Atopic Dermatitis

Atopic dermatitis, the most common type of eczema, is a condition where the skin becomes dry, inflamed and irritated, making it very itchy. The itching leads to scratching, which in turn worsens the atopic dermatitis. It is especially common in babies and small children.¹

Typically, there are periods when the condition is worse, called flare-ups or flares, followed by remissions – times when the skin improves or clears up.¹

Anything that causes a flare-up is known as a trigger. Some common triggers include certain chemicals in some skin care products, weather (cold or hot), wool clothing, stress, and fragranced laundry detergents.²

Atopic dermatitis isn’t contagious i.e. it can’t be spread from one person to another.¹

Living with atopic dermatitis can sometimes be difficult and may even reduce the quality of life for both the person who has the condition and their families, but a good treatment plan and home management will help reduce flare-ups and make symptoms less uncomfortable.¹

Anyone can develop atopic dermatitis, but it occurs most often in babies and children, usually starting between 2 months and 5 years of age. In many cases, it clears up completely before adolescence, but sometimes it persists into the teenage and adult years. Occasionally, atopic dermatitis appears for the first time in adulthood.^1,3

There’s a greater chance of developing atopic dermatitis if you have a family history of it, or of an allergic disease like asthma or hay fever.¹

Where you live can also be a risk factor. People living in cities are more likely than those living in rural areas to develop atopic dermatitis – possibly because urban areas have worse air pollution. Dry, cold climates may also increase risk.⁴

Atopic dermatitis tends to start suddenly with an extremely itchy skin; scratching the itch often causes a rash on one or several areas. Symptoms may include:⁵

• Itching
• Dry, scaly (flaky) patches
• Red rash (especially for people with lighter skin tones)
• Dark brown, purple, or grey patches (in people with darker skin tones)
• Small, rough bumps (more common with darker skin tones)
• Skin that feels warm and may be swollen, as a result of inflammation
• Raw skin, scratch marks
• Bumps or rashes leaking fluid
• Blisters that ooze and crust over
• After healing, the previously affected areas may appear lighter or darker

While the skin is healing in one area, flare-ups may occur in other areas. The flare-ups can also re-occur in the same place.⁵

Over many years, atopic dermatitis can cause the skin to become thickened cracked, and persistently itchy.⁵

Poor sleep from itching and discomfort at night is common in anyone who suffers from atopic dermatitis.⁵

People with atopic dermatitis often have other conditions, such as asthma and allergies.¹

Early diagnosis and treatment is important to help prevent atopic dermatitis from worsening, and the skin from becoming thickened, The more severe the condition becomes, the harder it can be to treat and the more likely it will persist into adulthood.³

To diagnose atopic dermatitis, your doctor will likely ask about your family history of allergies, whether you also have hay fever, asthma or food allergies, and about your exposure to potential triggers. They will also examine the affected area of skin and may order lab tests to help confirm the diagnosis.⁶

Atopic dermatitis can’t be cured, but it can be controlled to help relieve discomfort and reduce flare-ups. Treatment depends on the severity of the condition and usually includes a combination of therapies. These may include:^2,6

• Routine skin care, such as applying moisturisers after bathing to help keep the skin hydrated and recreate its protective layer. Choose a dermatologically-tested brand specifically formulated for eczema-prone skin such as Mustela Stelatopia, which is safe for use in children from newborn age onwards.
• Medications prescribed by your doctor. These are usually topical ointments applied to the skin, which improve its ability to keep out irritants and germs, as well as helping retain moisture. If infections develop from atopic dermatitis, your doctor may also prescribe topical or oral antibiotic treatments. While topical medication helps most patients, some need stronger systemic medication that works throughout the body.
• Phototherapy, which involves using ultraviolet light as a therapy to treat symptoms. (Note: Don’t try “DIY” light exposure such as sunlamps or even sitting in the sun. Overheating or sunburn can trigger a flare-up, potentially damage your skin and raise risk for skin cancer.)

Medical scientists don’t yet fully understand what causes atopic dermatitis, but they know that it develops when there are problems with the skin’s natural “barrier” function.⁴

The skin’s outer layer acts as a protective barrier against potential irritants in the environment such as tobacco smoke, dust mites, and fragrances in cleaning and skin care products. This barrier also helps keep the skin hydrated, preventing dryness and irritation.⁴

In atopic dermatitis, however, gaps form in the barrier that let too much moisture escape from the skin, causing dryness, and allowing environmental irritants to get through, leading to inflammation.⁴

Germs can also cross the barrier more easily, which can cause infection.⁴

Living with atopic dermatitis can be challenging, but these measures go a long way to making it manageable:^2,6

• Follow a daily skincare routine, as discussed with your doctor:
• Take lukewarm baths or showers (not more than one per day) to clean the skin without drying it out excessively.
• Use mild, fragrance-free cleansers e.g. Mustela Stelatopia Cleansing Gel and Cleansing Oil. These products gently clean and protect against the drying effect of hard water, reducing skin irritation.
• Pat skin dry gently. Don’t dry the skin completely before moisturising.
• Moisturise immediately after patting dry to replenish dry skin, soothe itchy sensations and improve comfort. Choose suitable moisturisers such as Stelatopia Emollient Cream which contains natural ingredients such as organic sunflower.
• Protect your skin from irritants and rough or scratchy clothing fabric.
• Identify and avoid triggers, where possible – some people may not be able to find their specific triggers.
• Use medication as instructed
• Manage stress. Stress management and relaxation techniques can help reduce flare-ups.
• Avoid scratching or rubbing, which irritates the skin and increases inflammation and itchiness. Keep fingernails short.
• Maintain constant indoor temperatures. Keep your home at a cool, pleasant temperature, and keep humidity levels constant too – don’t let air get too dry.
• Remember you’re not alone. If you’re feeling overwhelmed about your atopic dermatitis, reach out to family, friends and patient support groups, and consider counselling with a mental health professional.

^{Last reviewed : 11 April 2024}