Atopic dermatitis is the most common cause of eczema. It causes dry skin, intense itching and flares of red patches that can seriously affect sleep and quality of life. It is very common in childhood, but I also see it often in adults, and in many people it starts or gets worse in adult life.
Why does it happen?
In people with atopic dermatitis the skin’s “barrier” is weaker: it loses water easily and lets irritants and allergens in. On top of this, the immune system overreacts and causes inflammation. There is often a family history of eczema, asthma or hay fever. It is not contagious.
Common symptoms
- Itching, often worse at night.
- Dry, rough skin.
- Red patches in the creases of the elbows and knees, on the neck, face or hands.
- Thickened, darker skin in areas that are scratched a lot.
What makes it worse
- Harsh soaps and long, very hot showers.
- Wool or synthetic fabrics against the skin.
- Sweat, heat or cold, dry air.
- Stress and lack of sleep.
- Skin infections.
Everyday skin care (the foundation)
- Moisturise every day with a fragrance-free emollient, ideally straight after showering and even when your skin looks fine.
- Short, lukewarm showers with a gentle soap-free wash.
- Cotton clothing, and avoiding any triggers you know about.
Treatment
For flares: anti-inflammatory creams (topical steroids or calcineurin inhibitors). Used correctly, they are safe and effective. For many people, applying them twice a week to the areas that tend to flare helps prevent relapses.
For moderate to severe eczema that creams cannot control, there are now treatments that have transformed life for many patients:
- Biologic medicines (such as dupilumab, tralokinumab or lebrikizumab), which selectively block the signals that drive inflammation.
- JAK inhibitor tablets (such as upadacitinib or abrocitinib), which work quickly on the itch.
- Traditional immunosuppressants, such as ciclosporin or methotrexate, in selected cases.
Each treatment has its own indications and monitoring. In clinic I look at how much skin is affected, the impact on your life and your medical history to choose the best option for you.
When should you see a dermatologist?
- If the itch keeps you awake or affects your work or studies.
- If your usual creams no longer work, or you need them all the time.
- If you notice yellow crusts, pus or pain (a possible infection).
Atopic dermatitis is one of my main areas of interest. If you would like me to review your case, book an appointment.
This article is for information only and does not replace a medical consultation.
