Description

Atopic dermatitis is a chronic, relapsing inflammatory skin disease characterised by intense pruritus and eczematous lesions. It is the most common inflammatory skin disease in children but frequently persists into adulthood. It is associated with a defective epidermal barrier (filaggrin mutations) and immune dysregulation (Th2 skewing).

Symptoms

Intense pruritus (hallmark symptom)
Erythematous, oedematous patches and plaques
Xerosis (dry skin)
Excoriations from scratching
Lichenification in chronic cases
Flexural distribution in older children and adults

Causes & Triggers

Genetic barrier defects (filaggrin mutations)
Immune dysregulation (Th2-dominant response)
Environmental triggers (allergens, irritants)
Stress and weather changes
Microbial colonisation (Staphylococcus aureus)

Severity Classification

Mild Dry skin with infrequent itching, minimal impact on daily activities

Moderate Frequent itching, visible eczematous lesions, disturbed sleep

Severe Widespread inflammation, constant itching, significant quality-of-life impairment

Treatment Ladder

1 Foundational: Emollient therapy — liberal use of fragrance-free moisturisers
2 Mild: Low-potency topical corticosteroids (hydrocortisone 1%)
3 Moderate: Medium-potency topical corticosteroids + calcineurin inhibitors for steroid-sparing
4 Severe: Short courses of potent topical steroids, phototherapy
5 Refractory: Systemic immunomodulators (dupilumab, JAK inhibitors)

Relevant Compounds

Allantoin

Soothing and barrier-protective agent

Allantoin is a naturally occurring nitrogenous compound found in botanical extracts (particularly co…

Aloe Vera

Anti-inflammatory and soothing botanical

Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…

Centella Asiatica Extract

Barrier support — promotes wound healing and reduces inflammation in eczematous skin

Centella asiatica is a herbaceous plant used for centuries in Ayurvedic and traditional medicine. It…

Ceramides

Barrier repair — replaces deficient intercellular lipids

Ceramides are a family of waxy lipid molecules that make up approximately 50% of the lipids in the s…

Cholesterol

Barrier lipid — restores cholesterol-deficient intercellular lipid matrix in eczematous skin

Cholesterol is an essential component of the stratum corneum lipid matrix, constituting approximatel…

Coenzyme Q10

Antioxidant — supports cellular repair

Coenzyme Q10 (ubiquinone) is a naturally occurring lipid-soluble benzoquinone that is present in vir…

Dimethicone

Skin protectant — forms breathable barrier to reduce TEWL and irritant exposure

Dimethicone is an FDA-approved skin protectant and the most commonly used silicone in dermatological…

Glycerin

Humectant — replenishes moisture in barrier-impaired skin, supports AQP3 function

Glycerin is the most widely used humectant in skincare and cosmetic formulations. A naturally occurr…

Hyaluronic Acid

Humectant — maintains hydration in dry eczematous skin

Hyaluronic acid is a naturally occurring glycosaminoglycan found abundantly in the dermis and epider…

Hydrocortisone

Low-potency corticosteroid for flare management

Hydrocortisone is a low-potency topical corticosteroid identical to endogenous cortisol. It is the m…

Jojoba Oil

Gentle barrier-supporting emollient — supplements deficient surface lipids with sebum-analogous wax esters, improving barrier cohesion without irritation

Jojoba oil is a liquid wax ester extracted from the seeds of the jojoba shrub (Simmondsia chinensis)…

Linoleic Acid

Barrier lipid — restores ceramide EOS (acylceramide) structure in linoleic acid-deficient stratum corneum

Linoleic acid is an essential omega-6 polyunsaturated fatty acid (PUFA) that cannot be synthesized e…

Niacinamide

Enhances ceramide synthesis and reduces inflammation

Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…

Palmitamide MEA

Anti-inflammatory and anti-pruritic — activates PPAR-α to suppress NF-κB-mediated inflammation, reduces mast cell degranulation, and alleviates eczematous itch

Palmitamide MEA (palmitoylethanolamide / N-palmitoylethanolamine) is an endogenous fatty acid amide …

Panthenol

Provitamin B5 — promotes barrier repair and wound healing

Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…

Petrolatum

First-line occlusive — reduces TEWL by >98% and promotes barrier recovery through intercellular lipid integration

Petrolatum is the gold standard occlusive agent in dermatology, reducing transepidermal water loss (…

Phytosphingosine

Barrier repair — serves as ceramide precursor and controls S. aureus colonization

Phytosphingosine is a sphingoid base naturally present in the stratum corneum, where it serves as a …

Shea Butter

Anti-inflammatory emollient — lupeol cinnamate inhibits LOX/COX pathways, while stearic acid and phytosterols replenish deficient barrier lipids

Shea butter is a fat extracted from the nuts of the African shea tree (Vitellaria paradoxa). It is u…

Sodium PCA

Endogenous hydration factor — compensates for filaggrin deficiency-related NMF depletion, improving corneocyte hydration and barrier function

Sodium PCA (sodium salt of pyrrolidone carboxylic acid) is the most abundant amino acid derivative i…

Squalane

Emollient — mimics skin lipids, restores barrier

Squalane is the hydrogenated (saturated) form of squalene, a naturally occurring lipid produced by h…

Zinc Oxide

Skin protectant — provides UV protection with anti-inflammatory and barrier-protective properties for sensitive eczematous skin

Zinc oxide is an inorganic (mineral) broad-spectrum UV filter that provides protection against both …

Recommended Drugs

Cortaid OTC hydrocortisone for mild flares Dupixent First biologic approved for moderate-to-severe atopic dermatitis Folitrax Off-label immunosuppressant for severe refractory eczema Imuran Steroid-sparing immunosuppressant for severe eczema Jakinus Off-label oral JAK inhibitor for refractory atopic dermatitis Mycept Steroid-sparing immunosuppressant for severe eczema Panimun Bioral Rapid-acting immunosuppressant for severe eczema

Suggested Cosmetics

Advantan Cream (Methylprednisolone Aceponate 0.1%) Safe potent steroid for moderate eczema with low atrophy risk Bioderma Sensibio Light Cream Gentle moisturiser for eczema-prone skin CeraVe Moisturising Cream Ceramide MVE cream for eczema barrier repair Cetaphil Gentle Skin Cleanser Soap-free cleanser that preserves skin barrier Cetaphil Moisturising Cream Occlusive moisturiser for eczema maintenance Cipla Excela Moisturiser Gentle moisturiser with niacinamide and allantoin The Derma Co 5% Hyaluronic Acid Serum with Ceramides HA hydration with ceramides for eczema barrier repair Desonate Gel (Desonide 0.05%) Mild steroid safe for facial eczema and infant eczema Diprovate Cream (Betamethasone Dipropionate 0.05%) Potent steroid for moderate eczema flares Dot & Key Ceramide & Hyaluronic Acid Moisturiser Multi-ceramide barrier repair moisturiser Dr. Sheth's Ceramide & Vitamin C Sunscreen SPF 50 PA+++ Ceramide-enriched sunscreen for barrier-compromised skin Earth Rhythm Phyto Ceramide Deep Moisture Cream Phytoceramide barrier repair for eczema Elidel Cream (Pimecrolimus 1%) Non-steroidal calcineurin inhibitor for mild-to-moderate eczema Elocon Cream (Mometasone Furoate 0.1%) Potent topical steroid for moderate-to-severe eczema flares Eucrisa Ointment (Crisaborole 2%) Topical PDE4 inhibitor for mild-to-moderate eczema Eumovate Cream (Clobetasone Butyrate 0.05%) Moderate steroid for mild-to-moderate eczema Flutivate Cream (Fluticasone Propionate 0.05%) Moderate steroid with good safety for eczema Foxtale Hydrating Daily Moisturiser with Ceramides & Hyaluronic Acid Ceramide moisturiser for barrier repair Fucidin Cream (Fusidic Acid 2%) Fusidic acid for secondary bacterial infection in eczema Fusiderm B Cream (Fusidic Acid 2% + Betamethasone 0.1%) Fusidic acid + steroid for infected eczema Halovate Cream (Halobetasol Propionate 0.05%) Superpotent steroid for severe, recalcitrant eczema (short-term) La Shield Fisico Matte Sunscreen Gel SPF 50+ PA+++ Mineral sunscreen for sensitive eczema-prone skin Locoid Cream (Hydrocortisone Butyrate 0.1%) Mild-moderate steroid for facial eczema Minimalist 2% Hyaluronic Acid + PGA Serum Gentle hydration serum for eczema-prone skin Opzelura Cream (Ruxolitinib 1.5%) Topical JAK inhibitor for mild-to-moderate atopic dermatitis Physiogel AI Calming Relief Cream BioMimic lipid barrier repair cream for eczema Re'equil Ceramide & Hyaluronic Acid Moisturiser Ceramide-based barrier repair moisturiser Suncros Matte Finish Soft Lotion SPF 50+ PA+++ Mineral sunscreen for sensitive eczema skin T-Bact Ointment (Mupirocin 2%) Topical mupirocin for secondary bacterial infection in eczema Tacroz Ointment (Tacrolimus 0.03% / 0.1%) Steroid-sparing calcineurin inhibitor for moderate-to-severe eczema Tenovate Cream (Clobetasol Propionate 0.05%) Short-term use for severe, recalcitrant eczema The Ordinary Hyaluronic Acid 2% + B5 Gentle hydrating serum for eczema-prone skin Venusia Max Intensive Moisturising Cream Intensive emollient for eczema maintenance

Lifestyle Tips

Moisturise liberally and frequently — within 3 minutes of bathing
Use lukewarm water for bathing — avoid hot showers
Wear soft, breathable fabrics (cotton) — avoid wool
Identify and avoid personal triggers (dust mites, certain detergents)
Keep nails short to minimise excoriation damage
Consider wet wrap therapy during severe flares

When to Refer

Severe or widespread disease not controlled with topical therapy
Need for systemic immunomodulators or biologics
Suspected eczema herpeticum (urgent referral)
Recurrent secondary infections
Significant impact on sleep, work, or mental health

Atopic Dermatitis