Atopic dermatitis (eczema)
Created: 09.01.2025
Updated 01.01.2026
Approved by: Consultant Dermatologist, Dr James Denny
What is Atopic dermatitis?
Atopic dermatitis, commonly referred to as eczema, is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed skin. It tends to follow a relapsing and remitting course, with periods of flaringes and relative improvement.
Atopic dermatitis is closely associated with other atopic diseases, including food allergies, asthma, and allergic rhinitis, also known as hay fever. These conditions often develop sequentially, beginning with eczema in infancy, followed by food allergies, then asthma, and later allergic rhinitis. This progression is commonly described as the atopic march.
A key underlying feature of atopic dermatitis is a weakened skin barrier. This allows moisture to escape from the skin and enables irritants, allergens, and microorganisms to penetrate more easily, triggering inflammation and immune activation.
There is a strong genetic component. One well-established risk factor is a mutation in the gene responsible for filaggrin, a protein essential for maintaining skin barrier integrity. However, not everyone with a filaggrin mutation develops eczema, and many people with eczema do not have this mutation. Environmental factors play a major role in triggering and sustaining the condition.
What are the symptoms?
The most prominent symptoms of atopic dermatitis are dry skin and intense itching, which can significantly affect sleep, concentration, and quality of life. Scratching often worsens inflammation and can lead to skin thickening over time.
The appearance and distribution of eczema vary by age.
In infants, eczema often presents as red, weeping patches or small oozing blisters on the cheeks and scalp. It may also affect the trunk, outer arms, legs, and the diaper area.
In young children, the skin tends to become drier and more scaly. Eczema commonly affects the flexural areas, including the elbows, knees, wrists, ankles, and groin. Scratching is frequent and may lead to excoriations and thickened skin.
In adults, the skin is usually persistently dry, itchy, and thickened in certain areas due to chronic scratching. Eczema often appears symmetrically in the elbow and knee creases, on the neck, upper chest, hands, and face, particularly around the eyes.
People with atopic dermatitis are more susceptible to skin infections, especially bacterial infections such as Staphylococcus aureus. Viral infections and fungal infections may also occur more easily due to the impaired skin barrier.
What Causes atopic dermatitis?
The exact cause of atopic dermatitis is not fully understood. It is considered a multifactorial condition resulting from an interaction between genetic predisposition, immune dysregulation, and environmental triggers.
A family history of eczema, asthma, or hay fever significantly increases the likelihood of developing atopic dermatitis. Environmental factors that commonly worsen symptoms include:
- Irritants such as soaps, detergents, fragrances, and disinfectants
- Contact with rough fabrics, particularly wool
- Temperature changes, sweating, and low humidity
- Stress and sleep disruption
- Exposure to allergens such as dust mites, pollens, or animal dander
In some individuals, especially infants and young children with moderate to severe eczema, certain foods such as cow’s milk, eggs, wheat, soy, or nuts can aggravate symptoms. Food allergy should only be assessed and managed in collaboration with a healthcare professional. Avoidance diets during pregnancy or breastfeeding, and altering the timing of solid food introduction, have not been shown to reliably prevent eczema.
It is also important to distinguish atopic dermatitis from contact dermatitis, which is caused by direct skin exposure to irritants or allergens. The two conditions can coexist and may worsen each other.
What are the treatments?
There is currently no cure for atopic dermatitis, but symptoms can usually be well controlled with a structured, long-term treatment approach. Treatment focuses on restoring the skin barrier, reducing inflammation, relieving itching, and preventing complications.
General measures
Identifying and avoiding individual triggers is an important first step, although many people do not have a single identifiable cause.
Helpful general measures include:
- Avoiding known irritants such as harsh soaps, detergents, and fragranced products
- Using non-biological washing powders and avoiding fabric softeners
- Wearing loose-fitting cotton clothing rather than wool or synthetic fabrics
- Keeping indoor environments well ventilated and not excessively dry
- Avoiding overheating and excessive sweating
- Maintaining a smoke-free home
Sun exposure can improve eczema in some people, and supervised light therapy may be beneficial in selected cases.
Moisturising and emollients
Regular and generous use of emollients is the cornerstone of eczema management. Emollients help restore the skin barrier, reduce dryness, and decrease itching and flare frequency.
They should be applied several times daily, including after bathing or showering, and continued even when the skin appears clear. Ointments and thick creams are generally more effective than lotions.
Bathing should be brief and with lukewarm water. Soap can worsen dryness, so soap substitutes or gentle cleansers with a pH below 5.5 are preferred. Oil baths may be used frequently, often daily, to help maintain hydration.
Medication
For mild eczema, emollients alone may be sufficient. When inflammation persists, additional treatments are required.
Topical corticosteroids are the mainstay of anti-inflammatory treatment during flare-ups. They reduce redness, swelling, and itching when used appropriately. The strength and duration of treatment depend on the severity of eczema, the age of the patient, and the body area involved.
When used correctly under medical guidance, topical corticosteroids are safe and effective. Concerns about side effects often lead to underuse, which can result in poorly controlled disease.
In cases where topical corticosteroids are unsuitable or insufficient, topical immunomodulatory treatments may be prescribed. These reduce immune activity in the skin without the same risk of skin thinning.
Secondary skin infections may require treatment with topical or oral antibiotics or antiviral medication, depending on the cause.
What is the prognosis?
Atopic dermatitis is a chronic condition, but its course varies widely. Many children experience significant improvement with age, and some outgrow the condition entirely. Others continue to have eczema into adulthood, often with intermittent flares.
Although atopic dermatitis can be physically and emotionally challenging, most people are able to achieve good symptom control with appropriate skincare, trigger avoidance, and timely medical treatment. Early and consistent management may also reduce the risk of complications such as skin infections and long-term skin thickening.
Frequently asked questions
Is atopic dermatitis the same as eczema?
Atopic dermatitis is the most common type of eczema. The term “eczema” is often used broadly, but atopic dermatitis refers specifically to a chronic condition linked to a weakened skin barrier and a tendency toward allergic conditions such as asthma and hay fever.
What triggers flare-ups of atopic dermatitis?
Common triggers include irritants such as soaps, detergents, and fragrances, as well as sweating, stress, dry or cold weather, and rough fabrics like wool. Allergens such as dust mites or pollen may also worsen symptoms in some individuals.
Are emollients necessary even when the skin looks clear?
Yes. Regular use of emollients is essential, even when symptoms improve. Emollients help maintain the skin barrier, prevent dryness, and reduce the risk of future flare-ups.
Are topical corticosteroids safe to use?
When used as prescribed, topical corticosteroids are safe and effective for treating eczema flare-ups. They reduce inflammation and itching. Using too little or stopping treatment too early often leads to poor symptom control.
Can atopic dermatitis improve over time?
Many children experience improvement as they grow older, and some outgrow the condition. Others continue to have eczema into adulthood, often with intermittent flare-ups. With appropriate treatment, most people can manage symptoms effectively.
