Atopic Dermatitis

Because this text refers to allergy issues, I recommend reading it together with an introductory text about allergy, atopy, allergen and allergic reactions.

Atopic dermatitis or atopic eczema could be more clearly labeled as an allergic dermatitis. It is a chronic disease that often occurs at a young age and typically accompanies the affected person to his or her adulthood. It may, however, appear at any age and on the other hand it can often mysteriously disappear without a known cause. The disease can greatly worsen life quality.


Atopic dermatitis is a long-term form of allergic reaction that affects and damages the skin by a chronic inflammation. It is good to emphasize that also an illness called urticaria (hives) is also caused by a skin allergic reaction. Urticaria, however differs from atopic eczema. In hives itchy rash usually occurs shortly after a contact with an allergen and disappears in a short time. Atopic eczema also emerges on the basis of an allergic reaction but it persists and often there can not be found the direct causative allergen.

The disease is genetically based and therefore often has a family history. People with atopic eczema also have a higher chance of being affected by other allergic diseases. Their list you can found in the article dedicated to allergy.


Atopic eczema manifests differently and the symptoms usually vary according to age of the affected person. We distinguish several forms of the disease based on its actual clinical signs.


Atopic dermatitis in babies – It appears by a child around 2nd month of age. Large red patches may emerge on the skin, they itch and suppurate. Main affected location is the face, neck, abdomen and upper limbs. Itching is the most problematic. Children scratch and damaged skin becomes an ideal environment for subsequent bacterial infection (so called secondary impetigo).


Atopic dermatitis in older children – It occurs by older children or it may gradually evolve from a baby form. The symptoms are not as extensive, the dermatitis moves to elbows, knees and wrists. The appearance of red rash slowly changes into patches of dry and thickened skin.


Atopic dermatitis in adolescents and elderly – This form is typical for teenagers. Same as before it can occur in a previously healthy person or it may evolve from previously named forms. The affected skin is uncomfortably dry and thickened. Almost every par of the body can be affected including knees, wrists, neck, chest, toes and nails. Itchy red rash form also exists.

At puberty atopic eczema often disappears. By some people it however persists and sometime even worsens. Particularly hand affections can be very annoying and limiting. The symptoms tend to be worse during contact with various irritants (detergents, cleaners, disinfection, etc.) that could seriously restrict a person in his or her job.


The diagnosis is usually determined by a dermatologist or a pediatrician. In addition to symptoms we find higher levels f pro-allergic IgE antibodies in blood tests. Certainly it is appropriate to ask any other allergies present not only in the patient and in his or her family history. Specific allergens can be found using skin tests, but often no certain causative allergen is diagnosed.



We can not prevent the onset of disease, so at least we are try to prevent its worsening. The approach must be complex. Human skin affected with atopic eczema has to be considered very sensitive and according to it must be treated. It is advisable to wear loose and non-irritating clothes to allow aeration of the skin and to prevent damping. It is good to avoid skin contact with any aggressive chemicals such as detergents. If the patient has a confirmed allergy to a certain substance (food, pollen, dust mites etc.), it is important to avoid it. If the patient has atopic dermatitis in the form of dry skin, it is advisable to use oily and hydrating products such as creams and ointments. More specific and individual advices will best be given by your dermatologist.



Acute inflammatory processes can be treated by some drugs. Antihistamine agents are often used. They inhibit allergic processes and also significantly reduce skin itching. Corticosteroids are extremely powerful means of therapy, particularly when administered in the form of ointments. Corticosteroids suppress immunity reactions (and thus even the allergic reaction) in the skin and the effect could be really miraculous – eczema usually disappears quickly. After discontinuation of corticosteroid therapy, it however often reappears. A prolonged use of corticosteroid local products can damage the skin and that is why corticosteroids should be always used only according to the decision of treating dermatologist.

There are also modern immunomodulatory ways of treatment. It consists of application of special drugs to remove the hypersensitivity of the immune system and to prevent allergic reaction occurrence.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources