What Are the Symptoms of Atopic Dermatitis?

Reviewed by: HU Medical Review Board | June 2017 | Last updated: August 2020

The itch caused by AD is the most prevalent and distressing symptom. Itchiness is medically known as pruritus, and it is defined as an “unpleasant sensation that elicits the urge to scratch.”

Eczema itch

Both the symptom of itching and the scratching it provokes significantly contribute to the burden of AD.

What causes the eczema itch?

The exact disease processes that cause itch in AD are not completely understood, but doctors know that the “itch-scratch cycle” (the skin feels itchy, which leads to scratching, which then causes the skin to feel even more itchy) perpetuates the disease. The itching and scratching can lead to psychological distress, difficulty concentrating, disruption of sleep, and physical damage to the skin barrier which leads to increased water loss, increased risk of infection, increased inflammation, and lichenification (thickening of the skin that is constantly itchy).1

Dry, scaly eczema rash

One of the most noticeable symptoms of AD is the rash or patches of dry, scaly skin. The rash caused by AD usually appears in a characteristic pattern depending on the age of the person:

  • In infants and young children, the rash shows up on the scalp or face, especially the cheeks or chin, or the arms and legs
  • In older children, AD frequently appears as a rash on the inside creases of the elbows or knees, the neck, wrists, ankles, and/or the crease between the buttocks and the thighs
  • In adults, the rash can appear anywhere, such as on the inner creases of the elbows or knees, and/or the nape of the neck, or it may be localized to just the hands, feet, or nipples2

Skin color changes and eczema

Acute areas of AD can cause changes in skin color, creating redness or darkened areas. Chronic areas of AD can also create changes in skin color, as the skin becomes thickened. AD may also cause hyperpigmentation (excess of color) or hypopigmentation (lighter or completely white areas).3

Oozing eczema or weepy sores

AD can cause blisters that ooze, or weepy sores. Weepy areas leak fluid, which is usually clear. Weepy sores can also be a sign of infection. Infection is a common complication as bacteria or other microorganisms due to the damage to the skin barrier with AD.4,5

Thickened skin or lichenification

Thickened skin is also called lichenified skin, or areas of lichenification. It appears as leathery patches with accentuated skin lines where the skin has experienced chronic bouts of AD, and the repeated scratching of the area causes it. Lichenified patches are always itchy, and proper treatment of AD is important to reduce the risk of developing these thickened areas.1

Papules and eczema

Papules are small, raised bumps that may appear like pimples without pus. They are a sign of inflammation caused by AD.4

Eczema knots

Knots seen with AD are thick bumps or areas of thickened skin. These are seen with chronic AD and may make the skin appear lumpy.6

Eczema blisters or vesicles

AD can cause blisters or vesicles (fluid-filled cysts), which make leak fluid. Blisters and vesicles may be a sign of infection, a common complication among people with AD.3

Skin cracks behind the ear

Some people experience AD in the skin behind the ears or in the junction between the ear and the face. This may cause painful cracks behind their ears.7

Eczema eye symptoms

Eye complications that may occur in people with AD include itching or dry skin around the eyelids, eye watering, inflammation of the eyelid (blepharitis), and infection (conjunctivitis).6,8

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