Atopic Dermatitis (Eczema)
Atopic dermatitis (eczema) is a chronic, relapsing inflammatory skin condition, managed per the AAD 2023 adult topical therapy guideline.
Symptoms
Itching, redness, dryness, and sometimes weeping or crusting, classically in the creases of elbows and knees, though distribution varies by age.
Causes and risk
A genetic tendency toward a weakened skin barrier, combined with immune dysregulation; family history of eczema, asthma, or allergies raises risk substantially.
How it is evaluated
Diagnosis is clinical, based on established criteria (itching plus a typical pattern and course); it's a clinical diagnosis, not one requiring lab testing.
Treatment
Moisturizers are foundational for every severity level. Topical corticosteroids, potency matched to body site and age, are first-line for flares, with twice-weekly medium-potency maintenance to prevent recurrence; high-potency steroids should be limited to under about 4 weeks. Calcineurin inhibitors are steroid-sparing options. For moderate-to-severe disease not controlled topically, biologics (dupilumab, tralokinumab, lebrikizumab) and oral JAK inhibitors are guideline-supported per current FDA labeling.
When to seek care
Monomorphic, "punched-out" blisters with fever and swollen lymph nodes suggest eczema herpeticum, a dermatologic emergency requiring prompt antiviral treatment.