Everything You Need to Know About Atopic Dermatitis

Often called eczema, atopic dermatitis (AD) is an inflammatory skin condition that commonly appears as an inflamed, excessively dry, and itchy rash on the skin. Millions of people have atopic dermatitis, and while it can affect all of us, research suggests that it affects 15 to 20% of children and 1 to 3% of adults worldwide.

Atopic dermatitis is one that causes discomfort in the everyday lives of those who live with it. Although people who can get it range from newborns to adults, 50% of all people with atopic dermatitis develop other allergic symptoms within the first year of their lives, and as many as 85% experience the onset of their symptoms below the age of five.

Symptoms of atopic dermatitis

Atopic dermatitis can flare up anywhere on the body; symptoms may include, but are not limited to:

  • Dry and cracked skin

  • Severe itching

  • Rash that differs depending on the skin color; having brown or black skin commonly results in gray to violet-brown discoloration rather than red

  • Small, raised bumps

  • Oozing and crusting

  • Thickened skin

  • Raw, sensitive skin due to scratching

In infants and children up to 2 years old, rashes usually appear on the scalp, face, and skin around the joints that touch when the joint bends. In children 2 years and older, these thickened rashes typically flare up on the ankles, neck, and in the bends of the knees and elbows.

In teens and adults, red to dark brown scaly rashes tend to appear on the hands, neck, ankles, bends of the knees and elbows, and the skin around the eyes. Other symptoms can also include darkening of the skin beneath the eyes and having an extra fold of skin under the eye, also called the Dennie-Morgan fold.

If experiencing one or more of these symptoms, it is best to seek a professional opinion from a licensed dermatologist, as self-diagnosis and self-medication can have severe and negative effects.

Common misconceptions about atopic dermatitis

People usually try to diagnose and cure a condition, especially now that everything is just a Google search away. The problem is that the internet is rife with false information, and a lot of it is the product of misconceptions passed off as facts. Below are some of the misconceptions surrounding AD and the truth behind these myths.

  • Myth: One misconception about relieving the symptoms of AD is finding the thing that is causing it. Most people try to cure AD by simply removing foods such as eggs, milk, and nuts from their diet that they think cause it.

  • Fact: AD is not an allergic reaction; it is a complex disease, and years of research have been inconclusive as to what exactly causes AD. Triggers can be identified and avoided, but to associate a specific food or thing as the direct cause of AD is wrong.

  • Myth: Atopic dermatitis will cure itself, and children who have it will outgrow the disease.

  • Fact: While it is true that AD can go away on its own, it is still worth noting that this can be a lifelong disease; thus, there is no way to identify if the disease will cure itself or remain.

  • Myth: People believe that taking fewer baths and showers will relieve AD.

  • Fact: Research shows that taking shorter baths daily helps relieve AD. Longer baths can cause the skin to lose moisture and weaken the skin barrier, contributing to a possible trigger. Atopic dermatitis can also lead to skin infections because of all the scratching, so taking baths regularly can help by removing bacteria and germs on the skin that might contribute to AD flare-ups.

Who is at risk of atopic dermatitis?

People of all ages and races can get atopic dermatitis, but it is more common in children. It usually appears during infancy and childhood, and some children might experience this continuing through puberty and adolescence while others experience it going away before their teenage years. In rare cases, AD can also develop after 60 years of age.

Research suggests that African American and Asian American children tend to develop the disease more than white children. Research also suggests that AD is more common in non-Hispanic black children.

The chances of having AD are slightly higher for people who have a family history of the same disease, hay fever, or asthma.

Potential triggers

Researchers have discovered that the following likely cause AD and contribute to flares:

  • Family history

  • Food allergies, asthma, or fever

  • Immune system

  • Environmental triggers: where you live

  • External factors such as pollution, stress, and smoke

How to control atopic dermatitis

Due to the gap in current knowledge as to what exactly causes AD, treating it can involve a variety of approaches and strategies. Flare-ups can be relieved by easing symptoms such as itching and swelling. Below are some of the ways that one can control AD flare-ups.

  • Moisturize: Moisturizers work well by sealing in moisture in the skin and preventing it from drying out. Moisturizing also strengthens the skin barrier and can contribute to healthier skin overall. Finding the best one that suits your skin's needs is important, and the best ones should be safe and effective.

  • Daily baths: Taking short and daily baths with lukewarm water offers protection from bacteria and germs that can contribute to AD flares.

  • Gentle cleanser: When choosing a product to clean the skin, opt for non-soap cleansers—those that are free of dye, alcohol, and fragrance that may irritate the skin. Antibacterial soaps also contribute to dry skin as they tend to remove necessary skin oils. Also, avoid scrubbing and use a washcloth or loofah.

Medications for atopic dermatitis Topical

Topical medications, such as creams or ointments, can control the symptoms of AD. Most AD medications are OTC and can be bought without a doctor’s prescription, but it is still wise to consult a physician first.

  • Corticosteroids: One of the most commonly used and prescribed medications to ease the symptoms of all types of eczema is corticosteroid, commonly known as "steroid." This type of drug can reduce inflammation and itching, which helps with the healing of the skin.

  • Pimecrolimus cream or tacrolimus ointment: Pimecrolimus is recommended for mild to moderate cases of AD, while tacrolimus is for moderate to severe cases. Both work as calcineurin inhibitors that alter the immune system by suppressing the production of pro-inflammatory cytokines that can contribute to flare-ups.

  • Crisaborole ointment: This type of ointment helps treat AD by blocking the action of natural substances in the body that cause inflammation. This medication is to be used according to how it was prescribed and with caution. After applying the ointment, wash your hands thoroughly to remove residues. Avoid getting it in the eyes, mouth, or vagina.

  • Ruxolitinib cream: This is the first topical Janus kinase (JAK) inhibitor cream for treating AD approved by the FDA. It is used for the treatment of mild to moderate AD. It is prescribed to those whose disease is not effectively controlled with other topical medications.

Oral Prescription

Oral medications are also being prescribed for AD. However, as with any other drug, they require close supervision by a medical expert.

  • Immunosuppressants: As their name suggests, immunosuppressants work by suppressing the action of the immune system. Some of the pathways that are involved in AD are modulated by the immune system; often, an overreaction of the immune system leads to inflammation. Medications such as methotrexate and azathioprine are included in this category.

  • Corticosteroids: It is very obvious by now that inflammation plays a huge role in AD. Thus, medications such as prednisolone can help manage AD.


Biologics, or biologicals, are a class of medications that includes vaccines, monoclonal antibodies, and immune modulators, to name a few. Biologicals used for AD are targeted therapies that work by blocking certain pathways, leading to less severe flare-ups and fewer AD symptoms.

  • Dupilumab: Dupilumab is a monoclonal antibody that works by blocking interleukin 4 and 13. This results in a reduction of inflammation, especially in AD cases where flare-ups are triggered by pro-inflammatory pathways.

  • Tralokinumab-ldrm: Similar to dupilumab, it is designed to target specific parts of the immune system that contribute to inflammatory diseases such as AD.