Atopic dermatitis: where does it come from, what causes inflammation? Causes, symptoms, care.
Atopic dermatitis (AD for short) is a hereditary inflammatory disease, the symptoms of which affect both children and adults. It is also known as atopic eczema or eczema. The first symptoms of atopic dermatitis in children can be noticed during the first 5 years of life, and the disease can appear even in infants.
It's safe to say that atopic dermatitis is already a lifestyle disease —the incidence of atopic dermatitis is highest in developed countries and continues to grow. This article will help you learn about the origins of atopic dermatitis, whether its causes can be identified, what the key symptoms are, and what really works for atopic dermatitis: are wet dressings and petroleum jelly effective skin care methods during a flare-up?
Where does atopic dermatitis come from: causes of the disease
Atopic dermatitis is primarily an "enemy of childhood," affecting 10–20% of young patients , with the disease resolving in most cases (60–90%) before adulthood . Despite this, atopic dermatitis is still present in the adult population, affecting 2,1–4,9% of people [1]. Interestingly, in approximately one-quarter of adult patients with atopic dermatitis, the symptoms appear as a completely new health problem (i.e., the patient did not suffer from this condition in childhood, and the first symptoms appeared only later in life).
Where does atopic dermatitis come from, and what factors contribute to the development of this chronic disease?
Causes of atopic dermatitis
Instead of a single, simple cause of atopic dermatitis , we usually encounter complex interactions between several factors that together create a "vicious cycle of inflammation ." Imagine your child's skin is a defensive wall. In atopic dermatitis, this wall is breached, and the defense mechanisms overreact. Where does atopic dermatitis come from?
Experts point to four main causes – groups of disorders that overlap:
🔹 Epidermal barrier defect (i.e., the aforementioned "leaky skin wall"): This is a key element and the main cause of skin problems. In patients with atopic dermatitis, the epidermal barrier is defective. This means that the epidermis is unable to adequately protect the body from external factors or maintain proper hydration. When this "lipid barrier" is damaged, water loss and irritants and allergens can easily penetrate.
🔹 Genetic disorders : Susceptibility to atopic dermatitis is often inherited. Inherited genetic predispositions affect the structure and function of the skin.
🔹 Immune dysfunction (overly aggressive alarm system): In patients with atopic dermatitis, the immune system exhibits abnormal activity, particularly the Th2 system. This leads to excessive production of proinflammatory cytokines (such as IL-4 and IL-13), which fuel the bothersome symptoms of inflammation and itching.
🔹 Microbiological disorders : This refers to disturbances in the skin's bacterial flora, or microbiome. Patients with atopic dermatitis are particularly susceptible to colonization (settlement) or infection with a pathogen, most commonly Staphylococcus aureus.
Other causes? The development and course of atopic dermatitis are influenced by numerous environmental and individual factors that exacerbate inflammation and disease symptoms.
You already know where atopic dermatitis comes from and that the etiology of this disease is often complex. However, it's worth knowing that the disease progresses with periods of exacerbation and remission (symptoms subside) for several years, and in most cases , it disappears when the child reaches puberty.
What causes atopic dermatitis symptoms? Can food or inhalant allergies exacerbate atopic dermatitis?
The answer is clear: yes, both food and inhalant allergies are the most common factors exacerbating atopic dermatitis (AD), which is crucial in conducting therapy and eliminating bothersome symptoms.
Expert advises
AD is often compared to the "atopic march" because it is the first step in the development of other allergic diseases, such as allergic rhinitis or bronchial asthma. In this complex process, the patient's immune system becomes hypersensitive – and this reaction manifests itself on the skin.
Causes of atopic dermatitis: food allergens and their relationship to the disease
Food allergens have the greatest impact on skin condition in young children and infants. However, when considering the causes of atopic dermatitis and the exacerbation of inflammation, it's important to remember that the patient's age plays a significant role in the context of allergens:
🔹 Babies and toddlers (up to 5 years of age):
Approximately 20–40% of the youngest patients with atopic dermatitis are diagnosed with a coexisting food allergy [1,2]. Clinical studies show that in approximately 50% of them, skin lesions are exacerbated by the consumption of allergenic foods. The most common are cow's milk and egg white proteins (so-called classic food allergens), as well as fish, peanuts, soy, and wheat [1].
🔹 Older children, adolescents and adults:
In this age group, reactions to classic food allergens are less common. Exacerbations are often the result of "allergic cross-reactions ," caused by simultaneous sensitization to plant pollen allergens (inhalants) and specific foods.
If the relationship between food hypersensitivity and atopic dermatitis is clinically confirmed, a temporary elimination diet is recommended, preferably in consultation with a doctor and an experienced dietitian.
What Causes Atopic Dermatitis? Inhalant Allergy: Adults' Main Enemy
While young children primarily react to foods , in older children and adults, airborne allergens are considered the most common cause of atopic dermatitis exacerbation. The skin of people with atopic dermatitis, who are prone to allergic reactions (IgE-dependent), is very sensitive to airborne agents. What exactly, or what inhaled agents, exacerbate skin inflammation?
These allergens include:
- House dust mites
- Plant pollen
- Animal hair
- Molds
- Cockroaches and human skin
Once you know causes exacerbation of inflammation in atopic dermatitis, you may now be wondering what to do next, how to help your child?
Expert advises
Avoiding contact with specific allergens is essential in the treatment of atopic dermatitis. In patients whose skin is not adequately treated with topical treatments and whose allergy to inhalant allergens is confirmed by testing, the doctor may recommend allergen-specific immunotherapy (SIT). The best-documented clinical effects of SIT are achieved in patients allergic to house dust mites and pollen.
In summary: AD is a relapsing disease. Effective symptom control requires close collaboration with a physician and avoidance of identified exacerbating factors , which in individual patients may be both dietary and inhaled.
AD: symptoms in infants and older children
The main symptoms of atopic dermatitis are severe and persistent itching and dryness and roughness of the skin without a hydrolipid coat.
Expert advises
In infants from 3 months of age and children up to 3 years of age, symptoms in the form of erythematous lesions, known as atopic eczema, most often appear on the cheeks, scalp, trunk, and extremities (primarily on the extensor side). Interestingly, atopic dermatitis in infants usually does not affect the skin under the diaper. In older children, skin lesions usually affect the inside of the elbows and knees, the neck, wrists, ankles, and around the mouth and eyes.
Constant itching of the skin forces the child to scratch , which leads to increased inflammation and bacterial infections , mainly caused by Staphylococcus aureus bacteria , resulting in skin lesions in the form of scabs and weeping lesions.
You already know where atopic dermatitis comes from and what symptoms it causes, but due to the difficulties in diagnosing and differentiating skin diseases in children, we encourage you to read our article on the symptoms of seborrheic dermatitis.
Atopic skin care: what about atopic dermatitis? Are petroleum jelly and wet dressings a good idea?
Proper atopic skin care is not a supplement to therapy, but a pillar of treatment , essential in the patient's daily routine. Let's look at two fundamental methods of supporting skin with atopic dermatitis.
What about atopic dermatitis? Emollients as the foundation of care.
Emollients are the foundation of care for every atopic dermatitis patient . Although classic Vaseline , as one of the greasiest ingredients, isn't the only solution, it perfectly illustrates the purpose of emollients – lubrication and sealing.
Why are emollients crucial + what can replace classic Vaseline?
🔹 Rebuilding the lipid barrier (passive and active action):
Emollients, especially active ones (containing physiological fats such as ceramides, cholesterol, and free fatty acids), are designed to reconstruct the skin's lipid barrier . In caring for atopic skin in children, traditional petroleum jelly (a synthetic emollient) can be replaced with skin-friendly, natural, and active emollients—read more about emollients in our other article.
🔹 Reduction of itching and inflammation:
Moisturizing dry skin significantly reduces itching and helps soothe inflammation. It also restores proper hydration of the epidermis.
🔹 Steroid Sparing Effects :
Regular and systematic application of emollients (recommended 3–4 times a day) helps keep the skin in better condition, which reduces the need and frequency of use of topical glucocorticosteroids (TCS).
Remember that lasting improvement in the skin's barrier function is achieved only after 2–4 weeks of systematic use of emollients. This article provides more information on what works best for atopic dermatitis – cosmetics for atopic dermatitis skin care.
Recommended products
Pharmacologist, Chief expert in the field of opinions on cosmetics, medical devices, washing and rinsing agents and biocides, Institute of Mother and Child
Atopic skin care: Whether and when to use wet dressings (Wet-Wrap Treatment) make sense?
Wet dressings (WWT) are an intensive, short-term emergency treatment used in emergency situations, not for everyday atopic skin care . How do wet dressings work and when are they used?
- For whom:
This method is recommended primarily for children aged 6 months to 10 years with severe atopic dermatitis (when the SCORAD index exceeds 50).
- Procedure:
The therapy involves applying two layers: a wet dressing soaked in an emollient (or topical corticosteroids in the case of a severe flare) and a dry layer on top. This method is performed for 3–14 days under strict medical supervision.
- Key Benefits:
Wet dressings produce a spectacular therapeutic effect (observable after just one week). They have a cooling, anti-inflammatory, and anti-itching effect . Additionally, they create a mechanical barrier that protects the child from unconscious scratching.
Expert advises
Caution should be exercised because the use of TCS under occlusion (wet dressing) increases the absorption of the drug, which in the case of long-term therapy may be associated with an increased risk of side effects, e.g. adrenal suppression.
To sum up, the topic " What to do for atopic dermatitis ": emollients are a daily reinforcement for the skin barrier, while wet dressings are an "emergency first aid kit" for severe and treatment-resistant exacerbations of atopic dermatitis symptoms.
Bibliography:
- Nowicki RJ, Trzeciak M., Rudnicka L. et al., Biological drugs in the treatment of atopic dermatitis – recommendations of the Polish Dermatological Society, the Polish Allergology Society, the Polish Pediatric Society and the Polish Society of Family Medicine, "Alergologia Polska - Polish Journal of Allergology", 2020, volume 7, pp. 171-179
- Nowicki R., Trzeciak M., Wilkowska A. et al., Atopic dermatitis – current therapeutic guidelines. Expert opinion from the Dermatology Section of the Polish Society of Allergology and the Allergology Section of the Polish Society of Dermatology., "Progress in Dermatology and Allergology" (Postep Derm Alergol), 2015, XXXII (4)
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