Atopic dermatitis is a chronic skin disease that is accompanied by a rash and itching. The condition is also known as atopic eczema or atopic dermatitis. Around ten to 15 percent of all children and two percent of all adults suffer from this chronic, inflammatory skin disease.
Like allergic asthma and allergic rhinoconjunctivitis, atopic dermatitis is also a type of atopic dermatitis.

Scaly, reddened skin and severe itching are among the main symptoms of atopic dermatitis © Gina Sanders | Fotolia
It has not yet been possible to clarify exactly how atopic dermatitis develops.
However, it is known that a genetic component plays a role. There appears to be a predisposition to neurodermatitis: if one parent suffers from atopic eczema, there is a 40 percent risk of the child also developing neurodermatitis. If both parents suffer from atopic eczema, the probability of developing the disease is almost 70 percent.
Those who suffer from atopic dermatitis also have a higher risk of other atopic impairments. For example, neurodermatitis sufferers are more likely to suffer from asthma or hay fever.
The natural protective function of the skin is impaired in atopic dermatitis. As a result, various physical, microbial or chemical stimuli can lead to a flare-up. Such flare-ups are often triggered by
- Synthetic or woolen clothing,
- frequent washing,
- contact with allergens such as animal hair or pollen,
- cold, dry or humid weather conditions,
- environmental toxins such as tobacco smoke or exhaust fumes and ozone,
- microbes,
- psychological stress,
- hormonal fluctuations (for example during pregnancy or menstruation).
The number of atopic dermatitis cases is steadily increasing in western industrialized countries. Doctors suspect that high standards of hygiene are the cause. The immune system is understretched by the lack of contact with pathogens and reacts too strongly to stimuli that are actually harmless.
Too frequent washing also damages the natural skin barrier, making the skin more sensitive to environmental irritants.
Atopic dermatitis manifests itself in many different ways. The first signs can be noticeable as early as infancy. One indication of atopic dermatitis is cradle cap: red to yellow-brown and scaly patches of skin on the forehead, scalp, cheeks or neck.
In young children, on the other hand, the bends of the arms and legs and the neck are most often affected by the disease. The skin appears thicker and coarse, with crusting and agonizing itching. This can persist throughout the day, but often worsens at night and in the evening. This makes it very difficult for those affected to sleep. During the day, they often suffer from poor concentration and severe fatigue.
The unpleasant skin symptoms with scaling and papules also appear in adulthood. They occur preferentially on the flexor sides of the extremities, on the neck and on the face.
Due to the frequent scratching, the affected person's fingernails are often shiny and polished ("shiny nails").
Atopic dermatitis and other atopic diseases can be accompanied by other symptoms:
- a noticeable pallor around the mouth,
- thinning of the eyebrows,
- a double lower eyelid crease,
- recurrent conjunctivitis of the eye,
- cataracts.
The symptoms of atopic dermatitis can also occur in a similar form in other skin diseases. The doctor will therefore only make a diagnosis if certain criteria are met. A basic distinction is made between primary and secondary criteria. Atopic dermatitis is diagnosed with certainty if
- three out of four main criteria and
- one of four secondary criteria
are fulfilled.
The main criteria include
- severe itching,
- a typically distributed skin rash,
- a chronic recurrent course and
- pre-existing atopic diseases in the patient or close relatives.
The secondary criteria primarily include the characteristics listed above, which can occur in atopic diseases. Further secondary criteria are
- Torn corners of the mouth and earlobes,
- cornification disorders (ichthyosis) on the hands and
- an increase in 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 in the treatment of atopic dermatitis is strict avoidance of the triggering factors. For example, patients should avoid clothing made of wool or synthetic fibers and wear gloves when coming into contact with irritating substances. The sensitive skin also requires daily care with rich creams and ointments that keep the atopic dermatitis skin moist and supple.
Avoid frequent showers and baths to protect the skin from drying out.
During an active flare-up, atopic eczema is treated with medication that reduces the activity of the immune system. This primarily includes the group of glucocorticoids with substances such as prednisolone or dexamethasone. Anti-inflammatory substances such as tacrolimus and pimecrolimus are also suitable. They are used in the form of ointments or creams, particularly in local therapy.
Strong immunosuppressants such as Ciclosporin A or methotrexate, on the other hand, are only prescribed by the doctor in very severe cases. These medications can have considerable side effects.
Atopic dermatitis cannot be cured. However, it can disappear spontaneously at any time.
Around a third of all those affected still suffer from the unpleasant symptoms in adulthood. They are often associated with severe emotional stress.
However, early and intensive therapy can have a positive effect on the course of the inflammatory skin disease. As a result, neurodermatitis sufferers can usually lead a normal life without major restrictions.
Dermatologists are the right people to contact for the examination, diagnosis and treatment of red and itchy skin areas. Thanks to their training as specialists in skin and venereal diseases, they are specialists in neurodermatitis.
Allergic reactions of the immune system also play a role in the development of neurodermatitis. It is therefore often advisable to contact an allergist. Allergists have completed a further 18 months of training to be allowed to use this designation.
Last but not least, psychological factors such as stress and lack of rest can also lead to an exacerbation of atopic dermatitis. Under certain circumstances, treatment by a psychotherapist can therefore also help.
If children are affected by atopic dermatitis, the pediatrician is also an important point of contact.