Atopic eczema

What is atopic eczema and who does it affect?

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. Despite this, 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 of atopic eczema

The exact cause of atopic eczema is still not fully understood and is therefore the subject of intensive research. However, it is suspected that three factors play a central role in its development:

  • A hereditary predisposition: It is considered relatively certain that a genetic disorder of the skin barrier is inherited. This is supported by the fact that atopic eczema runs in families. This means that parents pass on an increased risk of developing atopic eczema to their children.
  • A disturbed skin barrier function: With atopic eczema, the natural skin barrier is disturbed. This means that the hydro-lipid film of the uppermost skin layer can no longer fulfill its function. On the one hand, the skin loses too much moisture and becomes dry. On the other hand, foreign substances such as bacteria or pollutants can penetrate unhindered and cause irritation.
  • An overactive immune system: The immune system of atopic dermatitis sufferers can respond to the penetration of normally harmless foreign substances through the skin with strong defensive reactions. The body then produces special antibodies, which in turn provoke the release of inflammatory substances and tissue-damaging substances. These substances can in turn damage the skin barrier.

It is also possible that certain hygiene measures play a role in the immune response. In fact, studies show that cases of the disease have increased in recent decades, especially in industrialized countries. Improved hygiene means that children come into less contact with germs. In somewhat simplified terms, this means that the immune system is less trained and harmless substances are mistakenly classified as dangerous.

Triggers of atopic eczema

Triggers and provoking factors are external influences that can trigger an atopic eczema flare-up. The following factors are known as possible triggers:

  • Certain clothing, e.g., wool, synthetic fibers.
  • Dry air: heater air or a cold winter day further dries out the skin.
  • Infections: colds, flu or other illnesses can trigger a flare-up.
  • Stress and psychologically stressful situations.
  • Certain work-related activities: handling dirt, chemicals, dust, wearing gloves (made of rubber, latex, or vinyl) for long periods of time, heavy mechanical stress on the skin.
  • Food: foods containing histamine (red wine, ripened cheese, sauerkraut, etc.), citrus fruits, foods with a high gluten content (especially baked goods), coffee and hot spices.
  • Excessive hygiene and intensive use of cosmetic products as well as too hot bathing and showering
  • Fragrances, e.g., in cosmetics, aftershave or perfume.
  • Tobacco smoke.
  • Allergy triggers, if an allergy exists: especially pollen, dust mites, animal hair, molds, and in children, foods.
  • Constant scratching.
  • Heavy sweating, e.g., at warm temperatures or during sports.
  • Hormonal changes.

Typical symptoms of atopic eczema

Atopic eczema can practically occur on all areas of the body. Nevertheless, certain areas are more often affected. These include:

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

Treating atopic eczema

Your treating doctor will tell you which therapeutic measures are necessary and practical. Generally, these depend on several 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 agonizing 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 kinds of food.


  • 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 can help to the symptoms.