Overview
Atopic dermatitis (eczema) is a chronic skin disease in which the skin becomes dry, itchy, red, and inflamed. It usually starts in infancy and childhood; 60% appears before age 1.
It affects 15-20% of children and 1-3% of adults. In most children it decreases or disappears with age; in some it continues into adulthood.
Symptoms
Symptoms vary from person to person and flare periodically:
- Itching (the most prominent symptom; especially at night)
- Dry, scaly skin
- Red, inflamed patches
- Small, fluid-filled blisters
- Thickened, cracked skin (lichenification)
- Sensitive, swollen skin
- Color changes (darkening or lightening)
- Wounds from constant scratching
Involvement by age:
- In infants: Cheeks, forehead, scalp
- In children: Inside elbows, behind knees, wrists
- In adults: Hands, around eyes, neck, flexion areas
Causes
The exact cause is unknown; multifactorial:
- Genetics: Filaggrin gene mutation (weakens skin barrier)
- Immune system dysregulation
- Environmental factors
- Impaired skin barrier function
Triggers
- Hot, dry, or very cold weather
- Excessive sweating
- Wool, synthetic fabrics
- Soaps, detergents, perfumes
- Stress and emotional changes
- Certain foods (milk, eggs, peanuts — in some people)
- Pollen, dust mites, animal dander
- Chlorine (pool)
- Cigarette smoke
- Some textile dyes
- Bacterial infections
Risk Factors
- Family history (atopic dermatitis, asthma, hay fever)
- Childhood
- Urban living
- Early antibiotic use
- Being an only child
Complications
- Asthma and hay fever ("atopic march")
- Skin infections: Bacterial (staph), viral (herpes - eczema herpeticum), fungal
- Sleep disturbances (due to itching)
- Behavior and school performance problems
- Low self-esteem, social anxiety
- Hand eczema (work-related in adults)
When to See a Doctor
- If the skin condition is affecting daily life
- If constant itching is disturbing sleep and daily activities
- Signs of skin infection (fever, pus, warmth)
- If it does not respond to over-the-counter treatments
- If your child has widespread eczema
- Active eczema on the face or around the eyes
Diagnosis and Treatment
Diagnosis: Made by visual examination. Allergy tests and skin biopsy can be done when needed.
Treatment:
1. Skin care (essential):
- Warm bath 1-2 times a day (short duration)
- Mild, unscented cleanser
- Moisturizer immediately after bathing
- Thick, unscented moisturizers (petroleum jelly, ceramide-containing)
- Moisturize at least twice a day
2. Medication:
- Topical corticosteroids (during flares: hydrocortisone, mometasone)
- Topical calcineurin inhibitors (tacrolimus, pimecrolimus)
- Crisaborole (PDE4 inhibitor)
- Antihistamines (for itching, especially at night)
- Antibiotics (in case of infection)
- Oral corticosteroids (short-term, in severe flares)
- Immunomodulators (cyclosporine, methotrexate)
- Biological agents: Dupilumab (moderate-severe cases)
- JAK inhibitors: New class
3. Other treatments:
- Phototherapy (UV)
- Wet wrap therapy
- Education and psychological support
Prevention and Lifestyle
- Moisturize regularly (most important)
- Identify and avoid your triggers
- Wear cotton, soft clothing
- Avoid perfumed soaps, detergents, cosmetics
- Do not take very hot baths
- After bathing, pat dry; do not rub
- Keep nails short (reduces scratching damage)
- Manage stress
- Use air conditioning (avoid excessive dryness)
- Prefer mild detergents
- Avoid wool and synthetic fabrics
- Stay under regular follow-up