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Atopic Dermatitis – Causes, Symptoms and Treatment

Atopic dermatitis is a chronic inflammatory skin condition characterized by intense itching, dry skin, and recurring eczematous lesions. It is one of the most common skin disorders worldwide.

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Things worth knowing about "Atopic Dermatitis"

Atopic dermatitis is a chronic inflammatory skin condition characterized by intense itching, dry skin, and recurring eczematous lesions. It is one of the most common skin disorders worldwide.

What is Atopic Dermatitis?

Atopic dermatitis (also referred to as atopic eczema or eczema) is a chronic, relapsing inflammatory skin disease characterized by intense itching, dry skin, and recurrent eczematous lesions. It belongs to the atopic triad, which also includes allergic asthma and allergic rhinitis. The condition most commonly begins in infancy or early childhood, but can persist into or first present in adulthood.

Causes

The development of atopic dermatitis is multifactorial and not yet fully understood. Key contributing factors include:

Genetic predisposition: Mutations in the filaggrin gene impair the skin barrier, making it more susceptible to irritants and allergens.
Immune dysregulation: An overactive immune response, particularly involving the Th2 pathway, drives skin inflammation.
Environmental triggers: House dust mites, pollen, pet dander, mold, and chemical irritants can trigger or worsen flares.
Skin microbiome imbalance: Overgrowth of Staphylococcus aureus on the skin surface aggravates inflammation.
Psychosocial stress: Stress is a well-recognized trigger for disease flares and can worsen existing symptoms.

Symptoms

Symptoms vary depending on age and disease severity:

Intense, persistent itching (pruritus), often worse at night
Dry, scaly skin (xerosis cutis)
Redness, vesicles, and weeping skin lesions during acute flares
Lichenification (thickening and hardening of the skin) in chronic cases
Typical locations: inner elbows, back of the knees, neck, face (especially in infants and children)
Secondary skin infections due to scratching and a compromised skin barrier

Diagnosis

Atopic dermatitis is primarily diagnosed clinically based on the following criteria and methods:

Medical history: Family history of atopy, onset and course of symptoms
Clinical examination: Assessment of skin lesions using validated scoring tools such as SCORAD (Scoring Atopic Dermatitis) or EASI (Eczema Area and Severity Index)
Allergy testing: Skin prick tests or specific IgE blood tests to identify potential sensitizations
Differential diagnosis: Contact dermatitis, psoriasis, and other skin conditions must be excluded

Treatment

Treatment is individualized and follows a stepwise approach based on disease severity:

Basic Skin Care

Regular use of emollients and moisturizers forms the foundation of all treatment. Fragrance-free, pH-neutral products are recommended to restore and maintain the skin barrier.

Pharmacological Treatment

Topical corticosteroids: First-line treatment for acute flares to reduce inflammation and itching
Topical calcineurin inhibitors: Tacrolimus and pimecrolimus as steroid-free alternatives, especially for sensitive areas such as the face and neck
Systemic therapies: Ciclosporin, methotrexate, or mycophenolate mofetil for severe disease
Biologics: Dupilumab, a monoclonal antibody targeting IL-4 and IL-13, is approved for moderate-to-severe cases and shows excellent efficacy
JAK inhibitors: Newer oral or topical agents such as baricitinib and upadacitinib are approved for severe forms
Antihistamines: May provide some relief from itching, though their overall efficacy in atopic dermatitis is limited

Non-Pharmacological Measures

Avoidance of individual trigger factors (allergens, stress, sweating)
Patient and caregiver education programs
UV phototherapy for widespread skin involvement
Psychological support for patients with significant emotional burden

Prognosis

In many children, symptoms improve significantly over time or resolve entirely. However, in approximately one-third of cases, the condition persists into adulthood. Consistent skin care and appropriate treatment can greatly improve quality of life and reduce the frequency and severity of flares.

References

Wollenberg A. et al. - ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic eczema in adults and children. Journal of the European Academy of Dermatology and Venereology, 2020.
Bieber T. - Atopic Dermatitis. New England Journal of Medicine, 2008; 358(14):1483-1494.
Eichenfield L.F. et al. - Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology, 2014; 70(2):338-351.

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