Atopic eczema in adults: symptoms, causes & treatment

Atopic eczema, also known as constitutional eczema, is a long-term inflammatory skin disease characterized by periods of itching, redness, and dryness. It is one of the most common skin conditions among adults and can significantly affect your daily life.

The disorder is caused by a combination of genetic predisposition and environmental factors. The word “atopic” refers to an inherited tendency to develop allergic diseases. If you have atopic eczema, you are more likely to also suffer from other atopic conditions such as asthma, hay fever, or food allergies. These disorders often run in the same family.

In atopic eczema, your skin barrier does not work optimally. Healthy skin forms a strong protective layer that retains moisture and keeps harmful substances out. In people with atopic eczema, this barrier is weakened, causing the skin to dry out more quickly and become more sensitive to external stimuli. This explains why your skin reacts so strongly to things that other people barely notice.

It is important to know that atopic eczema is not contagious. You can't transfer it to others and you won't get it from someone else. The condition has everything to do with how your own skin and immune system function.

Although atopic eczema often starts in childhood, it can also appear for the first time in adulthood. In many people who had it as children, the condition improves during puberty. However, about half of the disease appears to recur later in life or remains present in a milder form.

The exact cause of atopic eczema has not yet been fully elucidated, but we do know that several factors play a role in the development and worsening of the condition.

Hereditary predisposition

The most important factor is heredity. If one or both parents have atopic eczema, asthma, or hay fever, you are much more likely to develop atopic eczema yourself. This genetic predisposition ensures that your skin reacts differently to environmental stimuli and that your immune system is hypersensitive.

Disrupted skin barrier

In people with atopic eczema, the skin does not produce enough lipids (fats) and moisture-binding substances. As a result, the outer layer of your skin cannot perform its protective function properly. Moisture evaporates faster, the skin dries out and allergens and irritants can penetrate more easily.

Immune system

Your immune system also plays an important role. In atopic eczema, the immune system reacts too strongly to certain stimuli, leading to inflammatory reactions in the skin. These inflammations cause the typical red, swollen and itchy areas.

Triggering factors (triggers)

Atopic eczema progresses in flares, alternating periods of serious symptoms with quieter periods. Various factors can trigger such an upsurge. Skin irritation due to sweating, scratching, rough clothing, or frequent washing with soap and water may make symptoms worse. As a result, the skin dries out further and becomes more damaged.

Stress and emotional tension can also cause or worsen an upsurge. It is often a vicious cycle: stress worsens the eczema, and eczema in turn causes more stress due to itching, appearance and discomfort.

Allergic reactions play a role in some people. Allergies to dust mites, pets, certain foods, or pollen can make eczema worse in sensitive people. However, it's important to know that not everyone with atopic eczema has allergies, and that avoiding allergens doesn't improve everyone.

Climate and seasons also have an influence. Many people notice that their eczema gets worse in the winter, when the air is drier and there is a lot of heating inside. Summer can have both positive and negative effects: sunlight can be healing, but sweating actually makes eczema worse.

The most important and bothersome symptom of atopic eczema is a chronic, itchy rash. This itch can be so intense that it interferes with your sleep and affects your concentration during the day. The urge to scratch is often irresistible, but scratching worsens eczema and can lead to wounds and infections.

External features

The rash in atopic eczema may look different, depending on the phase and severity. You can often see red spots on dry, scaly skin. The skin can feel rough and thickened, especially in areas where eczema has been around for a long time. Sometimes small blisters or bumps form from which fluid can come out, which is called wet eczema. This moisture dries up over time and forms scabs.

Continuous scratching often causes scratch wounds and skin damage. These wounds can become infected with bacteria, which can be recognized by suppuration and yellowish scabs. After the eczema has healed, scars or discolorations may remain.

Difference in skin color

In people with lighter skin, the eczema is often bright red. In dark-skinned people, the eczema may look purple, dark brown, or gray. Dark or lighter spots can also occur after healing, although they usually fade over time.

Physical sensations

In addition to itching, there may be other unpleasant sensations. The skin may feel tight, burn, or sore, especially when cracks occur. These cracks often occur in areas that move a lot, such as the knuckles of your fingers or in your knee cavities.

Psychological impact

The continuous itching, the visible nature of the disorder and the unpredictability of outbreaks can take a severe psychological toll. Many people with atopic eczema experience feelings of shame, embarrassment, or even depression. Insomnia due to nocturnal itching can lead to tiredness and irritability during the day. It is a vicious cycle in which stress worsens the eczema and the eczema in turn causes more stress.

In adults, atopic eczema often appears in specific, characteristic areas of the body. By knowing where the eczema typically occurs, doctors can make the diagnosis easier.

Typical locations

The most common areas of atopic eczema in adults are the face, neck, eyelids, popliteal cavities, and inside elbows. Common to these areas is that the skin there is thinner and more sensitive, and that they often come into contact with irritants or exercise a lot.

On the face, eczema can mainly occur around the eyes, cheeks and around the mouth. The eczema on the eyelids can be particularly difficult because the skin there is so thin and sensitive. On the neck, it often occurs in the folds and in areas that come into contact with clothing or jewelry.

The hands and wrists are also common areas, especially among people who work a lot with water, soap or chemicals. The eczema on the hands can range from dry, scaly patches to painful, deep cracks.

Spread over the body

Atopic eczema can also spread to other parts of the body, such as the torso, arms, and legs. In severe cases, it can occur over large areas of the body. The rash is often symmetrical, which means that the same areas are affected on both sides of the body.

Skin folds are sensitive areas where eczema often occurs. This is because these areas are warm and humid due to sweating, and there is a lot of friction. Think of the armpits, the groin, under the breasts or in abdominal folds.

The most important thing to know is that atopic eczema is a chronic condition that cannot be completely cured. The treatment therefore focuses on two main goals: taking good care of your skin to restore its barrier function, and treating flares to relieve symptoms.

Daily skin care

The basis of each treatment is to moisturize your skin daily, even if you don't have active eczema. Hydrating creams, ointments, lotions, and bath oils help keep your skin moist and strengthen the skin barrier. You can use these products as often as needed, multiple times a day if your skin benefits.

The best time to hydrate is right after showering or bathing, when your skin is still moist. Gently pat your skin dry and then apply your hydrating product right away. Ointment is often more effective than cream for very dry skin because ointment contains more fat and evaporates less quickly.

Preferably choose hypoallergenic products without perfume, colorants and preservatives. These substances can irritate the skin extra. Many pharmacists can also make customized moisturizers, often based on cetomacrogol or urea. By the way, an expensive product is not necessarily better than a simple base cream.

Treatment of flares

When you have a flare-up, your doctor usually prescribes cortisone creams or ointments. Cortisone is a powerful anti-inflammatory that helps reduce redness, swelling, and itching. There are different strengths of cortisone, and your doctor will choose the right strength depending on the severity of your eczema and where it is on your body. Facial skin, for example, gets a milder cortisone preparation than the skin on your legs.

It's important to use cortisone products exactly as your doctor has prescribed. Some people occasionally need to use low-dose cortisone cream preventively to prevent new flare-ups. This is called maintenance therapy.

Complementary treatments

If you have chronic severe eczema with frequent flare-ups, your doctor may consider other treatment options. Light therapy (phototherapy) can help by reducing the inflammatory response in the skin. This exposes your skin to specific types of UV light under medical supervision.

There are also creams and medicines available that act on your immune system. These are usually prescribed by a dermatologist when other treatments have insufficient effect. While using these agents, you should be careful about exposure to sunlight.

Dietary supplements are sometimes recommended for eczema, but scientific research shows that they usually do not significantly improve the symptoms.

Treatment duration and expectations

The duration of a treatment varies greatly from person to person. Some people have sufficient control over their symptoms with good skin care and occasional cortisone cream. Others require more intensive, long-term treatment. It's a matter of patience and finding what works best for you.

Unfortunately, there are many misunderstandings and myths about atopic eczema and its treatment. It's important to know what isn't effective so you don't waste time and money on useless treatments.

It won't go away by itself

Some people think that atopic eczema goes away on its own as you become an adult, but this isn't always the case. Although it does indeed decrease in many people after puberty, around half of the people with pediatric eczema continue to suffer from it as adults. Without good skin care and treatment, eczema will not improve.

Diet is not the solution

A common misunderstanding is that a special diet or avoiding certain foods will cure eczema. For most people with atopic eczema, diet plays no role. Avoiding that specific food can only help with a proven food allergy, but this only occurs in a small group. Restrictive diets without a medical indication can even be harmful and lead to deficiencies in important nutrients.

Too much washing worsens it

While hygiene is important, washing too often can actually make your eczema worse. Showering or bathing daily, especially with warm water and plenty of soap, dehydrates your skin and further weakens the skin barrier. Limit yourself to taking a short shower two to three times a week with lukewarm water and use as little soap as possible. Bath oil can help prevent dehydration.

Tanning bed is not a treatment

Some people think that tanning beds help against eczema because natural sunlight sometimes has a beneficial effect. However, tanning beds are strongly discouraged because they can cause other skin problems and increase the risk of skin cancer. If you benefit from light, get referred to a dermatologist for medical light therapy.

Alternative treatments without evidence

There are many alternative treatments being touted for eczema, from specialty creams to homeopathy. Most of these treatments have no scientific evidence of effectiveness. Some may even be harmful or cause allergic reactions. Always talk to your doctor before trying new treatments.

Is Atopic Eczema Contagious?

No, atopic eczema is definitely not contagious. You can't transfer it to others through touch, sharing towels, or other forms of contact. It is a disorder that results from your own genetic predisposition and how your immune system functions. Even when eczema becomes infected with bacteria, the underlying condition remains non-transmissible.

How long does a surge last?

The duration of a flare-up varies widely from person to person and depends on various factors, such as how quickly your treatment starts, how consistently you care for your skin, and whether you can avoid the triggering factor. With treatment, mild flare-ups can improve within one to two weeks. Severe flares can take four to six weeks or longer to fully heal. Without treatment, a flare-up can last for months.

Can atopic eczema be prevented?

You cannot change the genetic predisposition to atopic eczema, but you can take measures to reduce and make them less serious. Good daily skin care with hydrating products is essential. Try to avoid familiar triggers, such as excessive sweating, stress, or contact with irritants. Wear soft, breathable clothing and don't keep your home too warm. These measures can make the difference between frequent serious outbreaks and easily manageable complaints.

When do you need to see a doctor?

See your doctor if you first develop symptoms of eczema and aren't sure what it is. Also visit your doctor if your familiar eczema suddenly gets worse, does not respond to your usual treatment, shows signs of infection such as festering or yellow scabs, or if the itching is so severe that it seriously affects your sleep and daily functioning. If your eczema is emotionally difficult for you, it is also important to discuss this with your doctor.

Will eczema always come back?

Atopic eczema is a chronic condition, which means that the predisposition to it persists for life. However, this does not mean that you will always have equally serious complaints. Many people learn how to deal with their eczema better over time and discover what works for them. With good skin care and avoiding triggers, some people can have long periods without significant complaints. Others require continuous treatment to control the condition. The course is different for everyone.

Does atopic eczema affect my career choice?

Certain occupations can make your eczema worse or more difficult to treat. Work that involves frequent hand washing, contact with chemicals, or working in extremely hot or cold conditions can be problematic. Think of nurses, hairdressers, cleaners, construction workers or chefs. If your eczema worsens professionally, the company doctor can help you with workplace adjustments or advise on protective measures. Sometimes it is wise to avoid certain occupations in case of severe eczema.

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