Atopic dermatitis

Atopic dermatitis is a chronic inflammatory skin disease. A more fragile skin barrier and inflammation promote dryness, itching and eczema flares.

• It may begin in infancy but also affects children, teenagers and adults.
• It often alternates between improvement and relapse.
• It may occur with other atopic conditions such as rhinitis, asthma or some allergies, without meaning that one allergen alone explains the eczema.
• Diagnosis is primarily clinical: allergy tests are not needed for everyone.

A flare is active inflammation. The aim is to treat it early according to your prescribed plan rather than waiting until it becomes severe.

• Do not use the same strength or product on every area without instructions: the face, skin folds, infant skin and thick skin may require different approaches.
• Do not extend, shorten or change treatment yourself if the prescribed plan is unclear.
• If the same areas relapse very often, a doctor may suggest intermittent anti-inflammatory maintenance treatment; follow the prescribed schedule exactly.

Inflammation → itching → scratching → damaged skin → more inflammation

Itching is part of the disease. Simply saying ‘do not scratch’ is not enough: better control of inflammation and dryness also helps reduce scratching.

• keep nails short;
• avoid overheating and keep the bedroom cool if heat increases itching;
• choose comfortable, well-tolerated clothing;
• apply prescribed care to reduce inflammation;
• tell your doctor if itching regularly disrupts sleep.

• Do not remove one or more foods solely because a test is positive.
• Do not start an elimination diet ‘as a trial’ without medical advice.
• In children, unnecessary avoidance may cause nutritional difficulties and complicate eating.
• Targeted food-allergy assessment is mainly relevant when the history suggests a genuine reaction to a food or in certain specific clinical situations.

Not routinely. Atopic dermatitis is primarily diagnosed clinically and additional tests are often unnecessary.

Allergy assessment may be considered particularly when:

• a suggestive immediate reaction occurs after a food or another exposure;
• there is associated rhinitis, asthma or other allergic symptoms;
• contact eczema is suspected;
• progress remains inadequate despite correctly followed care;
• in a child, the doctor suspects a specific situation requiring targeted assessment.

• pustules;
• unusual crusting or rapid spread of oozing lesions;
• increasing pain;
• hot or very swollen skin;
• fever;
• feeling generally unwell;
• sudden worsening despite usual care.

• eczema remains poorly controlled despite correct treatment use;
• flares are very frequent or extensive;
• itching regularly prevents sleep;
• the condition affects school, work, sport, relationships or emotional wellbeing;
• topical care has become very difficult to manage;
• infections recur.