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Dermatology

Atopic dermatitis

Atopic dermatitis, or atopic eczema, is a chronic, non-contagious skin condition defined by inflammation and intense itching that typically worsens at night. The disease follows a recurrent pattern of flare-ups and remissions, presenting as dry, cracked, or brownish patches. 

Its appearance shifts with age; infants usually develop small bumps on their cheeks, whereas older children and adults typically experience rashes on the scalp, hands, or within the folds of the elbows and knees. Because the condition compromises the skin barrier, patients face an increased risk of secondary bacterial and viral infections, often marked by crusting or the presence of pus.

While atopic dermatitis affects a significant number of children and adults globally, the majority of patients first exhibit symptoms during their first year of life. Although the number of new diagnoses continues to rise, a large portion of those who develop the condition in early childhood experience spontaneous remission before they reach adolescence. For those whose symptoms persist into adulthood, the disease requires ongoing management to control inflammation and prevent localized infections.

Types of atopic dermatitis

Clinicians categorized atopic dermatitis into two primary types based on the body's immune response: extrinsic and intrinsic. The extrinsic (allergic) type involves high levels of IgE (an antibody the immune system produces when it overreacts to allergens) and clear sensitization to external triggers. In contrast, the intrinsic (non-allergic) type presents with normal IgE levels and shows no specific allergic sensitivities.

Because no single laboratory test can determine the severity of the disease, doctors use a combination of objective and subjective tools to guide treatment. They rely on clinical scales like the EASI, SCORAD, and IGA to assess the extent of skin damage, while also evaluating patient-reported factors such as itch intensity and sleep disruption. These measurements allow healthcare providers to track how well a patient responds to therapy and adjust their care accordingly.

Vicente, living with Atopic Dermatitis

What causes atopic dermatitis?

The exact cause of atopic dermatitis is not completely clear. It may involve genetic and environmental factors leading to abnormalities in the epidermis and the immune system.

Atopic dermatitis can appear, or flare up, when a person is exposed to something in his or her environment. This is commonly called a trigger. Known triggers for atopic dermatitis include exposure to allergens, such as pollen, or stress, dry skin and infection. Skin irritants such as some fabrics, soaps and household cleaners may also trigger an atopic dermatitis flare-up. 

Discover atopic dermatitis triggering factors

Alicia, living with Atopic Dermatitis

How is atopic dermatitis diagnosed?

Doctors primarily diagnose atopic dermatitis through a physical examination and a detailed review of your medical history, as no specific blood test or scan can confirm the condition. They look for "essential" features, such as intense itching and the characteristic appearance of red, dry, or leathery patches in age-specific areas like the face in babies or the creases of the elbows and knees in adults. Your physician will also check for a "personal or family history of atopy", meaning they will ask if you or your close relatives suffer from asthma, hay fever, or food allergies. While clinicians occasionally use skin swabs to rule out bacterial infections or patch tests to identify contact allergies, they generally rely on established clinical frameworks, such as the UK Working Party criteria, to make a definitive diagnosis.

Find more about atopic dermatitis diagnosis

How to detect atopic dermatitis

Atopic dermatitis is defined by intense pruritus (itching) and skin inflammation that typically worsens at night, often leading to severe scratching and bleeding. As a primary diagnostic feature, this itching accompanies symptoms like dry, cracked, or eczematous patches. The disease’s appearance varies by age: infants typically develop bumps on the cheeks, while older children and adults experience rashes in joint folds, on hands, or on the scalp. Consequently, the relentless itching causes significant sleep disturbances, including insomnia and frequent waking. These sleep deficits often result in daytime drowsiness, irritability, and impaired concentration, potentially affecting growth and behaviour. 

How is atopic dermatitis treated?

There is no total cure for atopic dermatitis but, based on disease severity, there are many effective treatments. Flare-ups can be treated with topical steroids, non-steroid topical creams and phototherapy. Systemic drugs are also used to control flare-ups.

In addition to treatments, it is important to have a regular schedule of care that includes bathing with a gentle cleanser and moisturizing to lock water into the skin. 

FAQs

References

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  • European guideline: Wollenberg_2025_European Guideline (EuroGuiderm) on atopic eczema: living update