How do you know if your itchy, red, inflamed skin rash is atopic dermatitis or contact dermatitis? These two skin conditions can have similar symptoms, but different causes and triggers. You can have both atopic and contact dermatitis.
See your doctor if you think you have dermatitis. They can diagnose your skin condition and then prescribe treatments to help you manage or prevent flare-ups.
What’s Dermatitis?
Dermatitis is a common term for red, inflamed, often dry and itchy skin. There are different types of dermatitis, including atopic dermatitis, also called eczema, and contact dermatitis.
Atopic dermatitis is chronic, or long-lasting. It can occur at any age, but it often appears in early childhood. Atopic dermatitis is the most common type of eczema.
Atopic dermatitis causes these symptoms:
- Red, itchy, dry, scaly, or cracked skin
- Patchy outbreaks on any part of the body, like the scalp, eyelids, face, neck, chest, arms, elbows, knees, or feet
- Small, red, raised bumps on the skin that may blister, crack, and ooze when scratched
- Raw, sensitive skin after you’ve scratched it
Contact dermatitis is another type of red, itchy skin rash. Your skin becomes inflamed when it makes contact with something that causes an allergic reaction.
Contact dermatitis symptoms are similar to those of atopic dermatitis:
- Red rash on the area of skin that makes contact with something that causes a reaction
- Severe itching
- Cracked, dry, or scaly skin
- Raised red bumps that may crack and ooze
- Swollen, hot, blistered skin
How Are They the Same?
Both atopic dermatitis and contact dermatitis can make your skin itch so badly that it keeps you awake at night. Rashes and itching from either type of dermatitis can also cause you a lot of stress.
You can even develop both atopic dermatitis and contact dermatitis together. Both skin conditions can flare up because your immune system reacts in a rash as a response to a trigger. Atopic dermatitis makes your skin very sensitive. You’re more likely to react in a rash if your skin touches something like hand soap or scratchy wool.
Is It Atopic or Contact?
How do you know if you have atopic dermatitis or contact dermatitis? Here are a few clues:
When flares happen:
- Atopic dermatitis flares up from time to time. You may not have a skin flare for years, and then have an outbreak that appears out of nowhere.
- Contact dermatitis flares up quickly a few minutes or hours after your skin touches the substance that’s irritating. The rash may last for a few weeks before it clears up.
Where rashes appear:
- Atopic dermatitis rashes can appear on the skin on many places of your body.
- When you have contact dermatitis, the rash usually appears on the area of your skin where it touched the substance.
- Atopic dermatitis rashes usually appear on both sides of the body, like the skin on both legs. Contact dermatitis rashes usually appear only on one side of your body where your skin touched the trigger.
What Are the Causes?
Atopic dermatitis and contact dermatitis may have different causes:
Genes. Atopic dermatitis is caused by a faulty code in the gene that makes filaggrin, a protein that forms a barrier to protect the outer layer of your skin. People with atopic dermatitis have a gene mutation, so they don’t make enough filaggrin. This makes their skin more porous. Moisture escapes their skin easily. Their skin gets very dry, itchy, and sensitive. Germs, irritants, and allergens get into the skin more easily. Their skin reacts with rashes.
Allergies and family links. Often, people with atopic dermatitis also develop allergies like hay fever or asthma at some point. If you or a family member has allergies, you’re more likely to get atopic dermatitis, too. Contact dermatitis isn’t caused by your genes or linked to other allergies. It doesn’t run in families.
Risk factors. You’re also at higher risk to have atopic dermatitis if you’re female, Black, or have a family member with atopic dermatitis.
Contact allergy. Contact dermatitis is an allergic reaction to something that touches your skin. Your skin inflames only after contact with a substance that’s irritating, like soap or perfume, or an allergen like poison ivy.
Many people with contact dermatitis have skin rashes as a reaction to an irritant. The rest may have allergic contact dermatitis, or skin that breaks out in a rash as an allergic reaction.
Risk factors. People who touch chemicals or cleansers in their daily work, such as hairstylists, auto mechanics, landscapers, or janitors, are at higher risk for contact dermatitis.
What Are Their Triggers?
Atopic dermatitis and contact dermatitis may both have certain triggers that set off your flares. If you can avoid your triggers, you may be able to calm skin rashes or even prevent them.
- Atopic dermatitis triggers may be soaps or detergents, dust, pollen, sweat, or stress. Long, hot showers or baths can also be triggers.
- Contact dermatitis triggers may be something that irritates your skin, like detergents, chemicals, bleach, dust, shampoo, makeup, or metals like nickel in jewelry or zippers. Other triggers may cause your skin to have an allergic reaction when you touch them, like a wool sweater, poison ivy, perfumes, or a preservative called thimerosal.
How Are They Diagnosed?
See your regular doctor or a dermatologist if you or your child have skin rashes. They can diagnose atopic dermatitis or contact dermatitis with a physical exam. They’ll ask you about symptoms and when they seem to flare, and your medical and family history.
They may also do a patch test to rule out other skin diseases or to pinpoint triggers that cause your rashes. They’ll attach small patches coated in different substances to the skin to see if anything causes a reaction.
What Are the Treatments?
Try to avoid your triggers:
- Watch out for any products like soaps that irritate your skin, and avoid them if possible.
- Keep skin moisturized and cool. Use a humidifier to keep the air in your home from becoming too dry.
- Even if your skin itches, try not to scratch it too much. Cover an itchy, raw patch of skin with a light bandage so you don’t scratch it more.
Topical agents. Your doctor may prescribe a steroid cream to treat skin rashes caused by either atopic dermatitis or contact dermatitis. Calcineurin inhibitor creams like tacrolimus (Protopic) or pimecrolimus (Elidel) are another prescription treatment for atopic dermatitis in people 2 and older. Crisaborole (Eucrisa) is prescription-strength nonsteroidal topical that is also available for mild to moderate atopic dermatitis. Antibiotic ointments can treat cracked skin or sore spots.
Oral medications. For more severe atopic dermatitis, your doctor can prescribe a short course of oral steroids like prednisone to treat a flare. If severe atopic dermatitis doesn’t respond to topical treatments, they can also prescribe dupilumab (Dupixent) or tralokinumab (Adbry), monoclonal antibody shots.
Your doctor can prescribe an oral steroid to ease a severe flare of contact dermatitis. You can also take an OTC oral antihistamine like diphenhydramine (Benadryl) to control severe itching from contact dermatitis.
Can Home Remedies Help?
There are a number of at-home and OTC remedies you can try to manage dermatitis:
Itch relief. OTC creams that contain 1% hydrocortisone or antihistamines, or calamine lotion may help relieve itch from contact dermatitis.
Moisturizers. Keep your skin moist if you have atopic dermatitis or contact dermatitis. Apply lotions or creams at least twice a day and after you wash your skin.
Bath treatments. Soak in a warm or lukewarm bath with baking soda or colloidal oatmeal (Aveeno) to soothe skin with atopic dermatitis or contact dermatitis.
Stay cool. Don’t wear tight or heavy clothes that irritate your skin or make you sweat if you have atopic dermatitis.
Protect your skin. If you have contact dermatitis, wear gloves when you know you may touch a trigger at home or work, like detergent.
