Atopic eczema

What is atopic eczema and who does it affect?

[Translate to en_DE:] Hautproblem Neurodermitis

Atopic eczema, which is also medically known as neurodermatitis, atopic dermatitis or endogenous eczema, is one of the most common chronic skin diseases. In Germany alone, several million people are affected by atopic eczema, in particular toddlers (approx. 20%). Around half of the patients suffer from a moderate to severe form of atopic eczema. But there is good news: Particularly during childhood, the condition improves over time and even disappears completely. Yet even in adulthood, around 2-4% of the population still suffer from this skin disease.

In most cases, atopic eczema develops in the first year of life. Cradle cap can be the first indication for this.

Even though the severity and areas of skin affected by atopic eczema may differ depending on the individual, the disease follows a typical pattern. It alternates between acute bouts, which are treated with anti-inflammatory medicinal products for example, and bout-free phases. In the bout-free phases, treatment with anti-inflammatory preparations might not be necessary, but a sufficient amount of suitable skin care products should nevertheless be applied to the skin on a regular basis.

Causes and triggers of atopic eczema

Although atopic eczema has long been identified as a skin disease, there is not just "one cause" for it. Rather, it is a multifactorial disease that can be influenced by various factors. In addition to a genetic disposition, environmental influences or an impaired barrier function of the skin can also be major reasons for the occurrence of atopic eczema.

A wide range of factors can also intensify the disease or trigger acute bouts in affected patients. Furthermore, climatic conditions can play a role. If it is cold outside and there is dry, heated air inside, the symptoms may increase. Even professions where frequent hand disinfection is required or protective clothing needs to be worn for longer periods of time (e.g. protective gloves) can favour the development of atopic eczema symptoms. The individual's mental state can also affect the disease. Stress for example can trigger a bout of atopic eczema. It can also be aggravated by certain textiles, excessive perspiration or incorrect cleaning.

This is why it is especially crucial for patients to determine the different triggers so that they can specifically avoid these factors. This can help to reduce the intensity of the symptoms or even to delay the occurrence of acute bouts.

Typical symptoms of atopic eczema

Atopic eczema can practically occur on extensive areas of the entire body. Nevertheless, only certain typical areas are often affected. These include:

  • joint bends
  • hands / wrists
  • eyelids
  • scalp
  • neck

In acute bouts, the affected areas of skin appear red and scaly, sometimes often accompanied by weeping eczema: particularly if those affected only knew how to deal with the pronounced itching by scratching it. This agonising itching can be a burden to those affected over the whole day and may even worsen during the evening and at night. This disrupts their sleep and the body cannot regenerate properly, which often results in a lack of concentration during the day.

In addition to treating acute inflammation, the first task is to interrupt the itching-scratching cycle. This is why it is particularly important to care for the skin on a regular basis, even during bout-free periods, as the skin affected by atopic eczema remains sensitive. Our guide to atopic eczema can help you further.

You can find more information on itching with atopic eczema here.

Treating atopic eczema

Your treating doctor will tell you which therapeutic measures are necessary and practical. Generally, these depend on a number of things, such as severity of the disease, the affected areas and the age of the individual.

Acute bout of atopic eczema

The inflammation occurring during an acute bout can be treated with e.g. anti-inflammatory and/or immune-modulating medicinal products depending on the type and extent. Which treatment options are relevant for patients differ depending on the patient and must be decided on by the treating doctor.

Basic therapy

Even if the symptoms of atopic eczema are considerably less pronounced or even non-existent in the bout-free periods, the regular application of suitable, lipid-replenishing products is an important part of atopic eczema treatment. This "basic therapy" consists of reducing aggravating factors as well as treating the skin with creams, lotions and bath additives. A consistent basic therapy can also significantly relieve the agonising itching.

Further measures

Investigations have shown that the severity or frequency of bouts can only be reduced in some of the patients if they avoid certain foodstuffs.

  • Making sure the water is not too hot when bathing (not above 36 degrees if possible) can help to prevent the skin from drying out.
  • The water jet in the shower should not be too powerful
  • Instead of rubbing yourself dry, it is recommended to gently pat the skin dry after bathing or showering.
  • Visiting swimming pools can also result in additional skin irritations due to the chlorine and the prevailing differences in temperature. Gentle, extensive showers and applying lipid-replenishing lotions to your body afterwards relieve the symptoms.

Sources

Association of the Scientific Medical Societies (AWMF). S2k-Leitlinie der Deutschen Dermatologischen Gesellschaft (DDG): Leitlinie Neurodermitis [atopisches Ekzem; atopische Dermatitis] [S2k guideline of the German Society of Dermatology (DDG): Guideline on atopic dermatitis [neurodermatitis; atopic eczema]. . URL: https://www.awmf.org/leitlinien/detail/ll/013-027.html

Werfel, T., Schwerk, N., Hansen, G., Kapp, A. (2014): Diagnostik und Stufentherapie der Neurodermitis [The diagnosis and graded therapy of atopic dermatitis], from: Deutsches Ärzteblatt [German magazine for doctors], volume 29-30, p. 509

Institute for Quality and Efficiency in Health Care (IQWiG), Neurodermitis [atopic eczema]. URL: https://www.gesundheitsinformation.de/neurodermitis.2257.de.html