Atopic Dermatitis Unit

Despite having been described over a century ago, the precise causes of atopic dermatitis are still not fully understood. What is well established is that eczema in atopic patients results from a disruption of the skin barrier (the protective layer that prevents dehydration and blocks the entry of potentially harmful agents), combined with an exaggerated inflammatory response of the immune system when exposed to certain triggers such as cosmetics, pollen, pet dander, chemicals, detergents and similar substances.

Multiple factors contribute to impairment of the skin barrier, making it more permeable to irritants. Notably, atopic dermatitis is considered a disease of industrialised societies and is far less common in developing countries or less advantaged regions. It is also more prevalent in urban environments and less frequent in rural areas.

This observation, together with the fact that the prevalence of atopic dermatitis has tripled over the past three decades in industrialised countries, has led the scientific community to suggest that in addition to genetic predisposition, environmental and lifestyle factors play a significant role. These may include air pollution, dietary factors, exposure to certain unidentified toxins during pregnancy, antibiotic use during pregnancy, and prolonged exposure to toxic substances in everyday life.

The most common and characteristic symptom of atopic dermatitis is the appearance of eczema—reddened, inflamed skin with scaling or oozing—in a specific area, accompanied by intense itching. This itching often leads to vigorous scratching, which worsens inflammation, aggravates eczema and increases the risk of wounds and excoriations. These lesions are highly prone to infection and may result in scarring.

The location of eczema varies according to the patient’s age. In infants, it commonly affects the face, trunk and limbs. In older children, lesions more frequently appear in the flexural areas of the arms and legs, as well as on the neck and feet. In adults, typical locations include the nape of the neck, elbows, backs of the hands and feet, and flexural areas of the wrists and legs. However, many adults with atopic dermatitis also show residual lesions characteristic of childhood disease.

There are also atypical manifestations of atopic dermatitis that must be considered, as they can complicate diagnosis. At the Grupo Pedro Jaén Atopic Dermatitis Unit, the following atypical presentations are also evaluated

Pityriasis alba

Rounded, whitish, scaly patches that do not itch and appear on apparently healthy skin of the face and limbs.

Atopic prurigo

An eruption of papules, most commonly on the legs, associated with intense itching that often leads to deep lesions and ulceration.

Juvenile plantar dermatitis

Relatively common in children and adolescents who frequently wear sports footwear. It is characterised by redness of the soles and undersides of the toes, which appear shiny and parchment-like. Fissures may develop in some cases.

Acrovesiculosis

Vesicles on the fingers and/or palms of the hands and feet, causing itching, oozing, crusting, scaling and fissures. These lesions may also be painful.

Itching, or pruritus, is a normal sensory response to irritating stimuli affecting the skin, such as insect bites or contact with irritants. Scratching is a reflex action aimed at relieving this sensation, although it often worsens the itch.

In patients with atopic dermatitis, itching becomes part of a particularly intense vicious cycle. During flare-ups, patients experience severe itching that leads to scratching. Scratching, in turn, intensifies the itch and promotes more aggressive scratching, ultimately resulting in excoriations and painful wounds that may bleed and become infected. Breaking this cycle is essential for effective flare-up control.

Relieving itching is crucial for several reasons. First, pruritus in atopic patients is significantly more intense than usual and can severely interfere with daily activities, particularly because most patients are children. Second, scratching leads to skin damage that may progress to infections, ulcers and scarring, requiring specific medical treatment.

Initial management of itching is typically based on topical medications that inhibit histamine release, a cellular signalling molecule involved in several biological reactions, including the sensation of itch.

Patients with atopic dermatitis have a marked tendency towards skin dehydration and scaling due to impairment of the skin barrier, which allows excessive water loss. Dry skin causes tightness and itching and acts as a trigger for flare-ups and eczema, with all the associated consequences described above. Management of skin dryness is based on the use of emollient creams designed to repair the skin barrier, restore hydration and prevent water loss. These products are specifically formulated for atopic skin to minimise irritation.

Eczema lesions characteristic of atopic skin are primarily treated with anti-inflammatory medications aimed at controlling inflammation during flare-ups. Depending on the individual case, these treatments may be combined with additional therapies to manage infection (when present), modulate the exaggerated immune response—often once the flare-up has been controlled—or, in selected cases, advanced therapies targeting specific molecular pathways involved in atopic inflammation.

In selected patients who do not respond to other treatment lines, and particularly in adults, some of these medications may be administered orally or by injection.

Controlled exposure to ultraviolet radiation is used as a therapeutic option in selected cases of atopic dermatitis, generally as a second-line treatment, due to its immunomodulatory and anti-inflammatory effects. Phototherapy is usually reserved for moderate to severe atopic dermatitis in adults. In children, it is only considered in severe cases, according to specialist judgement.

One of the main objectives of the atopic dermatitis workshops is to help both children and adults understand the disease by providing practical, evidence-based information supported by scientific knowledge. The sessions usually begin with an educational talk addressing the key aspects of atopic dermatitis, its clinical course, available treatments and the most relevant recent advances in this field.

This is followed by a round-table discussion focusing on the most common questions and controversial issues, such as the use of topical corticosteroids, living with pets, hygiene routines and daily skincare. These discussions involve families and specialists from the Atopic Dermatitis Unit and aim to address the disease in a holistic manner while helping clinicians better understand the concerns and needs of affected families.

At the same time, children participate in parallel sessions with other members of the unit, where—through playful activities, games and drawings—they learn how to control itching, scratch without causing harm, apply prescribed creams correctly and identify triggering factors.

The main goal is to create an educational environment that encourages experience-sharing, disease awareness and patient empowerment, ultimately improving disease control and long-term outcomes.

How to break the itch–scratch cycle

When the skin itches, avoiding scratching is extremely difficult for anyone—especially when the patient is a child. However, it is important for children with atopic dermatitis to learn as early as possible how to control this natural impulse. To do so, they should learn to identify the factors that contribute to itching (inflammation, dry air, heat, dry skin, etc.) and develop strategies to avoid scratching—or at least to do so gently.

At the Grupo Pedro Jaén Atopy School, workshops are held regularly to help parents understand that simply saying “don’t scratch” not only fails to prevent scratching, but often increases the child’s anxiety and urge to do so.

For this reason, we teach distraction strategies so that children stop focusing on the itch and have an alternative activity that reduces the frequency of scratching. These activities may range from crafts to colouring, or helping with a task their parents are doing. Relaxation techniques can also help control the urge to scratch intensely.

It is helpful to keep a moisturiser close at hand to apply a thin layer as soon as itching begins, and to repeat moisturising routines several times a day to prevent dryness. Spraying thermal water or applying cold to the itchy area can also reduce itching, as cold “tricks” itch receptors. A very useful tip is to keep creams and sprays in the fridge so they remain cool at all times.

In addition, children should be taught not to scratch with their nails, but instead to use soft alternatives that do not damage the skin, such as mittens, gloves, the back of the hand or the fingertips.

How to control unconscious scratching

Distraction strategies can help reduce unconscious daytime scratching, but it is important to remember that children with atopic dermatitis may also scratch when they are distracted or at night while asleep. To help prevent this, children should sleep in lightweight cotton pyjamas, the bedroom should not be overheated, and they may go to bed wearing cotton or silk gloves or mittens. Bedding should be changed frequently and washed with mild detergents, without fabric softener.

Daily hygiene for atopic patients

Patients with atopic dermatitis should generally choose showers rather than baths, as the longer the skin remains in contact with water, the more it becomes dehydrated. For this reason, showers should be brief, and it is advisable to turn off the water while soaping. Water temperature should be kept between 32 and 34°C, as very hot water increases evaporation from the skin.

That said, bathing a very young child is not always easy, and a bath may be more practical. In these cases, it is advisable to add an emollient product to bath water (there are water-dispersible oils specifically designed for atopic skin) and to keep the bath under ten minutes.

Syndet (soap-free) cleansers should be used, with a pH as close as possible to that of the skin (5.5–5.6), to avoid dryness and preserve the integrity of the skin barrier. These products are best applied with the hands rather than sponges or shower gloves. Shampoo should also be gentle and suitable for frequent use.

After washing, the skin should be dried with a soft towel by patting gently, avoiding excessive rubbing, as this can trigger itching. Immediately afterwards, the skin must be moisturised with products specifically formulated for atopic skin, designed to restore the skin barrier and prevent moisture loss. Applying emollient cream to slightly damp skin helps reduce dehydration, as the product penetrates more effectively.

It is important not to apply moisturisers to areas with active eczema, and to keep nails consistently short and clean.

Holidays and atopic dermatitis

Higher temperatures, fewer febrile illnesses and travel to more humid coastal areas often lead to improvement in children with atopic dermatitis. However, not all summer-related factors are equally beneficial, and in some cases symptoms may worsen significantly during this time of year.

For example, chlorine in swimming pools can aggravate eczema, and daily hygiene in holiday destinations with very hard water (high in limescale) or high magnesium content may increase irritation in this type of skin. However, it is neither possible nor desirable to deprive children of enjoyable time in the pool, nor is it possible to change the composition of tap water at the destination.

For this reason, it is advisable to visit the dermatologist before travelling, so that the specialist can assess the child’s skin and help design a personalised plan to enjoy the summer while minimising discomfort.

The specialist may also recommend barrier creams that help protect the skin from chlorinated water. These creams are formulated to repel water and create a protective layer between water and the skin. The aim is to prevent water loss from within the skin and reduce contact between chlorinated or salty water and atopic skin. Barrier creams can also help reduce irritation from other fluids (saliva, urine, sweat, etc.) that may affect certain areas (around the mouth, the nappy area, armpits, and so on).

Finally, it is advisable to keep bathing time as short as possible. After leaving the water, the skin should be rinsed thoroughly with fresh water after each swim, and the usual emollient should be applied at the end of each day.

Regarding sun protection, children with atopic dermatitis should use physical sunscreens—also known as mineral filters—because they contain particles that are not absorbed by the skin and remain on the surface. This helps avoid penetration of chemical substances such as octocrylene (present in many conventional sunscreens), which may irritate atopic skin in the short term or contribute to allergy development in the long term. These sunscreens should ideally be water-resistant, although they must still be reapplied every two hours.

In carefully selected cases, dermatologists may recommend brief daily sun exposure without sunscreen for only a few minutes, in order to improve the skin in a way similar to controlled phototherapy used in clinical settings. This approach aims to take advantage of the sun’s immunomodulatory effects, which can be beneficial in several skin conditions, including atopic dermatitis.

In any case, during the summer months it is important not to neglect daily skincare routines for children with atopic dermatitis and—unless the dermatologist advises otherwise—to maintain them even when travelling to destinations where dermatitis tends to improve.

Atopic dermatitis at school

As with other chronic conditions, coping in the school environment can be a real challenge for children with atopic dermatitis. The intense itching characteristic of this disorder increases the likelihood of behaviours that may be uncomfortable or difficult for teachers and classmates to understand, such as irritability or drowsiness (due to antihistamine use or poor sleep).

Children with atopic dermatitis often sleep poorly, which may affect mood and school performance. For this reason, school staff should be familiar with the condition in order to minimise its impact.

These behaviours are not related to poor conduct in class and may be more pronounced during exam periods, as anxiety and stress are clear triggers for flare-ups and therefore for intense itching. With understanding and appropriate support, however, a child with atopic dermatitis can lead a completely normal school life.

Teachers and school nursing staff should be informed of the student’s condition so they can help when needed, but the child must learn to follow the treatment and self-care plan prescribed by the dermatologist. Families should inform the school about the medication the child is taking, and the child should carry their creams, gloves, mittens, etc., for use when necessary.

It is advisable for the child to be able to shower after sports activities, using their specific products. If the child wears a uniform and the fabric contains synthetics or wool, it is advisable to wear a cotton undershirt underneath. Although wool is a natural fibre, it is not recommended for atopic skin.

A special diet is not required unless the child also has a confirmed food allergy or intolerance.

Corticosteroid phobia: is it justified?

In clinical practice, there are many medications with an undeserved negative reputation. Dermatology is no exception. In atopic dermatitis, topical corticosteroids often cause reluctance or rejection despite being safe and effective.

It is common for parents of children with atopic dermatitis to feel hesitant about applying the topical corticosteroid prescribed by the dermatologist, due to fear or lack of understanding regarding its benefits and correct use.

However, topical corticosteroids have proven effective in the treatment of atopic dermatitis, including in paediatric patients. Their strong anti-inflammatory effect and local action make them a key tool for the atopic dermatitis specialist. Avoiding these medications or using them incorrectly worsens eczema and negatively affects medium- and long-term prognosis.

How to apply topical corticosteroids correctly

• Apply preferably after bathing, once the skin is dry.
• Spread a thin layer, using enough product to cover the eczema area. Massage gently to aid absorption.
• Follow the prescribed dose and frequency, both in acute phases and in maintenance phases; during maintenance, it is common to adjust treatment by introducing an immunomodulator, in addition to the emollient or moisturiser.
• Do not stop treatment early, even if the lesions improve, unless advised by the specialist.

Is atopic dermatitis contagious?

No. Atopic dermatitis is not contagious, even with close and prolonged contact. It is not transmitted by sharing towels, utensils or clothing used by patients with atopic dermatitis. However, it is important to note that the skin lesions may become infected; in that case, precautions are required to avoid transmission of the infectious agent—but not of atopic dermatitis itself.

Main triggers of atopic flare-ups

Atopic dermatitis flare-ups may be triggered by friction from certain fabrics (synthetics, wool, etc.), cold, heat, sweating, exercise, stress, anxiety, fear, exposure to smoke, detergents, cosmetics containing fragrance or alcohol, soaps, fever, and other factors.

Can atopic dermatitis be prevented?

No. Several research lines are exploring this question, but there are still no solid conclusions. However, flare-ups may be reduced or spaced out by identifying and avoiding triggers whenever possible. Early initiation of treatment also helps reduce disease severity and improves medium- and long-term outcomes.

When does atopic dermatitis improve?

Atopic dermatitis improves in a high proportion of cases as children grow older. From around seven years of age, approximately 80% of children begin to improve significantly, although many will retain a tendency towards dry skin that irritates easily.

That said, this is not a fixed rule. A proportion of patients continue to have the disease in adulthood, usually in a milder form.

Which conditions can be confused with atopic dermatitis?

Seborrhoeic dermatitis may present very similarly in infants. To differentiate them, it is important to note that seborrhoeic dermatitis almost always begins in the first month of life, lesions tend to be more yellowish and greasy (rather than scaly or oozing as in atopic dermatitis), and they may appear on the eyebrows and scalp—locations that are less typical for atopic dermatitis. In addition, itching in seborrhoeic dermatitis is generally not as intense.

Atopic dermatitis may also be confused with other skin conditions such as irritant nappy dermatitis, contact dermatitis, certain immunodeficiencies or scabies, although these are less common.

Are there foods that can trigger atopic flare-ups?

Yes. Beyond individual susceptibility to food allergies, some foods may contribute to eczema development, including cow’s milk, eggs, peanuts, wheat flour, certain fish and seafood, and fruits such as kiwi.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

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