Overview
Atopic dermatitis (AD), is also referred to as eczema, a Greek term meaning to boil over.  Eczema is a generic term for inflammatory conditions of the skin, sometimes referred to as weeping rash.  

Onset is usually early in life.  Six months to one year is typical (may begin at birth) with a high percentage of onset by age five. 

Skin is the "target organ" for inflammation secondary to foods and inhalant allergens.  AD, an inflammatory condition of the skin, causes intense itching.  Breaking the itch and scratch cycle is a major goal of therapy as scratching worsens the condition.  Secondary infection of the skin, which can be caused by scratching, must also be treated or prevented.

Summary

Typical findings in Atopic Dermatitis or eczema include the following:

Family history of allergy

Early age of onset

Chronic condition

Dry skin

Intense itching usually worse at night

There is a strong association with allergic rhinitis and asthma.

Symptoms
AD can involve a large portion of the body or manifest as a few localized patches.  Patterns of distribution can change with age and seasons can cause variation in the severity, such as worsening during dry winter months. 

Early lesions may be red and dry with small inflamed pimple-like spots and mild scaling, with some areas of more significant scaling. Chronically affected skin areas involve thickening of the skin and may have abnormal skin coloring.  Lesions are sometimes moist and oozing.  Sudden worsening of AD may suggest bacterial infection of the skin.  Lesions may appear red, crusted, or weepy.

Triggers
AD is known to be triggered by foods in a majority of cases, and some evidence supports environmental allergens as a trigger.  Irritating substances and overheating of the skin worsen AD.

Foods
A large number of individuals suffering with AD have significant food allergies triggering the inflammatory skin condition.  An allergist can take a thorough history and help identify foods that cause AD in a particular individual.  Skin testing and a food elimination diet with a plan for reintroducing foods may be recommended. 

Inhalant Allergens
Exposure to house-dust mites can worsen AD in mite allergic individuals.  Measures to limit exposures to house-dust mites are not only important in respiratory allergies such as asthma or allergic rhinitis but also can be part of AD management in some individuals.  Pollen directly contacting skin with eczema can worsen skin symptoms in pollen-allergic individuals with AD.

When skin testing is not possible due to eczema, allergy blood tests help identify aeroallergens that are triggering respiratory or AD symptoms.

Irritants
Products containing alcohol, chemicals such as solvents, harsh soaps, overuse of mild soaps, fabrics such as polyester that do not breathe and wool which can be scratchy can cause the skin to get red, itch, and burn.  Overheating from exercise, dressing too warmly, or setting thermostats at high temperatures in the winter can contribute to flares of AD.  Perspiration irritates AD.  Laundry detergents and softeners with fragrance can make the skin worse. 

Dry Skin
AD can get significantly worse when the skin is dry.  Dry skin leads to scratching which worsens eczema. Use all soaps sparingly. Use moisturizers regularly.  Petroleum-based moisturizers are recommended.  Petroleum jelly (Vaseline®) is best! Do not use lotions with an alcohol base, high water content, or fragrance. Blot the skin with a clean soft, preferably cotton, towel after a bath.  Apply medications and Vaseline® immediately after bathing.  Keep thermostats low-to-moderate in winter.  Winter humidifier use helps if it does not contribute to indoor mold growth.