What Is Atopic Dermatitis? (and How to Tell If You Have It)

An itchy, pimply rash that comes and goes. Red, inflamed skin patches that “weep” when scratched. Dry or leathery skin. All are classic signs of atopic dermatitis, a chronic and recurring skin condition that people commonly call eczema. If you are bothered by one or more of these symptoms, rest assured you’re in good company. More than 30 million Americans have some form of this inflammatory skin condition. And, yes, many are adults.

Atopic dermatitis, or AD, the most common type of eczema, was once considered a childhood malady that many kids would eventually outgrow. It’s true that most people develop symptoms before the age of 5, and some children experience fewer or less severe symptoms as they enter young adulthood. But the latest evidence suggests it’s probably a lifelong illness, and there may be more adult-onset cases than researchers previously thought.

Overall, about 12% of children in the United States are diagnosed with atopic dermatitis. The prevalence in the adult population—more than 10% according to a recent study—isn’t much different. Yet dermatologists don’t always recognize the extent to which adults are dealing with this disease, said study author Jonathan Silverberg, M.D., Ph.D., professor of dermatology at Northwestern University’s Feinberg School of Medicine in Chicago. Patients, too, are often caught off guard by the diagnosis.

“They are often surprised and wonder what triggered the disease in their adult life,” Silverberg said. “Though, I explain to them that adult onset or adult recurrence of AD is not an uncommon scenario.”

How do you know if you have atopic dermatitis and not some other skin disease? It can be hard to tell sometimes because everyone’s symptoms are different. One telltale sign is a niggling urge to scratch. Rubbing or scratching can cause the skin to become red, inflamed, and weepy. Itchy skin patches can morph into itchy, fluid-filled blisters, and when you scratch, you're only worsening your symptoms.

Eczema can be confused with psoriasis, another chronic skin condition. Psoriasis causes mild itching and well-defined scaly patches that can appear almost anywhere on the body.

If you have atopic dermatitis, chances are you or someone in your family has allergies, hay fever (also called allergic rhinitis), or asthma. The condition is associated with a higher prevalence of asthma in adults. People with atopic dermatitis often have elevated levels of a protein called immunoglobulin E (IgE) in their blood. IgE causes the body's immune system to wage a chemical attack against perceived allergens.

Ask yourself: Have you had allergic disease and skin symptoms since childhood? Have you developed thick skin patches that sometimes ooze and crust? Then you probably have atopic dermatitis.

Sometimes, atopic dermatitis pops up later in life. Often it’s a recurrence of prior symptoms, explained Jon Hanifin, M.D., professor of dermatology at Oregon Health & Science University in Portland, Ore.

“They either lose it and forget it or they move to a different climate and then it comes out because of certain stresses on their skin,” he said.

People who move to the Northwestern corner of the U.S. from humid, tropical climates, for example, may suddenly start to itch. Even sitting on a plane, where the air is dry, can induce symptoms, Hanifin said.

If you think you have eczema, your doctor will likely examine your skin and ask about your medical history. Family and personal history of allergies and symptoms may help to narrow the cause of your condition.

“The person may need a consult of (skin) biopsy to diagnose and rule out any other inflammatory skin disorders,” said Kim Nichols, M.D., a dermatologist and cosmetic surgeon in Greenwich, Conn.

Sometimes allergy testing is conducted too.

Here are a few other surprising facts associated with adult eczema:

• It can pack a financial punch. Adults with eczema shell out $371 to $489 more per year out of pocket, on average, than people who don’t have this skin condition, Silverberg reported in JAMA Dermatology in 2015. And that’s just health care costs. It doesn’t include the amount spent on moisturizers or other non-prescription products.
• It cuts into workplace productivity. People with eczema are much more likely to miss at least six workdays per year, the same study found.
• It’s associated with risky health behaviors. Adults with eczema are more likely to be current or former smokers than people without this diagnosis Silverberg reported in the March 2015 issue of the Journal of Allergy and Clinical Immunology. They’re also more likely to drink moderately or heavily and less likely to engage in vigorous activity.
• It may be a marker for heart risks. Adult eczema is associated with greater odds of obesity, high blood pressure, prediabetes, diabetes, and high cholesterol, the same study found.

Managing symptoms can test anyone’s patience, but a regular bathing and moisturizing routine can set you on the right path.

“Medication or phototherapy is best to help heal the skin,” said Nichols. “Corticosteroid creams and ointments are good to use to prevent flare-ups and worsening symptoms,” she said.