UNDERSTAND YOUR SKIN
Atopic Dermatitis
What is atopic dermatitis?
Atopic dermatitis is one of the most common chronic inflammatory skin conditions. It can occur in both children and adults, and is characterised by periods of flare-ups and remission. Dryness, itching, redness, irritation and a compromised skin barrier are among the most characteristic symptoms.
The term ‘atopic skin’ is often used to describe skin that is dry, sensitive and more prone to irritation, but atopic skin does not always mean that a person has atopic dermatitis. In some people, the skin barrier is more vulnerable and reacts more strongly to external factors, whilst in others a genuine inflammatory condition develops.
Atopic dermatitis is not contagious and is not transmitted by contact. However, it can significantly affect daily comfort, sleep and quality of life. The good news is that modern dermatology offers effective methods for managing symptoms and keeping the skin in better condition.
Main signs and symptoms
The most characteristic symptom is itching. It can be mild or very severe and often leads to scratching. This creates a vicious circle – the itching triggers scratching, the scratching damages the skin, and this further exacerbates the inflammation.
Depending on age and individual characteristics, rashes may appear on different parts of the body. In young children, the face and the outer parts of the limbs are often affected, whilst in older children and adults, changes are frequently observed in the creases of the elbows and knees, the hands, the neck and other areas.
Atopic skin is usually dry, sensitive and reacts easily to cold, heat, sweat, certain cosmetic products and other factors. However, not all dry or sensitive skin is atopic.
Types and patterns
Atopic dermatitis can present differently depending on age and the stage of the condition.
Atopic dermatitis in infants and young children – rashes often appear on the face, scalp and the outer parts of the limbs. In older children, the creases of the elbows and knees may gradually become affected.
Atopic dermatitis in adults – it often affects the hands, neck, eyelids, face and the creases of the limbs. The skin may become dry, thickened and rougher as a result of prolonged scratching.
Localised atopic dermatitis – in some people, symptoms are concentrated in specific areas, such as the hands or face.
Generalised form – in more severe cases, large areas of the skin may be affected.
It is important to distinguish between atopic dermatitis and other conditions with similar symptoms, including contact dermatitis, psoriasis, certain fungal infections and other inflammatory skin conditions. An accurate diagnosis is the basis for appropriate treatment.
Why does it develop?
Atopic dermatitis is a chronic inflammatory skin condition in which the skin barrier function is impaired and the immune system reacts more actively. The skin loses moisture more easily, becoming dry and more vulnerable to irritants.
Causes and risk factors
There is no single cause of atopic dermatitis. Its development results from the interaction between genetic factors, characteristics of the skin barrier, the immune system and environmental factors.
Some people have a hereditary predisposition to atopic conditions. Changes in the proteins involved in the formation and normal functioning of the skin barrier may play an important role.
Factors that may trigger or exacerbate symptoms include:
- cold, dry air;
- high temperatures and sweating;
- stress;
- harsh soaps and cleansing products;
- certain cosmetic ingredients;
- rough fabrics and mechanical friction;
- certain allergens in sensitive individuals;
- skin infections.
It is important to note that food is not a universal cause of atopic dermatitis. Some children with atopic dermatitis may have a food allergy, but eliminating foods without a proven allergy is not a recommended approach and may lead to unnecessary restrictions.
Is it a medical condition?
Yes. Atopic dermatitis is a chronic inflammatory skin condition. It is not contagious and cannot be passed from one person to another.
For many people, the condition comes and goes in waves. There are periods when the skin looks almost normal, followed by flare-ups with more severe itching, dryness and inflammation. The duration and severity of these periods vary from person to person.
Atopic dermatitis may be associated with other atopic conditions, such as asthma or allergic rhinitis, but this does not mean that everyone with atopic dermatitis will develop such conditions.
A particularly unpleasant aspect is the impact on sleep. Itching may be more severe in the evening and at night, leading to frequent waking and chronic fatigue.
Everyday care
Daily skincare is a key part of managing atopic dermatitis. The aim is to restore and maintain the skin barrier, reduce dryness and minimise factors that cause irritation.
A suitable routine includes:
Regular moisturising – using emollients and moisturising products helps to reduce dryness and maintain the skin barrier. These should be applied regularly, even when symptoms have subsided.
Gentle cleansing – it is advisable to use mild cleansing products without harsh soaps or strong fragrances. Prolonged hot showers can further dry out the skin.
Suitable clothing – soft, breathable fabrics are generally better tolerated than coarse fabrics. If you sweat heavily, you should change your clothes, as sweat can exacerbate irritation in some people.
Managing individual triggers – it is helpful to note when flare-ups occur and whether there is a link to certain products, weather conditions, stress or other factors.
Nails should be kept short, particularly when there is severe itching, to reduce the risk of scratching and causing wounds.
Popular home remedies: benefits and limitations
With atopic skin, it is advisable to approach home remedies with caution. The fact that a product is of natural origin does not automatically mean that it is suitable for sensitive or atopic skin.
The safest basis for home care is proven emollients and moisturising products that are suitable for atopic skin. Some people find that products with a higher lipid content and ingredients that support the skin barrier are particularly well tolerated.
Cool compresses may temporarily relieve itching in some people. However, it is important not to apply ice directly to the skin.
It is not advisable to use lemon juice, concentrated essential oils, alcohol or other harsh substances on inflamed skin. These can further damage the skin barrier and exacerbate irritation.
When should you see a doctor?
In cases of persistent dryness, recurring rashes or constant itching, it is advisable to consult a dermatologist. This is particularly important if the symptoms do not respond to standard moisturising care.
A specialist should also be consulted when:
- the rash is spreading rapidly;
- the itching is disrupting sleep;
- the skin cracks or bleeds;
- there are weeping areas, scabs or pus-filled blisters;
- the symptoms appear after using a specific product;
- the condition often flares up;
- the treatment you are using is not working.
A rapidly developing, painful, weeping or pus-filled lesion may be a sign of infection and requires medical assessment.
Seek urgent same-day advice for rapidly worsening painful skin, clusters of blisters, fever or feeling unwell, particularly if the eyes are involved. These can be signs of a serious infection.
Modern treatment options
Treatment is determined by the severity of the condition, the patient’s age and the affected areas. There is no one-size-fits-all treatment for all patients.
During flare-ups, the dermatologist may prescribe topical corticosteroids, which reduce inflammation and itching. In certain patients, topical calcineurin inhibitors or other modern anti-inflammatory agents are also used.
In cases of moderate to severe atopic dermatitis that is not adequately controlled by topical therapy, phototherapy and systemic or biologic therapies may be considered. Biologic medicines and certain targeted medicines act on specific mechanisms of inflammation and are prescribed by a specialist for suitable patients.
An important part of the modern approach is the individualisation of treatment. In some patients, the main focus is on restoring the skin barrier, whilst in others, more active suppression of inflammation is required.
The aim is not simply to temporarily clear the rash, but to achieve long-term control of the condition, minimise flare-ups and improve quality of life.
Read the clinical guidance on this concern. Treatment suitability, risks and availability should be discussed during consultation. Find your Skin Line clinic for assessment and personalised advice.