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SYMPTOMS

Finding and understanding the signs and symptoms of atopic dermatitis

If you live with atopic dermatitis or eczema, you may have to deal with a lot of symptoms. You're probably familiar with your symptoms already and one thing's for sure – they can get in the way. Understanding the symptoms of AD can help you get to know your condition a lot better.

Firstly, what is a symptom?

Signs and symptoms are the evidence of physical or mental changes from what is considered 'normal', that are associated with a particular condition.1

*AD in adults

AD symptoms in adults include:2,3

  • Rashes – typically appearing red on lighter skin, and purple or grey on darker skin
  • Dry, itchy and scaly skin
  • Oozing and crusting skin
  • Thick, leathery skin
  • Skin discolouration
  • Flares
  • Swelling

You might find symptoms recurring in these places:3

  • Face
  • Neck
  • Upper arms and back
  • Elbow and knee creases
  • Back of the hands, feet, fingers, and toes

*A diagnosis of AD needs confirmation from your doctor. Not all of the symptoms listed will lead to a diagnosis of AD. Please speak to your doctor about any signs and symptoms that you are experiencing.

AD in children and infants

The symptoms of AD can vary depending on a person's age, and there are specific symptoms to look out for in children as a caregiver.

In infants under 2, symptoms can include:3,4

  • Dry, itchy, scaly skin
  • Rashes on the scalp or cheeks
  • Upper arms and back
  • Rashes that bubble and ooze clear fluid

In children between 2 and 11 years old, symptoms can include:4

  • Rashes in the creases of elbows, knees, or both
  • Scaly patches of skin near a rash
  • Lightened or darkened skin spots
  • Thick, leathery skin
  • Extremely dry and scaly skin
  • Rashes on the neck and face, especially around the eyes

Like with adults, symptoms in children usually present on the hands, wrists, ankles, feet, elbow and knee creases.3

AD can present differently on different skin colours

The way AD presents itself is mostly similar across all people, but its appearance does vary based on skin colour.5 Differences in skin pigmentations and the distribution of lesions can affect the way some of your symptoms look.5

Rashes may appear red on people with lighter skin but may appear more purple on individuals with darker skin.3

People of Asian descent may have more defined lesions, increased scaly skin and lichenification (hardened, leathery skin) compared to people with white skin.5

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Underlying Cause

A deeper look at the AD signs and symptoms

You may be used to seeing and feeling your symptoms, but you might not understand why they're occurring. So, let's break it down.

Itchy skin and rash formation

It's the symptom you're probably all too used to experiencing, but why is your skin so itchy? And why can't you seem to stop itching?

The immune cells are sending inflammation signals up to the surface, causing your itch.2 This creates an intense need to scratch, called pruritus, which isn't easy to ignore.6 Scratching breaks down the outer layer of your skin, allowing germs, viruses, or allergens to enter.2 This can cause rashes to appear on your skin as a visible sign of deeper inflammation.2,4,6 Your immune system responds to this by sending even more signals to the surface, causing even more redness and itching.2,6

This is known as the itch-scratch cycle – the more you scratch, the more your skin barrier is damaged and the cycle continues.4,6 The cycle can lead to bleeding and swelling of the skin, but it can have a wider impact on your quality of life too.2,6 It's easy for people to say, ‘just don't scratch it', but we know it can be almost impossible to resist the urge. If you're feeling stuck in the cycle, you should talk to your doctor about finding a treatment plan that keeps your itch at bay.

Dry, scaly skin

You've probably experienced the feeling of dry skin before. Creams and moisturisers might become your best friend, but what's causing your skin to dry up so much?

With AD, your skin barrier isn't as protective as it should be, which means your skin is more prone to being dry and itchy.5 So, when you scratch your skin, it can physically damage the skin barrier even more, allowing moisture to escape, and viruses and bacteria to enter.2,7 When your skin gets too dry, it can become brittle, scaly, rough, or tight, which may cause the flares you see and feel on your skin.7

The strongest risk factor for AD is a positive family history so genetics play a significant role in the disease.8

Some people with AD also have a mutation of the gene responsible for creating the protein filaggrin.7

Filaggrin helps to maintain a healthy, protective skin barrier, but a reduction in its levels makes your body fail to provide a strong barrier.7

Oozing and crusting

This is one of the more unpleasant AD symptoms, and unfortunately, it's pretty common. So, why has your skin started to ooze?

Scratching can mean higher levels of bacteria get into the skin – which can lead to oozing.9 Crusting can then form when the oozing dries, which can appear leathery and hard.9,10

Not sure if you have this symptom? Look out for:9

  • Yellow, clear pus
  • Fever or flu-like symptoms
  • Dry crusts on the skin
  • Small, red spots around body hair
  • Swollen glands in the neck, armpit, or groin area
Understanding AD

'Oozing and crusting’ might sound odd to you, but it’s the correct term for the symptom so don’t shy away from using the right words with your doctor.

Thick, leathery skin

Your skin can change in texture as a result of the scratching, itching and rubbing that comes with AD.10 This change might be referred to as 'lichenification', a term that refers to thickened skin, and exaggerated wrinkles and cracks.10

Skin discolouration

Another symptom caused by continuous scratching is skin discolouration, which appears in different ways. You may experience hyperpigmentation (excess pigment), which makes your skin appear darker, or hypopigmentation (lack of pigment) which makes the skin appear lighter.11 A lack of pigment may be caused by underlying inflammation that causes AD, but is usually an effect of your skin healing after having red or purple patches.11,12

Confidence

Your symptoms shouldn't hold you back

Whichever symptoms you experience, and however they appear, you should discuss them with your doctor. Be open and honest during your appointments. Your doctor needs a clear picture of your condition, so they can help you find the long-term control you deserve.

Managing AD

Managing AD

Feeling like you ve tried everything to manage your AD? Don't lose hope. We've got the tips, tools and information you need to get closer to control.

Go to Managing AD
AD Glossary

Glossary

Feeling lost in a sea of terminology? Our glossary can help you feel confident when you discuss your AD.

Expand your vocabulary
Severity

Severity

Knowing more about your AD severity level could help you get closer to control. Here we take a look at the basics of severity.

Learn more

References

  1. MerriamqWebster. Symptom. Available at: https://www.merriam-webster.com/dictionary/symptom. Accessed: June 2021.

  2. Eczema Exposed. Understanding Eczema. Available at: https://www.eczemaexposed.com/understanding-eczema. Accessed: June 2021.

  3. Skin of color society. Eczema. Available at: https://skinofcolorsociety.org/dermatology-education/eczema/. Accessed: June 2021.

  4. Healthline. What is Atopic Dermatitis? Available at: https://www.healthline.com/health/atopic-dermatitis/what-is-atopic-dermatitis. Accessed: June 2021.

  5. Kaufman BP et al. Exp Dermatol 2018; 27: 340–357.

  6. National Eczema Association. What is Eczema? Available at: https://nationaleczema.org/eczema/. Accessed: June 2021.

  7. National Eczema Association. Eczema Causes and Triggers. Available at: https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/. Accessed: June 2021.

  8. Weidinger S et al. Lancet 2016; 387: 1109–1122.

  9. Healthline. What You Should Know About Weeping Eczema. Available at: https://www.healthline.com/health/eczema/weeping-eczema. Accessed: June 2021.

  10. Healthline. What Is Lichenification and How Can I Treat It? Available at: https://www.healthline.com/health/lichenification. Accessed: June 2021.

  11. Atopic Dermatitis.net. Skin Color Changes and Atopic Dermatitis. Available at: https://atopicdermatitis.net/changes-skin-color/. Accessed: June 2021.

  12. Healthline. What Causes Hypopigmentation, and How Is It Treated? Available at: https://www.healthline.com/health/skin-disorders/hypopigmentation. Accessed: June 2021.