Atopic dermatitis (AD), commonly called eczema, is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, skin barrier dysfunction, a…
Medically reviewed by MedCentralHub Medical Review Board, Licensed Pharmacists & Physicians ·
Atopic dermatitis (AD), commonly called eczema, is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, skin barrier dysfunction, and immune dysregulation driven predominantly by Th2 cytokines (IL-4, IL-13, IL-31). It affects approximately 15–20% of children and 2–10% of adults worldwide, making it the most prevalent chronic inflammatory skin condition. AD frequently co-occurs with asthma, allergic rhinitis, and food allergy — the 'atopic march' — and significantly impairs quality of life through sleep disruption, psychological burden, and social limitation.
This information is for educational purposes only. Always consult a qualified healthcare professional for diagnosis and personalized treatment.
Intense, chronic or recurrent pruritus (itch) — the hallmark symptom
Erythematous, poorly defined patches and plaques with scaling
Lichenification (skin thickening) from chronic scratching
Weeping, crusted lesions during acute flares
Dry, sensitive skin (xerosis) even between flares
Distribution varies by age: infantile (cheeks, scalp, extensor limbs); childhood/adult (flexural folds — antecubital, popliteal fossa, neck, wrists)
Excoriations and secondary bacterial superinfection (S. aureus, eczema herpeticum)
Sleep disturbance due to nocturnal pruritus
Clinical diagnosis based on Hanifin and Rajka criteria or UK Working Party criteria
Major criteria: chronic relapsing pruritic dermatitis with typical morphology and distribution
Disease severity assessment: EASI (Eczema Area and Severity Index), IGA (Investigator Global Assessment), POEM (Patient-Oriented Eczema Measure)
Skin culture if bacterial superinfection suspected (S. aureus, MRSA)
Patch testing if allergic contact dermatitis is a contributing factor
Serum total IgE and specific IgE/skin prick testing if IgE-mediated food allergy suspected
Skin biopsy only if diagnosis uncertain (histology shows spongiosis and eosinophilic infiltrate)
Topical Corticosteroids
Cornerstone of AD treatment. Mild potency (hydrocortisone 1%) for face/folds; moderate (triamcinolone 0.1%) for body; potent (clobetasol) for palms/soles. Use short courses; avoid long-term facial use to prevent skin atrophy.
Topical Calcineurin Inhibitors (Tacrolimus, Pimecrolimus)
Steroid-sparing option. Tacrolimus 0.03% (children) or 0.1% (adults); pimecrolimus 1% for mild-moderate AD. Preferred for face, eyelids, genitalia. Initial burning sensation common.
Emollients / Moisturizers
Daily liberal application restores skin barrier. Best applied immediately after bathing. Choose fragrance-free, ceramide-containing formulations. Non-negotiable foundation of all AD management.
Dupilumab (Dupixent)
IL-4Rα monoclonal antibody — blocks IL-4 and IL-13. First-line biologic for moderate-severe AD. 600 mg loading, then 300 mg q2w SC. Approved from 6 months of age. Watch for conjunctivitis.
Topical PDE4 Inhibitor (Roflumilast, Crisaborole)
Crisaborole 2% ointment for mild-moderate AD ≥2 years. Roflumilast 0.15% foam/cream (newer, more potent). Steroid-free alternatives; minimal systemic absorption.
JAK Inhibitors (Upadacitinib, Abrocitinib, Ruxolitinib)
Oral JAK inhibitors for moderate-severe refractory AD. Upadacitinib 15–30 mg daily; abrocitinib 100–200 mg daily. Topical ruxolitinib for mild-moderate. Monitor for infections, CBC. Boxed warning for JAK inhibitors.
Moisturize skin at least twice daily; apply within 3 minutes of bathing ('soak and seal')
Lukewarm baths (not hot) with gentle, fragrance-free cleansers
Identify and avoid personal triggers (soaps, fragrances, wool, sweat, stress, specific foods)
Wear soft, breathable cotton clothing; avoid wool and synthetic fabrics
Keep fingernails short to minimize skin damage from scratching
Maintain cool, humid home environment (humidity 45–55%)
Wet wrap therapy for severe flares (topical steroid under wet wraps)
Manage stress through mindfulness, cognitive behavioral therapy
Prognosis
AD often improves with age: approximately 40–60% of children experience significant improvement or resolution by adulthood. However, 10–30% of childhood cases persist or relapse in adulthood. Adults with late-onset AD tend to have a more chronic course. Modern biologics (dupilumab) and JAK inhibitors have transformed outcomes for moderate-severe disease, achieving clear or almost-clear skin in 30–50% of patients. Persistent disease is associated with significant psychological comorbidity (anxiety, depression, ADHD) and increased cardiovascular risk in severe cases.
Atopic Dermatitis (Eczema) is a medical condition classified under Dermatology. Atopic dermatitis (AD), commonly called eczema, is a chronic, relapsing inflammatory skin disease characterized by intense pruritus, skin barrier dysfunction, and immune dysregulation driven predominantly by Th2 cytokines (IL-4, IL-13, IL-31). It affects approximately 15–20% of children and 2–10% of adults worldwide, making it the most prevalent chronic inflammatory skin condition. Understanding Atopic Dermatitis (Eczema) is essential for patients, families, and healthcare providers to ensure timely diagnosis, appropriate treatment, and optimal outcomes.
Last reviewed by MedCentralHub Medical Review Board · MedCentralHub Editorial Policy
Medical Disclaimer
The information on this page is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Always consult your doctor or a qualified healthcare provider with any questions about a medical condition.