Atopic dermatitis

This is a chronic skin condition which is also a form of eczema. It is the most common type of eczema which is characterised by a series of itchy, red rashes in the folds of the skin. These include the creases behind the knees and the folds of the elbow.

Atopic dermatitis is an exaggerated response to the immune system which responds by causing these skin rashes and accompanying symptoms.

Who is most likely to get atopic dermatitis?

Infants and young children are most of risk of developing this condition. Many of these outgrow it by the time they reach their late teens or early twenties but continue to have sensitive skin. However, there are others who suffer with this throughout their life.

Atopic dermatitis affects both men and women. It also accounts for a high percentage of referrals to dermatologists.

Causes of atopic dermatitis

It’s difficult to pinpoint an exact cause. Genetics plays a part so if you have a family history of this condition then expect this tendency to continue. This is also the case if anyone in your family suffers from asthma or hay fever.

It is not caused by an allergy but occurs if you are exposed to allergens which trigger hay fever or asthma. These include pollen, fur (dog or cat), dust, mites, stress, extremes of temperature, e.g. too hot or too cold, excessive washing and contact with particular substances.

These triggers will worsen the symptoms.

Symptoms of atopic dermatitis

These differ between adults and children.

Infants under the age of 2 develop a crusty, weeping rash on their arms, legs, hands and face.

Children will develop this rash in the folds of skin behind the knees and the elbow crease. This rash is dry, scaly and itchy.

Older children, teenagers and adults will develop a rash on the face, neck, hands, feet and the folds behind the elbows and knees. This type of rash is thick and dry and itches as well. In severe cases it can spread to other areas of the body.

These rashes vary from dry, scaly skin, red, inflamed blisters through to cracked, oozing sores. The skin may change colour and appear lighter or darker in tone. Too much scratching will cause these rashes to bleed and the skin to become red raw as a result.

The skin itches to start with followed by the appearance of a rash. This is a defining feature of this condition.

Diagnosing atopic dermatitis

Your GP will examine you and ask you a series of questions about your family/medical history. This may be followed by a series of tests which include a skin biopsy and allergy testing.

A skin biopsy involves the removal of a small sample of skin for laboratory analysis. This is a painless procedure which is carried out under a local anaesthetic.

Allergy testing can take the form of a prick test or patch testing. The skin prick test involves the injection of a tiny amount of a potential allergen into the skin to see if there is a reaction.

Patch testing is very similar. Small samples of potential allergens are taped onto the skin and left for one to 2 days. They are checked at intervals to see if there has been a reaction.

These tests are performed on people with a severe form of atopic dermatitis or a similar condition. Also useful if someone is suffering from an allergy as well.

Treatment for atopic dermatitis

This is a combination of self help and prescribed remedies. Self help means following a daily skin care routine in order to keep the skin soft and lubricated. Avoid the skin becoming dry as this will only worsen the symptoms.

Do not excessively wash or scrub the skin but have a quick shower or bath instead and use gentle body washes and cleansers. Apply a moisturising cream afterwards. Apply a topical cream which is available over the counter from your pharmacist or via a prescription from your GP.

Find out more in our skin care advice section.

Do not pick or scratch the rash as this will make it worse and may lead to scarring. If you are the parent of a child with atopic dermatitis then trim their fingernails and encourage them to wear a pair of gloves if the itching is a problem. Do this particularly at night time as they may scratch whilst asleep.

Avoid contact with anything which will trigger the symptoms of this condition.

Medication: antihistamines can help and these are available from your pharmacist. But severe cases will require prescription medication such as topical creams or lotions which are applied onto the skin. Another option is antibiotics or medicines which suppress the immune system such as methotrexate. These will dampen down a hypersensitive immune system.

UV light therapies such as phototherapy can also help. This and other remedies are covered in more detail in our dermatology treatments section.

Prognosis

This condition can be controlled with the right treatment and lifestyle changes. But severe cases are much harder to deal with. Anyone who developed atopic dermatitis in their childhood; has one or more allergies, e.g. asthma and a family history of dermatitis will find it difficult to control their condition.

Plus there is a risk of complications such as bacterial or viral infections and deep scarring.