Atopic dermatitis (eczema)

Created: 09.01.2025

Updated 09.01.2025

Approved by: Consultant Dermatologist, Dr James Denny

What is Atopic Dermatitis?

Atopic dermatitis, also known as eczema, is a chronic inflammatory skin condition that causes the skin to become red, itchy, and inflamed.

It is often associated with other 'atopic diseases'. Food allergies and atopic eczema usually occur first and typically start in early childhood. This can be followed by asthma and then allergic rhinitis. The term commonly used to describe how these diseases are interconnected is "the atopic march." It is believed that the association is related to a compromised skin barrier, which allows allergens and other substances to penetrate the body more easily and come into contact with the immune system.

It has a hereditary component, where a strong genetic risk factor for developing atopic eczema is a mutation in the gene encoding an important skin barrier protein called filaggrin. However, filaggrin mutation is not necessary or sufficient to develop the disease.

What are the Symptoms?

Atopic dermatitis is characterised by dry and itchy skin, with rashes particularly appearing in the "flexures," such as the back of the knees and inside the elbows. The rash consists of dry red or pink patches of skin, with occasional weeping, blisters or areas of swollen skin during a flare up.

In infants, it is often found as small oozing blisters on the cheeks and scalp. It can also occur on the back of the arms, shins and in the diaper area.

In young children, it is often drier and frequently becomes scratched. The changes are often symmetrically present on the body, arms, and legs, and frequently in the areas of the groin, knees, ankles, elbows, and wrists.

In adults, the skin is generally dry and itchy and often thickened in certain areas due to scratching. Symmetrical eczema changes can be found on the upper body, around the elbow and knee creases and face, particularly around the eyes.

In general, there is a higher susceptibility to bacterial infections in eczema-affected skin due to the weakened barrier function of the skin.

The exact cause of atopic eczema is unknown, but it is considered a multifactorial condition, typically resulting from a combination of genetic and environmental factors. The presence of atopic diseases in the mother, father, or both increases the likelihood of a child developing atopic eczema. In some cases, particularly in infants with severe eczema, certain foods such as milk, eggs, soy, wheat, and nuts can worsen the condition. Avoiding specific types of food during pregnancy or breastfeeding, as well as the timing of introducing solid foods, has not been shown to have a definitive impact on the risk of developing atopic eczema.

What are the Treatments?

General measures

If triggering factors can be identified and removed, that is always the first step. However, for most people, there are no simple factors that cause the disease, so the focus is on relieving symptoms, preventing skin damage, and managing complications. Sun exposure can also be beneficial, and vacations in sunny areas or light therapy can have a positive effect.

Certain foods and nutrients may worsen atopic eczema. If you suspect that certain foods aggravate your child's eczema, you should try to identify the specific triggers in collaboration with a doctor.

Indoor environments should not be excessively dry, especially during winter. Sweating, for example, due to wearing excessively warm clothing, can also worsen eczema. Avoid carpets and other dust-collecting surfaces, and do not keep pets where there is an obvious allergy. No one should smoke in a home where someone has atopic eczema. Clothes should be washed with a non biological washing powder.

Moisturising

It is crucial to keep the skin moisturised and prevent it from drying out. Use moisturising creams regularly, especially after bathing or showering. Reduce the frequency of bathing, particularly with very hot water. Soap can dry out the skin, so avoid using soap on areas affected by eczema. Soap with a pH below 5.5 is preferable. Oil baths should be used frequently, ideally on a daily basis.

Medication

In children with mild symptoms, moisturising treatment alone may be sufficient. However, for more severe symptoms, the use of steroid creams or ointments or immunomodulatory treatments (which dial down your immune system) is necessary. It is crucial to use these medications correctly to achieve the best effect.

What is the Prognosis?

Atopic dermatitis is a lifelong condition, but many people experience periods of flare-ups followed by remission. While it can be challenging to manage, with proper treatment and skincare, most individuals can control their symptoms effectively. The condition may improve with age, particularly in children, although flare-ups can occur at any time.