Atopic Dermatitis

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

What is atopic dermatitis?

Atopic dermatitis is a long-lasting (chronic) skin problem. It causes dry skin, intense itching, and then a red, raised rash. In severe cases, the rash forms clear, fluid-filled blisters. It cannot be spread from person to person.

Atopic dermatitis is most common in babies and children. Some children with atopic dermatitis outgrow it or have milder cases as they get older.¹ You may also get atopic dermatitis as an adult.

Atopic dermatitis is sometimes called eczema or atopic eczema. But atopic dermatitis is only one of many types of eczema.

See a picture of atopic dermatitis.

What causes atopic dermatitis?

The cause of atopic dermatitis is not clear.

People with atopic dermatitis seem to have very sensitive immune systems that are more likely to react to irritants and allergens.

Most people who have atopic dermatitis have a personal or family history of allergies, such as hay fever (allergic rhinitis) and asthma. The skin inflammation that causes the atopic dermatitis rash is thought to be a type of allergic response.

Things that may make atopic dermatitis worse include:

• Stress.
• Certain foods, such as eggs, peanuts, milk, wheat, or soy products.
• Allergens, such as dust mites or animal dander.
• Harsh soaps or detergents.
• Weather changes, especially dry and cold.
• Skin infection.

What are the symptoms?

The main symptom of atopic dermatitis is itching, followed by rash. The rash is red and patchy and may be long-lasting (chronic) or may come and go (recurring). Tiny bumps or blisters may appear and ooze fluid or crust over. Scratching can cause the sores to become infected. Over time, a recurring rash can lead to tough and thickened skin.

People tend to get the rash on different parts of the body, depending on their age. Common sites include the face, neck, arms, and legs. Rashes in the groin area are rare.

How severe the symptoms are depends on how large an area of skin is affected. It also depends on how much you scratch the rash and whether the sores get infected. Mild atopic dermatitis usually affects a small area of skin. It does not itch much and goes away with enough moisturizing. Severe atopic dermatitis usually covers a large area of skin that is very itchy. It does not go away with moisturizing.

How is atopic dermatitis diagnosed?

A doctor can usually tell if you have atopic dermatitis by doing a physical exam and asking questions about your past health. Some of the questions might be: Do allergies run in your family? When did the itch first start? When did the rash first appear? Checking to see what the rash looks like and where it is located will help your doctor decide if you have atopic dermatitis.

Your doctor may advise allergy testing to find the things that trigger the rash. Allergy tests are done by an allergist (immunologist).

How is it treated?

Although atopic dermatitis is an ongoing problem, there are things you can do to control it.

• Use moisturizing creams and lotions often.
• Avoid things that trigger rashes, such as harsh soaps and detergents, dander, and any other things you are allergic to.
• Control scratching. You may want to cover the rash with a bandage to keep from rubbing it. Put mittens or cotton socks on your baby's hands to help prevent him or her from scratching.
• Use medicine prescribed by your doctor.
• Bathe with cool or lukewarm—not hot—water and for short periods.

In severe cases, your doctor may prescribe pills or give you a shot to stop the itching. Or you may get ultraviolet (UV) light treatment at a clinic or doctor’s office.

Can you prevent your baby from getting atopic dermatitis?

If you or other family members have atopic dermatitis or other allergies, there is a chance that your baby could get it. If possible, breast-feed your baby for at least 6 months to boost the immune system and to help protect your baby.

Frequently Asked Questions

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	Skin care for atopic dermatitis

The cause of atopic dermatitis is poorly understood and is the subject of active research. Research shows that it develops as a result of interaction between the environment, your immune system, and genetics (heredity). People with this condition seem to have very sensitive immune systems that are more prone to react to numerous irritants and allergens.

Most people who have atopic dermatitis have a personal or family history of allergic conditions, such as hay fever (allergic rhinitis). The skin inflammation that causes the atopic dermatitis rash is considered a type of allergic response.

Itching and rash can be triggered by a variety of factors, including:

• Exposure to allergens, such as pollen, animal dander, or molds. Dust mites may be an allergen, although experts don't know whether they affect atopic dermatitis.
• Exposure to irritants, such as using soaps, rubbing the skin, and wearing wool.
• Exposure to workplace irritants, such as fumes and chemicals.
• Climate factors, especially winter weather and low humidity. Cold air does not contain much moisture, which can result in drier skin and increased itchiness.
• Temperature changes. Sudden changes in temperature can result in increased itchiness. A suddenly higher temperature may bring on sweating, which can cause itching. Lying under blankets, entering a warm room, or going from a warm shower into colder air can all promote itching.
• Emotional stress. Emotions such as frustration or embarrassment may lead to increased itchiness and scratching.
• Exposure to certain foods, typically eggs, peanuts, milk, soy, or wheat products. Up to 40% of children with moderate to severe atopic dermatitis also have some type of food allergy.² But experts do not agree on whether foods can cause atopic dermatitis.
• Excessive washing. Repeated washing dries out the top layer of skin, leading to drier skin and increased itchiness, especially in the winter months when humidity is low.

The main symptom of atopic dermatitis is itching. The itching can be severe and persistent, especially at night. Scratching the affected area of skin usually causes a rash. The rash is red and patchy and may be long-lasting (chronic) or come and go (recurring). The rash may:

• Develop fluid-filled sores that can ooze fluid or crust over. This can happen when the skin is rubbed or scratched or if a skin infection is present. This is known as an acute (sudden or of short duration), oozing rash.
• Be scaly and dry, red, and itchy. This is known as a subacute (longer-duration) rash.
• Become tough and thick from constant scratching (lichenification).

The severity of symptoms depends on how large an area of skin is affected, how much you scratch the rash, and whether a secondary infection develops. Mild atopic dermatitis usually involves a small area of skin that does not itch much and goes away with adequate moisturizing. Severe atopic dermatitis usually involves a large area of skin that is very itchy and does not go away with moisturizing.

The usual location of the rash on the body varies by age group.

Infants (age 2 months to 2 years)

• The areas most commonly affected are the face, scalp, neck, arms and legs (especially the front of the knees and the back of the elbows), and trunk. The rash usually does not appear in the diaper area. It is most commonly seen in babies during the winter months as dry, red, scaling areas on the baby's cheeks. See an illustration of atopic dermatitis in an infant.
• The rash is often crusted or oozes fluid.
• Rubbing and scratching can lead to frequent infections.

Children (age 2 to 11 years)

• The symptoms may appear for the first time or may be a continuation of the infant phase.
• The rash occurs primarily on the back of the legs and arms, on the neck, and in areas that bend, such as the back of the knees and the inside of the elbows.
• The rash is usually dry. But it may go through stages from an acute oozing rash to a red, dry subacute rash to a chronic rash that causes the skin to thicken (lichenification). Lichenification often occurs after the rash goes away.
• Rubbing and scratching can lead to infections.

Adolescents and adults

• Atopic dermatitis often improves as you get older.
• The areas affected by atopic dermatitis are usually small and commonly include places that bend, such as the neck, the back of the knees, and the inside of the elbows. Rashes can also affect the face, wrists, and forearms. Rashes are rare in the groin area.

There are other conditions with similar symptoms or conditions that may be associated with atopic dermatitis, such as dry skin (xerosis) and ringworm and poison ivy and other forms of contact dermatitis.

Atopic dermatitis causes repeated attacks of itching and rash that can become quite severe. It is most common in babies and children. Older studies indicated that most children outgrow the condition. More recent studies report that many people continue to have relapses or to have the condition, although not as severely, as teenagers and adults.¹ You may also develop atopic dermatitis as an adult.

Infants and children (2 months to 11 years old)

• Of children with atopic dermatitis, approximately 50% first develop symptoms in the first year of life and 30% between ages 1 and 5.²
• About 80% of children with atopic dermatitis develop asthma or allergic rhinitis later in childhood.²
• Infants and children with a food allergy that triggers atopic dermatitis are at higher risk for developing asthma.

Atopic dermatitis may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.

Adolescents and adults

Teens and adults with a history of atopic dermatitis usually continue to itch and have a rash.

• When atopic dermatitis occurs for the first time in adulthood, it is usually more severe than long-standing atopic dermatitis.
• Although some affected adults have had no skin problems since infancy, others have had attacks of atopic dermatitis throughout childhood.
• Atopic dermatitis in adults can often be related to a change in environment, such as going from a humid environment to a dry environment, or increased exposure to allergens, such as dust mites or animal dander.

Complications

Some people with atopic dermatitis develop patches of lighter skin, especially on the face, upper arms, or shoulders. Chronic scratching or rubbing of the skin can also lighten or darken skin color. When atopic dermatitis has been successfully controlled, it takes about 9 months for skin color to return to normal; the darker the natural skin color, the longer this might take.³

Infections caused by bacteria are common. Infected skin may become red and warm, and a fever may develop. Skin infections are treated with antibiotics.

Atopic dermatitis can affect the skin and tissue surrounding the eyes, but these eye problems are rare.

Eczema herpeticum results when atopic dermatitis is infected with the herpes simplex virus, the virus that causes cold sores and genital herpes. In this condition the rash blisters and may begin to bleed and crust, and you may have a high fever. This is a serious infection; contact your health professional immediately.

Atopic dermatitis and smallpox vaccination

People with skin conditions such as atopic dermatitis have a high risk of developing a severe rash called eczema vaccinatum if they receive the smallpox vaccine or touch another person’s vaccination mark before the scab has fallen off. Although most people recover from eczema vaccinatum, the rash can be quite severe, sometimes leading to death. People who do not have eczema at the time of vaccination but have a history of eczema also are at increased risk of developing eczema vaccinatum.

The major risk factor for atopic dermatitis is having a family history of the condition. You are also at risk for developing atopic dermatitis if family members have asthma, allergic rhinitis, or other allergies.

An infant with one parent who has had atopic dermatitis has a 60% chance of developing this condition; if both parents have a history of atopic dermatitis, the child has an 80% chance of developing it.⁴

Call your health professional if you or your child has atopic dermatitis and:

• Itching makes you or your child irritable or inconsolable.
• Itching is interfering with daily activities or with sleep.
• There are crusting or oozing sores, serious scratch marks, widespread rash, severe discoloration of the skin, or a fever that is accompanied by a rash.
• Painful cracks develop on the hands or fingers.
• Atopic dermatitis on the hands interferes with daily school, work, or home activities.
• Signs of bacterial infection develop. These include:
  • Increased pain, swelling, redness, tenderness, or heat.
  • Red streaks extending from the area.
  • A discharge of pus.
  • A fever of 100.4°F (38°C) or higher with no other cause.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment.

• For minor rashes, watchful waiting and home treatment are often sufficient. If home treatment clears up the rash, mention it to your health professional at your next visit.
• If home treatment does not clear up the rash, see your health professional. He or she can suggest other treatments or prescribe a stronger medication.

Who To See

For the diagnosis and treatment of atopic dermatitis, consult with a:

• Family medicine doctor.
• Nurse practitioner.
• Physician assistant.
• Pediatrician.
• Dermatologist.

If food or other allergies are suspected to be a factor in atopic dermatitis, consider seeing an allergist (immunologist) for specialized evaluation. For more information, see the topic Food Allergies.

To prepare for your appointment, see the topic Making the Most of Your Appointment

Most cases of atopic dermatitis can be diagnosed from a medical history and a physical exam. You will be asked about your family history of allergic conditions, when the itch first started, and when the rash first appeared. What the rash look likes and where it is located will help your health professional make a diagnosis. Your or your child's condition is more likely to be atopic dermatitis if a parent or brother or sister has an allergic condition (especially asthma, allergic rhinitis, or atopic dermatitis).

Allergy testing

Your health professional may recommend allergy testing to identify any factors that are related to atopic dermatitis flares. Allergy testing is most helpful for people with atopic dermatitis who also have respiratory allergies or asthma. Allergy testing can help identify certain allergens. However, test results are often false-positive. For more information, see the topic Allergy Tests.

If a specific allergen is thought to trigger your atopic dermatitis, you and your health professional will discuss how to eliminate it from your diet or environment while closely observing and recording your symptoms.

Although there is no cure for atopic dermatitis, it can be controlled with preventive measures and medications. Treatment helps stop the rash from recurring (flares) and controls itching. You can generally bring the rash and itching under control within 3 weeks of a flare. Specific treatment depends on the type of rash you have. Generally, a combination of corticosteroid medications and moisturizers is used.

Initial and ongoing treatment

Initial and ongoing treatment for atopic dermatitis includes:

• Avoiding dry skin. This is essential in treating atopic dermatitis. Keep your or your child's skin hydrated through proper bathing and use of moisturizers. This includes bathing in warm water, bathing for only 3 to 5 minutes, avoiding gels and bath oils, and using soap regularly only on the underarms, groin, and feet. Apply a moisturizer immediately after bathing. For more information, see:

  Skin care for atopic dermatitis.

• Avoiding irritants that cause a rash or make a rash worse. These include soaps that dry the skin, perfumes, and scratchy clothing or bedding.
• Avoiding possible allergens that cause a rash or make a rash worse. These may include dust and dust mites, animal dander, and certain foods, such as eggs, peanuts, milk, wheat, or soy products. Talk to your health professional first to determine whether allergens are contributing to your atopic dermatitis. For more information, see the topic Food Allergies.
• Controlling itching and scratching. Keep your fingernails trimmed and filed smooth to help prevent damaging the skin when scratching. You may want to use protective dressings to keep from rubbing the affected area. Put mittens or cotton socks on your baby's hands to help prevent him or her from scratching the area. Coal tar preparations applied to the skin also may help reduce itching.

You may need medication to heal your rash and reduce itching.

• Topical corticosteroids (such as hydrocortisone, betamethasone, and fluticasone propionate) are the most common and effective treatment for atopic dermatitis.⁵ They are used until the rash clears and may be used to prevent atopic dermatitis flares. Topical medications, such as creams or ointments, are applied directly to the skin.
• Calcineurin inhibitors (pimecrolimus and tacrolimus) are topical immunosuppressants—medicines that weaken your body's immune system. However, the U.S. Food and Drug Administration (FDA) recommends caution when prescribing or using Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment because of a potential cancer risk.⁶ The FDA also stresses that these medicines only be used as directed and only after trying other treatment options. Calcineurin inhibitors are not approved for children younger than 2 years of age.
• Antihistamines (such as diphenhydramine and hydroxyzine) are often used to treat itching and to help you sleep when severe night itching is a problem. However, histamines are not always involved in atopic dermatitis itching and may not help all people with the condition.²
• Antibiotic, antiviral, or antifungal medications are used to treat an infected rash.

Treatment if the condition gets worse

For severe cases of atopic dermatitis or cases that do not improve with other treatment, treatment can include:

• A bandage or dressing that is wrapped around the affected skin, which covers any open sores and prevents contact with air.
• Exposure to ultraviolet (UV) light at a clinic or health professional's office with or without additional medication. Options include phototherapy or photochemotherapy.
• High-strength topical corticosteroids or oral corticosteroids. These may be used when the rash covers large areas of the body or when complications occur, such as skin infections.
• Cyclosporine or interferon, which is sometimes used in adults if other treatment is not successful.

In severe cases, hospitalization may be needed. A short stay in the hospital can quickly control the condition.

What To Think About

A combination of preventive measures, such as moisturizing your skin and avoiding irritants, along with medications usually works best to control atopic dermatitis. You may need to try different treatments before finding what works best for you or your child.

Atopic dermatitis sometimes improves when daily stresses are reduced. Relaxation techniques, such as meditation or imagery exercises, can help relieve stress. For more information, see the topic Stress Management.

Atopic dermatitis may affect how children feel about themselves. A child may feel strange or different from other children because of the rash or restrictions in diet. The rash may make a child feel unattractive.

If you have problems with skin infections along with atopic dermatitis, your health professional might suggest soaking in a weak bleach solution.

If your baby is at risk for developing atopic dermatitis because you or other family members have it or other allergies, these steps may help prevent a rash or reduce its severity:

• If possible, breast-feed your baby for at least 6 months to boost his or her immune system. Studies have reported that exclusively breast-feeding children for the first 3 months or longer after birth may reduce the risk of atopic dermatitis in children with a family history of the condition.⁷
• Talk to your doctor about your diet if you are breast-feeding. Your diet may affect whether your baby develops atopic dermatitis. Although the effect of a breast-feeding mother's diet is a point of controversy, researchers have observed that some infants' rashes improve when their mothers eliminate milk from their diets and get worse when milk is reintroduced. Other allergenic foods can potentially have a similar effect on breast-fed babies. This connection is neither well supported nor strongly refuted by current research.⁷
• When you give your child solid foods, discuss with your health practitioner whether your child should avoid foods that frequently cause food allergies, such as eggs, peanuts, milk, soy, and wheat.

If you or your child has atopic dermatitis, you may decrease flares by:

• Avoiding dry skin. This is essential in treating atopic dermatitis. Keep your or your child's skin hydrated through proper bathing and use of moisturizers. This includes bathing in warm water, bathing for only 3 to 5 minutes, avoiding gels and bath oils, and using soap only on the underarms, groin, and feet on a regular basis. Apply a moisturizer immediately after bathing, even while your skin is still wet. For more information, see:

  Skin care for atopic dermatitis.

• Avoiding irritants that cause a rash or make a rash worse. These include soaps that dry the skin, perfumes, and scratchy clothing or bedding.
• Avoiding possible allergens that cause a rash or make a rash worse. These may include dust and dust mites, animal dander, and certain foods, such as eggs, peanuts, milk, wheat, or soy products. Talk to your health professional first to determine whether allergens are contributing to your atopic dermatitis. For more information on food allergies, see the topic Food Allergies.
• Controlling itching and scratching. Keep your fingernails trimmed and filed smooth to help prevent damaging the skin when scratching. You may want to use protective dressings to keep from rubbing the affected area. Put mittens or cotton socks on your baby's hands to help prevent him or her from scratching the area.

Home treatment for atopic dermatitis may include:

• Avoiding dry skin. People with atopic dermatitis have overly sensitive skin, so it is important that you take care of your skin. Keep your skin hydrated through proper bathing and use of moisturizers. This includes bathing in warm water, bathing for only 3 to 5 minutes, avoiding gels and bath oils, and using soap only on the underarms, groin, and feet on a regular basis. Apply a moisturizer immediately after bathing, even while your skin is still wet. For more information, see:

  Skin care for atopic dermatitis.

• Avoiding irritants that cause a rash or make a rash worse. These include soaps that dry the skin, perfumes, and scratchy clothing or bedding.
• Avoiding possible allergens that cause a rash or make a rash worse. These may include dust and dust mites, animal dander, and certain foods, such as eggs, peanuts, milk, wheat, or soy products. Talk to your health professional first to determine whether allergens are contributing to your atopic dermatitis. For more information on food allergies, see the topic Food Allergies.
• Controlling itching and scratching. Keep your fingernails trimmed and filed smooth to help prevent damaging the skin when scratching. You may want to use protective dressings to keep from rubbing the affected area. Put mittens or cotton socks on your baby's hands to help prevent him or her from scratching the area. Coal tar preparations applied to the skin also may help reduce itching.

Medications for atopic dermatitis include the following.

• Topical corticosteroids (such as hydrocortisone, betamethasone, and fluticasone propionate) are the most common and effective treatment for atopic dermatitis.⁵ They are used until the rash clears and may be used to prevent atopic dermatitis flares. Topical medications, such as creams or ointments, are applied directly to the skin. Only low-strength topical corticosteroids should be used on your face.
• Calcineurin inhibitors (pimecrolimus and tacrolimus) are topical immunosuppressants—medicines that weaken your body's immune system. However, the U.S. Food and Drug Administration (FDA) recommends caution when prescribing or using Elidel (pimecrolimus) cream and Protopic (tacrolimus) ointment because of a potential cancer risk.⁶ The FDA also stresses that these medicines only be used as directed and only after trying other treatment options. Calcineurin inhibitors are not approved for children younger than 2 years of age.
• Antihistamines (such as diphenhydramine and hydroxyzine) are often used to treat atopic dermatitis itch and to help you sleep when severe night itching is a problem. However, histamines are not always involved in atopic dermatitis itch and may not help all people with the condition.²
• Oral corticosteroids (such as prednisone and prednisolone) are used in severe cases when the rash covers large areas of the body or when complications occur.
• Cyclosporine or interferon is sometimes used in adults if other treatment is not successful.

If the rash becomes infected, antibiotic, antiviral, or antifungal medications are used. Skin that has been broken down by scratching and inflammation can become infected.

Coal tar preparations applied to the skin may help reduce itching. They are sometimes used to control the condition after a stronger medication has successfully improved atopic dermatitis.

Mild- to moderate-strength corticosteroids that are applied to the skin, together with heavy moisturizing, are effective in reducing atopic dermatitis rash in most cases. Specific treatment depends on the type of rash you have.

If you or your child has a very mild itch and rash, you may be able to control it without medication by using home treatment and preventive measures. However, if symptoms are getting worse despite home treatment, it is essential that you use medical treatment to prevent the itch-scratch-rash cycle from getting out of control.

Leukotriene inhibitors, such as zafirlukast (Accolate) and montelukast (Singulair), may have a role in the treatment of atopic dermatitis. They are taken by mouth (orally) and reduce inflammation that may lead to the rash. Azathioprine has been used in severe atopic dermatitis. It suppresses the response of the immune system to reduce symptoms. The American Academy of Dermatology notes that there is not enough evidence to support the use of leukotriene inhibitors in atopic dermatitis and that there is conflicting research on azathioprine.⁸

There is no surgical treatment for atopic dermatitis.

Other treatment for atopic dermatitis includes light therapy and complementary therapies.

Light therapy

Severe atopic dermatitis may be treated by exposing affected skin to ultraviolet (UV) light. There are two types of ultraviolet light, called ultraviolet A (UVA) and ultraviolet B (UVB).

• Phototherapy uses UVA, UVB, or a combination of UVA and UVB.
• Photochemotherapy uses UVA light along with psoralen medications, which make the skin more sensitive to UV light.

Excessive sun exposure and light treatment (such as with UVA or UVB treatments) increases your risk of skin cancer.

Complementary or alternative treatments

Complementary or alternative treatments used for atopic dermatitis include:

• Taking dietary supplements of essential fatty acids (EFAs). Increasing the amount of EFAs in the diet may help the immune system function better and thus reduce atopic dermatitis. However, this theory is not scientifically proven.
• Using traditional Chinese herbal therapy. The traditional herbs may contain naturally occurring corticosteroids, which may reduce itching. However, this therapy has been linked to cases of liver toxicity.⁹
• Taking supplements of probiotics (bacteria that live in the digestive system). Probiotic supplements taken by both pregnant mothers and newborns may decrease the risk of atopic dermatitis in children with a family history of allergies.^{10, 11}

If you are interested in these treatments, ask your health professional about their use, their effectiveness, and any possible interactions related to other medications you are taking.

Organizations

• Allergic Rhinitis
• Asthma in Children
• Asthma in Teens and Adults
• Food Allergies

Citations

1. Boguniewicz M, Leung DYM (2003). Atopic dermatitis. In N Franklin Addison Jr et al., eds., Middleton's Allergy Principles and Practice, vol. 2, pp. 1559–1580. New York: Mosby.

2. Leung DYM, et al. (2003). Atopic dermatitis (atopic eczema). In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., vol. 1, pp. 1180–1194. New York: McGraw-Hill.

3. Kristal L, Klein P (2000). Atopic dermatitis in infants and children. Pediatric Clinics of North America, 47(4): 877–895.

4. Knoel KA, Greer KE (1999). Atopic dermatitis. Pediatrics in Review, 20(2): 46–52.

5. Boguniewicz M, Leung D (1998). Atopic dermatitis: A question of balance. Archives of Dermatology, 134(7): 870–871.

6. U.S. Food and Drug Administration (2006). FDA approves updated labeling with boxed warning and medication guide for two eczema drugs, Elidel and Protopic. FDA News. Available online: http://www.fda.gov/bbs/topics/news/2006/NEW01299.html.

7. Smethurst D, Macfarlane S (2003). Atopic eczema. Clinical Evidence (9): 1785–1801.

8. Hanifin JM, et al. (2004). Guidelines of care for atopic dermatitis. Journal of the American Academy of Dermatology, 50(3): 391–404.

9. Leung D (2000). Atopic dermatitis: New insights and opportunities for therapeutic intervention. Journal of Allergy and Clinical Immunology, 105(5): 860–76.

10. Kalliomäki M, et al. (2001). Probiotics in primary prevention of atopic disease: A randomised placebo-controlled trial. Lancet, 357(9262): 1076–1079.

11. Kalliomäki M, et al. (2003). Probiotics and prevention of atopic disease: 4-year follow-up of a randomised placebo-controlled trial. Lancet, 361(9372): 1869–1870.

Other Works Consulted

• Berger TG (2005). Scaling disorders section of skin, hair, and nails. In LM Tierney et al., eds., Current Medical Diagnosis and Treatment , 44th ed., pp. 93–94. New York: Lange Medical Books/McGraw-Hill.

• Habif TP, et al. (2005). Atopic dermatitis. In Skin Disease: Diagnosis and Treatment, 2nd ed., pp.64–69. Philadelphia: Elsevier Mosby.

• Stevens SR (2005). Eczematous disorders, atopic dermatitis, and ichthyoses. In DC Dale, DD Federman, eds., ACP Medicine, section 2, chap. 4. New York: WebMD.