Prevalence in children and adults
The prevalence of the disease is linked to factors such as climate and age. It affects up to 25% of the population in northern Europe, where there is less sunshine, while in the coastal region of southern Europe, only around 1% is affected. In Germany, experts estimate that a total of 10 – 15% of the population is affected, based on data from health insurance providers. Babies and toddlers are the most affected age group at 23%. By the time children reach school age, the figure drops to around 8%. These numbers indicate that the disease improves in most patients as they get older. However, 2 – 4 % of adults also have atopic dermatitis, and it is therefore not considered a ‘childhood disease’. Even so, spontaneous recovery can occur at any time.
Causes and triggers
The predisposition to atopic dermatitis is hereditary. There are many other factors that determine whether the disease actually occurs (medical term: triggering factors). This means that children whose parents already suffer from the disease are more likely to develop it than children whose parents do not have it. However, there is no way to predict with absolute certainty whether it will occur or not. Allergies are an example of a triggering factor that may worsen the disease or cause flares. But a trigger is not always identified.
So what is the difference between healthy skin and the skin of a person with atopic dermatitis? In simple terms, researchers believe that the skin’s protective mechanism is less effective in people with atopic dermatitis and that there is an imbalance in the immune system. The skin loses moisture due to an impaired barrier function and is less able to protect itself against external irritants, bacteria or viruses.
Symptoms
The symptoms of atopic dermatitis are individual and depend on factors such as the age of the patient and the progression and severity of the disease. Common symptoms include dry skin and eczema, often accompanied by intense itching. Some patients also experience thickening of the skin, nodules or pustules. In infants, the most commonly affected areas are the face, scalp or the extensor surfaces of the arms and legs. Children typically display symptoms in joints such as elbows, behind the knees, wrists and ankles. In adults, symptoms usually appear on the hands and face, but can occur on any part of the body.
Diagnosis
If atopic dermatitis is suspected, the doctor asks the patient about his or her personal and family history (medical term: anamnesis) and performs a thorough examination of the entire skin. The doctor also attempts to uncover any psychosomatic background, environmental factors and eating habits. The symptoms and the outward appearance of the skin are often sufficient to distinguish the disease from other skin diseases. In rare cases, a skin sample is taken (medical term: biopsy) and examined under a microscope.
It is decided on a case-by-case basis whether further examinations for potential allergies are necessary. This is because many patients experience reactions when tested for pollen, animal hair or house dust mite allergies. It must then be determined whether this sensitivity is actually affecting the patient’s health.
Therapy
Every patient with atopic dermatitis should be treated individually according to the severity and progression of the disease; there are no general guidelines for therapy. However, skin care is the foundation of treatment. This usually involves the use of moisturising creams and special, well-tolerated cleansing lotions. It is also recommended to prevent or reduce exposure to triggering factors, if these are known.
Treatment is adapted to the severity of the disease. For example, cortisone creams or topical immunomodulators are prescribed for mild to moderate eczema. The aim of these types of therapy is to reduce inflammation and relieve itching. Only patients with severe and chronic atopic dermatitis are prescribed systemic treatment – medications that affect the entire body, some of which may be orally administered.
Non-medicinal treatments such as UV light therapy and bath treatments may be recommended as complementary therapies. These therapies are prescribed on an individual basis. In addition, the working group for atopic dermatitis training (AGNES) in Germany provides patient training for children, adolescents and their guardians, as well as support, tips and information on managing the disease.
Many patients go on elimination diets with no specific indication, cutting out certain foods such as milk, eggs or sugar. However, experts advise against this as it may lead to nutrient deficiencies during growth and development phases. For this reason, an elimination diet should only be followed if a specialist has diagnosed a food intolerance that could trigger or worsen atopic dermatitis and has recommended the diet. Changes to the diet should always be supervised by a qualified nutritionist in order to ensure a well-balanced diet.
Living with atopic dermatitis
The treatment of atopic dermatitis often requires patience and a combination of different therapies. Disease progression, therapies and triggers vary from patient to patient, which is why general guidelines are not helpful.
Nutrition and care
Our everyday tips can help you find out whether you can improve your atopic dermatitis through diet and care and how to go about it.
Occupation
Some occupations expose people to stimuli that can have a negative impact on atopic dermatitis. One example is when a job requires frequent hand washing or the regular handling of substances that irritate the skin, as hairdressers must do. If you want to practice or train in an occupation that may worsen the disease, speak to your doctor about preventive measures.
Prof. Dr. med. Dr. h. c. T. Zuberbier
Last changes made: February 2017
Further Information
Sonderheft Neurodermitis. Pädiatrische Allergologie in Klinik und Praxis, Hrsg. Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA), 2017.