What is atopic eczema

Atopic eczema (neurodermatitis)

Atopic eczema, also known as neurodermatitis or atopic dermatitis, is a chronic inflammatory skin disease that progresses in phases. Very dry, itchy skin prone to eczema is typical. The predisposition to this is innate. However, environmental influences, allergies and stress contribute to the onset of the disease or to new flare-ups.

Atopic eczema is a chronic skin disease that occurs in phases. Due to a predisposition-related disruption of the barrier function, the skin is extremely dry, itchy and flaky. In addition, inflammatory reactions occur, causing the skin to crack and wet. Atopic eczema is not contagious. But because the skin's function is disturbed, bacteria and viruses can easily settle and increase inflammation.

The skin symptoms usually appear in early childhood. In a large proportion of children, however, the symptoms disappear by puberty.

The clinical picture of neurodermatitis is very different from patient to patient and also differently pronounced. Most patients suffer from a milder form. Depending on the extent and type of the affected skin areas, atopic eczema can take a severe course that significantly affects the quality of life.

Atopic eczema, together with allergic rhinitis (such as hay fever) and allergic asthma, belongs to the so-called atopic group of forms. Atopy is the congenital tendency to develop one or more of these diseases. However, this does not necessarily mean that every atopic person actually develops one of the three diseases: there is simply a predisposition to it.

Children whose parents suffer from neurodermatitis, asthma or hay fever are significantly more likely to get sick. If both parents are affected by such a disease, the probability is even very high that one child will develop such a disease.

Many people with neurodermatitis also suffer from allergies that can provoke eczema flare-ups. Allergens can be certain bee pollen, animal dander, food or house dust mite feces. But scratchy wool or sweat on the skin can also contribute to a flare-up.

Mental stress such as stress and grief are also triggers for the skin symptoms. This quickly leads to an interplay of eczema and stress, which push each other up further and further.

The clinical picture of atopic eczema is very different from patient to patient and also depends on the age of the person affected. The main symptoms are very dry skin and severe itching, often on typical parts of the body.

Very mild forms of atopic eczema are normal. Typical are cracked, inflamed lips, cracked corners of the mouth and ear lobes, eczema-afflicted regions of the back of the head as well as scaly redness and tears in the area of ​​the fingertips and toes.

With more pronounced manifestations, the affected body regions depend on the age (see below). The repeated or permanent inflammation of the skin, itching and scratching lead to a thickening and thus to a typically changed appearance of the skin. This is particularly noticeable on the face.

The excruciating itching leads to the fact that those affected sometimes scratch themselves bloody. Afterwards the itching is even stronger. Viruses and bacteria can settle particularly well on damaged skin. Skin infections of all kinds are therefore common in people with atopic eczema.

The itching also robs many of those affected from getting a good night's sleep. Sleep disorders lead to difficulty concentrating and irritability. In the case of children, the rest of the family is usually also affected by the nocturnal disturbance of the peace and its side effects.

In addition, there is the emotional stress for the patient from the skin manifestations and their symptoms.

There is no simple test that clearly identifies atopic eczema. The overall picture of the skin symptoms is decisive for the diagnosis. In addition, the doctor asks about the personal and family medical history.

Many people with atopic eczema have allergies that can provoke the flare-ups. It is therefore important to test whether the patient is reacting to some or more allergens.

For the so-called prick test, droplets of dissolved potential allergens are dripped onto the patient's forearm. The doctor lightly scratches the skin at this point with a fine lancet. If the patient has an allergic reaction, wheals develop and itching sets in. Allergies to certain foods, pollen from trees and grass or house dust mites are common.

A blood test can also help track down possible allergies. In this case, special proteins, the immunoglobulins E (IgE), are greatly increased in the blood. These are determined using the RAST (Radio-Allergo-Sorbent Test). The RAST shows whether there is an allergic reaction and, if so, how strong it is. However, a blood test alone does not allow a clear diagnosis.

The most important task of therapy is to improve or restore the impaired barrier function of the skin. This is achieved above all through consistent basic therapy. In addition to avoiding known triggers (allergens, stressful situations), the basic therapy for atopic eczema is consistent skin care: Ointments with their high fat content are suitable for dry skin, creams and lotions with their higher water content for less dry and weeping areas of the skin. Additives such as urea (urea; improves water retention in the skin), ceramides (protective fats) or vegetable oils such as evening primrose seed oil are often helpful. Consistent skin cleansing is also important.

In particular, active creams help during a bout, and there are other treatment options:

  • Glucocorticoids (cortisone): Creams containing cortisone have an anti-inflammatory effect and dampen the excessive immune reaction in the body. They can be dosed depending on the severity, but should not be used permanently because of possible side effects.
  • Topical calcineurin inhibitors (cortisone-free): Creams with the active ingredients tacrolimus and pimecrolimus inhibit the production of messenger substances that stimulate the immune system. They are particularly suitable when glucocorticoids are not effective enough or when eczema occurs on the neck and face. Unlike glucocorticoids, they do not thin the skin over time, so they can be used for a longer period of time.
  • UV light therapy: Light therapy with UVA or UVB rays, carried out around two to three times a week, can significantly reduce the inflammatory symptoms in atopic eczema.
  • Systemic therapy: In the case of pronounced manifestations that cannot be treated satisfactorily with external therapy, internal therapy with various immune-inhibiting drugs can also be considered after careful examination. This therapy must be prescribed on a case-by-case basis and closely monitored by the attending physician.
  • Antihistamines can weaken the allergic reaction. They inhibit the body's own messenger substance histamine. Among other things, histamine leads to itching and other allergic symptoms.
  • Specific immunotherapy (desensitization): In order to get the relapsing allergies under control, specific immunotherapy (desensitization) is sometimes useful. However, this is not used to treat eczema, but to treat allergies to dust, pollen, insect venom or animal hair.
  • Antibiotics / antivirals: If the skin becomes infected, the doctor can prescribe antibiotics or antiviral drugs (antivirals) depending on the pathogen.
  • Stress relief: In addition, learning a relaxation technique helps (e.g. progressive muscle relaxation according to Jacobson, autogenic training). This allows those affected to reduce stress, which further worsens the condition of the skin or can even trigger relapses. Patients who are emotionally stressed by the skin disease should seek psychotherapeutic support.

The unprotected skin of eczema patients offers germs the best conditions. Almost 90 out of 100 patients are colonized by the bacterium Staphylococcus aureus. This is not necessarily associated with inflammatory reactions, but it can also disrupt the function of the skin. Other bacterial and fungal infections are also common. Viruses that cause cold sores or warts, for example, also have an easy time of it.

An important secondary illness is located in the psychological area. The recurring or persistent symptoms with skin changes, itching, sleep disorders can lead to psychosocial problems and even depression.

The long-term external application of creams containing active ingredients or the use of systemic medication can lead to undesirable side effects and secondary diseases. These differ depending on the active ingredient and should be discussed with the practitioner for each individual case.

Atopic eczema changes its appearance in the course of life. In infants, it first shows up in the form of what is known as the cradle cap on the scalp. Later itchy red rashes appear on the face. The neck, the outside of the limbs, and the diaper area are also commonly affected.

Young children mainly suffer from eczema in the arms and knees as well as on the wrists and ankles. In many children, eczema also occurs on the neck. Constant scratching of the itchy eczema foci can thicken the skin.

Atopic dermatitis often improves spontaneously up to school age, but it can return at any age. In adolescents, the disease is usually milder than in children and is characterized by dry skin and eczema. In adults, a special form of neurodermatitis sometimes develops: It is accompanied by very itchy skin lumps all over the body (prurigo form).

Proof of text

  • Author: almeda GmbH
  • Medical quality assurance: Dr. med. Claudia Link, specialist in dermatology


  • Guideline of the German Dermatological Society (DDG): Neurodermatitis, last revision: 04/2008 (S2), www.awmf.org (accessed on July 22, 2015)
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