Atopic dermatitis, or atopic eczema, is a very common chronic skin condition that occurs in people of all all ages. The disease is multifaceted, but typical symptoms include redness, roughness and scaling of the skin, often accompanied by quite severe itching. A dermatologist makes a diagnosis based on the symptoms of the rash and its location on the body. Laboratory or allergy tests are not necessary.
Atopic dermatitis is common in all age groups
Atopic eczema has become more prevalent in recent decades and is one of the most common skin diseases in Finland. It occurs in about one-fifth of the population at some point in life, with the majority experiencing it in a mild form. In about half of cases, eczema develops before the age of one. The condition, previously known as milk scab, often improves or at least becomes less severe during childhood, but may worsen again in adolescence or adulthood. For some, the disease continues into adulthood or throughout life. Atopic dermatitis can also first appear in adulthood, even in old age.
In infants, atopic dermatitis often occurs on the scalp, cheeks, and generally on the body. In toddlers and school-age children, typical areas include the neck and nape of the neck, the skin around the eyes and lips, behind the ears, and on the limbs, especially the folds of the arms and knees. In adults, the rash often appears on the head and upper body. Hand rash is common in people of all ages with atopic dermatitis.
There is no single explanatory factor for atopic dermatitis. A predisposition to this condition may be inherited, but environmental and stress factors also play a role in its onset.
Symptoms of atopic dermatitis
Atopic eczema is a fluctuating skin disease characterised by alternating periods of improvement and exacerbation. The symptoms of atopic dermatitis can also vary markedly from one individual to another. Some people experience only mild symptoms, while for others, the symptoms can be severe and significantly disrupt their lives, at least intermittently.
- Itching: This is the most common symptom of atopic dermatitis, and often the first sign of an outbreak. Itching can range from mild to very intense and painful. Often the itching is worst at night, disturbing sleep.
- Skin dryness and flaking: In atopic dermatitis, the skin’s natural protective mechanism is impaired, leading to moisture evaporation and skin dryness. The skin becomes rough, uneven and flaky.
- Redness: In atopic eczema, there is an inflammatory reaction in the skin that causes redness. The redness is caused by the dilation of blood vessels as the body responds to inflammation.
- Broken skin: Scratching the skin due to itching can cause it to break, leading to cracks and sores. The wounds may become infected, further worsening the situation.
- Swelling and bright red pimples: The areas where rash is found may be swollen, and small pimples may appear.
- Blisters: In some cases, fluid-filled blisters may form in the eczema. In time, the blisters may rupture, letting the fluid ooze out.
- Thickening and lichenification of the skin: This change typically occurs as a result of prolonged and repeated scratching or rubbing. When the skin is continuously irritated, it thickens as a protective response.
- Hyperpigmentation or skin discolouration: Continuous scratching and inflammation can lead to permanent skin discolouration.
Treatment of atopic dermatitis
Mild atopic dermatitis
For most individuals with atopic dermatitis, the severity of atopic dermatitis is mild. Characteristic of mild forms of the condition is skin dryness and infrequent periods when the condition worsens. For example, during the winter, those with a mild form of the condition may develop eczema in skin folds or localised red, itchy patches. However, their eczema is not continuous or disruptive to their daily lives.
Mild atopic dermatitis is primarily treated with emollients. These moisturise and soften the skin, making it feel more supple and reducing any discomfort. They reduce skin dryness and itching, which helps decrease scratching and the skin breakage it can lead to. During periods when the condition worsens, corticosteroid creams may be used as a course of treatment, depending on the location and severity of the eczema. Prescription medications such as tacrolimus and pimecrolimus ointments can also be used as needed, especially on areas where the skin is thinner, such as the face and neck.
Moderate to severe atopic dermatitis
In moderate cases of the disease, eczema episodes are longer, and the rash is itchier and more severe than in the mild form. However, the condition can usually be managed quite well with basic treatment. Corticosteroids can be used as a course of treatment, while tacrolimus and pimecrolimus ointments can be used for longer periods. Maintenance therapy may also be employed between periods in which the condition worsens. Phototherapy sessions may also help, for example in winter if the rash typically worsens at that time of year.
Severe atopic dermatitis
Severe atopic dermatitis involves persistently symptomatic, highly itchy and easily broken skin that significantly impairs everyday life. If topical medications such as corticosteroid and tacrolimus ointments no longer offer sufficient help, orally administered drugs may be considered in addition to other treatments. Doctors may prescribe conventional immunosuppressive drugs as long-term medication to weaken the immune response. The first biological medicine for this condition has recently become available, and more are in development.
A dermatologist can help
Atopic dermatitis is a chronic condition for which there is currently no complete cure. The treatment requires patience, and active self-care combined with medical interventions yields the best results. Regularly applying basic moisturisers helps maintain the skin’s moisture balance and protects it from external irritants. Moisturising should be continued even after the symptoms of eczema have abated.
Even the most diligent self-care efforts may not always be sufficient to keep eczema under control. If itching and tenderness of the skin are bothersome, or if the appearance of eczema alone has a restrictive impact on your life, it is advisable to seek help from a dermatologist. There are various treatments available for atopic dermatitis, and their effectiveness varies individually and depends on the clinical presentation of the condition. In collaboration with the patient, a doctor can create an individualised treatment plan to manage eczema and improve the quality of life.
Book an appointment with a dermatologist in at least these situations:
- If the symptoms of eczema do not improve with regular use of basic moisturisers or over-the-counter creams and medications from the pharmacy without a prescription.
- If the skin starts to appear moist or inflamed, or if blisters or abscesses develop. You could have a bacterial infection that requires medical attention from a doctor.
- If the symptoms of eczema significantly impact your quality of life, for example if they disturb sleep or cause substantial discomfort.
- If new, unfamiliar symptoms or changes appear on the skin that may indicate another skin condition.
