Atopic Dermatitis Across the Lifespan
Atopic dermatitis (eczema) is a chronic, itchy skin disease that is most common in children, although it also affects many adults. As a chronic condition, atopic dermatitis may have periods of remission (when symptoms are lessened or non-existent) and periods of relapse (flares of worsened symptoms). Atopic dermatitis may appear differently depending on the age of the person affected.1
Locations of rashes from infancy to adulthood
Infants and toddlers
The onset of atopic dermatitis is most common in infants, typically occurring between 3 and 6 months of age. Approximately 60% of cases of atopic dermatitis develop in the first year of life. In infants, atopic dermatitis may appear as a rash on the scalp, face, or arms and legs. Atopic dermatitis makes the skin dry, itchy, and scaly, and there may also be areas that bubble up and ooze fluid. Atopic dermatitis causes a significant itch, and scratching can cause sleep disturbances and lead to increased risk of infection.1,2
How to treat infants and toddlers
A key part of treating atopic dermatitis in infants and toddlers is rehydrating the skin with good skin care, including bathing in lukewarm water, using mild and fragrance free soaps, and moisturizing the skin immediately after bath with an emollient. For children who have repeated bacterial skin infections, adding 2 teaspoons of bleach per gallon of water can reduce the chance of infections. Topical corticosteroids may be prescribed for children with atopic dermatitis whose condition doesn’t respond to good skin care and regular use of emollients.1,3
While 60% of atopic dermatitis occurs in the first year of life, 90% develops by 5 years of age. Approximately 10% of all atopic dermatitis cases are diagnosed after age 5. In children, atopic dermatitis frequently begins in the inside creases of the elbows or knees, the neck, wrists, ankles, and/or the crease between the buttocks and legs. The rash is itchy and scaly and may form bumps. The skin may lighten or darken where atopic dermatitis affects the body.1,4
Some children develop complications from atopic dermatitis, including infections, sleep problems, food allergies, asthma, hay fever, or psychological effects.
How to treat children
Treatment for atopic dermatitis in children includes good skin care (lukewarm baths, mild soaps, and daily moisturizers). Medications that may be prescribed for children with atopic dermatitis include topical corticosteroids, topical calcineurin inhibitors, antibiotics, and/or antihistamines. In severe cases of childhood atopic dermatitis, systemic immunosuppressants, biologics and phototherapy may be prescribed.1,2,6
Will my child grow out of it?
Remission occurs in approximately 65% of children with atopic dermatitis by the age of 11, although that clearance rate falls to 53% as some of those children have recurrences of atopic dermatitis in their teenage years. Some people have atopic dermatitis persist into adulthood, and others find that their atopic dermatitis becomes localized, such as hand eczema, in contrast to when they were children.5
The majority of people who have atopic dermatitis as a child have resolution of the disease – it goes into remission – by adulthood, however, 10-30% continue to have relapses of atopic dermatitis in adulthood. In addition, a small number of people develop atopic dermatitis as an adult. This accounts for about 5% of all cases of atopic dermatitis.1 In adults, the rash from atopic dermatitis is scalier than it is in younger patients. Atopic dermatitis often shows up in adults on the inner creases of the elbows or knees, hand, and/or the nape of the neck. The rash may cover much of the body and can be especially noticeable on the face and neck.4
How to treat adults
Treatment for atopic dermatitis in adults includes daily moisturizers, mild soaps, and medications such as topical corticosteroids, topical calcineurin inhibitors, antibiotics, and antihistamines. Phototherapy, which uses light waves directed at the skin, is a second-line treatment strategy. That is, it is only recommended for use after topical treatments and lifestyle approaches have failed to improve symptoms of atopic dermatitis. Immunosuppressants or biologics may be prescribed for people with severe cases of atopic dermatitis that have not responded to previous treatment.1