16th July 2026

Atopic Dermatitis

Clinical features

Atopic dermatitis is also known as atopic eczema. It is the most common inflammatory dermatitis. It tends to affect people with positive family history or personal history of atopy. Usually starts from infancy and may settle in late childhood or adolescence. All ages can be affected. Risk factors for developing atopic dermatitis can be broken down into genetic and environmental risk factors. Genetic: positive family history, filaggrin gene defects (FLG), which cause a skin barrier defect, and the immune system (Th2-associated cytokines contribute to loss of skin barrier function). Environmental factors include dry skin associated with low humidity, frequent hand washing, winter weather, and irritants such as detergents.

It commonly affects the flexural aspect of the skin; however, it can affect all parts of the skin depending on age. In darker skin types, it may also affect the extensor surfaces more commonly than in lighter skin types. In chronic cases, skin may become thickened (lichenified) and less erythematous compared to the acute phase.

Investigations

• Normally, a clinical diagnosis
• Patch testing may be utilised in treatment-resistant cases.

Management

• Avoidance of irritants or exacerbating factors
• Topical therapy such as regular emollients, topical steroids, topical antibiotics (if only secondary infection), and topical calcineurin inhibitors 
• Phototherapy: UVB or PUVA 
• Systemic treatment: Prednisolone (severe flare), ciclosporin, azathioprine, antihistamines 
• Janus Kinase Inhibitor: Abrocitinib, bariticinib 
• Biologics: Dupilumab, Tralokinumab

Steroid Potencies

Complications 

• Secondary infection:
  • Bacterial – Staphylococcus and streptococcal infection
  • Viral – Eczema herpeticum, Eczema coxsackium, Molluscum contagiosum
  • Fungal- Dermatophyte (Trichophyton rubrum / Epidermophyton skin infection)
• Dyspigmentation of the skin 
• Erythroderma