Atopic Dermatitis: Understanding the Itch
- Patricia T
- 13 minutes ago
- 3 min read
Atopic dermatitis (AD), commonly referred to as eczema or atopic eczema, is a chronic inflammatory skin disease characterized by recurrent episodes of skin inflammation. The term atopic comes from the Greek word atopia, meaning “out of place,” referring to an abnormal immune response.
AD is the most common inflammatory skin condition worldwide, affecting approximately 230 million people of all ages. It typically presents with red, dry, itchy skin and rashes, but its impact extends beyond the skin. Persistent itching and discomfort can lead to sleep disturbances, mood changes, difficulty concentrating, and an increased risk of mental health conditions such as anxiety and depression.
Causes and Risk Factors
The exact cause of atopic dermatitis is not fully understood, but evidence points to a combination of genetic predisposition and environmental factors. Individuals with a family history of eczema, asthma, or allergic rhinitis are at higher risk.
Environmental triggers—such as allergens, irritants, stress, climate changes, and infections—can worsen symptoms and lead to flare-ups.
Skin Barrier Dysfunction and Immune Response
A hallmark of atopic dermatitis is a compromised skin barrier. In healthy skin, the outer layer acts as a protective shield that retains moisture and blocks irritants, allergens, and microbes. In people with AD, this barrier is weakened. Research has shown that many patients with AD have:
Mutations in the filaggrin (profilaggrin) gene
Reduced levels of ceramides, which help maintain skin hydration
Elevated immunoglobulin E (IgE) levels, reflecting immune system overactivity
These changes result in increased water loss, dryness, inflammation, and a higher susceptibility to skin infections.
Clinical Appearance and Distribution
The appearance and location of atopic dermatitis vary with age:
Infants: Face, scalp, and extensor surfaces
Children: Elbows, knees, wrists, and ankles
Adolescents and adults: Hands, neck, face, and flexural areas
It is important to emphasize that atopic dermatitis is not contagious and is not caused by poor hygiene. In fact, higher rates of AD are observed in highly sanitized environments. Children exposed to a greater variety of microbes early in life may be less likely to develop AD, supporting the hygiene hypothesis.
Figure 1. Pathophysiology of atopic dermatitis. Source: Abdel-Mageed HM, 2025 (CC BY 4.0).
Management and Treatment
There is currently no cure for atopic dermatitis. Treatment focuses on reducing inflammation, restoring the skin barrier, relieving symptoms, and preventing flare-ups.
For mild atopic dermatitis, management includes:
Daily use of fragrance-free moisturizers (emollients) to maintain skin hydration
Gentle bathing and cleansing routines
Trimming fingernails short or wearing cotton gloves at night to reduce skin damage from scratching
Wearing loose-fitting, soft clothing and avoiding tight or scratchy fabrics such as wool
Using a humidifier to prevent dry indoor air, especially in cold or winter climates
Avoiding known triggers such as harsh soaps, fragrances, and stress
For moderate to severe disease, additional therapies may be required, including:
Topical anti-inflammatory medications (e.g., corticosteroids or calcineurin inhibitors)
Phototherapy
Systemic treatments or biologic medications for severe or treatment-resistant cases
Early diagnosis and consistent adherence to a treatment plan are essential for long-term disease control.
Conclusion
Atopic dermatitis is a chronic, relapsing inflammatory condition with both physical and psychological effects. Although it cannot be cured, improved understanding of skin barrier dysfunction and immune mechanisms has led to more effective treatment strategies. With proper medical care and daily skin-protective habits, individuals with AD can significantly reduce symptoms and improve their quality of life.
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