Atopic Dermatitis: Symptoms, Skin Care, and Treatment

What is Atopic Dermatitis?

Atopic dermatitis, also known as atopic eczema, is a chronic inflammatory skin disease characterized by intense itching, dry skin, and eczematous lesions that flare up periodically.

Although it most often begins in childhood, it is not solely a childhood disease. It can persist into adulthood or become more pronounced in some individuals during adulthood. The Turkish Dermatology Association also defines the disease as one that can occur at any age, characterized by dryness, itching, and recurrent rashes. (Turkish Dermatology Association)

Briefly, what you need to know

Atopic dermatitis is not contagious.

It's not just an "allergy".

Disruption of the skin barrier is a key component of the disease.

Itching is one of the most important symptoms and can seriously disrupt sleep quality.

It can occur in conjunction with other atopic diseases such as asthma and allergic rhinitis.

The goal of treatment is not only to clear the existing rash, but also to protect the skin barrier and reduce flare-ups.

For moderate to severe disease, much more powerful options are available today, including biological drugs and targeted oral therapies. (American Academy of Dermatology)

What does atopic dermatitis look like?

The appearance may vary depending on age and the stage of the disease.

Common findings include:

intense itching,

pronounced dryness,

redness,

flaking,

cracking,

irritation due to scratching,

It is the thickening of the skin in a long-term illness.

While infants may more frequently affect the face and outer surfaces of the extremities, older children and adults may more often involve areas such as the neck, hands, inner elbows, and backs of the knees. (Turkish Dermatology Association)

Why does this happen?

There isn't just one reason.

In the development of atopic dermatitis:

genetic predisposition + skin barrier disorder + immune system dysfunction + environmental factors

They play a role together.

Because:

“"Atopic dermatitis is caused by allergies."”

That's an incomplete explanation.

Some patients may have co-morbid allergic diseases; however, the entire disease cannot be attributed to a single food or environmental allergen.

Why does skin become so dry?

A healthy skin barrier prevents the skin from losing water and provides protection against irritants from the external environment.

In atopic dermatitis, this barrier may not function properly. As a result:

water loss increases,

skin dries out,

Irritants take effect more easily.,

Itching and inflammation become easier.

Therefore, moisturizing is not just a cosmetic addition, but a fundamental part of treatment. The AAD strongly recommends moisturizers in the treatment of atopic dermatitis. (American Academy of Dermatology)

Why is itching so important?

In atopic dermatitis, itching is more than just an uncomfortable symptom.

Scratching:

itch → scratching → barrier damage → inflammation → more itching

It can create a loop like this.

Nighttime itching, in particular, can disrupt sleep; it can affect school performance in children and daily life and work performance in adults. The Turkish Dermatology Association especially emphasizes this burden on sleep and concentration.

Is atopic dermatitis an allergy?

Not exactly.

In people with atopic dermatitis:

asthma,

allergic rhinitis,

some food allergies

It can occur more frequently than the societal average.

However:

There is atopic dermatitis → there is definitely a food allergy.

The result is incorrect.

Therefore, conducting extensive food panels and eliminating numerous foods from the diet, especially without a clear clinical history, may not be the appropriate approach.

Do all patients with atopic dermatitis need allergy tests?

No.

Tests should be used in a targeted manner when the history suggests a specific allergic trigger.

Unnecessary elimination diets, especially in children:

nutritional deficiencies,

growth problems,

unnecessary family anxiety

That could be the reason.

We can later develop this into a comprehensive guide titled "Atopic Dermatitis and Food Allergy.".

How is atopic dermatitis diagnosed?

Diagnosis is usually:

patient history,

Characteristics of itching,

distribution of lesions,

chronic or recurrent course,

accompanying atopic features

It is determined after evaluation.

There is no single blood test that definitively diagnoses atopic dermatitis.

Biopsy is not necessary in most typical patients; it is more often used in selected cases where differential diagnosis is difficult.

How is atopic dermatitis treated?

It is more understandable to think of treatment in terms of three main goals:

Improve skin barrier function → control inflammation → reduce new flare-ups.

Moisturizers

It is the basis of treatment.

A good moisturizer:

It reduces dryness.,

It supports the skin barrier.,

It can help reduce itching.,

It can prolong the time between flare-ups.

The AAD strongly recommends moisturizers for adult atopic dermatitis. (American Academy of Dermatology)

Topical corticosteroids

It is one of the primary anti-inflammatory treatments for atopic dermatitis flare-ups.

However:

Which steroid + which area + which strength + how long?

These questions are important.

The treatment used for eyelid eczema may not be the same as the treatment used for thickened hand eczema.

While these medications are quite beneficial when used correctly, the fact that patients avoid using them altogether due to their "fear of cortisone" can lead to the disease becoming unnecessarily uncontrolled.

Non-steroidal topical treatments

Topical calcineurin inhibitors, such as tacrolimus and pimecrolimus, are good options, especially for certain areas like the face, around the eyes, and in crease regions.

Newer topical PDE-4 and JAK inhibitors have also been added to treatment options. The AAD's 2025 update also added tapinarof and roflumilast to the list of strongly recommended new topical options for adult atopic dermatitis. (American Academy of Dermatology)

Key point:

Treatment for atopic dermatitis is no longer limited to moisturizers and corticosteroid creams.

Phototherapy

For more widespread disease or disease that is not adequately controlled with topical treatment, phototherapy methods such as NB-ultraviolet B (UVB) may be considered.

However, the treatment plan is determined by considering the patient's age, the extent of the disease, and other treatment options.

What to do in cases of moderate to severe illness?

The biggest change in the treatment of atopic dermatitis in recent years has occurred here.

Now, for suitable patients:

Biological therapies

dupilumab,

tralokinumab,

lebrikizumab,

nemolizumab

There are targeted biological drugs such as these.

JAK inhibitors

upadacitinib,

abrocitinib,

baricitinib

Oral targeted therapies, such as these, can also be used in suitable patients.

The 2025 EuroGuiDerm Living Guideline incorporates all of these modern treatments into the current systemic treatment algorithm.

Important message:

We don't have to manage moderate to severe atopic dermatitis for years with only repeated cortisone treatments.

Should systemic cortisone be used?

No, not as a long-term treatment.

The current AAD guidelines recommend against routine long-term use of systemic corticosteroids. (American Academy of Dermatology)

Short-term special circumstances may be considered separately; however:

“"Eczema flares up → get a cortisone injection → it will go away"”

A repetitive system like this is not the management of chronic atopic dermatitis.

Why might infections be more frequent?

In atopic dermatitis, the disruption of the skin barrier can increase susceptibility, particularly to certain bacterial and viral infections.

Yellow crusting, discharge, rapid worsening, or painful, widespread lesions may suggest a secondary infection.

Common herpes infections, particularly eczema herpeticum, may require prompt medical evaluation.

Is bathing bad for eczema?

No.

The problem is often not taking a bath:

very hot water,

staying underwater for a long time,

harsh cleaners,

The key is not to moisturize after bathing.

The AAD conditionally supports bath and wet-wrap treatments in suitable patients. (American Academy of Dermatology)

Which moisturizer should be used?

Generally:

unscented,

low irritation potential,

providing adequate occlusion,

that the patient can use regularly

One product is preferred.

For very dry skin, cream or ointment form may be more effective than mild lotions.

The best moisturizer is not just one with a good formula, but one that the patient actually uses regularly.

Does atopic dermatitis completely go away?

The course of the disease varies from person to person.

In some children, it may significantly lessen with age; in others, however, it persists into adulthood or reappears periodically.

Because:

“"It will definitely pass when the child grows up."”

or

“"It will always be like this for life."”

Neither of these two extreme statements is true.

The goal of modern treatment is to keep the disease under control and symptom-free for as long as possible.

When should you consult a dermatologist?

Especially:

If itching is disturbing your sleep,

If the disease affects large areas,

If there is facial/eye area involvement,

if frequent infections develop,

If flare-ups continue despite repeated cortisone use,

if school or work life is significantly affected

Dermatological evaluation is appropriate.

Frequently Asked Questions

Is atopic dermatitis contagious? No.

Is atopic dermatitis an allergy? It cannot be defined as an allergic disease on its own; genetic, barrier, and immunological mechanisms play a role together.

Are cortisone creams harmful? When used at the correct strength, in the appropriate anatomical area, and for the correct duration, topical corticosteroids are fundamental and effective treatments. The problem is inappropriate and uncontrolled use.

Is a special diet necessary for atopic dermatitis? There is no single "atopic dermatitis diet" that is specific to everyone. Any identified food allergies are managed separately.

Is moisturizing truly a treatment? Yes. Protecting the skin barrier is a fundamental part of atopic dermatitis management. (American Academy of Dermatology)

Can biological drugs be used in severe disease? Yes. In suitable moderate-to-severe patients, biological and targeted therapies are important options according to current guidelines.