Atopic Dermatitis:
Symptoms, Triggers & Modern Treatment

At a glance

Affected in Germany Several million; children affected considerably more often than adults
Other names Atopic eczema, eczema (in German: Neurodermitis)
Atopic triad Atopic dermatitis, asthma and hay fever — often occur together
Course Chronic with flares; improves significantly by puberty in many children
Medications (selection) Corticosteroid creams, 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 cycle
  4. Diagnosis
  5. Base therapy: skincare
  6. Medications: step therapy
  7. Atopic dermatitis in children
  8. Mental strain 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-speaking countries Neurodermitis) is a chronic inflammatory skin disease. It belongs to the group of atopic conditions — together with asthma and hay fever (the so-called atopic triad). Some of those affected also have an allergic component.

Typical features are extremely dry, itchy skin with inflammatory skin changes that usually occur in flares. The often distressing itch is considered the cardinal symptom and is experienced by many as the greatest burden.¹˒³

An estimated several million people are affected in Germany — children much more often than adults. In many children, the condition improves significantly by puberty.¹˒⁴

Important: atopic dermatitis is NOT contagious The condition has a strong genetic component — those affected are born with the predisposition. It cannot be transmitted by skin contact, shared towels or through the air.

2. Symptoms and distribution by age

Cardinal symptom: itch

Intense itch is the main symptom and often the greatest burden. It is often particularly pronounced at night and during flares — and can lead to sleep problems, exhaustion, problems with concentration and psychological strain. Scratching can further damage the skin and drive the typical vicious cycle on.

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 chronic disease
  • Scratch marks, crusting and occasional secondary skin infections

Distribution by age — typical and diagnostically important

Infants From around 3 months of age — face and extensor sides

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

Children 2–12 Flexural eczema — inner elbows, behind the knees

The inner elbows, the backs of the knees (so-called flexural eczema), wrists, the nape of the neck and the tops of the feet are commonly affected.

Adolescents & adults Hands, face, neck — often with lichenification

Often on the hands (hand eczema can have occupational implications), but also on the face, neck, nape and upper chest. Eyelids and lips are not uncommonly involved as well. Lichenification (leathery thickening of the skin) is 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 it can respond to antifungal therapy.

3. Causes, triggers and the vicious cycle

Genetic basis

  • Most of those affected have relatives with atopic conditions (atopic dermatitis, asthma, hay fever)
  • A relevant proportion of those affected have variants in the filaggrin gene, which is responsible for an important skin-barrier protein — the result can be an impaired skin barrier through which irritants and allergens can enter more easily
  • The immune system typically reacts in an overactive way (Th2 response) — with increased release of messengers such as IL-4, IL-13 and IL-31. Modern biologics target these structures¹

Typical triggers

  • Irritants: Wool, rough synthetic fabrics, harsh soaps or detergents, perfume, disinfectants
  • Climate: Cold and dry indoor heating in winter, sweating in summer, rapid temperature changes
  • Allergens: e.g. dust mites, pollen, animal dander, mold
  • Foods: Relevant in individual cases in infants and young children (e.g. cow's milk, hen's egg); rarer in adults
  • Bacteria: The skin is often heavily colonized with Staphylococcus aureus — which can intensify inflammation and itch
  • Stress and psychological strain — one of the most common triggers for flares
  • Infections: Even minor infections can trigger flares
Emergency: eczema herpeticum An infection with herpes simplex viruses on already affected skin is a medical emergency. With sudden painful, blister-like skin changes with fever, seek medical help immediately.
The vicious cycle Impaired skin barrier → irritants get in → immune system overreacts → inflammation → itch → scratching → skin barrier further damaged → and around again. Treatment generally needs to act at several points.

4. Diagnosis

The diagnosis is generally made clinically — there is no single lab test that definitively proves atopic dermatitis.¹

  • Clinical diagnosis: Marked itch, age-dependent distribution, a chronic relapsing course, personal or family history of atopy. Additionally: generally dry skin, elevated IgE level.
  • Severity assessment: Standardized scores (e.g. SCORAD or EASI) assess extent and intensity — important for choosing the treatment step.
  • Trigger work-up: Allergy tests (skin prick test or specific IgE in the blood) only with concrete clinical suspicion — blanket screening tests without suspicion are usually not useful.¹
Differential diagnoses Contact dermatitis, psoriasis, scabies, fungal skin infections or seborrheic dermatitis.

Learn more: Preparing for a doctor's appointment.

5. Base therapy: skincare — the foundation

Consistent daily skincare is generally the foundation of any treatment for atopic dermatitis — also in flare-free periods. Without good base skincare, medications usually work less well too. The aim is to support the impaired skin barrier and supply the skin with adequate moisture.¹˒³

  • Usually apply moisturizer twice a day — to the whole body, not just the affected areas. A rich, fragrance-free emollient is recommended.
  • In winter, often a richer formulation (e.g. water-in-oil emulsion); in summer, lighter, more water-based creams.
  • Avoid perfume, fragrances, certain preservatives and essential oils where possible.
  • Urea can bind moisture — but it can sting in acute flares. Alternatives: glycerin- or ceramide-containing products.
  • Keep baths and showers short, lukewarm rather than hot. Moisturizing wash lotions are usually better tolerated than classic soaps.
  • Apply moisturizer soon after bathing — absorption is usually best then.
Common mistake: using too little moisturizer The amount may generally be generous. Using too little is much more often a problem than using too much.

6. Medications: step therapy

Which treatment makes sense in any particular case is always decided by your treating dermatology team — usually based on severity and the individual situation. The current S3 guideline describes a step-by-step scheme in which base therapy continues at every step.¹

Step 1 Dry skin without inflammation — base therapy

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

Step 2 Mild to moderate eczema — topical therapy
Topical corticosteroids (cortisone creams)
Considered one of the most important anti-inflammatory treatments for flares. Different potencies: mild products for the face or for children, stronger ones for thick, chronic patches on the body.
Proactive therapy (S3 guideline): After healing, treatment is continued at previously affected sites at a markedly lower frequency — to prevent flares.
Used correctly and under medical guidance, modern cortisone preparations are generally considered safe — also in children. Skin thinning usually occurs only with too long or too strong use.¹
Calcineurin inhibitors — tacrolimus and pimecrolimus
An alternative to cortisone — especially for sensitive areas: face, eyelids, genital area, skin folds. No risk of skin thinning. According to the guideline, they are also suitable for proactive therapy. Burning during the first applications is possible and usually subsides after a few days.¹
Learn more: Stopping cortisone.
Topical JAK inhibitor — ruxolitinib cream
A topical option for certain patient groups. Can often relieve itch quickly. No risk of skin thinning. The exact indication and duration are always determined by your treating dermatology team.
Steps 3–4 Moderate to severe atopic dermatitis — systemic therapy

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

Biologics (antibody therapies)

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

JAK inhibitors (usually as tablets)

They intervene in the signaling pathways of multiple inflammatory messengers. Possible advantage: often a fast onset of action — particularly on itch. Before starting and during treatment, regular blood tests are needed (blood count, liver values, thromboembolism risk).¹˒²

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

Conventional systemic therapy

Cyclosporine
An immunosuppressant for certain situations. Generally acts 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 Considered only short-term — not as long-term therapy. After stopping, the condition can rebound.

Learn more: Medication interactions.

7. Atopic dermatitis in children

Atopic dermatitis is one of the most common chronic conditions in childhood.¹˒⁴

  • Cradle cap is often a first sign — but not every case of cradle cap is automatically atopic dermatitis
  • In many children, the condition improves significantly by puberty; later recurrence is possible, however
  • Atopic march: Atopic dermatitis can occur over time together with food allergies, asthma or hay fever — but it doesn't have to
  • Cortisone creams in children: At the correct strength and for a limited time, they are generally considered safe. The current S3 guideline is clear: a blanket "fear of cortisone" is usually not justified
  • Dupilumab is approved from a very young age and is a systemic option for young children with severe atopic dermatitis
  • Blanket elimination diets without medical supervision should be avoided — in children, this otherwise risks malnutrition
  • Sleep problems from nighttime itch often burden the whole family — this should be raised early
  • Structured atopic dermatitis education programs (e.g. AGNES, in Germany) are evidence-based and usually covered by statutory health insurance

8. Mental strain and quality of life

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

  • Sleep problems from nighttime itch lead to chronic fatigue and problems with concentration
  • Shame about how the skin looks can contribute to social withdrawal (e.g. when swimming or doing sport)
  • Depression and anxiety disorders are described more often in studies in atopic dermatitis than in the general population
  • Stress is considered a common trigger — with the risk of a vicious cycle of stress and flare
  • The burden on caring parents should also be taken seriously
S3 guideline: raise mental health actively 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 fragrance-free detergent.
  • Indoor climate: Moderate room temperature and adequate humidity — especially in winter, when indoor heating can dry the skin out further.
  • Swimming: Chlorinated water can irritate — moisturize before and after swimming. Salt water is experienced as pleasant by some.
  • Stress: Relaxation techniques such as progressive muscle relaxation, autogenic training or mindfulness have shown a beneficial effect in atopic dermatitis in studies.
  • Work: Hand eczema can have occupational implications in jobs with frequent water contact (nursing, cleaning, hairdressing). Workplace skin protection and occupational dermatology advice can be helpful.
  • Travel: Pack skincare products in your carry-on. Mineral, fragrance-free sunscreens in strong sun. Learn more: Medication when traveling.

How brite helps you with atopic dermatitis

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

  • Medication reminders — Cortisone cream, biologic injection or JAK inhibitor: brite reliably reminds you of every dose. Set up a reminder
  • Health tracking — Document flares, itch, possible triggers and sleep quality in a structured way — useful for the dermatology appointment. Track your history
  • Interaction check — Check JAK inhibitors or cyclosporine in combination with other medications for free. Check now
  • Digital medication plan — all medications and skincare products clearly laid out for your dermatology team. Go to medication plan
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FAQ: Common questions about atopic dermatitis

In the classic sense, atopic dermatitis is not curable — but it can be well controlled in most people affected. In many children, the condition improves significantly by puberty. Modern therapies (dupilumab, further biologics and JAK inhibitors) can also significantly improve quality of life in severe cases.¹
No. Atopic dermatitis is a genetically determined skin condition and not an infection. It cannot be transmitted by skin contact or by shared towels.
Used correctly at the right strength, applied thinly and for a limited time, modern cortisone creams are generally considered safe — including in children. Skin thinning usually occurs only with too long or too strong use. For sensitive areas (face, eyelids), calcineurin inhibitors are a possible alternative. A blanket fear of cortisone is, according to the current guideline, usually not justified.¹
Dupilumab is a biologic that specifically inhibits the signaling pathways of the messengers IL-4 and IL-13. It is given subcutaneously, approved from a very young age and has significantly 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 — generally well treatable.¹˒²
Lebrikizumab is an antibody that specifically blocks the messenger 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 generally possible in maintenance therapy.²
There is no general "atopic dermatitis diet." Individual food allergies can trigger flares — especially in infants; this should be evaluated medically with allergy tests. Blanket elimination diets without medical supervision are not advisable, particularly 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 messengers and can significantly reduce the itch. JAK inhibitors target an even earlier point in the signaling cascade and can often improve itch particularly quickly.¹
Topical cortisone creams and calcineurin inhibitors are generally covered by statutory health insurance. Dupilumab, tralokinumab, lebrikizumab and JAK inhibitors are also generally reimbursed for moderate to severe atopic dermatitis with the corresponding specialist indication. For base skincare (moisturizing creams), the situation varies and depends, among other things, on age. (German statutory health insurance system; rules differ in other countries.)

12. Related topics

Asthma Psoriasis Stopping cortisone Medication interactions Medication side effects Stopping medication

Sources

  1. S3 Guideline on Atopic Dermatitis (German Dermatological Society et al., AWMF reg. no. 013-027). awmf.org
  2. German Dermatological Society (DDG): Biologics and JAK Inhibitors in Moderate to Severe Atopic Dermatitis. derma.de
  3. gesundheitsinformation.de (IQWiG): Atopic Dermatitis (Atopic Eczema). gesundheitsinformation.de
  4. Deutscher Neurodermitis Bund e. V. (German Atopic Dermatitis Association). neurodermitis-bund.de
  5. Allergie-Centrum Charité: Atopic Dermatitis Education Program (AGNES). neurodermitisschulung.de
  6. gesundheitsinformation.de (IQWiG): Lebrikizumab (Ebglyss) in Atopic Dermatitis. gesundheitsinformation.de
Medical disclaimer: This article is for general information only and is not a substitute for medical advice, diagnosis or treatment. The choice of medication, dosing and any systemic therapy (e.g. biologics or JAK inhibitors) are always determined individually by your treating dermatology team. With a severe flare, signs of a skin infection (especially eczema herpeticum — an emergency) or questions about systemic therapy, see a dermatology practice promptly. Cortisone creams and biologics should not be stopped on your own. Last updated: April 2026.