Last updated: November 2023
Also known as: Atopic eczema
What is atopic dermatitis?
Atopic dermatitis is a common condition where the skin becomes red, dry, swollen and very itchy. The itchiness may interfere with sleep. The inflammation and itchiness wax and wane in severity.
In infants, atopic dermatitis often affects the cheeks, scalp, outsides of the arms and legs and the trunk. In children and adults, the inflammation involves the creases in the front of the arms and behind the knee, and the wrists, ankles and buttocks.
Who gets atopic dermatitis?
Atopic dermatitis usually begins in infancy or early childhood but can also begin in young adults or even later in life. Atopic dermatitis can exist with other allergic reactions, such as asthma, hay fever and food allergies. Individuals with the genetic tendency to develop allergic reactions (i.e., hay fever, asthma, allergic conjunctivitis) or who have family members who do, are more likely to develop atopic dermatitis.
What causes atopic dermatitis?
While atopic dermatitis may be caused by both genetic and environmental influences, there is no known single factor that causes the skin to become itchy and inflamed.
Individuals with atopic dermatitis often have relatives with eczema or sensitive skin, asthma, hay fever, food allergies or allergic conjunctivitis. Hereditary factors predispose an individual to having dry skin and a skin barrier that is less able to keep out environmental irritants and allergens. It also predisposes an individual to producing immune antibodies to bacteria, such as staphylococcal aureus and other allergens.
What does atopic dermatitis look like?
The appearance varies with the age of the affected individual. However, itching, scratching (often breaking the skin with scratching) and rubbing are present in all cases of atopic dermatitis. An itch–scratch-itch cycle may develop that leads to thickening, scaling and redness of the skin.
In infants under the age of 6 months the inflammation on the scalp, face and neck may lead to weeping and crusting. From 2 to 12 years the eczema is drier. The knee and elbow creases are involved. The skin of the neck, around the mouth, wrists and ankles is often inflamed. The dryness of the skin becomes more obvious.
From 12 years onwards, including adults, the atopic dermatitis may be more chronic, widespread, severe and treatment resistant. It may also develop for the first time as hand dermatitis or mainly involve the face.
Sometimes other causes of severely itching skin may mimic the changes of atopic dermatitis.
How is atopic dermatitis diagnosed?
Atopic dermatitis is usually diagnosed based on patient history and clinical/physical examination. In some cases, further investigations may be required, such as patch testing.
How is atopic dermatitis treated?
Treatment options will vary depending on the individual and their needs.
Some general measures that may help atopic dermatitis include:
- Avoid triggers that can directly inflame the skin, such as fabrics, chemicals, humidity and dryness. Known food allergies that may exacerbate atopic dermatitis.
Topical treatment options may include:
- Over-the-counter treatments, such as emollients and moisturisers, and antiseptics
- Prescription topical treatments, such as coal tar, topical steroids, topical calcineurin inhibitors, crisaborole ointment and phototherapy
- Systemic treatments, such as antihistamines, systemic steroids, immunosuppressive and anti-inflammatory agents, biological agents and Janus kinase inhibitors
What is the likely outcome of atopic dermatitis?
Atopic dermatitis is often worse between the ages of 2-4 years old. It may improve or clear after this, but can be aggravated or reappear during adulthood. For individuals with sensitive skin, atopic dermatitis may persist throughout life.
| Conjoint Professor Orli Wargon | November 2023 |
| Conjoint Professor Orli Wargon | September 2022 |