Atopic dermatitis
Also known as: atopic dermatitis, atopic eczema, eczema, infantile eczema, childhood eczema, adult atopic dermatitis, flexural eczema, chronic relapsing eczema, atopic skin disease
Atopic dermatitis is a chronic, relapsing inflammatory skin disorder characterised by itch, dryness, impaired skin-barrier function and recurrent eczema. It often begins during infancy or childhood but may persist into adulthood or first appear later in life. The distribution varies with age: infants commonly develop facial and extensor involvement, while older children and adults often have eczema in the elbow and knee creases, hands, neck, face or eyelids. Scratching can cause excoriation, thickened skin, bleeding, sleep disturbance and secondary infection. Atopic dermatitis is not contagious. It is associated with genetic susceptibility, immune dysregulation, skin-barrier impairment and environmental influences and commonly coexists with asthma, allergic rhinitis or food allergy. Potential aggravating factors include heat, sweating, low humidity, fragranced products, harsh cleansers, wool, occupational irritants, stress, skin infection and contact allergy. Diagnosis is clinical, but patch testing, allergy assessment, skin swabs, biopsy or laboratory investigation may be appropriate when the presentation is atypical or treatment-resistant. Standard management includes regular emollient use, gentle bathing and cleansing, avoidance of relevant irritants and appropriate anti-inflammatory treatment. Prescribed therapies may include topical corticosteroids, topical calcineurin inhibitors, topical phosphodiesterase or Janus kinase inhibitors, wet-wrap therapy, phototherapy and systemic immunomodulatory or biologic medicines for moderate-to-severe disease. Acupuncture and Chinese herbal medicine may be considered only as adjunctive approaches for symptom burden, itch, sleep or stress after appropriate dermatological assessment. They must not replace moisturisers, prescribed anti-inflammatory treatment, antimicrobial therapy or urgent management of eczema herpeticum, cellulitis, severe drug reactions or systemic infection.
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Lifestyle & Diet
- •Apply a fragrance-free emollient regularly and whenever the skin feels dry.
- •Apply moisturiser soon after bathing while the skin remains slightly damp.
- •Use lukewarm rather than hot showers or baths.
- •Use gentle, fragrance-free cleansers or soap substitutes.
- •Continue prescribed topical corticosteroids or other anti-inflammatory medicines according to the treatment plan.
- •Ask a doctor or pharmacist to demonstrate the correct amount, potency and application method for topical treatment.
- •Do not avoid prescribed topical corticosteroids because of unverified social-media claims.
- •Identify genuine individual triggers without attempting to eliminate every possible exposure.
- •Choose soft, breathable clothing and avoid fabrics that consistently irritate the skin.
- •Wash new clothing before use and consider fragrance-free laundry products.
- •Keep fingernails short and smooth.
- •Use cool compresses or prescribed wet-wrap therapy where appropriate.
- •Avoid overheating and manage sweating when it triggers itch.
- •Maintain a cool sleeping environment.
- •Address sleep disruption with the treating clinician.
- •Seek prompt care for painful blisters, fever, rapidly spreading redness, pus or marked worsening.
- •Do not share topical medicines unless prescribed for the other person.
- •Avoid tobacco smoke and vaping exposure.
- •Use sun protection appropriate for sensitive skin.
- •Discuss swimming and chlorine-management strategies with the dermatologist if these trigger symptoms.
- •Use occupational gloves and skin protection where irritants are unavoidable.
- •Consider patch testing when allergic contact dermatitis is suspected.
- •Do not undertake broad food-elimination diets without medical and dietetic supervision.
- •Infants and children with suspected food allergy, poor growth or restricted eating require paediatric assessment.
- •Maintain recommended vaccination and infection-prevention care during systemic treatment.
- •Use psychological or behavioural support when itch, sleep loss or visible disease causes significant distress.
Cautions & Contraindications
- •Do not replace prescribed anti-inflammatory treatment with acupuncture, herbs, supplements or dietary restriction.[,,]
- •Do not delay antiviral treatment for suspected eczema herpeticum.[,]
- •Do not delay antibiotics or urgent assessment for cellulitis, systemic infection or sepsis.[,]
- •Do not needle, cup, scrape or bleed active lesions.[,]
- •Do not apply undiluted essential oils, alcohol, bleach, vinegar, acids or caustic herbal powders directly to inflamed skin.[,]
- •Do not use household bleach baths unless specifically prescribed with exact dilution instructions.[,]
- •Do not recommend abrupt withdrawal of topical or systemic corticosteroids.[,]
- •Do not diagnose topical steroid withdrawal without specialist assessment because infection, undertreatment, allergy and severe eczema can appear similar.[,]
- •Do not impose restrictive diets on infants, children, pregnant patients or nutritionally vulnerable adults without qualified supervision.[,]
- •Do not assume food allergy is the cause of eczema based solely on IgG testing or unvalidated testing.[,]
- •Do not use herbs containing Aristolochia species or aristolochic acid.[]
- •Mù Tōng and Fáng Jǐ must be botanically authenticated to exclude aristolochic-acid-containing substitutions.[]
- •Dāng Guī, Chì Sháo, Mǔ Dān Pí and other Blood-moving herbs require pregnancy and bleeding-risk review.[]
- •Gān Cǎo may worsen hypertension, oedema and hypokalaemia.[]
- •Rén Shēn may interact with warfarin, diabetic medicines and stimulants.[]
- •Kǔ Shēn and other concentrated topical herbs may cause irritant or allergic contact dermatitis.[]
- •Bàn Xià and toxic herbs must be correctly processed and professionally prescribed.[]
- •Avoid unregulated creams that may contain undeclared corticosteroids, heavy metals or pharmaceutical ingredients.[]
- •Screen all oral herbs for pregnancy, breastfeeding, liver disease, kidney disease, allergy and medicine interactions.[]
- •Do not interpret blistering, infection, skin peeling or systemic illness as detoxification or a healing reaction.[]
When to reassess or seek care again
- •Reassess disease severity, treatment adherence and infection risk at every visit and escalate any flare or new blistering.[,]
- •Refer back to dermatology or the treating GP for step-up therapy when flares recur despite optimised topical treatment.[,]
- •Undertreatment or steroid phobia
- •Skin infection including Staphylococcus and herpes simplex
- •Heat, sweating and low humidity
- •Irritants, fragranced products and harsh cleansers
- •Stress, sleep loss and occupational exposures
Any suspected eczema herpeticum, cellulitis, erythroderma or anaphylaxis during care warrants immediate emergency referral rather than continued acupuncture.
Frequently Asked Questions
What is atopic dermatitis?+
Atopic dermatitis is a chronic inflammatory skin condition that causes dry, itchy and inflamed skin with recurrent flares, per DermNet [2].
Is atopic dermatitis contagious?+
No. Atopic dermatitis cannot be passed from one person to another [5].
What commonly triggers eczema flares?+
Potential triggers include heat, sweating, dry air, fragranced products, harsh cleansers, wool, stress, infection and occupational irritants [1,2].
How is atopic dermatitis treated?+
Treatment commonly includes regular moisturiser, trigger reduction and prescribed topical anti-inflammatory medicines, with phototherapy or systemic treatment for more severe disease [1,2,5].
What is eczema herpeticum?+
Eczema herpeticum is a potentially serious herpes-virus infection causing rapidly spreading painful blisters or punched-out erosions, often with fever [3].
When does infected eczema need urgent care?+
Urgent review is needed for fever, rapidly spreading redness, severe pain, pus, painful blisters, facial or eye involvement or systemic illness [1,3,4].
Can acupuncture cure eczema?+
No cure can be guaranteed. Acupuncture may be considered only as adjunctive symptom support and must not replace standard dermatological treatment [7,8].
Can acupuncture needles be inserted into eczema lesions?+
No. Active, infected, weeping, blistered or broken skin should not be needled [7,8].
Should children with eczema avoid common foods?+
Not routinely. Restrictive diets can cause nutritional harm and should be used only after appropriate allergy and dietetic assessment [1,6].
Can Chinese herbal creams cause reactions?+
Yes. Topical herbs can cause irritation or allergic contact dermatitis, and unregulated products may contain undeclared medicines or contaminants [8].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- Healthdirect Australia · 2025
- DermNet New Zealand · 2026
- DermNet New Zealand · 2026
- DermNet New Zealand · 2026
- American Academy of Dermatology · 2026
- Eczema Association of Australasia · 2026
- World Health Organization · 2008
- World Health Organization · 2021
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.