Atopic Dermatitis: Specialists & Information

Exactly how neurodermatitis develops is not yet fully understood.

However, it is known that a genetic component plays a role. There appears to be a predisposition to developing atopic dermatitis: If one parent has atopic dermatitis, the child has a 40 percent risk of developing it as well. If both parents have atopic dermatitis, the likelihood of the child developing the condition rises to nearly 70 percent.

People with neurodermatitis also have a higher risk of developing other atopic conditions. For example, people with neurodermatitis are more likely to suffer from asthma or hay fever.

In atopic dermatitis, the skin’s natural protective function is impaired. As a result, various physical, microbial, or chemical irritants can trigger a flare-up. 

Such a flare-up is often triggered by:

• Clothing made of synthetic fabrics or wool
• Frequent washing
• Contact with allergens such as pet dander or pollen
• Cold, dry, or humid weather conditions
• Environmental toxins such as tobacco smoke, exhaust fumes, and ozone
• Microbes
• Psychological stress
• Hormonal fluctuations (for example, during pregnancy or menstruation)

The number of cases of atopic dermatitis is steadily increasing in Western industrialized nations. Medical experts suspect that high hygiene standards are the cause. Due to a lack of exposure to pathogens, the immune system is underutilized and overreacts to stimuli that are actually harmless.

Excessive washing also damages the skin’s natural barrier, making the skin more sensitive to environmental irritants.

Atopic dermatitis manifests in a variety of ways. The first signs can appear as early as infancy. 

One indication of atopic dermatitis is cradle cap: these are red to yellowish-brown, scaly patches of skin on the forehead, scalp, cheeks, or neck.

In young children, however, the condition primarily affects the creases of the arms and legs as well as the neck. The skin appears thicker and rougher. Crusting and excruciating itching occur. 

This itching can last all day, but often worsens at night and in the evening. As a result, those affected have great difficulty sleeping. During the day, they often suffer from difficulty concentrating and severe fatigue.

Even in adulthood, the unpleasant skin symptoms—including scaling and papules—persist. They occur primarily on the flexor sides of the extremities, on the neck, and on the face.

Due to frequent scratching, the person’s fingernails are also often polished to a shine (“shiny nails”).

In cases of neurodermatitis and other atopic conditions, additional accompanying symptoms may occur:

• a noticeable pallor around the mouth
• thinning of the eyebrows
• a double lower eyelid fold
• recurrent conjunctivitis
• Cataracts

The symptoms of atopic dermatitis can also occur in a similar form with other skin conditions. Therefore, a doctor will only make the diagnosis if certain criteria are met.

Generally, doctors distinguish between major and minor criteria. 

Atopic dermatitis is considered confirmed if:

• three out of four major criteria and
• one of the four secondary criteria are met

The primary criteria include:

• severe itching
• a rash with a typical distribution
• a chronic, recurrent course, and
• pre-existing atopic conditions in the patient or a close relative

Secondary criteria primarily include the characteristics listed above that may occur in atopic conditions. 

Additional secondary criteria include:

• cracked corners of the mouth and earlobes
• skin thickening (ichthyosis) on the hands and
• elevated levels of IgE antibodies in the blood

Atopic dermatitis cannot be cured. However, various measures can alleviate the unpleasant symptoms and prevent flare-ups.

The most important component of atopic dermatitis treatment is strictly avoiding trigger factors. For example, patients should avoid clothing made of wool or synthetic fibers.

When coming into contact with irritating substances, those affected should wear gloves. Sensitive skin requires daily care with rich creams and ointments that keep the skin moisturized and supple.

Avoid frequent showers and baths to protect the skin from drying out.

During an active flare-up, atopic eczema is treated with medications that suppress the activity of the immune system. 

These primarily include glucocorticoids, such as prednisolone or dexamethasone. 

Anti-inflammatory agents such as tacrolimus and pimecrolimus are also suitable. They are used in the form of ointments or creams, particularly for topical treatment.

Strong immunosuppressants such as cyclosporine A or methotrexate, however, are prescribed by a doctor only in very severe cases. These medications can have significant side effects.

Although atopic dermatitis cannot be cured, it can disappear spontaneously at any time.

One-third of those affected continue to experience symptoms even in adulthood. These symptoms are often associated with significant emotional distress.

Early and intensive treatment can positively influence the course of this inflammatory skin condition. As a result, people with atopic dermatitis can usually lead a normal life without major limitations.

Dermatologists are the appropriate professionals to consult for the examination, diagnosis, and treatment of red and itchy skin areas. 

Thanks to their training as specialists in skin and sexually transmitted diseases, they are experts in atopic dermatitis.

Allergic reactions of the immune system also play a role in the development of atopic dermatitis. Therefore, it is often advisable to consult an allergist as well. 

Allergists have completed 18 months of advanced training to be eligible to use this title.

Last but not least, psychological factors such as stress and a lack of rest can also lead to a worsening of atopic dermatitis. 

In some cases, treatment with a psychotherapist may therefore also be helpful.

If children are affected by atopic dermatitis, the pediatrician is also an important point of contact.