Atopic eczema, also known as atopic dermatitis, is a chronic skin disease characterised by pronounced itching, dry skin and recurring flares of inflammation. It can significantly affect everyday life – which is why consistent maintenance therapy is all the more important. In addition to appropriate skincare, preventive measures also play a key role in preventing flare-ups and stabilising the skin in the long term. Dealing with the condition at an early stage helps those affected to better manage their daily lives and improve their well-being.
Atopic eczema at a glance
Atopic eczema is a chronic inflammatory skin disease characterised by flares and remissions and is usually accompanied by severe itching and dry, sensitive skin. In Switzerland, 5 to 15 percent of people are affected by atopic dermatitis. The onset of the condition is often in early childhood. In a large proportion of those affected, the symptoms subside over the years or disappear completely.
Atopic eczema is less common in adulthood. However, those who suffer from it often showed the first signs of the condition in childhood, which in some cases went unrecognised. Atopic eczema is one of the commonest skin diseases in Switzerland and often appears alongside other atopic conditions such as hay fever or bronchial asthma.
Although atopic eczema cannot be cured by medical intervention, the condition can be well controlled with targeted treatment. The aim is to alleviate the symptoms, prevent flares and sustainably improve the quality of life of those affected.
Causes and risk factors for atopic eczema
The exact cause of atopic eczema is not yet fully understood. The condition is caused by a combination of genetic factors and environmental influences. A dysfunctional skin barrier plays a central role, which facilitates the penetration of irritants and allergens.
The most common risk factors include:
- Genetic predisposition: Atopic eczema often runs in families.
- Allergies: Many sufferers are sensitive to pollen, dust mites or certain foods.
- Environmental influences: Cold air, dry heated air, harmful substances or irritating skincare products can trigger flare-ups.
- Irritating clothing fabrics: Materials such as wool or synthetic fibres can be harsh on sensitive skin and increase itching.
- Intensive skin cleansing: Frequent washing with soap-containing products or regular contact with detergents can weaken the skin barrier and promote inflammation.
- Cigarette smoke: Passive smoking and inhalation of tobacco smoke can worsen the condition of the skin and trigger acute flare-ups.
- Mental strain and stress, which can further worsen the skin condition.
- Infections or hormonal fluctuations can also play a role.
Symptoms: recognising atopic eczema
The symptoms of atopic dermatitis vary depending on the patient’s age and the severity of the condition. Typical examples are:
- Severe itching, often including at night, which can lead to disturbed sleep
- Dry, flaky skin
- Redness, inflammation and patches of eczema
- Thickened areas of skin due to frequent scratching
- In serious cases: development of weeping and crusty areas
- In babies, atopic eczema usually occurs on the face (as a form of cradle cap). In older children and adults it is mainly in the crooks of the arms, backs of the knees, neck or hands.
It is also important to clearly distinguish atopic eczema from other skin diseases with a similar appearance. Not every reddened, itchy or dry area of skin can be put down to atopic eczema. Skin conditions such as psoriasis, allergic contact eczema or parasitic infections such as scabies can also cause similar symptoms. A thorough dermatological check-up is therefore essential.
Diagnosis
The diagnosis of atopic eczema is usually made via a dermatological examination. The doctor assesses the typical appearance of the skin and asks the patient about symptoms, possible causes and pre-existing conditions.
In addition, the following examinations may be carried out:
- Allergy tests (e.g. skin prick tests or specific IgE blood tests)
- Skin swabs if additional infections are suspected
- Rarely: skin biopsy to rule out other skin diseases
Treating atopic eczema
The treatment of atopic eczema is based on several elements and is individually adapted to the severity of the condition. The aim is to alleviate the symptoms, prevent flares and restore the skin barrier.
The most important therapeutic approaches are:
- Maintenance therapy with lipid-replenishing creams or ointments to strengthen the skin barrier
- Anti-inflammatory medications such as corticosteroid preparations or calcineurin inhibitors
- Antihistamines to relieve itching
- Phototherapy (light therapy) for chronic or severe cases
- Biologics or immunomodulators for severe, treatment-resistant forms
- Avoidance of triggers and low-allergen lifestyle
Treatment of atopic eczema with corticosteroids
Corticosteroids (often known simply as ‘steroids’) play a key role in the treatment of atopic eczema, as they effectively inhibit inflammation and significantly relieve the agonising itching. They are usually applied externally in the form of creams or ointments. It is important, however, that corticosteroids are only used when you have a clear medical diagnosis. For other skin conditions such as acne, rosacea or fungal infections, they can even worsen the symptoms.
The right dosage and duration of treatment are crucial for safe and effective use. Corticosteroid preparations should only be used as recommended by your doctor in terms of strength and duration of use. If used incorrectly, the risk of side effects such as skin thinning, stretch marks or pigment changes is significantly increased. Particular care should be taken on the face and on children, as here the skin is more sensitive. In such cases, weaker preparations are usually used.
Although corticosteroids are usually used externally for atopic eczema, systemic therapy with corticosteroid tablets may be necessary in severe or particularly persistent cases. This form of treatment is used if there are large areas or severely inflamed areas of the skin and external treatment alone is not sufficient.
The effect is usually quick: swelling, redness and itching are significantly reduced. However, systemic use is associated with a higher risk of side effects such as metabolic changes, skin changes, osteoporosis, gastrointestinal problems or hormonal changes. For these reasons, corticosteroid tablets are only used for a short time and at the lowest possible dose for atopic eczema.
Atopic eczema and mental well-being
Alongside physical treatments, psychosomatic therapies and training on how to deal with the condition can also sustainably improve the quality of life of those affected. This is because atopic eczema does not solely affect the skin – the patient’s mental well-being can also suffer severely. The permanent itching, visible skin changes and the chronic nature of the condition present a major emotional challenge for many of those affected. Holistic treatment should therefore not focus only on the skin, but also on the mind.
Preventing atopic eczema
To prevent flare-ups of atopic eczema, consistent skincare and avoidance of individual triggers are key. The daily use of mild, perfume-free skincare products helps strengthen the skin barrier and minimise irritation.
Dry indoor air can put additional strain on the skin, particularly during periods when the heating is on. Humidifiers or regular ventilation can help with this. The choice of clothing also plays an important role: soft, breathable materials such as cotton are better tolerated than wool or synthetic fabrics, which can lead to itching. In addition, fragrances in detergents or cosmetics should be avoided.
Stress is also a common trigger, so relaxation techniques such as yoga, meditation or targeted mindfulness exercises can help stabilise the skin condition in the long term. For newborns with a family history of atopic conditions such as atopic eczema, breastfeeding for as long as possible in the first four to six months of life is recommended in order to reduce their risk of developing them. During this sensitive phase, the administration of any other proteins should be avoided if possible. As an alternative to breastfeeding, hypoallergenic formula milk can be given.
Frequently asked questions about atopic eczema
Where is atopic eczema most commonly seen in children?
In babies, atopic eczema usually appears first on the face, especially on the cheeks, on the scalp (cradle cap) and on the forehead. As children get older, the affected areas often shift to the extensor (outer) surfaces of the arms and legs, and later also to the insides of the elbows, backs of the knees, front of the neck and wrists. The skin in these places is usually dry, reddened and very itchy.
Where does atopic eczema typically occur in adults?
In adults, atopic dermatitis usually occurs on the flexural (bending) surfaces, i.e. insides of the elbows, backs of the knees and front of the neck. The face, hands, back of the neck, chest and upper back can also be affected. In some cases, the eczema only occurs in individual areas, such as the eyelids or the hands.
Can atopic eczema be cured?
No, atopic eczema is not considered curable. With the right treatment, however, the condition can be well controlled. Many of those affected experience a significant improvement in their symptoms as they get older.
Which foods should be avoided in cases of atopic eczema?
Dairy products, eggs, nuts, wheat and certain vegetables such as celery and peppers are often amongst the foods that can promote symptoms of atopic eczema. Citrus fruits, alcohol, caffeinated drinks and spicy foods can also exacerbate symptoms in some patients.
How does stress affect atopic eczema?
Stress can be responsible both as a cause of eczema flare-ups and as an amplifier of existing symptoms. It can upset the immune system and increase inflammation in the skin. Those affected often experience more itching under stress, which leads to increased scratching and thus worsening of symptoms. Relaxation techniques such as yoga, meditation or psychotherapy can support skin health.
Which skincare products are suitable for atopic eczema?
For daily skincare, perfume-free, lipid-replenishing creams or ointments without irritating additives are the most suitable. They help to hydrate the skin and stabilise the weakened skin barrier. In acute flare-ups, a cream containing corticosteroids may also be necessary to quickly alleviate the consequences of inflammation and severe itching. Corticosteroids are only to be used in consultation with your attending doctor, and only for specific areas and limited periods.
How is atopic eczema treated in babies?
When treating atopic eczema in babies, the focus is on gentle skincare with lipid-replenishing, perfume-free ointments that strengthen the skin barrier and relieve itching. It is also important to dress your baby in breathable clothing made from natural materials such as cotton as much as possible, and to avoid overheating. Avoiding potential irritants, such as perfumed skincare products or rough clothing, also plays a key role. In particularly pronounced cases, short-term treatment with low-dose corticosteroid preparations may be necessary in consultation with their paediatrician.
How is atopic eczema related to other allergic conditions?
Atopic eczema is one of the so-called atopic diseases. The immune system reacts hypersensitively to harmless environmental factors. People who already suffer from an atopic disease such as hay fever, asthma or a food allergy are more likely to develop atopic eczema. Conversely, if you already have atopic eczema, further atopic complaints may occur during the course of your life. Experts call this phenomenon ‘atopy’. All atopic disorders are based on the same genetic predisposition.