Atopic Dermatitis in Children: What It Is and How It Manifests

Dry, rough patches on a baby's cheeks or itchy creases at the elbows of a school-age child — this is often how atopic dermatitis first appears. It is not contagious: it is linked to the function of the skin barrier and the immune system. Let's look at what it is, why it appears, and what it looks like at different ages.

What atopic dermatitis in children is

Atopic dermatitis, also known as atopic eczema, is a common chronic skin disease in which the skin itches, flakes, and becomes inflamed. People of any age can be affected, but most often it occurs in young children. It cannot be completely cured, but the symptoms can be controlled.

The course is wave-like: there are periods of flare-ups and calm intervals. Some children improve over time, while in others the manifestations return later.

Atopic dermatitis is not contagious: it cannot be caught from another child.

Figures for reference: in developed countries the prevalence is 10–20%. Symptoms first appear by 6 months of age in 60% of children, by 1 year in 75%, and by 7 years in 80–90%.

Why it occurs in a child

The cause is not always known. The risk is higher if one or both parents have atopic dermatitis, and also if the child or close relatives have bronchial asthma or allergic rhinitis.

At the root is a reaction in the skin: itching, swelling, redness. The skin retains water less well due to a lack of proteins that maintain its barrier; in some children with moderate and severe course, filaggrin mutations are found.

Flare-ups can be triggered by soap and laundry detergent, wool and rough fabrics, house dust, pollen, animals, certain foods, heat and temperature changes, cold dry air in winter, colds, and stress. Frequent bathing and swimming also dry out the skin.

A point that is often confused: allergy tests in such children are often positive, but the dermatitis itself is not caused by allergy.

How it manifests in newborns and infants

In children under 2 years of age, the rash starts on the face, scalp, hands, and feet. In infants, the typical location is the cheeks, where red, slightly raised patches appear.

The skin is dry and itchy, and blisters may form that ooze and become covered with crusts. The child scratches the skin.

Age-related forms: infantile (from 1 month to 2 years), childhood (from 2 to 12 years), adolescent (over 12 years).

Manifestations on the face and body in older children

In older children, the rash is more often located on the inner side of the elbows and knees, as well as on the neck, hands, and feet. During a severe flare-up, the rash can be anywhere.

The skin looks different: dry, cracked, flaking, thickened; the color is red, white, purple, gray, or lighter or darker than the surrounding skin, depending on skin tone. There may be areas scratched until they bleed.

Itching often appears before the rash — which is why the condition is called "the itch that rashes."

How atopic dermatitis is diagnosed

The doctor examines the skin and takes a history: how long ago the changes appeared, how they change, whether the child and relatives have atopy. The diagnosis is made based on the appearance of the skin and family history.

Sometimes a skin biopsy is needed — to confirm the diagnosis or rule out other causes of dry itchy skin. If there are signs of infection, cultures may be taken.

Skin allergy tests are used in certain cases: for dermatitis that is difficult to control, for other allergic symptoms, or for a rash that appears only in a certain area after contact with a specific substance.

Complications and when to see a doctor

• addition of staphylococcal, fungal, or herpetic skin infection;
• thickened, leathery areas after prolonged scratching;
• scratches down to sores and areas of raw skin;
• difficulty controlling the condition with early onset, a large affected area, or combination with asthma and allergy.

See a doctor, and if necessary a dermatologist, if the child has signs of atopic dermatitis, and also if the prescribed treatment is not helping.

If the child's skin has become painful, swollen, or hot to the touch, pustules or oozing areas have appeared, the condition has sharply worsened, or a fever has developed — the child should be shown to a doctor urgently on the same day: these may be signs of a skin infection.

Atopic dermatitis by itself is not a reason to call an ambulance; 103/112 — if the child's condition is life-threatening (for example, a sharp deterioration with high fever and a severe general condition).

This material is for reference and does not replace a doctor's consultation: if in doubt, show the child to a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer