No lab test is needed to identify atopic dermatitis (eczema). Your doctor will likely make a diagnosis by examining your skin and reviewing your medical history. He or she may also use patch testing or other tests to rule out other skin diseases or identify conditions that accompany your eczema.
If you suspect a certain food caused your child's rash, tell the doctor and ask about identifying potential food allergies.
Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if treatment is successful, signs and symptoms may return (flare).
It's important to recognize the condition early so that you can start treatment. If regular moisturizing and other self-care steps don't help, your doctor may suggest one or more of the following treatments:
Creams that control itching and help repair the skin. Your doctor may prescribe a corticosteroid cream or ointment. Apply it as directed, after you moisturize. Overuse of this drug may cause side effects, including thinning skin.
Other creams containing drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. They are used by people older than age 2 to help control the skin reaction. Apply it as directed, after you moisturize. Avoid strong sunlight when using these products.
These drugs have a black box warning about a potential risk of cancer. But the American Academy of Allergy, Asthma & Immunology has concluded that the risk-to-benefit ratios of topical pimecrolimus and tacrolimus are similar to those of most other conventional treatments of persistent eczema and that the data don't support the use of the black box warning.
- Drugs to fight infection. Your doctor may prescribe an antibiotic cream if your skin has a bacterial infection, an open sore or cracks. He or she may recommend taking oral antibiotics for a short time to treat an infection.
- Oral drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone. These drugs are effective but can't be used long term because of potential serious side effects.
- Newer option for severe eczema. The Food and Drug Administration (FDA) has recently approved a new, injectable biologic (monoclonal antibody) called dupilumab (Dupixent). It is used to treat people with severe disease who do not respond well to other treatment options. This is a newer medication, so it doesn't have a long track record in terms of how well it helps people. Studies have shown it to be safe if used as directed. It is very expensive.
- Wet dressings. An effective, intensive treatment for severe atopic dermatitis involves wrapping the affected area with topical corticosteroids and wet bandages. Sometimes this is done in a hospital for people with widespread lesions because it's labor intensive and requires nursing expertise. Or, ask your doctor about learning how to do this technique at home.
Light therapy. This treatment is used for people who either don't get better with topical treatments or who rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the skin to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) either alone or with medications.
Though effective, long-term light therapy has harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, phototherapy is less commonly used in young children and not given to infants. Talk with your doctor about the pros and cons of light therapy.
- Counseling. Talking with a therapist or other counselor may help people who are embarrassed or frustrated by their skin condition.
- Relaxation, behavior modification and biofeedback. These approaches may help people who scratch habitually.
Treatment for eczema in babies (infantile eczema) includes:
- Identifying and avoiding skin irritants
- Avoiding extreme temperatures
- Lubricating your baby's skin with bath oils, creams or ointments
See your baby's doctor if these measures don't improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the rash or to treat an infection. Your doctor may also recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.
Lifestyle and home remedies
To help reduce itching and soothe inflamed skin, try these self-care measures:
- Moisturize your skin at least twice a day. Find a product or combination of products that works for you. You might try bath oils, creams, ointments or sprays. For a child, the twice-a-day regimen might be an ointment before bedtime and a cream before school. Ointments are greasier and sting less when applied.
- Apply an anti-itch cream to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. Apply it no more than twice a day to the affected area, after moisturizing. Using the moisturizer first helps the medicated cream penetrate the skin better. Once your reaction has improved, you may use this type of cream less often to prevent flare-ups.
- Take an oral allergy or anti-itch medication. Options include nonprescription allergy medicines (antihistamines) — such as cetirizine (Zyrtec) or fexofenadine (Allegra). Also, diphenhydramine (Benadryl, others) may be helpful if itching is severe. But it causes drowsiness, so it's better for bedtime.
- Don't scratch. Rather than scratching when you itch, try pressing on the skin. Cover the itchy area if you can't keep from scratching it. For children, it might help to trim their nails and have them wear gloves at night.
- Apply bandages. Covering the affected area with bandages helps protect the skin and prevent scratching.
- Take a warm bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others). Soak for 10 to 15 minutes, then pat dry. Apply moisturizer while the skin is still damp.
- Choose mild soaps without dyes or perfumes. Use soap that's superfatted and nonalkaline. Be sure to rinse off the soap completely.
- Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home.
- Wear cool, smooth-textured clothing. Reduce irritation by avoiding clothing that's rough, tight or scratchy. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating.
- Treat stress and anxiety. Stress and other emotional disorders can worsen atopic dermatitis. Acknowledging those and trying to improve your emotional health can help.
Coping and support
Atopic dermatitis can be especially stressful, frustrating or embarrassing for adolescents and young adults. It can disrupt their sleep and even lead to depression. And close family members of people with this condition may face financial, social and emotional problems.
Seek psychological support from counselors, support groups, friends or family.
Preparing for your appointment
You're likely to start by seeing your family or primary care doctor. But in some cases when you call to set up an appointment, you may be referred to a specialist in skin diseases (dermatologist).
Here's some information to help you prepare for your appointment.
What you can do
- List your signs and symptoms, when they occurred, and how long they lasted. Also, it may help to list factors that triggered or worsened your symptoms — such as soaps or detergents, tobacco smoke, sweating, or long, hot showers.
- Make a list of all the medications, vitamins, supplements and herbs you're taking. Even better, take the original bottles and a written list of the dosages and directions.
- List questions to ask your doctor. Ask questions when you want something clarified.
For atopic dermatitis, some basic questions you might ask your doctor include:
- What might be causing my signs and symptoms?
- Are tests needed to confirm the diagnosis?
- What treatment do you recommend, if any?
- Is this condition temporary or chronic?
- Can I wait to see if the condition goes away on its own?
- What are the alternatives to the primary approach you're suggesting?
- What skin care routines do you recommend to improve my symptoms?
What to expect from your doctor
Your doctor is likely to ask you several questions, including:
- When did you begin having symptoms?
- How often do you have these symptoms?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Do you or any family members have asthma or allergies?
- What are your hobbies?
- Do you come in direct contact with pets or animals? What products do you use on your skin?
- Does your condition affect your sleep or your ability to go about your daily activities?