}</ref><ref name="Adtralza EPAR">{{cite web |date=20 April 2021 |title=Adtralza EPAR |url=https://www.ema.europa.eu/en/medicines/human/EPAR/adtralza |access-date=9 July 2021 |website=[[European Medicines Agency]] (EMA)}} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref><ref name="FDA-Adbry">{{cite web |date=27 December 2021 |title=Drug Approval Package: ADBRY |url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2022/761180Orig1s000TOC.cfm |archive-url=https://web.archive.org/web/20220803033420/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2022/761180Orig1s000TOC.cfm |url-status=dead |archive-date=3 August 2022 |access-date=6 March 2022 |publisher=US Food & Drug Administration}}</ref> [[Lebrikizumab]] is also approved in the EU for treating moderate-to-severe AD<ref>{{Cite web |title=Ebglyss |url=https://www.ema.europa.eu/en/medicines/human/EPAR/ebglyss |access-date=15 April 2024 |website=European Medicines Agency|date=21 November 2023 }}</ref> but in the US its approval was declined due to manufacturing issues.<ref>{{Cite web |title=FDA Rejects Lilly's Eczema Treatment Over Third-Party Manufacturing Issues |url=https://www.biospace.com/article/fda-rejects-lilly-s-eczema-treatment-over-third-party-manufacturing-issues/ |access-date=3 October 2023 |website=BioSpace|date=2 October 2023 }}</ref> [[Abrocitinib]] and [[upadacitinib]] have also been approved in the US for the treatment of moderate-to-severe eczema.<ref>{{cite press release |title=U.S. FDA Approves Pfizer's Cibinqo (abrocitinib) for Adults with Moderate-to-Severe Atopic Dermatitis |website=Pfizer Inc. |date=14 January 2022 |url=https://www.pfizer.com/news/press-release/press-release-detail/us-fda-approves-pfizers-cibinqor-abrocitinib-adults |access-date=16 January 2022}}</ref><ref>{{cite press release |url=https://news.abbvie.com/news/press-releases/us-fda-approves-rinvoq-upadacitinib-to-treat-adults-and-children-12-years-and-older-with-refractory-moderate-to-severe-atopic-dermatitis.htm |title=U.S. FDA Approves Rinvoq (upadacitinib) to Treat Adults and Children 12 Years and Older with Refractory, Moderate to Severe Atopic Dermatitis |website=AbbeVie |access-date=6 March 2022}}</ref> [[Nemolizumab]] (Nemluvio) was approved to treat atopic dermatitis in December 2024.<ref>{{Cite web |title=NEMLUVIO® (nemolizumab-ilto) for injection, for subcutaneous use Initial U.S. Approval: 2024 |url=https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761391s000lbl.pdf |website=www.accessdata.fda.gov}}</ref>

[[Allergen immunotherapy]] may be effective in relieving symptoms of AD, but it also comes with an increased risk of [[adverse event]]s.<ref>{{cite journal | vauthors = Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, Chu AW, Ceccaci R, Acosta-Madiedo AS, Wen A, Moreno-López S, MacDonald M, Barrios M, Chu X, Islam N, Gao Y, Wong MM, Couban R, Garcia E, Chapman E, Oykhman P, Chen L, Winders T, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel J, Wang J, Wheeler KE, Schneider L, Chu DK | title = Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms | journal = The Journal of Allergy and Clinical Immunology | volume = 151 | issue = 1 | pages = 147–158 | date = January 2023 | pmid = 36191689 | doi = 10.1016/j.jaci.2022.09.020 | s2cid = 252656283 | doi-access = free | title-link = doi | hdl = 10576/44628 | hdl-access = free }}</ref> This treatment consists of a series of injections or drops under the tongue of a solution containing the allergen.<ref name="Tam2016">{{cite journal | vauthors = Tam H, Calderon MA, Manikam L, Nankervis H, García Núñez I, Williams HC, Durham S, Boyle RJ | title = Specific allergen immunotherapy for the treatment of atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 2 | pages = CD008774 | date = February 2016 | pmid = 26871981 | pmc = 8761476 | doi = 10.1002/14651858.CD008774.pub2 | hdl-access = free | hdl = 10044/1/31818 }}</ref>

The skin of people with AD can easily get infected, most commonly by the bacteria [[Staphylococcus aureus]]. Signs of this include oozing fluid, a yellow crust on the skin, worsening eczema symptoms and fever. Antibiotics are commonly used to target overgrowth of ''S. aureus'' but their benefit is limited, and they increase the risk of [[antimicrobial resistance]]. For these reasons, they are only recommended for people who not only present symptoms on the skin but feel systematically unwell.<ref name="NIHR Evidence-2024" /><ref name="George-2019" /><ref>{{Cite web |date=2 March 2021 |title=Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing. NICE guideline [NG190] |url=https://www.nice.org.uk/guidance/ng190/chapter/Recommendations |access-date=26 July 2024 |website=National Institute for Health and Care Excellence}}</ref>

===Diet===
The role of [[vitamin D]] on atopic dermatitis is not clear, but vitamin D supplementation may improve its symptoms.<ref name="DebinskaSikorskaSzaflik2015">{{cite journal | vauthors = Dębińska A, Sikorska-Szaflik H, Urbanik M, Boznański A | title = The role of vitamin D in atopic dermatitis | journal = Dermatitis | volume = 26 | issue = 4 | pages = 155–161 | year = 2015 | pmid = 26172483 | doi = 10.1097/DER.0000000000000128 | type = Review | s2cid = 35345939 }}</ref><ref name="KimBae2016">{{cite journal | vauthors = Kim G, Bae JH | title = Vitamin D and atopic dermatitis: A systematic review and meta-analysis | journal = Nutrition | volume = 32 | issue = 9 | pages = 913–920 | date = September 2016 | pmid = 27061361 | doi = 10.1016/j.nut.2016.01.023 | type = Systematic Review and Meta-Analysis }}</ref><ref>{{cite journal | vauthors = Hattangdi-Haridas SR, Lanham-New SA, Wong WH, Ho MH, Darling AL | title = Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children | journal = Nutrients | volume = 11 | issue = 8 | pages = 1854 | date = August 2019 | pmid = 31405041 | pmc = 6722944 | doi = 10.3390/nu11081854 | doi-access = free | title-link = doi }}</ref>

There is no clear benefit for pregnant mothers taking [[Omega-3 fatty acid|omega 3 long-chain polyunsaturated fatty acid]] (LCPUFA) in preventing the development of AD in their child.<ref>{{cite journal | vauthors = Venter C, Agostoni C, Arshad SH, Ben-Abdallah M, Du Toit G, Fleischer DM, Greenhawt M, Glueck DH, Groetch M, Lunjani N, Maslin K, Maiorella A, Meyer R, Antonella M, Netting MJ, Ibeabughichi Nwaru B, Palmer DJ, Palumbo MP, Roberts G, Roduit C, Smith P, Untersmayr E, Vanderlinden LA, O'Mahony L | title = Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology | journal = Pediatric Allergy and Immunology | volume = 31 | issue = 8 | pages = 889–912 | date = November 2020 | pmid = 32524677 | pmc = 9588404 | doi = 10.1111/pai.13303 | veditors = Peters R }}</ref><ref>{{cite journal | vauthors = Trikamjee T, Comberiati P, D'Auria E, Peroni D, Zuccotti GV | title = Nutritional Factors in the Prevention of Atopic Dermatitis in Children | journal = Frontiers in Pediatrics | volume = 8 | pages = 577413 | date = 12 January 2021 | pmid = 33585361 | pmc = 7874114 | doi = 10.3389/fped.2020.577413 | doi-access = free | title-link = doi }}</ref>

Several [[probiotics]] seem to have a positive effect, with a roughly 20% reduction in the rate of AD.<ref>{{cite journal | vauthors = Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, Murrell DF, Tang ML, Roberts A, Boyle RJ | title = Probiotics for treating eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD006135 | date = November 2018 | pmid = 30480774 | pmc = 6517242 | doi = 10.1002/14651858.CD006135.pub3 }}</ref><ref>{{cite journal | vauthors = Rusu E, Enache G, Cursaru R, Alexescu A, Radu R, Onila O, Cavallioti T, Rusu F, Posea M, Jinga M, Radulian G | title = Prebiotics and probiotics in atopic dermatitis | journal = Experimental and Therapeutic Medicine | volume = 18 | issue = 2 | pages = 926–931 | date = August 2019 | pmid = 31384325 | pmc = 6639913 | doi = 10.3892/etm.2019.7678 }}</ref><ref>{{cite journal | vauthors = Umborowati MA, Damayanti D, Anggraeni S, Endaryanto A, Surono IS, Effendy I, Prakoeswa CR | title = The role of probiotics in the treatment of adult atopic dermatitis: a meta-analysis of randomized controlled trials | journal = Journal of Health, Population, and Nutrition | volume = 41 | issue = 1 | pages = 37 | date = August 2022 | pmid = 35978397 | pmc = 9386980 | doi = 10.1186/s41043-022-00318-6 | doi-access = free | title-link = doi }}</ref> Probiotics containing multiple [[Strain (biology)|strains]] of bacteria seem to work the best.<ref>{{cite journal | vauthors = Chang YS, Trivedi MK, Jha A, Lin YF, Dimaano L, García-Romero MT | title = Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials | journal = JAMA Pediatrics | volume = 170 | issue = 3 | pages = 236–242 | date = March 2016 | pmid = 26810481 | doi = 10.1001/jamapediatrics.2015.3943 | doi-access = free | title-link = doi }}</ref>

In people with [[Coeliac disease|celiac disease]] or [[non-celiac gluten sensitivity|nonceliac gluten sensitivity]], a gluten-free diet improves their symptoms and prevents the occurrence of new outbreaks.<ref name="FasanoSapone2015" /><ref name="MansuetoSeidita2014" />

Use of blood specific [[Immunoglobulin E|IgE]] or [[Skin allergy test|skin prick tests]] to guide dietary exclusions with the aim of improving disease severity or control is controversial. Clinicians vary in their use of these tests for this purpose, and there are very limited evidence of any benefit.<ref>{{cite journal | vauthors = Roberts K, Gilbertson A, Dawson S, Turner N, Ridd MJ | title = Test-guided dietary exclusions for treating established atopic dermatitis in children: A systematic review | journal = Clinical and Experimental Allergy | volume = 52 | issue = 3 | pages = 442–446 | date = March 2022 | pmid = 34862822 | doi = 10.1111/cea.14072 | hdl-access = free | s2cid = 244872550 | hdl = 1983/693f4124-283d-4a11-adb3-21e1916330be | url = https://research-information.bris.ac.uk/en/publications/693f4124-283d-4a11-adb3-21e1916330be }}</ref>

===Lifestyle===
Health professionals often recommend that people with AD bathe regularly in lukewarm baths, especially in salt water, to moisten their skin.<ref name="MSR" /><ref name="NP">{{cite journal | vauthors = Lio PA | title = Non-pharmacologic therapies for atopic dermatitis | journal = Current Allergy and Asthma Reports | volume = 13 | issue = 5 | pages = 528–538 | date = October 2013 | pmid = 23881511 | doi = 10.1007/s11882-013-0371-y | s2cid = 40875822 }}</ref> Dilute [[Sodium hypochlorite washes|bleach baths]] may be helpful for people with moderate and severe eczema, but only for people with Staphylococcus aureus.<ref>{{cite journal | vauthors = Bakaa L, Pernica JM, Couban RJ, Tackett KJ, Burkhart CN, Leins L, Smart J, Garcia-Romero MT, Elizalde-Jiménez IG, Herd M, Asiniwasis RN, Boguniewicz M, De Benedetto A, Chen L, Ellison K, Frazier W, Greenhawt M, Huynh J, LeBovidge J, Lind ML, Lio P, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Begolka WS, Schneider L, Chu DK | title = Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE | journal = Annals of Allergy, Asthma & Immunology | volume = 128 | issue = 6 | pages = 660–668.e9 | date = June 2022 | pmid = 35367346 | doi = 10.1016/j.anai.2022.03.024 | s2cid = 247847598 | doi-access = free | title-link = doi }}</ref>

Avoiding large-diameter [[woolen]] clothing or scratchy fibres is usually recommended for people with AD as they can trigger a flare.<ref name="Jaros-2020">{{cite journal | vauthors = Jaros J, Wilson C, Shi VY | title = Fabric Selection in Atopic Dermatitis: An Evidence-Based Review | journal = American Journal of Clinical Dermatology | volume = 21 | issue = 4 | pages = 467–482 | date = August 2020 | pmid = 32440827 | doi = 10.1007/s40257-020-00516-0 | s2cid = 218761019 }}</ref><ref>{{Cite web |date=11 February 2020 |title=Clothing and eczema |url=https://eczema.org/information-and-advice/triggers-for-eczema/clothing-and-eczema/ |access-date=10 April 2023 |website=National Eczema Society }}</ref> Safe alternatives are clothes made from fabrics with smaller diameters and smooth fibers. These include super- and ultrafine [[Merino|merino wool]] and fabrics with anti-microbial textile finishes. Wearing [[silk]] is also safe but does not improve symptoms of AD.<ref name="Jaros-2020" /><ref name="NIHR Evidence-2024" /><ref>{{cite journal | vauthors = Thomas KS, Bradshaw LE, Sach TH, Cowdell F, Batchelor JM, Lawton S, Harrison EF, Haines RH, Ahmed A, Dean T, Burrows NP, Pollock I, Buckley HK, Williams HC, Llewellyn J, Crang C, Grundy JD, Guiness J, Gribbin A, Wake EV, Mitchell EJ, Brown SJ, Montgomery AA | title = Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial | journal = Health Technology Assessment | volume = 21 | issue = 16 | pages = 1–260 | date = April 2017 | pmid = 28409557 | pmc = 5410632 | doi = 10.3310/hta21160 }}</ref>

=== Self-management ===
Living with AD requires a high level of self-management (for example avoiding triggers) and [[Adherence (medicine)|adherence]] to treatments (regularly applying medication). Good self-management contributes to better disease outcomes and quality of life.<ref>{{cite journal | vauthors = Ridd MJ, King AJ, Le Roux E, Waldecker A, Huntley AL | title = Systematic review of self-management interventions for people with eczema | journal = The British Journal of Dermatology | volume = 177 | issue = 3 | pages = 719–734 | date = September 2017 | pmid = 28432696 | pmc = 5637890 | doi = 10.1111/bjd.15601 }}</ref><ref name="Teasdale-2021">{{cite journal | vauthors = Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, Roberts A, Ridd MJ, Francis N, Yardley L, Thomas KS, Santer M | title = Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies | journal = The British Journal of Dermatology | volume = 184 | issue = 4 | pages = 627–637 | date = April 2021 | pmid = 32531800 | doi = 10.1111/bjd.19299 | hdl = 1983/05ffa4c9-3868-469d-97b6-ac467bdf95b3 | hdl-access = free }}</ref> However, worries about topical treatments, misconceptions about the condition, unclear information and unsuitable communication from doctors can make living with AD more difficult.<ref name="NIHR Evidence-2024" />

People with AD often do not regard eczema as long-term condition and hope they will outgrow or cure it. This can cause worse adherence to the necessary long-term treatment. Doctors should not imply that it is a short-term condition and should emphasise that even though it cannot be cured it can be controlled effectively.<ref name="NIHR Evidence-2020">{{Cite report |url=https://evidence.nihr.ac.uk/alert/eczema-misconceptions-hinder-long-term-treatment/ |title=Addressing misconceptions about eczema could help people manage their condition over the long term |date=9 December 2020 |publisher=NIHR Evidence |doi=10.3310/alert_42973 |url-access=subscription }}</ref><ref name="Teasdale-2021" />

Appropriate communication from doctors can support self-management. Doctors need to address concerns about treatments and provide clear and consistent information about the condition.<ref name="NIHR Evidence-2020" /><ref name="Teasdale-2021" /> Treatment regimens can be confusing, and written action plans may support people in knowing which treatments to use where and when.<ref>{{cite journal | vauthors = Thandi CS, Constantinou S, Vincent R, Ridd MJ | title = Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? Systematic review | journal = Skin Health and Disease | volume = 3 | issue = 3 | pages = e213 | date = June 2023 | pmid = 37275422 | pmc = 10233085 | doi = 10.1002/ski2.213 | s2cid = 257729897 }}</ref> A website supporting self-management has been shown to improve AD symptoms for parents, children, adolescents and young adults.<ref>{{Cite journal |date=11 April 2023 |title=Online support improved eczema symptoms in children and young people |url=https://evidence.nihr.ac.uk/alert/online-support-improved-eczema-symptoms-in-children-and-young-people/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_57579|s2cid=258094184 |url-access=subscription }}</ref><ref>{{cite journal | vauthors = Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, Wilczynska S, Sach TH, Ridd MJ, Roberts A, Ahmed A, Yardley L, Little P, Greenwell K, Sivyer K, Nuttall J, Griffiths G, Lawton S, Langan SM, Howells LM, Leighton P, Williams HC, Thomas KS | title = Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials | journal = BMJ | volume = 379 | pages = e072007 | date = December 2022 | pmid = 36740888 | doi = 10.1136/bmj-2022-072007 | pmc = 11778922 | hdl-access = free | s2cid = 254367009 | hdl = 1983/6003736c-fa64-47a6-9ca7-984ba6a3bad1 }}</ref>

===Light===
[[Light therapy|Phototherapic]] treatment involves exposure to broad- or narrow-band [[ultraviolet]] (UV) light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares.<ref>{{cite journal | vauthors = Tintle S, Shemer A, Suárez-Fariñas M, Fujita H, Gilleaudeau P, Sullivan-Whalen M, Johnson-Huang L, Chiricozzi A, Cardinale I, Duan S, Bowcock A, Krueger JG, Guttman-Yassky E | title = Reversal of atopic dermatitis with narrow-band UVB phototherapy and biomarkers for therapeutic response | journal = The Journal of Allergy and Clinical Immunology | volume = 128 | issue = 3 | pages = 583–93.e1–4 | date = September 2011 | pmid = 21762976 | pmc = 3448950 | doi = 10.1016/j.jaci.2011.05.042 }}</ref><ref>{{cite journal | vauthors = Beattie PE, Finlan LE, Kernohan NM, Thomson G, Hupp TR, Ibbotson SH | title = The effect of ultraviolet (UV) A1, UVB and solar-simulated radiation on p53 activation and p21 | journal = The British Journal of Dermatology | volume = 152 | issue = 5 | pages = 1001–1008 | date = May 2005 | pmid = 15888160 | doi = 10.1111/j.1365-2133.2005.06557.x | s2cid = 22191753 }}</ref> Among the different types of phototherapies only narrowband (NB) ultraviolet B (UVB) exposure might help with the severity of AD and ease itching.<ref name="Chu-2023b" /><ref>{{cite journal | vauthors = Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C, Drucker AM, Gerbens L, Ferguson J, Ibbotson S, Dawe RS, Garritsen F, Brouwer M, Limpens J, Prescott LE, Boyle RJ, Spuls PI | title = Phototherapy for atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD013870 | date = October 2021 | pmid = 34709669 | pmc = 8552896 | doi = 10.1002/14651858.CD013870.pub2 | collaboration = Cochrane Skin Group }}</ref> However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk.<ref>{{cite journal | vauthors = Jans J, Garinis GA, Schul W, van Oudenaren A, Moorhouse M, Smid M, Sert YG, van der Velde A, Rijksen Y, de Gruijl FR, van der Spek PJ, Yasui A, Hoeijmakers JH, Leenen PJ, van der Horst GT | title = Differential role of basal keratinocytes in UV-induced immunosuppression and skin cancer | journal = Molecular and Cellular Biology | volume = 26 | issue = 22 | pages = 8515–8526 | date = November 2006 | pmid = 16966369 | pmc = 1636796 | doi = 10.1128/MCB.00807-06 }}</ref> [[Phototherapy|UV phototherapy]] is not indicated in young adults and children due to this risk of [[skin cancer]] with prolonged use or exposure.<ref name="Stander" />

=== Alternative medicine ===
While several [[Chinese herbal medicine]]s are intended for treating atopic eczema, there is no evidence showing that these treatments, taken by mouth or applied topically, reduce the severity of eczema in children or adults.<ref>{{cite journal | vauthors = Gu S, Yang AW, Xue CC, Li CG, Pang C, Zhang W, Williams HC | title = Chinese herbal medicine for atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 9 | pages = CD008642 | date = September 2013 | pmid = 24018636 | pmc = 10639001 | doi = 10.1002/14651858.CD008642.pub2 }}</ref>

== Impact ==
Atopic dermatitis significantly impairs the [[Quality of life (healthcare)|quality of life]] of affected individuals.<ref name="Fasseeh-2022">{{cite journal | vauthors = Fasseeh AN, Elezbawy B, Korra N, Tannira M, Dalle H, Aderian S, Abaza S, Kaló Z | title = Burden of Atopic Dermatitis in Adults and Adolescents: a Systematic Literature Review | journal = Dermatology and Therapy | volume = 12 | issue = 12 | pages = 2653–2668 | date = December 2022 | pmid = 36197589 | pmc = 9674816 | doi = 10.1007/s13555-022-00819-6 }}</ref><ref name="Page-2021">{{cite journal | vauthors = Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D | title = The PRISMA 2020 statement: an updated guideline for reporting systematic reviews | journal = BMJ | volume = 372 | pages = n71 | date = March 2021 | pmid = 33782057 | pmc = 8005924 | doi = 10.1136/bmj.n71 }}</ref> The impact of AD extends beyond physical symptoms, encompassing substantial humanistic and [[psychosocial]] effects. Its [[Disease burden|burden]] is significant, especially given the high indirect costs and psychological impacts on quality of life.<ref name="Fasseeh-2022" /><ref>{{cite journal | vauthors = Marron SE, Cebrian-Rodriguez J, Alcalde-Herrero VM, Garcia-Latasa de Aranibar FJ, Tomas-Aragones L | title = Psychosocial Impact of Atopic Dermatitis in Adults: A Qualitative Study | journal = Actas Dermo-Sifiliograficas | volume = 111 | issue = 6 | pages = 513–517 | date = 1 July 2020 | pmid = 32401725 | doi = 10.1016/j.ad.2019.03.018 | doi-access = free | title-link = doi }}</ref>

According to the [[Global Burden of Disease Study]], AD is the skin disease with the highest [[disability-adjusted life year]] burden and ranks in the top 15 of all nonfatal diseases. In comparison with other dermatological conditions like psoriasis and urticaria, AD presents a significantly higher burden.<ref name="Page-2021" />

While AD remains incurable, reducing its severity can significantly alleviate its burden. Understanding the extent of the burden of AD can aid in better resource allocation and prioritization of interventions, benefiting both people with atopic dermatitis and healthcare systems.<ref>{{cite journal | vauthors = Silverwood RJ, Mansfield KE, Mulick A, Wong AY, Schmidt SA, Roberts A, Smeeth L, Abuabara K, Langan SM | title = Atopic eczema in adulthood and mortality: UK population-based cohort study, 1998-2016 | journal = The Journal of Allergy and Clinical Immunology | volume = 147 | issue = 5 | pages = 1753–1763 | date = May 2021 | pmid = 33516523 | pmc = 8098860 | doi = 10.1016/j.jaci.2020.12.001 }}</ref>

=== Humanistic burden ===
Atopic dermatitis significantly decreases the quality of life by affecting various aspects of people's lives. The psychological impact, often resulting in conditions like [[Major depressive disorder|depression]] and [[Anxiety disorder|anxiety]], is a major factor leading to decreased [[quality of life]]. Sleep disturbances, commonly reported in people with AD, further contribute to the humanistic burden, affecting daily productivity and concentration.<ref name="Fasseeh-2022" />

=== Clinical and economic burden ===
Economically, AD imposes a substantial burden on healthcare systems, with the average direct cost per patient estimated at US $4411 and the average indirect cost reaching US $9068 annually.<ref name="Fasseeh-2022" /> These figures highlight the considerable financial impact of the disease on healthcare systems and people with the condition.<ref>{{cite journal | vauthors = Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL | title = Prevalence and psychosocial impact of atopic dermatitis in Bangladeshi children and families | journal = PLOS ONE | volume = 16 | issue = 4 | pages = e0249824 | date = 16 April 2021 | pmid = 33861780 | pmc = 8051797 | doi = 10.1371/journal.pone.0249824 | bibcode = 2021PLoSO..1649824P | doi-access = free | title-link = doi }}</ref><ref>{{Cite web |title=World Bank Country and Lending Groups – World Bank Data Help Desk |url=https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups |access-date=14 January 2024 |website=datahelpdesk.worldbank.org}}</ref>

=== Productivity loss ===
Atopic dermatitis also has a marked impact on productivity. The total number of days lost annually due to these factors is about 68.8 days for the general AD population, with [[presenteeism]] accounting for the majority of these days.<ref name="Fasseeh-2022" /> The impact on productivity varies significantly with the severity of AD, with more severe cases resulting in higher numbers of days lost.<ref name="Fasseeh-2022" /><ref>{{cite journal | vauthors = Avena-Woods C | title = Overview of atopic dermatitis | journal = The American Journal of Managed Care | volume = 23 | issue = 8 Suppl | pages = S115–S123 | date = June 2017 | pmid = 28978208 | url = https://pubmed.ncbi.nlm.nih.gov/28978208/?dopt=Abstract }}</ref>

=== Burden of disease in the Middle East and Africa ===
Atopic dermatitis leads to the highest loss in [[disability-adjusted life year]]s compared to other skin diseases in the Middle East and Africa.<ref name="Elezbawy-2023">{{cite journal | vauthors = Elezbawy B, Fasseeh AN, Fouly E, Tannira M, Dalle H, Aderian S, Abu Esba LC, Al Abdulkarim H, Ammoury A, Altawil E, Al Turaiki A, Albreiki F, Al-Haddab M, Al-Lafi A, Alowayesh M, Al-Sheikh A, Elsayed M, Elshamy A, Eshmawi M, Farag A, Hamadah I, Hedibel M, Kannenberg S, Karam R, Metni M, Raboobee N, Steinhoff M, Abaza S, Farghaly M, Kaló Z | title = Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region | journal = Dermatology and Therapy | volume = 13 | issue = 1 | pages = 131–146 | date = January 2023 | pmid = 36445612 | pmc = 9823172 | doi = 10.1007/s13555-022-00857-0 }}</ref> Patients with AD in these regions lose approximately 0.19 [[quality-adjusted life year]]s (QALYs) annually due to the disease. Egypt experiences the highest QALY loss and Kuwait the lowest.<ref name="Elezbawy-2023" />

The average annual healthcare cost per patient varies is highest in the United Arab Emirates, estimated at US $3569, and lowest in Algeria at US $312. These costs are influenced by the economic status of each country and the cost of healthcare. Advanced treatments like targeted therapies and phototherapy are among the main cost drivers.<ref name="Elezbawy-2023" />

Indirect costs, primarily due to productivity loss from [[absenteeism]] and presenteeism average about 67% in these countries. Indirect costs in Saudi Arabia are the highest in the area, estimated at US $364 million.<ref name="Elezbawy-2023" /> Factors like mental health impact, side effects of treatments, and other indirect costs such as personal care products are not fully accounted for in these estimates, suggesting that the actual burden might be even higher.<ref name="Elezbawy-2023" />

To mitigate the burden of AD, experts recommend strategic actions across five key domains: capacity building, guidelines, research, public awareness, and patient support and education. Key measures include increasing the number of dermatologists, establishing evidence-based treatment guidelines, investing in patient education, and enhancing public awareness to reduce stigma.<ref name="Elezbawy-2024">{{cite journal | vauthors = Elezbawy B, Farghaly M, Al Lafi A, Gamal M, Metni M, Visser W, Al-Abdulkarim H, Hedibel M, Fasseeh AN, Abaza S, Kaló Z | title = Strategic Approaches to Reducing the Burden of Atopic Dermatitis in the Middle East and Africa Region | journal = Value in Health Regional Issues | volume = 42 | pages = 100987 | date = July 2024 | pmid = 38703753 | doi = 10.1016/j.vhri.2024.100987 | doi-access = free | title-link = doi }}</ref> Improving access to effective treatments and conducting further research on AD's impact are also crucial for reducing the disease's clinical, economic, and humanistic burdens in the MEA.<ref name="Elezbawy-2024" />

== Epidemiology ==

Since the beginning of the 20th century, many inflammatory skin disorders have become more common; AD is a classic example of such a disease. Although AD was previously considered primarily a childhood disease, it is now recognized as highly prevalent in adults, with an estimated adult prevalence of 3–5% globally.<ref name="Fasseeh-2022" /><ref name="Page-2021" /> It now affects 15–30% of children and 2–10% of adults in developed countries, and in the United States has nearly tripled in the past 30–40 years.<ref name = MSR/><ref name=saito>{{cite journal | vauthors = Saito H | title = Much atopy about the skin: genome-wide molecular analysis of atopic eczema | journal = International Archives of Allergy and Immunology | volume = 137 | issue = 4 | pages = 319–325 | date = August 2005 | pmid = 15970641 | doi = 10.1159/000086464 | s2cid = 20040720 }}</ref> Over 15 million American adults and children have AD.<ref>{{cite web | url = http://www.uchospitals.edu/online-library/content=P01675 | title = Atopic Dermatitis | date = 1 January 2015 | work = www.uchospitals.edu | access-date = 2 April 2015 | archive-url = https://web.archive.org/web/20150408150538/http://www.uchospitals.edu/online-library/content%3DP01675 | archive-date = 8 April 2015 }}</ref>

== Society and culture ==

=== Conspiracy theories ===
A number of false and conspiratorial claims about AD have emerged on the internet and have been amplified by social media. These [[conspiracy theories]] include, among others, claims that AD is caused by [[5G]], [[formaldehyde]] in food, [[vaccine]]s, and topical steroids. Various unproven theories also claim that [[vegan]] diets, [[apple cider vinegar]], [[calendula]], and [[Witch-hazel|witch hazel]] can cure AD and that [[air purifier]]s reduce the risk of developing AD.<ref>{{cite journal | vauthors = O'Connor C, Murphy M | title = Scratching the surface: a review of online misinformation and conspiracy theories in atopic dermatitis | journal = Clinical and Experimental Dermatology | volume = 46 | issue = 8 | pages = 1545–1547 | date = December 2021 | pmid = 33864398 | doi = 10.1111/ced.14679 | hdl-access = free | s2cid = 233278383 | hdl = 10468/11402 }}</ref>

== Research ==
[[Antileukotriene|Leukotriene receptor antagonists]], such as [[montelukast]], might be a useful for the treatment of AD but their effectiveness has not yet been proven by research.<ref>{{cite journal | vauthors = Chin WK, Lee SW | title = A systematic review on the off-label use of montelukast in atopic dermatitis treatment | journal = International Journal of Clinical Pharmacy | volume = 40 | issue = 5 | pages = 963–976 | date = October 2018 | pmid = 29777328 | doi = 10.1007/s11096-018-0655-3 | s2cid = 21753181 }}</ref><ref>{{cite journal | vauthors = Ferguson L, Futamura M, Vakirlis E, Kojima R, Sasaki H, Roberts A, Mori R | title = Leukotriene receptor antagonists for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD011224 | date = October 2018 | pmid = 30343498 | pmc = 6517006 | doi = 10.1002/14651858.cd011224.pub2 }}</ref><ref>{{cite journal | vauthors = Toledo LM, Rodriguez R, Sivesind TE, Vakirlis E, Kojima R, Dellavalle RP | title = From the Cochrane Library: Leukotriene Receptor Antagonists for Eczema | journal = JMIR Dermatology | volume = 7 | pages = e50434 | date = April 2024 | pmid = 38607671 | pmc = 11053388 | doi = 10.2196/50434 | doi-access = free | title-link = doi }}</ref>

== References ==

{{Reflist}}

== External links ==
{{Medical resources
|   ICD10          = {{ICD10|L|20||l|20}}
|   ICD9           = {{ICD9|691.8}}
|   ICDO           =
| DiseasesDB=4113
|   OMIM           = 603165
|   MedlinePlus    = 000853
|   eMedicineSubj  = emerg
|   eMedicineTopic = 130
|   eMedicine_mult = {{eMedicine2|derm|38}} {{eMedicine2|ped|2567}} {{eMedicine2|oph|479}}
|   MeshID         = D003876
}}

{{Commons category|Atopic dermatitis}}

{{Diseases of the skin and appendages by morphology}}
{{Allergic conditions}}
{{Diseases of the skin and subcutaneous tissue}}
{{Hypersensitivity and autoimmune diseases}}
{{Portal bar | Medicine}}
{{Authority control}}

{{DEFAULTSORT:Atopic Dermatitis}}
[[Category:Atopic dermatitis| ]]
[[Category:Type I hypersensitivity]]
[[Category:Steroid-responsive inflammatory conditions]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Wikipedia emergency medicine articles ready to translate]]