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Symptoms – Papules (Skin Lesions)

One of the symptoms of atopic dermatitis (AD) is papules: which are small, raised bumps on the skin that may look like pimples without pus. In some people with darker pigmented skin, papules may be the only sign of AD. Other people have papules in addition to other symptoms from AD.1,2

Papules can also be a sign of a viral infection. Due to the damaged skin barrier, as well as the dysfunction in the immune system with AD, people with AD are at a greater risk of infection. Serious viral infections of the skin that may be a complication of AD include herpes simplex, warts, and molluscum contagiosum (a poxvirus infection).3,4

Cause of papules

Papules are caused by inflammation, and in AD, there is an increase in inflammation in the skin. In conditions like AD, the immune response is abnormally over-activated, causing a chronic inflammatory state. In addition, many people with AD produce elevated levels of immunoglobulin E (IgE) when exposed to an environmental allergen. Immunoglobulin is a type of protein that is part of the immune system and that acts as an antibody to attach and destroy foreign substances. There are five different types of immunoglobulin, and the IgE protein is found in increased levels in people with allergy. IgE causes the body to release histamine when it comes into contact with an allergen.5,6

How to treat papules

Treatment for AD involves a combination of good skin care, avoiding triggers, and medications. Moisturizers are one of the basic necessities for people with AD, regardless of the severity of their disease. Some of the anti-inflammatory medications available for treating AD also come in moisturizer formulations, which can help provide additional barrier repair and control itchiness.7

Medications used in the treatment of AD include:

  • Topical corticosteroids, to reduce redness, inflammation, and itching
  • Topical calcineurin inhibitors, to stop the dysfunctional immune response and reduce redness and itching
  • Immunomodulators, which also target the dysfunctional immune response to reduce symptoms7
  • If the papules are caused by a viral infection, treatment is customized to the type of virus and may include antiviral medications, cryotherapy (the use of extreme cold to freeze the infected area), or topical treatment.3,4

Phototherapy, which uses light waves directed at the skin, is a second-line treatment strategy. That is, it is only recommended for use after other treatments and lifestyle approaches have failed to improve symptoms of AD. Phototherapy is sometimes used as a maintenance therapy in people with chronic AD.8

Other symptoms of atopic dermatitis

In addition to papules, AD can cause a rash, scaly patches, weepy sores, itching, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by AD may become thickened.

A life with eczema is more than just skin symptoms. Share about your experiences with atopic dermatitis in our 4th Annual Atopic Dermatitis In America survey by clicking the button below!

Emily Downward | June 2017
  1. Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am. 2015;35:161-183.
  2. Cleveland Clinic. Accessed online on 4/18/17 at
  3. Peterson JD, Chan LS. A comprehensive management guide for atopic dermatitis. Dermatology Nursing. 2006;18(6):531-542. Accessed online on 4/5/17 at
  4. Leung, DYM. Infection in atopic dermatitis. Curr Opin Pediatr. 2003;15:399-404.
  5. lias PM, Steinhoff M. “Outside-to-inside” (and now back to “outside”) pathogenic mechanisms in atopic dermatitis. J Invest Dermatol. 2008;128(5):1067–1070.
  6. Medical dictionary. Accessed online on 4/8/17 at
  7. Eichenfield LF, Tom WL, Chamilin SL, et al. Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology 2014;70:338- 351.
  8. Sidbury R, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71(6):1218-1233.