Atopic Dermatitis

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Atopic dermatitis is one of the most common chronic conditions in childhood. In Switzerland and other Western countries, an estimated 10–20% of children and 1–5% of adults are affected. For many children, the condition improves during puberty, while for others, it persists into adulthood.

Symptoms can vary depending on age, body location, and severity. Typical signs include:

• Severe itching, often at night
• Red, dry, and flaky skin
• Thickened, cracked, or leathery skin (in chronic cases)
• Weeping and crusting during acute flare-ups
• Scratch marks from intense scratching

Typical locations depending on age:

• Infants: cheeks, scalp, extensor surfaces of the arms and legs
• Children: Elbow creases, backs of the knees, wrists, neck
• Adults: Elbows, backs of the knees, face, hands, neck

Atopic dermatitis is caused by a combination of several factors:

Atopic dermatitis tends to run in families. If one or both parents have atopy (a predisposition to allergies), the child’s risk is increased.

In affected individuals, the skin's protective function is impaired. The skin loses moisture more easily and is more permeable to allergens and irritants.

The immune system reacts hypersensitively to certain substances, triggering inflammatory reactions in the skin.

Possible triggers for flare-ups (vary from person to person):

• Dry air, cold, or heat
• Certain fabrics (e.g., wool, synthetic fibers)
• House dust mites, pet dander, pollen
• Certain foods (e.g., chicken eggs, cow’s milk, nuts—especially in children)
• Stress and psychological strain
• Perfumes, preservatives in cosmetics
• Sweat and friction

The treatment of atopic dermatitis is tailored to the individual and is supervised by a doctor. It aims to alleviate flare-ups, reduce their frequency, and strengthen the skin barrier over the long term. Generally, a distinction is made between:

Regular care of dry skin is the most important measure, even between flare-ups:

• Moisturizing, fragrance-free creams or ointments (emollients)
• Short, lukewarm baths or showers
• Apply moisturizer immediately after showering or bathing, while the skin is still slightly damp
• Avoiding irritating ingredients in skincare products

• Creams or ointments containing cortisone (corticosteroids) for a limited time and under medical supervision
• Calcineurin inhibitors (e.g., tacrolimus, pimecrolimus) as a cortisone-sparing alternative (prescription required)
• Moist compresses to cool the skin and relieve itching
• Systemic therapy (for severe cases)

In cases of severe atopic dermatitis that does not respond adequately to topical treatments, systemic therapies may be used—e.g., biologics (such as dupilumab) or other immunomodulatory agents. These are prescribed by specialized physicians.

• Identifying and Avoiding Individual Triggers
• Hypoallergenic Bedding for House Dust Mite Allergies
• Appropriate clothing choices (prefer cotton)
• Desensitization

Atopic dermatitis often begins in infancy or early childhood. In babies, it usually first appears on the face, especially on the cheeks. The severe itching can interfere with children’s sleep and development and also places a burden on the entire family.

Medical supervision is particularly important for children with atopic dermatitis, as treatment and skin care must be tailored to the child’s age and weight. Some children outgrow atopic dermatitis—however, it is not possible to predict this with certainty.

Chronic itching, sleep deprivation, and visible skin changes can significantly impair the quality of life for those affected. At the same time, stress is considered a common trigger for flare-ups. This connection between psychological stress and skin condition can create a vicious cycle.

If the condition causes ongoing psychological distress, it is advisable to discuss this with your doctor as part of your medical care.

Skin conditions such as atopic dermatitis are among the common concerns for which a telemedical evaluation may be possible. By reviewing photographs of the affected skin areas, doctors can make an initial assessment—for example, to evaluate an acute flare-up or to monitor the progression of a known condition.

A telemedical evaluation typically takes into account photos of the affected skin areas as well as information on symptoms, duration, previous treatment, pre-existing conditions, and any potential triggers.

Whether a telemedicine consultation is appropriate in a particular case depends on the severity of the flare-up and the patient’s individual situation and is determined by the treating physicians. In cases of very extensive flare-ups, suspected secondary infection, or in children with severe symptoms, a physical examination is generally indicated.