Atopic eczema

What is atopic eczema?

Atopic eczema, sometimes called atopic dermatitis, is the most common type of eczema affecting 10-20% of children and 1-3% of adults.[1] The word ‘atopic’ means sensitivity to allergens, and eczema is a condition where patches of your skin become inflamed, dry or blistered. So, ‘atopic eczema’ is when your skin becomes inflamed because of a reaction to an allergen, like pollen. Sometimes the condition can be inherited from a parent.

Atopic eczema typically begins during childhood, with 85% of cases starting before the age of five.^[1] But most eczema patients will go into clinical remission, which means they will have no symptoms before adulthood. For those who don’t, treatment might be necessary to prevent the symptoms from worsening.

Who can get atopic eczema?

Anyone can get eczema including adults, children and people of different ethnicities. It’s more common in children, with most eczema patients getting it before the age of five. It’s also more common in urban populations and developed countries.

How does atopic eczema differ from other types of eczema?

There are seven main types of eczema and the most common one is atopic eczema. Each eczema type is characterised by different symptoms. For example, dyshidrotic eczema causes itchy blisters on your feet, palms and hands.

Atopic eczema can appear anywhere on your body – it’s not specific to some areas, unlike ‘neurodermatitis’. It will appear red (or purple on darker skin) and will be itchy and dry. It sometimes can blister, but it’s less common than with dyshidrotic eczema. Additionally, it won’t have defined patches, such as circular patches in nummular eczema, or bordered patches in psoriasis.

You should get your eczema diagnosed by a doctor before starting treatment. This is because each type of eczema has different symptoms that will require different medications to treat them.

What causes atopic eczema?

Atopic eczema is a chronic, complex skin condition that can be caused by genetic, environmental or immunological factors: 

• Genetic factors: Eczema often runs in families. If a parent has eczema, there’s about a 50% chance their child will too, rising to 80% if both parents have it.[2] Also, eczema caused by mutations in certain genes, like the FLG gene – affects the protein filaggrin, which helps keep skin moisturized, repairs damage, and maintains the skin barrier. Without enough of this protein, your skin may become dry and more prone to infections.^[1]
• Environmental factors: Things in your environment can trigger flare-ups. High pollen, changes in weather, or certain foods—like eggs, milk, and peanuts—can make eczema worse. Triggers vary from person to person, so it’s helpful to keep a log and track what causes flare-ups for you.
• Immunological factors: People with eczema tend to have an overactive immune system. When your skin comes into contact with a substance, like pollen or a fragrance, your immune system deems it harmful and triggers an immune response. As a result, your body produces cells that cause inflammation to get rid of the ‘harmful’ substance. And although it doesn’t ‘qualify’ as an autoimmune disease, your immune system does play an important role in eczema.

What are the symptoms of atopic eczema?

Symptoms of atopic eczema are different depending on how severe it is. Generally, the common symptoms include dry, itchy and sore skin. If it worsens, these can be red (or purple/grey on darker skin), inflamed and painful to touch. The patches might also spread to other parts of your body where you don’t usually have eczema. 

In some cases, the symptoms of eczema can be confused with psoriasis symptoms. Both have similar symptoms, like redness and itching, but unlike eczema, psoriasis patches are more defined, with skin that’s crusty and scaly.

Can atopic eczema lead to other problems?

Atopic eczema can lead to other problems if not managed properly. The most common infection, which 90% of eczema patients get,^[3]  is caused by the bacteria Staphylococcus aureus (also known as a ‘staph infection’). This causes your skin to be blistered and filled with pus, and if not treated with antibiotics, it can become worse. To avoid getting infections, try not to scratch your skin. Instead, apply something cool on top or apply an anti-itch cream. 

Another infection is Eczema herpeticum (EH), which is less common than staph infections, but it’s more dangerous and can be life-threatening. When infected, small, red, blisters appear on your skin that are painful to touch, and you might also get a fever. If you think you’re infected with EH, it’s important you see a doctor as soon as possible. 

Asthma and food allergies are also more common among eczema patients. About 50% of children with eczema will develop asthma and 33% will have a food allergy.^[4] They’re caused by many factors, including genetic and environmental. But there are ways you can lower these risks, such as by breastfeeding and using emollients frequently.^[5]

Mental health issues are also common in eczema patients, especially in severe cases. Repeated flare-ups and daily challenges can cause stress, and stress can make your eczema worse, which can further take a toll on your mental health. If you’re struggling with your mental health, seeing a doctor or talking to a loved one can really help.