Atopic Dermatitis: signs and stages

Atopic dermatitis is the most common form of eczema. It is estimated that over 20 million people in the US live with the condition. Atopic is defined as “an allergy in which a hypersensitivity reaction such as dermatitis or asthma may occur in a part of the body not in contact with the allergen.” Then "dermatitis" means inflammation of the skin. Symptoms of atopic dermatitis will vary depending on which stage a flare-up is at. The stages are acute, subacute, and chronic.

Talking about the condition in terms of staging and symptoms can improve communication between doctors and patients.  The patient may become better able to identify patterns, or triggers to avoid, while the doctor can recommend the most appropriate treatment option(s). Depending on stage, sometimes a steroid is needed to reduce inflammation, other times an antibiotic is called for to fight an infection.

So, what are the main differences in the three stages of an atopic dermatitis outbreak?

The acute stage is when the atopic dermatitis flare happens. Symptoms are intense. This intensity may be the result of the increased bodily inflammation leading to the flare-up. During this stage the affected skin, which can be in almost any area of the body, will be quite itchy and red. The skin may also look swollen and feel warm to the touch. Blisters will likely form and start to crust. During the acute stage, a topical steroid cream is often prescribed to try and reduce discomfort.

As the patch of eczema begins to heal, so starts the subacute stage of the flare-up. The itchiness will have improved and the skin won’t look as red and irritated. If a prescription treatment was started during the acute phase, it is important to finish the therapy as it was prescribed or else the symptoms could return. During this stage, a doctor may recommend usage of gentle moisturizer to help soothe the skin as part of its healing process.

The chronic stage is most common for patients. This is when the skin patchiness has persisted for a matter of months. The affected area may take on a leathery appearance (this is also called “lichenified” skin). Depending on the severity of this stage and how long it lasts, a doctor may look to therapies that are more aggressive such as oral steroids an injectable medicine. Sometimes “light therapy” can help as well. This treatment, also called phototherapy, can help activate a person’s immune system in an effort to trigger an anti-inflammatory response in order to improve symptoms.

Atopic dermatitis can be a frustrating condition to manage. Often a treatment approach utilizing different tools is the most effective given the changes skin undergoes during a flare-up. It is important to understand the staging along with what makes the skin feel and look better. Patients who are able to limit contact with known (and suspected) irritants that led to the episode in the first place may experience fewer breakouts over time.