Recognizing and Caring for Dermatitis Atopic-Prone Skin

Atopic dermatitis (eczema) is a chronic skin condition primarily seen in infants and children. In many cases, symptoms emerge within the baby’s first few months. Developing atopic dermatitis is influenced by both genetic and environmental factors, and early onset is common, especially in children. While atopic eczema typically begins in early childhood, it also impacts many adults. In infants, this early-onset form is often referred to as infantile eczema, describing atopic dermatitis that appears in babies. In fact, research shows 90% of children with atopic dermatitis develop symptoms by age 5. These early-onset cases demonstrate the condition’s chronic, relapsing pattern. Atopic dermatitis results from a combination of genetic predisposition, immune dysfunction, and environmental triggers.

Meanwhile, in adults, atopic dermatitis symptoms often worsen with age. This progression is particularly noticeable in women, likely due to hormonal changes or chronic stress. The condition frequently coexists with other allergic disorders like asthma, food allergies, and hay fever. This pattern reflects a broader atopic tendency in affected individuals.

What is Atopic Dermatitis?

Atopic dermatitis (AD, also called atopic eczema) is an inherited condition marked by persistent skin itchiness and skin rashes. Typically, the disease fluctuates between symptom-free periods and sudden eczema flares or flare-ups. Moreover, symptoms vary depending on the patient’s age, and eczema triggers can make symptoms worse or cause sudden flare ups.

Critically, atopic dermatitis compromises the skin’s protective barrier, making it vulnerable to allergens, microbes, and irritants. This dysfunction triggers chronic skin inflammation, perpetuating the condition’s cycle. Environmental allergens often drive the reaction, common examples include pollen, mold, pet dander, and household chemicals. These triggers spark allergic response that worsen the skin’s inflammatory state.

Key contributing factors to atopic dermatitis include, among others: immune system dysfunction, genetic predispositions, environmental factors.

Most Common Atopic Dermatitis Symptoms

Atopic dermatitis has three primary symptoms: severe itching, very dry skin, and visible inflammatory changes. Specifically, an itchy rash and scaly skin are hallmarks of atopic dermatitis. Over time, the skin surface becomes rough, resembling sandpaper to the touch. As it progresses, the skin darkens to a brownish color and visibly thickens. Chronic scratching and irritation often lead to:

• Inflammatory infiltrates: Reddened, painful areas.
• Excoriation lesions: Linear epidermal defects resembling scratches or cracked skin.
• Scabs: Particularly after scratching blisters.
• Scaly patches: Characteristic feature of advanced atopic dermatitis.
• “Polished, shiny nails”: A result of constant skin rubbing.

Furthermore, dry skin isn’t just uncomfortable – it leads to other skin diseases like painful cracks that worsen inflammation. These openings also increase infection risks and cause burning sensations. These are accompanied by swelling and redness, making the skin appear chronically irritated. Atopic dermatitis symptoms evolve with age, and affected areas can vary depending on the individual and type of eczema. Careful identification of affected areas is important for proper treatment. Common patterns include:

• Infants: Dominated by itching and weeping lesions on the cheeks and hands.
• Older children: Lesions manifest as erythematous patches with vesicles, primarily in elbow and knee creases.
• Adults: Atopic eczema often affects the face (especially eyelids), neck, and hands and feet, disrupting daily life.

This symptom diversity demands a personalized approach – skincare for an infant differs significantly from that for dry, mature adult skin.

Atopic Dermatitis Symptoms in Infants and Children

Atopic dermatitis in children typically manifests between the second and third month of life. The earliest signs usually appear as red, itchy rashes on the cheeks and hands. Over time, lesions expand to the elbows, knees, and torso, changing as the child grows. Generally, this first phase features a relapsing course lasting about 1-2 years. During this period, flare-ups intermittently disrupt stretches of relative calm.

During the acute phase (flare-ups), an infant’s skin becomes dry, reddened, and covered with papules. Skin dryness triggers frequent and intense itching, leading to sleeplessness and an overall decline in quality of life. The child struggles to resist scratching, resulting in excoriation lesions (linear epidermal damage), itchy blisters, and even bleeding scabs. With an underdeveloped hydrolipid barrier, the skin lacks proper protection against irritation. Simple things like diaper friction worsen inflammation because damaged skin heals poorly.

The location of lesions also evolves with age:

• 0-2 years: Scalp, face (especially cheeks), limbs.
• 2-12 years: Elbow and knee creases, wrists, ankles.
• 12+ years: Hands, feet, eyelids, areas around the mouth.

Nearly 50% of children with atopic dermatitis develop the so-called atopic march (allergic march). This progression typically starts with atopic eczema, then advances to food allergies before potentially evolving into asthma or allergic rhinitis. Food allergy is a common trigger for severe eczema flare-ups in children and should be considered during diagnosis and management. A key aggravating factor is Staphylococcus aureus overinfection – a bacterial infection that worsens symptoms and intensifies itching and inflammation. This often requires medical treatment to prevent more serious complications.

Fortunately, in some children, skin lesions may clear on their own by age 2. However, early-onset atopic dermatitis strongly predicts future respiratory allergies regardless of resolution. Even after active symptoms subside, transient post-inflammatory hypopigmentation often lingers on the skin, gradually fading over several months.

Atopic Dermatitis Symptoms in Adults

Though atopic dermatitis is primarily associated with childhood, an increasing number of adults now experience a recurrence or symptoms worse. While atopic dermatitis in adults was once rare, today up to 10% of adults grapple with this condition. Atopic dermatitis in adults typically affects the following areas:

• Face: Especially eyelids and around the mouth.
• Neck
• Elbow and knee creases
• Hands: Particularly vulnerable due to frequent contact with detergents.

Atopic dermatitis lesions can appear differently across various skin tones. Rashes and discoloration may vary in both color intensity and visibility depending on pigmentation.

Adults with atopic dermatitis suffer intense itching that persists relentlessly. When paired with heightened skin sensitivity and chronic inflammation often leads to compulsive scratching. Over time, scratching exacerbates symptoms, damages the epidermal barrier, and leads to further complications – lichenification (skin thickening), peeling, redness, and even hyperpigmentation. Over time, the skin often resembles tree bark – dry, cracked, and prone to secondary bacterial skin infections.

Chronic inflammation also impacts mental health. Adults with atopic dermatitis frequently report:

• Insomnia: Itching intensifies in the evening, hindering sleep onset.
• Stigmatization: Visible lesions on the face and hands affect social interactions.
• Fatigue and depressive symptoms.

Unlike children, adults with atopic dermatitis typically show more symmetrical lesions, like matching redness on both eyelids. Their skin also reacts intensely to minimal irritant exposure (like trace concentration of allergens), often triggering flare-ups from barely detectable triggers.

How Does Atopic Dermatitis Differ from Psoriasis?

Atopic dermatitis (eczema) and psoriasis are two distinct conditions often confused due to overlapping symptoms. They differ not only in causes and progression but also in treatment approaches. This becomes clear when comparing them across five key aspects:

1. Skin Lesion Characteristics
   • Atopic Dermatitis: Thin, erythematous papules with intense constant itching (worsening at night), dryness, excoriation lesions (linear skin damage from scratching), and possible oozing vesicles.
   • Psoriasis: Thick, red plaques covered with silvery scales (resembling “fish scales”), usually accompanied by mild itching.
2. Lesion Location
   • Atopic Dermatitis: Face (eyelids, around the mouth), neck, elbow/knee creases, hands.
   • Psoriasis: Elbows, knees, scalp, sacral area, nails (showing “pitting” – small depressions resembling pinpricks).
3. Age of Onset
   • Atopic Dermatitis: Primarily affects children, with up to 90% experiencing first symptoms before age 5.
   • Psoriasis: Peak onset occurs between ages 20–40.
4. Underlying Causes
   • Atopic Dermatitis: Multifactorial – filaggrin gene mutations, impaired epidermal barrier, hyperreactivity to allergens.
   • Psoriasis: Autoimmune – rapid skin cell division driven by inflammation.
5. Complications
   • Atopic Dermatitis: Secondary bacterial infections (e.g., Staphylococcus), hand eczema, scarring from scabs.
   • Psoriasis: Psoriatic arthritis, increased risk of cardiometabolic diseases.

In atopic dermatitis, emollient-based care (intense skin moisturizing) is critical, while psoriasis management focuses on inhibiting excessive keratinization.

Atopic Dermatitis Causes: What Triggers Dermatitis Atopic?

Atopic dermatitis is a multifactorial condition, meaning its causes are complex and often require individualized assessment. Identifying individual eczema triggers is essential for effective management. Key contributing factors include:

1. Genetics: Dysfunction of the protein filaggrin, responsible for maintaining properly structured skin cells. Impaired cell-to-cell connections and disrupted skin hydration compromise the skin’s integrity, allowing increased penetration of microbes, allergens, and irritants.
2. Allergies:
   • Food allergies: Dietary allergens like cow’s milk (in infants, cow’s milk protein allergy), eggs, and others exacerbate skin lesions.
   • Contact allergies: Preservatives in cosmetics (e.g., parabens), nickel, textile dyes.
   • Inhalant allergies: Dust mites, pollen, pet dander, smog. Seasonal allergies, such as pollen sensitivity, can also act as eczema triggers and may trigger or worsen atopic dermatitis, especially during certain times of the year.
3. Environmental Factors:
   • Temperature fluctuations: Cold air dries the skin, while sweat aggravates itching.
   • Household chemicals: Laundry detergents, disinfectants, cleaning agents.
   • Prolonged hot baths: Intensify inflammation and trigger persistent itching.
4. Lifestyle & Psychological Factors:
   • Smoking.
   • Irregular daily routines.
   • Excessive stress: Worsens skin condition, amplifying dryness and itchiness.

How to Treat Atopic Dermatitis and Manage Its Symptoms?

Diagnosing atopic dermatitis starts with a thorough medical history review. Dermatologists inquire about skin changes, family allergy patterns, dietary habits, and skincare regimens. Key diagnostic markers include persistent itching and characteristic lesion distribution (like elbow/knee folds). Confirmatory tests may involve blood work or controlled allergen skin testing. Atopic dermatitis treatment involves multiple approaches, such as:

1. Using antihistamines (under a doctor’s guidance) to relieve itching without causing drowsiness.
2. Brief (5-10 minute) cold showers with gentle, allergen-free cleansers.
3. Applying moisturizer with emollients to slightly damp skin immediately after bathing.
4. Steroid creams are commonly prescribed topical treatments to reduce inflammation and manage severe eczema flare-ups.

The overall goal is to treat eczema through a combination of moisturising treatments, topical medications like steroid creams, and trigger avoidance. Therefore, treating atopic eczema often requires a personalized plan involving both pharmacological and non-pharmacological strategies to manage symptoms and improve quality of life. In daily care, it is crucial to keep the skin moisturized to prevent flare-ups, reduce itching, and minimize skin irritation.

If unsure which cleanser or emulsion is gentlest for your skin, opt for a product labeled “for babies from day 1.” . These cleansers avoid harsh detergents (SLS/SLES) and instead use nonionic surfactants – the mildest available. Such gels or emulsions produce minimal lather. You can also try Aleppo soap 1% (1% myristic acid; higher concentrations suit oily skin better).

Skin care is the cornerstone of Atopic Dermatitis Treatment

The rules are simple but require consistency:

• Avoid irritants: Alcohol, strong detergents, and fragrances that worsen symptoms.
• Use emollients with EFAs (Essential Fatty Acids) to rebuild the lipid barrier (e.g., Cream for moisturizing, Smoothing Cleanser for cleansing), thereby curbing atopic dermatitis progression.

• Prevent overheating: Avoid excessive sweating, overheating, and hot baths.

Stress is a widely reported an atopic dermatitis trigger. Stress reduction is highly personal, with no universal method. Strategies that work best for me include:

• Body-mind practices: Yoga, meditation.
• Occupational therapy: Painting, puzzles, classical music.
• Physical activity: Walking, gym workouts.

The Importance of Proper Skincare

A weakened skin barrier worsens atopic dermatitis by functioning like a faulty sieve. It allows harmful allergens, bacteria, and irritants to penetrate while losing crucial hydration. To counter this, we use a mix of pharmacological and non-pharmacological methods, with proper atopic skincare being the cornerstone. Skincare isn’t an add-on; it’s the foundation of treatment.

The 3 Pillars of Atopic Skincare

Emollients – Daily Protective Shield

• Apply them at least twice daily, even during remission. Layer onto slightly damp skin post-bath (or after thermal water mist) – this creates temporary occlusion, softening the skin and reducing tension. Immediate itch relief follows.
• Choose formulas with ceramides, urea, or linoleic acid (an omega-6 fatty acid) – these rebuild the lipid barrier. I particularly favor linoleic acid-based products, as they inhibit TEWL (transepidermal water loss), enhance elasticity, and ease tightness.

Gentle Cleansing

• Brief baths in lukewarm/cool water, using mild cleansers (as mentioned earlier).
• Pat-dry gently – press a towel against the skin; never rub.

Avoiding Irritants

• Fabrics: Cotton, linen, or silk instead of wool (may irritate) and synthetics.
• Cosmetics: Hypoallergenic, fragrance-free (even natural scents), alcohol-free. Fragrance allergens slow regeneration and further irritate.

For effective atopic skincare, Cream is ideal. This water-free formula, based on shea butter, cocoa butter, baobab, and coconut seed oils, is hypoallergenic and preservative-free. Produced at low temperatures to preserve naturally occurring fatty acids – including linoleic acid – it has an airy texture for effortless application on even the most sensitive skin. It forms a thin protective film that instantly soothes and relieves tightness. This product creates a satin-like protective layer that:

1. Creates ideal conditions for skin self-repair.
2. Shields against frost, wind, and pollution.
3. Reduces skin tension, soothing and smoothing while boosting elasticity.
4. Provides deep hydration without greasiness, leaving skin soft and touchable.

Remember: Even the best emollient fails without consistency. Like brushing your teeth – non-negotiable daily!

Pharmacological Treatment of Atopic Dermatitis – Topical and Systemic Therapy

In moderate-to-severe atopic dermatitis, dermatologists often recommend customized pharmacological treatment. They carefully select therapies based on the patient’s specific skin condition and any coexisting health issues. Topical therapies can include: topical corticosteroids, calcineurin inhibitors, urea-enriched emollients. Systemic therapies encompass options such as: oral antihistamines (1st or 2nd generation), cyclosporine, modern biologic therapies.

When undergoing pharmacological treatment, avoid self-discontinuing therapy or modifying doses without consulting your physician.

Phototherapy as a Treatment Method for Atopic Dermatitis

Light therapy utilizes specialized radiation to stimulate internal cellular structures, promoting wound healing and alleviating eczema symptoms. The treatment involves exposing the patient to UV radiation in controlled settings, such as light cabins or targeted body area irradiation. A specialist selects the UV wavelength and dosage based on the patient’s skin condition, age, and other factors. It is most commonly used for moderate to severe atopic dermatitis. UV radiation penetrates the skin, reducing the number of inflammatory and allergic cells. Additionally, it effectively lowers cytokine production – proteins responsible for inflammatory processes in the skin.

Phototherapy methods include:

• PUVA: Combines UVA radiation with oral psoralens (light-sensitizing agents).
• UVB 311 nm: Narrowband UVB irradiation effective for widespread or severe atopic dermatitis symptoms, often chosen during flare-ups.
• UVA1: Delivered via metal halide or fluorescent lamps; the former is reserved for the most severe clinical cases.

Atopic dermatitis requires tailored therapy – combining pharmacological treatments, phototherapy, and daily skincare. Key to success is avoiding individual triggers (e.g., allergens, stress) and maintaining consistency.

Remember: Even the most advanced treatments cannot replace conscious prevention – opt for hypoallergenic cosmetics, wear natural fabrics, and steer clear of allergens.

Aleksandra

Frequently Asked Questions