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 Also, a person may 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.
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.
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.
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. Research has shown that even the
unaffected skin of people with atopic dermatitis does not hold water as well as
it should.2, 3
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.4 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.
Symptoms
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 (ages 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 a picture of
atopic dermatitis in an infant.
The rash is often crusted or oozes
fluid.
Rubbing and scratching can lead to frequent
infections.
Children (ages 2 years 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 subacute red, dry 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.
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 Also, a person may develop atopic dermatitis
as an adult.
Infants and children (ages 2 months to 11 years)
Of children with atopic dermatitis,
approximately 50% first develop symptoms in the first year of life and 30%
between ages 1 and 5.4
About 80% of
children with atopic dermatitis develop
asthma or
allergic rhinitis later in childhood.4
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.5
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 doctor 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.
What Increases Your Risk
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 who has a parent or sibling with atopic dermatitis, asthma, or allergic
rhinitis has a 60% to 80% chance of developing atopic dermatitis.6
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 doctor 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 doctor at your next visit.
If home treatment does not
clear up the rash, see your doctor. He or she can suggest other treatments or
prescribe a stronger medicine.
Who To See
For the diagnosis and treatment of atopic dermatitis,
consult with a:
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.
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
doctor 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 doctor 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. But 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 doctor will discuss how
to eliminate it from your diet or environment while
closely observing and recording your symptoms.
Treatment Overview
Although there is no cure for
atopic dermatitis, it can be controlled with
preventive measures and medicines. 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 medicines and moisturizers is used.
Counseling also
can be helpful for children and adults with atopic dermatitis. Talking with a
counselor can help reduce stress and anxiety caused by atopic dermatitis and
can help a person cope with the condition.
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:
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 doctor 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 medicine to heal your rash and reduce
itching.
Topical corticosteroids (such as
hydrocortisone, betamethasone, and fluticasone) are the most common and
effective treatment for atopic dermatitis.7 They are
used until the rash clears and may be used to prevent atopic dermatitis flares.
Topical medicines, 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. 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.8 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. But histamines are not always involved in atopic
dermatitis itching, so these medicines may not help all people who have the
condition.4 Don't give antihistamines to your child
unless you've checked with the doctor first.
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
medicines usually works best to control atopic dermatitis. You may need to try
different treatments before finding what works best for you or your
child.
The regular use of moisturizers may help reduce the need
for high-strength corticosteroid medicines.2
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 doctor might suggest soaking
in a weak bleach solution.
Prevention
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.
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.9
When you are
ready to give your child solid foods, talk with your doctor about 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:
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 doctor 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.
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:
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 doctor 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.
Topical corticosteroids (such as
hydrocortisone, betamethasone, and fluticasone) are the most common and
effective treatment for atopic dermatitis.7 They are
used until the rash clears and may be used to prevent atopic dermatitis flares.
Topical medicines, 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. 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.8 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. But histamines are not always
involved in atopic dermatitis itch, so these medicines may not help all people
who have the condition.4 Don't give antihistamines to
your child unless you've checked with the doctor first.
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.
Coal tar preparations applied to the
skin may help reduce itching. They are sometimes used to control the condition
after a stronger medicine 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
medicine by using home treatment and preventive measures. But 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.
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.
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. But this theory is not scientifically
proved.
Using traditional
Chinese herbal therapy. The traditional herbs may
contain naturally occurring
corticosteroids, which may reduce itching. But this
therapy has been linked to cases of liver toxicity.10
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.11, 12
If you are interested in these treatments, ask your
doctor about their use, their effectiveness, and any possible interactions
related to other medicines you are taking.
Other Places To Get Help
Organizations
American Academy of Allergy, Asthma, and
Immunology
555 East Wells Street
Suite 1100
Milwaukee, WI 53202-3823
Phone:
1-800-822-2762 (doctor referral information only) (414) 272-6071
E-mail:
info@aaaai.org (For general questions only. The AAAAI cannot answer individual questions relating to the diagnosis or treatment of allergies.)
Web Address:
www.aaaai.org
The American Academy of Allergy, Asthma, and Immunology
publishes an excellent series of pamphlets on allergies, asthma, and related
information. It also provides physician referrals.
The American Academy of Dermatology provides information about the
care of skin, hair, and nails. You can find a dermatologist in your area by
calling 1-888-462-DERM (1-888-462-3376).
National Eczema Association for Science and
Education
4460 Redwood Hwy
Suite 16-D
San Rafael, CA 94903-1953
Phone:
(800) 818-7546 (415) 499-3474
Fax:
(415) 472-5345
E-mail:
info@nationaleczema.org
Web Address:
www.nationaleczema.org
The U.S. National Eczema Association for Science and
Education works to improve the health and quality of life of people living with
atopic dermatitis/eczema.
National Institute of Allergy and Infectious Diseases
(NIAID), National Institutes of Health
NIAID Office of Communications and Public Liaison
6610 Rockledge Drive, MSC 6612
Bethesda, MD 20892-6612
Phone:
1-866-284-4107 toll-free (301) 496-5717
Fax:
(301) 402-3573
TDD:
1-800-877-8339
Web Address:
www3.niaid.nih.gov
The National Institute of Allergy and Infectious
Diseases conducts research and provides consumer information on infectious and
immune-system-related diseases.
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Mosby.
Grimalt R, et al. (2007). The steroid-sparing effect
of an emollient therapy in infants with atopic dermatitis: A randomized
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61-67.
Loden M (2003). The skin barrier and use of
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Leung DYM, et al. (2008). Atopic dermatitis (atopic
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McGraw-Hill.
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Jones SM, et al. (2007). Atopic dermatitis. In P
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Rudikoff D, Bos JD (2006). Atopic dermatitis. In MG
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62-68. London: Mosby.
U.S. Food and Drug Administration (2006).
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online:
http://www.fda.gov/bbs/topics/news/2006/NEW01299.html.
Bath-Hextall F, Williams H (2007). Eczema (atopic),
search date February 2005. Online version of BMJ Clinical Evidence. Also available online:
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Leung D (2000). Atopic dermatitis: New insights and
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Kalliomäki M, et al. (2001). Probiotics in primary
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Lancet, 357(9262): 1076-1079.
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Berger TG (2008). Atopic dermatitis (eczema) section
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McGraw-Hill.
Habif TP, et al. (2005). Atopic dermatitis.
In Skin Disease: Diagnosis and Treatment, 2nd ed.,
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Stevens SR (2005). Eczematous disorders,
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