Identifying Symptoms and Effective Treatments for Atopic Dermatitis in Adults and Children in the United States 2025

Identifying Symptoms of Atopic Dermatitis in Adults and Children

Atopic dermatitis (AD) is the most prevalent form of eczema, presenting as a chronic inflammatory skin condition marked chiefly by dry, itchy, and inflamed patches. The disorder often begins in infancy, continues through childhood, and frequently persists or recurs in adulthood.

Primary Symptoms

• Itching (Pruritus): Intense itching is the defining symptom of AD, often appearing before rash development, which has earned it the nickname “the itch that rashes.” This can lead to discomfort, sleeping difficulties, and a reduced quality of life.
• Skin Rash: Individuals with lighter skin commonly exhibit red irritated patches, while those with darker skin may notice darker, brown, purple, or gray discolorations.
• Typical Areas Affected: Rashes commonly affect flexural regions such as the inner elbows, behind the knees, wrists, and neck, though they can appear anywhere on the body.
• Skin Alterations: Areas affected may show scaling, swelling, cracking, crusting, and occasionally oozing clear fluid.
• Chronic, Fluctuating Nature: Symptoms tend to come and go in flare-ups, with skin thickening (lichenification) developing over time from repeated scratching.

Understanding Triggers and Factors That Aggravate Atopic Dermatitis

Atopic dermatitis results from a blend of genetic influences affecting the skin barrier and immune system dysregulation. Many AD patients have defects in skin barrier proteins like filaggrin, making their skin more prone to dryness and irritation.

Frequent Triggers Include:

• Allergens: Exposure to pet dander, pollen, dust mites, and certain foods can provoke flare-ups.
• Irritants: Harsh soaps, detergents, fragrances, dyes, and chemicals often worsen symptoms.
• Environmental Conditions: Dry air, temperature changes, and sweating can aggravate AD.
• Stress and Infections: Emotional stress and skin infections may trigger or heighten symptoms.
• Genetic Susceptibility: A personal or family history of atopic diseases such as asthma and hay fever increases risk.

Because triggers vary widely among individuals, it is essential to identify and avoid personal aggravating factors through careful observation and professional medical advice.

How Atopic Dermatitis Is Diagnosed

Diagnosis primarily relies on clinical assessment by healthcare providers who evaluate the characteristic rash pattern, chronic itching, history, and related personal or family atopic background.

• Clinical Assessment: Detailed examination of the rash’s location, look, and distribution.
• Patient History: Questions regarding onset, symptom changes, and allergy background.
• Additional Tests: Skin biopsies or cultures may be employed to exclude infections or other conditions.
• Allergy Testing: Skin prick or patch tests can help pinpoint allergens contributing to flare-ups, although they do not diagnose AD itself.

Accurate diagnosis is key to distinguishing AD from other skin disorders, including contact dermatitis, psoriasis, or fungal infections.

Core Strategies for Managing Atopic Dermatitis Symptoms

Management centers on symptom relief, preventing flares, and maintaining skin barrier health. Since AD is chronic, ongoing care is necessary.

Fundamental Skin Care Approaches

• Moisturizing: Applying emollients at least twice daily supports skin barrier repair and reduces dryness.
• Mild Products: Select fragrance-free, alcohol-free, dye-free cleansers and avoid potential irritants.
• Controlling Environment: Use of humidifiers during dry months and avoiding extreme temperatures helps keep skin hydrated.
• Avoiding Triggers: Recognizing and reducing exposure to allergens and irritants lowers flare-up frequency.
• Bathing Practices: Limit bath duration, use lukewarm water, and avoid vigorous scrubbing.

Medical Therapies: Topical and Supplemental Options

Topical Corticosteroids

These remain a cornerstone for reducing inflammation and pruritus during exacerbations. They differ in potency and should be used under medical supervision to minimize risks such as skin thinning.

Topical Calcineurin Inhibitors

Immunomodulators like tacrolimus and pimecrolimus offer a nonsteroidal alternative, particularly for delicate areas like the face and eyelids, although they may cause localized burning sensations and have varying effectiveness.

New Developments: Roflumilast Cream 0.15%

A recent topical treatment innovation is roflumilast cream, a once-daily phosphodiesterase-4 (PDE4) inhibitor authorized for mild to moderate AD in patients aged six and above. The international INTEGUMENT-1 and INTEGUMENT-2 clinical trials, involving over 1,300 children and adults across multiple countries including the U.S., demonstrated:

• Noticeable improvements in eczema severity and skin clearance within four weeks.
• Rapid itch relief, sometimes within 24 hours after initial application.
• Favorable tolerance with minimal local irritation or adverse effects.
• A moisturizing, fragrance-free cream formulation that supports skin barrier health.

These findings position roflumilast cream as a promising nonsteroidal option with once-daily dosing, potentially improving adherence and safety.

Oral Antihistamines and Additional Therapies

While antihistamines might help alleviate itching in certain cases, they are usually supportive rather than primary treatments for AD. When scratching leads to secondary infection, appropriate antimicrobial therapy is critical.

Addressing Complications and Severe Cases

Persistent scratching damages the skin barrier and increases the risk of bacterial infections, which can manifest as pain, swelling, redness, and pus. Early recognition and prompt treatment of infections are vital to prevent further problems.

In severe or extensive AD cases, systemic immunosuppressive or biologic medications may be considered under specialist oversight.

Living with Atopic Dermatitis: Long-Term Management and Follow-Up

Given the chronic, relapsing nature of atopic dermatitis:

• A consistent daily skin care routine is essential.
• Regular follow-up and treatment adjustments with healthcare providers help optimize outcomes.
• Understanding and managing triggers can lessen disease impact.
• Patient and caregiver education enhances comfort and life quality.

Maintaining ongoing communication with healthcare teams is important for children, adults, and their caregivers to meet changing health needs.

Having a clear grasp of atopic dermatitis symptoms and treatments enables patients and families to cope more effectively with this enduring skin condition. Advances such as roflumilast cream provide new hope for better symptom management and improved quality of life in 2025.

Sources

• Cleveland Clinic. Atopic Dermatitis. https://my.clevelandclinic.org/health/diseases/24299-atopic-dermatitis
• MedlinePlus. Atopic Dermatitis. https://medlineplus.gov/ency/article/000853.htm
• Eichenfield LF, et al. Roflumilast Cream, 0.15%, for Atopic Dermatitis in Adults and Children: INTEGUMENT-1 and INTEGUMENT-2 Randomized Clinical Trials. JAMA Dermatology. 2025. https://jamanetwork.com/journals/jamadermatology/fullarticle/2823304

Disclaimer: Treatment availability and recommendations may differ across regions and healthcare providers. Patients should consult their healthcare professionals for personalized advice aligned with their specific circumstances.