Atopic Dermatitis
Also known as: Eczema, Atopic Eczema
Description
Atopic dermatitis is a chronic, relapsing inflammatory skin disease characterised by intense pruritus and eczematous lesions. It is the most common inflammatory skin disease in children but frequently persists into adulthood. It is associated with a defective epidermal barrier (filaggrin mutations) and immune dysregulation (Th2 skewing).
Symptoms
- Intense pruritus (hallmark symptom)
- Erythematous, oedematous patches and plaques
- Xerosis (dry skin)
- Excoriations from scratching
- Lichenification in chronic cases
- Flexural distribution in older children and adults
Causes & Triggers
- Genetic barrier defects (filaggrin mutations)
- Immune dysregulation (Th2-dominant response)
- Environmental triggers (allergens, irritants)
- Stress and weather changes
- Microbial colonisation (Staphylococcus aureus)
Severity Classification
Treatment Ladder
- 1 Foundational: Emollient therapy — liberal use of fragrance-free moisturisers
- 2 Mild: Low-potency topical corticosteroids (hydrocortisone 1%)
- 3 Moderate: Medium-potency topical corticosteroids + calcineurin inhibitors for steroid-sparing
- 4 Severe: Short courses of potent topical steroids, phototherapy
- 5 Refractory: Systemic immunomodulators (dupilumab, JAK inhibitors)
Relevant Compounds
Allantoin
Soothing and barrier-protective agent
Allantoin is a naturally occurring nitrogenous compound found in botanical extracts (particularly co…
Aloe Vera
Anti-inflammatory and soothing botanical
Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…
Ceramides
Barrier repair — replaces deficient intercellular lipids
Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…
Coenzyme Q10
Antioxidant — supports cellular repair
Coenzyme Q10 (ubiquinone) is a naturally occurring lipid-soluble benzoquinone that is present in vir…
Hyaluronic Acid
Humectant — maintains hydration in dry eczematous skin
Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…
Hydrocortisone
Low-potency corticosteroid for flare management
Hydrocortisone is a low-potency topical corticosteroid identical to endogenous cortisol. It is the m…
Niacinamide
Enhances ceramide synthesis and reduces inflammation
Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…
Panthenol
Provitamin B5 — promotes barrier repair and wound healing
Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…
Squalane
Emollient — mimics skin lipids, restores barrier
Squalane is the hydrogenated (saturated) form of squalene, a naturally occurring lipid produced by h…
Recommended Drugs
Suggested Cosmetics
Lifestyle Tips
- Moisturise liberally and frequently — within 3 minutes of bathing
- Use lukewarm water for bathing — avoid hot showers
- Wear soft, breathable fabrics (cotton) — avoid wool
- Identify and avoid personal triggers (dust mites, certain detergents)
- Keep nails short to minimise excoriation damage
- Consider wet wrap therapy during severe flares
When to Refer
- Severe or widespread disease not controlled with topical therapy
- Need for systemic immunomodulators or biologics
- Suspected eczema herpeticum (urgent referral)
- Recurrent secondary infections
- Significant impact on sleep, work, or mental health