Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
Table of ContentsView All
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Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Atopic dermatitisandcontact dermatitisare both very common types of eczema—a skin condition that can cause itchy, scaly, inflammatory rashes. While their symptoms are similar, the two have very different causes.
Contact dermatitis develops when the skin comes in contact with something that triggers a reaction. Properly identifying the type of eczema is key to getting the correct treatment.
In some cases, the difference between the two is quite obvious; in other cases, it is not. Some patients can even have both atopic and contact dermatitis at the same time, making assessment more difficult.
Verywell / JR Bee
Both atopic and contact dermatitis can go through eczema’sthree different phases.
During theacute phase, the first of the three, both types of dermatitis cause ared, itchy rash that may ooze or weep clear fluid. With contact dermatitis, small, fluid-filled blisters (called vesicles) are likely to develop, while weeping plaques (broad, raised areas of skin) are more common with atopic dermatitis. And while both conditions are extremely itchy during this phase, contact dermatitis is more likely to also cause pain and burning. If a case shows some distinction, it usually occurs in this phase.
It’s during the next phase, thesub-acute phase, that atopic dermatitis and contact dermatitis are particularly hard to tell apart. In both cases, the rashes are rough, dry, and scaly, often with superficial papules (small, red bumps).
Given that these phases are not concrete and any contrasts may or may not be pronounced, telling contact dermatitis from atopic dermatitis based on the look of the rash alone can be a challenge. That’s where some additional considerations come into play.
Symptoms of Contact Dermatitis
Location Differences
The location of the eczema rash is an extremely important clue when differentiating between atopic and contact dermatitis.
Atopic dermatitis most classically involves the flexural locations of the skin, such as the folds of the elbows (antecubital fossa), behind the knees (popliteal fossa), the front of the neck, folds of the wrists, ankles, and behind the ears.
Since atopic dermatitis begins as an itch that, when scratched, results in a rash, it makes sense that the locations easiest to scratch are those that are affected. The flexural areas are most often involved in older children and adults, but less so in babies, simply because they have trouble scratching these particular spots. In contrast, very young children tend to get atopic dermatitis on the face, the outside elbow joints, and the feet.
Age Symptoms Appear
The age of a person experiencing an eczematous rash can be an important distinction between the two conditions as well. Most people who develop atopic dermatitis are 5 years of age or younger, while contact dermatitis is less common in young children.
While atopic dermatitis can appear for the first time in adulthood, contact dermatitis is much more common in adults.
While not a symptom itself, age can help put symptoms in context.
How Age Affects Eczema
Atopic Dermatitis SymptomsOften dry and scalyAppears on flexural areasMost common in children under 5 years oldContact Dermatitis SymptomsOften blisters and weepsCan appear anywhere on the bodyMost common in adults
Atopic Dermatitis SymptomsOften dry and scalyAppears on flexural areasMost common in children under 5 years old
Often dry and scaly
Appears on flexural areas
Most common in children under 5 years old
Contact Dermatitis SymptomsOften blisters and weepsCan appear anywhere on the bodyMost common in adults
Often blisters and weeps
Can appear anywhere on the body
Most common in adults
Perhaps the most significant difference between atopic and contact dermatitis is a person’s susceptibility.
What to Know About Lichenoid Dermatitis
Atopic Dermatitis Mechanism
A person with atopic dermatitis often has a genetic mutation in a protein in their skin called filaggrin. A mutation in filaggrin results in a breakdown of the barriers between epidermal skin cells.
This leads to dehydration of the skin as well as the ability for aeroallergens, like pet dander and dust mites, to penetrate the skin. Such aeroallergens result in allergic inflammation and a strong itching sensation. Scratching further disrupts the skin and causes more inflammation and more itching.
An underlying propensity for allergy can also cause eczema to develop as a result of eating a food to which a person is allergic, causing T-lymphocytes (a type of white blood cell) to migrate to the skin and result in allergic inflammation. Without these underlying propensities, a person is unlikely to develop atopic dermatitis.
Common Eczema Causes and Triggers
Contact Dermatitis Mechanism
Contact dermatitis, on the other hand, is due to a reaction to a chemical exposure directly on the skin. It occurs among a majority of the population from interaction withpoison oak, poison ivy, or poison sumac (approximately 80% to 90% of people react to contact with these plants).Contact dermatitis is also common when exposed to nickel, cosmetic agents, and hair dye.
Contact Dermatitis Causes
Atopic Dermatitis CausesGenetic susceptibilityCommon in those with allergies and asthmaTriggers include stress, skin irritation, and dry skinContact Dermatitis CausesTopical exposure to offending substanceDelayed hypersensitivity responseTriggers include nickel, poison ivy/poison oak, and latex
Atopic Dermatitis CausesGenetic susceptibilityCommon in those with allergies and asthmaTriggers include stress, skin irritation, and dry skin
Genetic susceptibility
Common in those with allergies and asthma
Triggers include stress, skin irritation, and dry skin
Contact Dermatitis CausesTopical exposure to offending substanceDelayed hypersensitivity responseTriggers include nickel, poison ivy/poison oak, and latex
Topical exposure to offending substance
Delayed hypersensitivity response
Triggers include nickel, poison ivy/poison oak, and latex
In some instances, testing may be necessary.
The diagnosis of atopic dermatitisinvolves the presence of eczema rash, the presence ofitching (pruritus), and the presence of allergies. Allergies are common in those with atopic dermatitis and can be diagnosed using skin testing or blood testing. There is no specific test to diagnose atopic dermatitis, however.
The diagnosis of contact dermatitisinvolves the presence of eczema rash, which is usually itchy, and the ability to determine the trigger with the use of patch testing.
Contact Dermatitis: When Symptoms Start and Could End
A skin biopsy of both atopic and contact dermatitis will show similar features—namely, spongiotic changes in the epidermis, a swelling of the epidermal skin cells that appear like a sponge under a microscope. Therefore, a skin biopsy will not differentiate between these two conditions.
Itchy rash with typical age and location patterns
Family history
Diagnosing Contact DermatitisItchy rashEstablished contact with triggersPositive patch testing
Itchy rash
Established contact with triggers
Positive patch testing
Treatment for both atopic and contact dermatitis is similar, with the goal of reducing inflammation and itching and preventing future breakouts.
Keeping the skin well-moisturized is recommended for both conditions, but it’s critical for atopic dermatitis. Regular application of creams or ointments helps reduce and prevent flares. Moisturizing can help soothe the skin during an active contact dermatitis flare-up, but it will not prevent contact dermatitis.
Regardless of whether the eczema rash is from atopic dermatitis or contact dermatitis, identifying and avoiding the cause is the main treatment modality.
Medications used to treat the conditions are similar as well, but there are differences in when and how they’re used.
Atopic Dermatitis TreatmentRegular moisturizationTopical steroidsPhototherapyTopical calcineurin inhibitorsDilute bleach baths in some casesOral steroids rarely usedInterleukin-4 antagonistsContact Dermatitis TreatmentAvoiding triggersTopical steroidsPhototherapyOral steroids in severe casesTopical calcineurin inhibitors rarely usedDilute bleach baths not used
Atopic Dermatitis TreatmentRegular moisturizationTopical steroidsPhototherapyTopical calcineurin inhibitorsDilute bleach baths in some casesOral steroids rarely usedInterleukin-4 antagonists
Regular moisturization
Topical steroids
Phototherapy
Topical calcineurin inhibitors
Dilute bleach baths in some cases
Oral steroids rarely used
Interleukin-4 antagonists
Contact Dermatitis TreatmentAvoiding triggersTopical steroidsPhototherapyOral steroids in severe casesTopical calcineurin inhibitors rarely usedDilute bleach baths not used
Avoiding triggers
Oral steroids in severe cases
Topical calcineurin inhibitors rarely used
Dilute bleach baths not used
6 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Owen JL, Vakharia PP, Silverberg JI.The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.Am J Clin Dermatol. 2018;19(3):293-302. doi:10.1007/s40257-017-0340-7Fonacier L, Bernstein DI, Pacheco K, et al.Contact dermatitis: a practice parameter-update 2015.J Allergy Clin Immunol Pract. 2015;3(3 Suppl):S1-39. doi:10.1016/j.jaip.2015.02.009Thomsen SF.Atopic dermatitis: natural history, diagnosis, and treatment.ISRN Allergy.2014;354250. doi:10.1155/2014/354250Centers for Disease Control and Prevention.Poisonous plants and work.Adler B, DeLeo V.Allergic contact dermatitis.JAMA Dermatol. 2021 Jan;157(3):264. doi:10.1001/jamadermatol.2020.5639National Eczema Association.8 skincare ingredients to avoid if you have eczema, according to dermatologists.Additional ReadingChopra R, Vakharia PP, Sacotte R, Silverberg JI.Efficacy of bleach baths in reducing severity of atopic dermatitis: a systematic review and meta-analysis.Ann Allergy Asthma Immunol.2017;119(5):435-440. doi:10.1016/j.anai.2017.08.289Maarouf M, Shi VY.Bleach for atopic dermatitis.Dermatitis. 2018;29(3):120-126. doi:10.1097/DER.0000000000000358
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Owen JL, Vakharia PP, Silverberg JI.The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.Am J Clin Dermatol. 2018;19(3):293-302. doi:10.1007/s40257-017-0340-7Fonacier L, Bernstein DI, Pacheco K, et al.Contact dermatitis: a practice parameter-update 2015.J Allergy Clin Immunol Pract. 2015;3(3 Suppl):S1-39. doi:10.1016/j.jaip.2015.02.009Thomsen SF.Atopic dermatitis: natural history, diagnosis, and treatment.ISRN Allergy.2014;354250. doi:10.1155/2014/354250Centers for Disease Control and Prevention.Poisonous plants and work.Adler B, DeLeo V.Allergic contact dermatitis.JAMA Dermatol. 2021 Jan;157(3):264. doi:10.1001/jamadermatol.2020.5639National Eczema Association.8 skincare ingredients to avoid if you have eczema, according to dermatologists.Additional ReadingChopra R, Vakharia PP, Sacotte R, Silverberg JI.Efficacy of bleach baths in reducing severity of atopic dermatitis: a systematic review and meta-analysis.Ann Allergy Asthma Immunol.2017;119(5):435-440. doi:10.1016/j.anai.2017.08.289Maarouf M, Shi VY.Bleach for atopic dermatitis.Dermatitis. 2018;29(3):120-126. doi:10.1097/DER.0000000000000358
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Owen JL, Vakharia PP, Silverberg JI.The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.Am J Clin Dermatol. 2018;19(3):293-302. doi:10.1007/s40257-017-0340-7Fonacier L, Bernstein DI, Pacheco K, et al.Contact dermatitis: a practice parameter-update 2015.J Allergy Clin Immunol Pract. 2015;3(3 Suppl):S1-39. doi:10.1016/j.jaip.2015.02.009Thomsen SF.Atopic dermatitis: natural history, diagnosis, and treatment.ISRN Allergy.2014;354250. doi:10.1155/2014/354250Centers for Disease Control and Prevention.Poisonous plants and work.Adler B, DeLeo V.Allergic contact dermatitis.JAMA Dermatol. 2021 Jan;157(3):264. doi:10.1001/jamadermatol.2020.5639National Eczema Association.8 skincare ingredients to avoid if you have eczema, according to dermatologists.
Owen JL, Vakharia PP, Silverberg JI.The role and diagnosis of allergic contact dermatitis in patients with atopic dermatitis.Am J Clin Dermatol. 2018;19(3):293-302. doi:10.1007/s40257-017-0340-7
Fonacier L, Bernstein DI, Pacheco K, et al.Contact dermatitis: a practice parameter-update 2015.J Allergy Clin Immunol Pract. 2015;3(3 Suppl):S1-39. doi:10.1016/j.jaip.2015.02.009
Thomsen SF.Atopic dermatitis: natural history, diagnosis, and treatment.ISRN Allergy.2014;354250. doi:10.1155/2014/354250
Centers for Disease Control and Prevention.Poisonous plants and work.
Adler B, DeLeo V.Allergic contact dermatitis.JAMA Dermatol. 2021 Jan;157(3):264. doi:10.1001/jamadermatol.2020.5639
National Eczema Association.8 skincare ingredients to avoid if you have eczema, according to dermatologists.
Chopra R, Vakharia PP, Sacotte R, Silverberg JI.Efficacy of bleach baths in reducing severity of atopic dermatitis: a systematic review and meta-analysis.Ann Allergy Asthma Immunol.2017;119(5):435-440. doi:10.1016/j.anai.2017.08.289Maarouf M, Shi VY.Bleach for atopic dermatitis.Dermatitis. 2018;29(3):120-126. doi:10.1097/DER.0000000000000358
Chopra R, Vakharia PP, Sacotte R, Silverberg JI.Efficacy of bleach baths in reducing severity of atopic dermatitis: a systematic review and meta-analysis.Ann Allergy Asthma Immunol.2017;119(5):435-440. doi:10.1016/j.anai.2017.08.289
Maarouf M, Shi VY.Bleach for atopic dermatitis.Dermatitis. 2018;29(3):120-126. doi:10.1097/DER.0000000000000358
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