Atopic Dermatitis (Eczema)

What Is Atopic Dermatitis?

Atopic dermatitis (AD), commonly called eczema, is a chronic, relapsing inflammatory skin condition that affects approximately 10–20% of children and 1–3% of adults. It is caused by a combination of genetic factors (especially filaggrin gene mutations), immune dysregulation, and environmental triggers — not by a specific allergen contact.

The Atopic March

AD is often the first step in the "atopic march" — a progression that may include:

• Atopic dermatitis (typically begins in infancy)
• Food allergies
• Allergic rhinitis (hay fever)
• Asthma

Having AD significantly increases the risk of developing contact allergies, because a compromised skin barrier makes sensitization easier.

How Is It Different from Contact Dermatitis?

• AD is chronic and systemic; contact dermatitis is localized to contact sites
• AD flares are often triggered by heat, sweat, stress, and environmental factors (not specific chemicals)
• AD typically begins in childhood; contact dermatitis can begin at any age
• AD patients often have dry skin, family history of atopy, elevated IgE
• Patch testing is not the primary diagnostic tool for AD

The Connection to Contact Allergy

Many patients have both atopic dermatitis and superimposed contact allergies. Studies show up to 40% of AD patients who undergo patch testing have at least one relevant positive result — most commonly to fragrances, preservatives, and metals. Identifying and avoiding these contact allergens can significantly improve AD control.

Treatment Overview

• Daily moisturizing (cornerstone of all treatment)
• Topical corticosteroids (first-line for flares)
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
• Biologics: dupilumab (Dupixent) — FDA-approved for moderate-severe AD
• JAK inhibitors: abrocitinib, upadacitinib, ruxolitinib
• Trigger identification and avoidance