Atopic Dermatitis Across the Lifespan

Atopic dermatitis (AD) is a chronic, itchy skin disease that is most common in children, although it also affects many adults. As a chronic condition, AD may have periods of remission (when symptoms are lessened or non-existent) and periods of relapse (flares of worsened symptoms). AD may appear differently depending on the age of the person affected.1

Atopic dermatitis in infants and toddlers

The onset of AD is most common in infants, typically occurring between 3 and 6 months of age. Approximately 60% of cases of AD develop in the first year of life. In infants, AD may appear as a rash on the scalp, face, or arms and legs. AD makes the skin dry, itchy, and scaly, and there may also be areas that bubble up and ooze fluid. AD causes a significant itch, and scratching can cause sleep disturbances and lead to increased risk of infection.1,2

Some infants or toddlers develop complications from AD, including infection, eye complications, or sleep problems. A key part of treating AD 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 AD whose condition doesn’t respond to good skin care and regular use of emollients.1,3

Atopic Dermatitis Across the Lifespan

Atopic dermatitis in children

While 60% of AD occurs in the first year of life, 90% develops by 5 years of age. Approximately 10% of all AD cases are diagnosed after age 5. In children, AD 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 AD affects the body.1,4

Remission occurs in approximately 65% of children with AD by the age of 11, although that clearance rate falls to 53% as some of those children have recurrences of AD in their teenage years. Some people have AD persist into adulthood, and others find that their AD becomes localized, such as hand eczema, in contrast to when they were children.5

Some children develop complications from AD, including infections, sleep problems, food allergies, asthma, hay fever, or psychological effects. Treatment for AD in children includes good skin care (lukewarm baths, mild soaps, and daily moisturizers). Medications that may be prescribed for children with AD include topical corticosteroids, topical calcineurin inhibitors, antibiotics, and/or antihistamines. In severe cases of childhood AD, systemic immunomodulators and phototherapy may be prescribed.1,2,6

Atopic dermatitis in adults

The majority of people who have AD as a child have resolution of the disease – it goes into remission – by adulthood, however, 10-30% continue to have relapses of AD in adulthood. In addition, a small number of people develop AD as an adult. This accounts for about 5% of all cases of AD.1 In adults, the rash from AD is scalier than it is in younger patients. AD 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

Treatment for AD 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 AD. Immunomodulators may be prescribed for people with severe cases of AD that have not responded to previous treatment.1

Emily Downward | June 2017
View References