Atopic dermatitis (atopic eczema, neurodermatitis)
Neurodermatitis/atopic dermatitis is a chronic disease with an episodic course which typically occurs in infancy.
The skin disease is based on a hereditary predisposition. The symptoms appear in the first five years of life in 85% of cases. In atopic dermatitis the condition of the skin is constantly changing. The symptoms can appear simultaneously or in varying degrees.
Causes and triggers
The causes of neurodermatitis are many and varied. Genetic predisposition, environmental factors as well as inflammation taking place in the skin play a role. This reduced skin barrier is caused by a deficiency, an imbalance or defective functioning of substances (e.g. proteins or fats) that are responsible for the formation of the upper layer of the skin. As a result, more water evaporates and the skin becomes dry. In addition, the skin becomes more permeable to allergens and other environmental substances. These can trigger inflammatory reactions.
As well as the changes to the structure of the skin, climate/weather, psychological stress, chemical irritants (e.g. shower and washing products), etc. have an influence on the skin’s condition. The triggers for an episode of neurodermatitis differ from one person to the next and can change during the course of a lifetime. Several factors frequently play a part, which is why it is often difficult to identify the trigger or triggers.
Symptoms of neurodermatitis/atopic dermatitis
In atopic dermatitis the condition of the skin is constantly changing. The following symptoms may occur:
- Dry, sensitive skin
- Scaly skin
- Weeping patches of skin
- Crust formation
- Rough skin with raised surface
- Formation of nodules
These symptoms can appear simultaneously or in varying degrees. The eczema appears on typical areas of skin, depending on the sufferer’s age. During infancy it mainly affects the face, the upper body, hands and extensor surfaces of the arms and legs. In small children, the episodes mainly occur in the hollows of the knees, elbows, on the face, neck and throat. Hand and foot eczema may additionally be observed in older children, adolescents and adults.
Diagnosis and differential diagnosis
There is no laboratory test to establish atopic dermatitis. The diagnosis is based on the typical symptoms listed above. This requires a thorough discussion between the doctor and the parents or the sufferer as well as examination of the skin. Atopic illnesses in the family can be an important indicator.
Skin diseases such as psoriasis can sometimes cause similar symptoms. Detailed investigations with a dermatologist can provide the necessary information.
Therapy and treatment
Basic care is the foundation of treatment for atopic dermatitis. It involves cleansing and moisturizing the skin. This can prevent infections while suitable care products supply the skin with fat and moisture. Unfortunately, there is no general “all-in-one product” for all sufferers. The choice of care product should be adapted to the seasons:
- In winter when the air is cold and dry, select rather greasy products.
- In summer when the air is hot and damp, products with a low fat content and hence a higher moisture content feel comfortable.
Many sufferers experience severe itching. Scratching will temporarily get rid of the itching but it damages the skin, which in turn encourages itching. The aim of treatment is to break this vicious circle between itching, scratching and deterioration in the skin's appearance. Various measures may be helpful in this situation, e.g. cooling, skin-friendly and breathable fabrics, compresses and dressings with black tea, table salt or ointments.
If the condition of the skin deteriorates despite good basic care, anti-inflammatory therapy is often necessary as an additional measure. Cortisone creams and ointments and calcineurin inhibitors/immunomodulators are available for this purpose.
There are various possible factors, such as stress or miscellaneous irritants, that have an adverse effect on the condition of the skin. These should be avoided as far as possible.
Tips and tricks
- As sweating makes itching worse, it helps not to have too many bed covers on at night and, during the day, to wear clothing appropriate to the temperature.
- Wear the innermost layer of clothing with the seams outwards to prevent them from irritating the skin.
- Instead of fabric softener, use small amounts of vinegar.
- Relaxation techniques (e.g. yoga, progressive muscle relaxation, autogenic training) can help people deal with psychological stresses.
Facts and figures
Around 20% of children in Switzerland are affected by atopic dermatitis. The rate in adults is thought to be 4–5%. The symptoms appear in the first five years of life in 85% of cases.
aha! Swiss Allergy Centre helps
- The booklet "Allergies – simple to explain" is available in English
- Education and courses on the subject "Neurodermatitis" (in German)
- Products and services awarded the Allergy Seal of Quality – an added benefit for sufferers.
- Experts on the aha!infoline will be happy to answer personal queries: Monday to Friday, 08.30–12.00
- aha!shop: other booklets and factsheets provides detailed information and are available in German, French, Italian
- aha!kinderlager for children with allergies aged between 8 and 12 years (in German or French)
- aha!jugendcamp for youngsters aged between 13 and 16 years (in German)
- Other education and courses on the subjects "Allergy, asthma, chronic bronchitis", "Anaphylaxis" (in German)
- We value your opinion. Or would you like to exchange experiences with other sufferers? Find out more in german under "Advice and exchange" (in German)
- Your donation will enable us to provide important services to people with allergies, asthma and neurodermatitis. Your support will be put to effective use. Many thanks.