Atopic Dermatitis (Eczema): Symptoms, Triggers & Modern Treatment

At a glance

Affected in Germany Several million; children affected considerably more often than adults
Other names Atopic dermatitis, atopic eczema, neurodermatitis
Atopic triad Atopic dermatitis, asthma and hay fever — often occur together
Course Chronic and relapsing; in many children improvement by puberty
Medications (selection) Topical corticosteroids, calcineurin inhibitors, dupilumab, tralokinumab, lebrikizumab, JAK inhibitors
ICD-10 L20

Table of contents

  1. What is atopic dermatitis?
  2. Symptoms and distribution by age
  3. Causes, triggers and the vicious circle
  4. Diagnosis
  5. Basic therapy: skin care
  6. Medication: stepwise therapy
  7. Atopic dermatitis in children
  8. Psychological burden and quality of life
  9. Living with atopic dermatitis
  10. How brite helps you
  11. FAQ
  12. Related topics

1. What is atopic dermatitis?

Atopic dermatitis (also called atopic eczema or, in German, "Neurodermitis") is a chronic inflammatory skin disease. It belongs to the group of atopic disorders — together with asthma and hay fever (the so-called atopic triad). Some of those affected also have an allergic component.

Typical is extremely dry, itchy skin with inflammatory skin changes that usually occur in flares. The often tormenting itch is considered the leading symptom and is felt by many of those affected to be the greatest burden.¹˒³

In Germany, an estimated several million people are affected — children considerably more often than adults. In many children, the disease improves markedly by puberty.¹˒⁴

Important: atopic dermatitis is NOT contagious The disease has a clear genetic component — those affected are born with the predisposition. No skin contact, no towel and no air transmits atopic dermatitis.

2. Symptoms and distribution by age

Leading symptom: itch

An intense itch is the main symptom and often the greatest burden. It is often especially pronounced at night and during flares — and can lead to sleep disturbances, exhaustion, concentration problems and psychological strain. Scratching can additionally damage the skin and further drive the typical vicious circle.

Skin changes

  • Generally dry skin (xerosis) — usually also outside the inflamed areas
  • Redness, swelling and weeping in acute flares
  • Scaling, thickening and coarsening of the skin (lichenification) in a chronic course
  • Scratch marks, crusting and occasionally secondary skin infections

Distribution by age — typical and diagnostically important

Infants From the 3rd month of life — face and extensor sides

Typical are the so-called cradle cap on the head as well as cheeks and forehead; often also the extensor sides of arms and legs. The diaper area usually remains free.

Children 2–12 Flexural eczema — elbow creases, hollows of the knees

Frequently affected are the elbow creases, hollows of the knees (so-called flexural eczema), wrists, neck and the backs of the feet.

Adolescents & adults Hands, face, neck — often lichenification

Often in the area of the hands (a hand eczema can be occupationally relevant), but also on the face, neck, nape and décolleté. Eyelids and lips are not rarely involved. Lichenifications (leathery skin thickenings) are more common in this age group.

Special form: head-and-neck eczema A form in adults with sensitization to Malassezia yeasts. Often affects the scalp, face and neck — in some cases can respond to antifungal therapy.

3. Causes, triggers and the vicious circle

Genetic basis

  • A large proportion of those affected have relatives with atopic disorders (atopic dermatitis, asthma, hay fever)
  • In a relevant share of those affected, changes are found in the filaggrin gene, which is responsible for an important skin barrier protein — the result can be a disturbed skin barrier through which irritants and allergens penetrate more easily
  • The immune system typically reacts excessively (Th2 response) — with increased release of messenger substances such as IL-4, IL-13 and IL-31. Modern biologics target these structures¹

Typical triggers

  • Irritants: wool, rough synthetic fabrics, aggressive soaps or detergents, perfume, disinfectants
  • Climate: cold and dry heated air in winter, sweating in summer, rapid temperature changes
  • Allergens: e.g. house dust mites, pollen, animal dander, molds
  • Foods: relevant in individual cases in infants and toddlers (e.g. cow's milk, hen's egg); rarer in adults
  • Bacteria: skin often heavily colonized with Staphylococcus aureus — can amplify inflammation and itch
  • Stress and psychological strain — one of the most common triggers for flares
  • Infections: even ordinary infections can trigger flares
Emergency: eczema herpeticatum An infection with herpes simplex viruses on already affected skin is a medical emergency. With suddenly appearing painful, blister-like skin changes with fever, seek medical help immediately.
The vicious circle Disturbed skin barrier → irritants penetrate → immune system reacts excessively → inflammation → itch → scratching → skin barrier is further damaged → from the start. The therapy usually has to act at several points.

4. Diagnosis

The diagnosis is usually made clinically — there is no single laboratory test that clearly proves atopic dermatitis.¹

  • Clinical diagnosis: Pronounced itch, age-dependent distribution, chronic-relapsing course, personal or family history of atopy. In addition: generally dry skin, elevated IgE level.
  • Severity assessment: Standardized scores (e.g. SCORAD or EASI) assess extent and intensity — important for the choice of therapy stage.
  • Trigger diagnostics: Allergy tests (prick test or specific IgE in the blood) only with a concrete clinical suspicion — blanket screening tests without suspicion are mostly not sensible.¹
Differential diagnoses Contact eczema, psoriasis, scabies, fungal skin infections or seborrheic eczema.

More: Preparing for a doctor's appointment.

5. Basic therapy: skin care — the foundation

Consistent daily skin care is usually the basis of every atopic dermatitis treatment — even in flare-free phases. Without good basic care, medications mostly work less well too. The goal is to support the disturbed skin barrier and supply the skin with sufficient moisture.¹˒³

  • Usually apply cream twice a day — over the whole body, not just on the affected areas. A re-fatting, fragrance-free basic care is recommended.
  • In winter often a richer care (e.g. water-in-oil emulsion), in summer lighter, more water-based creams.
  • Avoid perfume, fragrances, certain preservatives and essential oils as far as possible.
  • Urea can bind moisture — but may sting during acute flares. Alternatives: glycerin- or ceramide-containing products.
  • Keep bathing and showering short, lukewarm instead of hot. Re-fatting wash lotions are usually better tolerated than classic soaps.
  • Apply cream promptly after bathing — the absorption of the care is then usually best.
Common mistake: applying cream too sparingly The amount may generally be measured generously. Too little care is a problem considerably more often than too much.

6. Medication: stepwise therapy

Which treatment makes sense in an individual case is always decided by the treating dermatology — usually on the basis of the severity and the individual situation. The current S3 guideline describes a stepwise scheme in which the basic therapy continues at every stage.¹

Stage 1 Dry skin without inflammation — basic therapy

Basic therapy in the foreground — supplemented by avoiding known triggers and, if appropriate, a structured education program.

Stage 2 Mild to moderate eczema — topical therapy
Topical corticosteroids (cortisone creams)
Considered one of the most important anti-inflammatory therapies for flares. Different potencies: mild preparations for the face or children, stronger ones for thick, chronic areas on the body.
Proactive therapy (S3 guideline): After healing, formerly affected areas continue to be creamed at a much lower frequency — to prevent relapses.
With correct, medically supervised use, modern cortisone preparations are generally considered safe — also in children. Skin thinning mostly occurs only with use that is too long or too strong.¹
Calcineurin inhibitors — tacrolimus and pimecrolimus
An alternative to cortisone — especially for sensitive areas: face, eyelids, genital area, skin folds. No skin-thinning risk. According to the guideline, they are also suitable for a proactive therapy. A burning sensation during the first applications is possible and usually subsides after a few days.¹
More: Stopping cortisone.
Topical JAK inhibitor — ruxolitinib cream
A topical option for certain patient groups. Can often relieve the itch quickly. No skin-thinning risk. The exact indication and duration are always determined by the treating dermatology.
Stage 3–4 Moderate to severe atopic dermatitis — systemic therapy

When topical therapy alone is not sufficient, systemic medications come into consideration. The S3 guideline classifies biologics and JAK inhibitors as important options.¹˒²

Biologics (antibody therapies)

Dupilumab (Dupixent)
Inhibits the signaling pathways of the messenger substances IL-4 and IL-13. Administered subcutaneously. Already approved from a very young age. The safety profile is considered favorable, also in the long term. Has markedly changed the treatment of moderate to severe atopic dermatitis in recent years. Most common side effect: conjunctivitis — usually well treatable. Can also be effective with accompanying asthma.¹˒²
Tralokinumab (Adtralza)
Specifically blocks the messenger substance IL-13. Administered subcutaneously. Approved for adolescents from 12 years and adults.
Lebrikizumab (Ebglyss) — EU approval November 2023
Another anti-IL-13 antibody. EU-approved since November 2023 for adolescents from 12 years (body weight ≥ 40 kg) and adults with moderate to severe atopic dermatitis. After an induction phase, a longer injection interval is usually possible in the maintenance therapy — the exact dosage is always determined by the treating dermatology.²

JAK inhibitors (usually as tablets)

They intervene in the signaling pathways of several inflammatory messenger substances. Possible advantage: often a fast onset of action — especially on the itch. Before the start of therapy and during its course, regular laboratory checks are necessary (blood count, liver values, thromboembolism risk).¹˒²

  • Upadacitinib (Rinvoq) — approved for adolescents from 12 years and adults
  • Abrocitinib (Cibinqo)
  • Baricitinib (Olumiant)

Conventional systemic therapy

Ciclosporin
An immunosuppressant for certain situations. Usually works quickly. According to the guideline, it is mostly more suitable for shorter-term use. Close monitoring is required (kidney values, blood pressure).¹
Systemic corticosteroids — only in exceptional situations They come into consideration only for a short time — not as a permanent therapy. After stopping, a renewed worsening can occur.

More: Drug interactions.

7. Atopic dermatitis in children

Atopic dermatitis is among the most common chronic diseases in childhood.¹˒⁴

  • Cradle cap is often a first sign — however, not every case of cradle cap is automatically atopic dermatitis
  • In many children the disease improves markedly by puberty; a later recurrence is, however, possible
  • Atopic march: Atopic dermatitis can over time appear combined with food allergies, asthma or hay fever — but does not have to
  • Cortisone creams in children: In the right potency and time-limited, they are generally considered safe. The current S3 guideline is clear: a blanket "cortisone fear" is mostly not justified
  • Dupilumab is already approved from a very young age and represents a systemic option for young children with severe atopic dermatitis
  • Blanket elimination diets without medical guidance should be avoided — in children there is otherwise the risk of malnutrition
  • Sleep disturbances due to nighttime itch often burden the whole family — the topic should be addressed early
  • Structured atopic dermatitis education programs (e.g. AGNES) are evidence-based effective and usually covered by health insurance

8. Psychological burden and quality of life

Atopic dermatitis is mostly far more than a skin disease. The "invisible" burden is often underestimated:

  • Sleep disturbances due to nighttime itch lead to chronic tiredness and concentration problems
  • Shame about the appearance of the skin can contribute to social withdrawal (e.g. when swimming or doing sport)
  • Depression and anxiety disorders are described more often in studies with atopic dermatitis than in the general population
  • Stress is considered a common trigger — with the danger of a vicious circle of stress and flares
  • The burden on caregiving parents should also be taken seriously
S3 guideline: actively address mental health The current guideline recommends actively addressing accompanying mental health conditions and treating them if needed. Structured education programs, psychological support and self-help groups can be important building blocks.¹

9. Living with atopic dermatitis

  • Clothing: Smooth, skin-friendly fabrics (e.g. cotton or silk) are usually well tolerated. Rough wool and scratchy synthetics can irritate. Wash laundry with a fragrance-free detergent.
  • Indoor climate: Moderate room temperature and sufficient humidity — especially in winter, when the heated air can additionally dry out the skin.
  • Swimming: Chlorinated water can irritate — apply cream before and after swimming. Salt water is felt to be pleasant by some of those affected.
  • Stress: Relaxation techniques such as progressive muscle relaxation, autogenic training or mindfulness have shown a favorable effect in studies with atopic dermatitis.
  • Work: A hand eczema can be occupationally relevant in jobs with frequent water contact (nursing, cleaning, hairdressing). Skin protection at the workplace and occupational-dermatology counseling can be sensible.
  • Travel: Pack care products in your hand luggage. Mineral, fragrance-free sun protection products in strong sun. More: Medications when travelling.

How brite helps you with atopic dermatitis

From the cortisone cream to the biologic injection — brite keeps the overview and helps you document flares.

  • Intake reminder — cortisone cream, biologic injection or JAK inhibitor: brite reminds you reliably of every dose. Set up a reminder
  • Health history — document flares, itch, possible triggers and sleep quality in a structured way — helpful for the dermatology appointment. Track your history
  • Interaction check — check JAK inhibitors or ciclosporin in combination with other medications for free. Check now
  • Digital medication plan — all medications and care products clearly organized for the dermatology. Go to medication plan
Start now for free
brite App

FAQ: Common questions about atopic dermatitis

In the classic sense, atopic dermatitis is not curable — but it can be well controlled in most of those affected. In many children the disease improves markedly by puberty. Modern therapies (dupilumab, further biologics and JAK inhibitors) can considerably improve quality of life, also in severe courses.¹
No. Atopic dermatitis is a genetically determined skin disease and not an infection. It can be transmitted neither through skin contact nor through shared towels.
With correct use in the right potency, applied thinly and time-limited, modern cortisone creams are generally considered safe — also in children. Skin thinning mostly occurs only with use that is too long or too strong. For sensitive areas (face, eyelids), calcineurin inhibitors are a possible alternative. A blanket cortisone fear is mostly not justified according to the current guideline.¹
Dupilumab is a biologic that specifically inhibits the signaling pathways of the messenger substances IL-4 and IL-13. It is administered subcutaneously, is already approved from a very young age and has markedly changed the treatment of moderate to severe atopic dermatitis. The safety profile is considered favorable, also in the long term. The most common known side effect is conjunctivitis — usually well treatable.¹˒²
Lebrikizumab is an antibody that specifically blocks the messenger substance IL-13. It has been EU-approved since November 2023 for adolescents from 12 years (body weight ≥ 40 kg) and adults with moderate to severe atopic dermatitis. After an induction phase, a longer injection interval is usually possible in the maintenance therapy.²
There is no general "atopic dermatitis diet". Individual food allergies can — especially in infants — trigger flares; the evaluation should be done medically via allergy tests. Blanket elimination diets without medical guidance are not recommended, especially in children.
Yes — cortisone creams and calcineurin inhibitors relieve the itch through their anti-inflammatory effect. Biologics such as dupilumab or IL-13 antibodies act specifically on central inflammatory messenger substances and can considerably reduce the itch. JAK inhibitors act at an even earlier point in the signaling cascade and can often improve the itch especially quickly.¹
Topical cortisone creams and calcineurin inhibitors are generally covered by health insurance. Dupilumab, tralokinumab, lebrikizumab and JAK inhibitors are also usually reimbursed for moderate to severe atopic dermatitis with the corresponding specialist indication. For basic care (care creams), the situation varies and depends, among other things, on age.

12. Related topics

Bronchial asthma Psoriasis Stopping cortisone Drug interactions Side effects of medications Stopping medications

Sources

  1. S3-Leitlinie Atopische Dermatitis (Deutsche Dermatologische Gesellschaft u. a., AWMF Reg-Nr. 013-027). awmf.org
  2. Deutsche Dermatologische Gesellschaft (DDG): Biologika und JAK-Hemmer bei moderater bis schwerer Neurodermitis. derma.de
  3. gesundheitsinformation.de (IQWiG): Neurodermitis (atopisches Ekzem). gesundheitsinformation.de
  4. Deutscher Neurodermitis Bund e. V. neurodermitis-bund.de
  5. Allergie-Centrum Charité: Neurodermitis-Schulung (AGNES). neurodermitisschulung.de
  6. gesundheitsinformation.de (IQWiG): Lebrikizumab (Ebglyss) bei Neurodermitis. gesundheitsinformation.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. The choice of medication, dosage and the selection of a systemic therapy (e.g. biologics or JAK inhibitors) are always determined individually by the treating dermatology. With a severe flare, signs of a skin infection (in particular eczema herpeticatum — an emergency) or with questions about systemic therapy, a dermatology practice should be consulted promptly. Cortisone creams and biologics should not be stopped on one's own. Last updated: April 2026.