Atopic Dermatitis

What is atopic dermatitis ?

Atopic dermatitis is a very common, chronic, non-infectious allergic skin disease, which is characterized by:

* Intense itching (itching)

* Typical skin lesions

* Family history of allergic diseases (allergic predisposition)

It could be distinguished into:

A. Atopic dermatitis of infants (or also called infantile eczema). Usually in the 2nd or 3rd month of life skin lesions appear on the face, rest of the head, but also on the whole body. The lesions are in the form of erythema plaques, with dry skin and the formation of small blisters that break and form a “crust”. If left untreated this leads to the formation of eczematous lesions. The baby feels intense itching and manifests it by rubbing the areas with skin lesions either on the clothes or with his hands.

B. Atopic dermatitis of childhood. It concerns children aged 4-5 years up to adolescence. At this stage the skin lesions tend to be limited to specific anatomical areas (cervix, eyelids, curved surfaces of knees and elbows, etc.). At these ages the formation of eczema lesions is clearer and there is usually universal dry skin all over the body.

C. Atopic dermatitis in adults. At this stage the skin lesions tend to be even more limited to the limbs (arms, legs) and neck, although of course there are often exceptions.

About 70-80% of people who develop atopic dermatitis will develop the condition by the age of 12.

What are the possible causes ?

 The exact cause of atopic dermatitis remains unknown, but it is probably a combination of genetic and environmental factors. Usually one or both parents of children with atopic dermatitis suffer from an allergic condition. Many environmental factors have been blamed. It has been suspected for many years that food allergens play a key role. Although positive skin tests or RASTs are often positive for some foods, a clear etiological correlation has not been confirmed. There is a lot of talk about air allergens (mainly for house dust mites), but in this case the same is true.

There is no doubt that there are many triggers that cause the disease to flare up. These include:

Climatic factors: During the winter there is a deterioration, while in summer there is a recession. Also large and abrupt changes in temperature and relative humidity cause outbreaks.

Psycho-emotional burden: Stressful situations often cause severe exacerbation of atopic dermatitis. This applies to all ages, even young children. A typical example is when the first child suffers from atopic dermatitis and the disease is in remission it exacerbates with the arrival of the second child in the family. Also, children with obvious skin lesions are often treated harshly by their peers, isolated and a vicious circle is created.

Allergens: Some foods, but also air allergens (as mentioned above) can make atopic dermatitis worse. In the past, but even nowadays, various avoidance measures are applied (diets, mattress covers and pillows, etc.), most of the time with questionable results. Care must be taken not to disrupt the full potential of the family and the quality of daily life with practices and behaviours that only increase stress and ultimately may aggravate rather than improve a situation.

Infections: Skin infections, often as a complication of scratching, aggravate the condition, but also systemic severe infections can cause flare-ups.

Irritants: The skin in atopic dermatitis is dry and easily irritated. Contact with substances and agents that irritate even normal skin is understood to have a multiplier effect on atopic skin. Contact with woolen or synthetic clothing, colognes and other cosmetics, intense rubbing, very hot bath, sweat and anything else that may irritate the skin may cause an exacerbation of the condition.

Are other conditions associated with atopic dermatitis ?


About 3/4 of children who develop atopic dermatitis in infancy will develop another allergic condition (rhinitis, asthma, urticaria, etc.) in later years.

Blepharitis is an inflammation on the outside of the eyelids but also on the inside. They are red, dry, wrinkled, there is itching, there is dry or oily discharge, especially at the edges, and often the lashes thin or fall out.

Corneal conjunctivitis is an inflammation of the conjunctiva and cornea. There are typical symptoms of conjunctivitis (redness of the eyes, tearing, itching, foreign body sensation, photophobia). The keratitiscan rarely cause an anatomical abnormality of the cornea, known as keratoconus, most likely due to constant rubbing of the eyes, which can cause vision problems.

Cataracts (blurring of the lens of the eye) can be caused by atopic dermatitis for unknown reasons, even in the age of twenty or thirty.

Skin infections. Atopic dermatitis is often complicated by staph infections on the skin. The herpes simplex virus can cause generalized skin infection with generalized erythema, blisters that bleed and form crust, and there may be high fever. It is a condition (called eczema herpeticum) and requires hospitalization. In the past, administration of the smallpox vaccine (not administered anymore as the virus has been eradicated) used to be of high risk in people with atopic dermatitis and could cause a condition known as eczema vaccinatum, which was in many cases fatal.

Irritant dermatitis: Many people who have had atopic dermatitis in the past and are now in remission may develop irritating dermatitis (especially on the hands) after contact with chemicals or other substances (eg detergents, etc.).

How is the diagnosis made ?

Diagnosis is often very easy, from the clinical picture and the characteristics of the skin lesions. The physician should always rule out other similar conditions (eg seborrheic dermatitis, contact dermatitis and many others) andthe allergist may deem it necessary to proceed with a special examination (skin tests, RAST etc) for possible localization of the main cause. There must always be preparation and vigilance for the possible occurrence of another allergic condition.


What treatment is there ?

The goals of treatment for atopic dermatitis should be:

  1. Reduction or elimination of triggers
  2. Reduction or disappearance of itching
  3. Hydration of the skin
  4. Restoration of skin integrity and reduction of recurrences
  5. Reduction of stress

The triggers mentioned above, should be carefully identified in each case and with proper cooperation of doctor and patient or his environment to be minimized.

* Excessive sweating

* Emotional pressure

* Cold air or conditions that can make the skin dry

* Hard soaps and detergents

* Fabrics may irritate the skin, especially wool

* Some skin care products

* Cigarette’s smoke

* Some chemicals

* Some foods

Itching must in any case disappear, because in addition to being torturous, it is also a risk factor for recurrence by resolving the skin integrity that can be caused. Antihistamines (oral only, NOT topically) are one way. They may need to be administered for a long time.

Adequate and daily hydration of the skin is the cornerstone for a healthy skin. There are many good moisturizers on the market, in each case the most suitable for each person must be selected and used daily. Your doctor will give you instructions and they should not be placed in areas where there is a solution of skin continuity.

Repair of skin lesions with medication, but also the care to reduce relapses isimportance. Topical corticosteroids, even in systemic administration (if the lesions are extensive) are necessary in the acute phase and until the skin lesions are repaired. In recent yearsdrugs that do not belong to the corticosteroids (calcineurin inhibitors), but have a comparable action with them, but without having their side effects, have entered the pharmacotherapy. In each case the physician will prescribe the medication. Sometimes antibiotics may be needed if a staph infection is present.

Stress control is very important, both for the control of the disease, and for the formation of a proper psychosocial development of the child.


* Watch out for sudden changes in temperature, humidity

* Not many baths a day, only one a day and not hot water

* Do not use antiseptic soaps very often because they “dry” the skin.

* After the bath, lightly wipe the body with a towel. Never rub hard.

* Use for your bath what your doctor recommended and then smear your body with moisturizer

* Avoid the factors that your doctor advised

* Hyperhidrosis never benefits atopic dermatitis

* Use cotton garments that come in direct contact with the skin

  • Keep fingernails close and clean to avoidscratch skin injuries. Wear gloves for infants
  • Avoid intense scratching because there is a risk of infection, but also the creation of permanent scars on the skin
  • Use the medication as recommended by your doctor and do not decide for yourself when to stop it.
  • Learn to distinguish yourself when there is a skin infection (intense hot area, redness, blistering with pus, possibly fever in young children) and ask your doctor immediately
  • Accept the chronicity of the disease, but always keep in mind that it can be controlled effectively
  • Reduce the impact of various stressful situations as much as possible, so that expert advice can help you effectively in case it is deemed necessary
  • Do not forget to report any discomfort to your doctor (eg from the eyes) or variations in the form of skin lesions.