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Atopic dermatitis (eczema)

Dermatitis atopica · Atopický ekzém (atopická dermatitida)

What it is

A leaky skin barrier plus an over-reactive immune system.

Symptoms & signs

  • Itchy dry red patches
  • flexural creases in children
  • weeping and crusting when infected
  • sleep loss from scratching
  • lichenified thick skin

🚩 Get help if…

  • call 112 / 911 now Painful clusters of blisters or punched-out sores with fever
  • see a doctor soon Weeping, crusted or yellow patches that are spreading
  • see a doctor soon Red, hot skin over most of the body
  • see a doctor soon Itch that stops sleep despite treatment

Where it strikes

Medical treatment

  • Emollients, many times a day trials support
  • Topical steroids, weakest that works trials support
  • Tacrolimus for the face and folds trials support
  • Dupilumab in severe disease, at a high price trials support
  • JAK inhibitors — fast, with warnings on clots, infection and heart events mixed evidence
  • Treating infection when it flares trials support
  • Ruxolitinib cream (Opzelura) — FDA-approved 2021 for mild to moderate eczema; in the EU licensed only for vitiligo
  • Nemolizumab (Nemluvio), an IL-31 blocker — approved (FDA 2024, EMA 2025) for moderate to severe eczema

Natural & lifestyle

  • Fragrance-free emollients
  • lukewarm short showers
  • soft cotton
  • dust-mite reduction
  • identify true food triggers only with testing
  • stress management

Emerging & experimental

  • Microbiome creams (Roseomonas)

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Evening primrose and borage oil — a Cochrane review found no benefit not confirmed in trials
  • Probiotics in pregnancy and infancy — may prevent eczema; trials disagree mixed evidence
  • Dilute bleach baths — trials disagree mixed evidence
  • Chinese herbal medicine — some trials show benefit; liver risk mixed evidence
  • Coconut and sunflower-seed oil on the skin — small trials improve the barrier early / small studies

ICD codes