Atopic Dermatitis
Atopic dermatitis is a chronic inflammatory skin disease: intense itching, dryness and rashes that settle down and then return. It often starts in early childhood, but adults get it too.
Over the years, different doctors may have called the same condition infantile eczema, allergic diathesis or diffuse neurodermatitis, so families often get confused by the diagnoses. No one can honestly promise that it will go away for good. But well-planned combined treatment makes the disease much easier to live with, helps reach lasting remission and means fewer flares.
The dermatology department of the Trichology Institute in Kharkiv sees adults and children. It is headed by Yuliya Kachuk, a dermatologist with a PhD in medicine and an associate professor, whose thesis was on combined treatment of atopic dermatitis.
When to see a dermatologist
Book an appointment if:
- itching gets in the way of sleep, school or work;
- dry, red, rough patches keep coming back;
- you notice these changes in a baby or toddler, especially if atopic dermatitis, allergic rhinitis or asthma runs in the family;
- flares are more frequent, cover a larger area, or treatment has stopped working;
- the skin in the patches has become thick and coarse;
- you or your child have used a steroid ointment for a long time and the skin has thinned or small blood vessels show through;
- different doctors have given different diagnoses and it is unclear what to treat.
When not to wait for a routine appointment
See a doctor promptly if:
- yellow crusts or pus appear on the patches, with growing pain and swelling: this may be a bacterial infection;
- the skin suddenly breaks out in many small blisters or sores, especially with fever and feeling unwell: this may be a widespread herpes infection, which needs treatment right away;
- redness spreads quickly over almost all the skin, with chills or weakness;
- a child with a rash becomes listless, refuses food or has a fever.
If no doctor is available at that moment, go to urgent care. Call an ambulance at once if the face, lips or tongue swell, breathing becomes difficult or the voice turns hoarse: this may be a severe allergic reaction.
Make an appointment
Why atopic dermatitis develops
There is still no single complete theory. The disease arises where heredity, the immune system and outside factors meet, and the mix is different for each person.
Heredity
Heredity matters: the tendency runs in families. But this is a risk, not a sentence.
Immunity and the skin
The immune system tends to overreact in an allergic way: it makes a lot of class E antibodies, and inflammatory cells build up in the skin. The skin is a weaker barrier, and microbes settle on it more easily, including Staphylococcus aureus and yeast-like fungi, which keeps the chronic process going.
What can trigger a flare
- food allergens, mainly in early childhood; in older children, teenagers and adults, household allergens matter more;
- household chemicals, cosmetics, synthetic clothing, metals, polluted air;
- large amounts of medicines, vitamins and dietary supplements, canned food and fast food;
- stress and a tense atmosphere at home;
- digestive disorders, liver problems and other coexisting conditions, and in children also intestinal worms;
- heat, sweating and sun: some patients notice they get worse after time in the sun.
The course of pregnancy and birth and health in the first months of life can also matter, so the doctor will ask about them. This is medical history, not anyone's fault.
Metabolism
This is the subject of Yuliya Kachuk's own research. Patients with atopic dermatitis were found to have disturbances in nitric oxide metabolism, antioxidant defense and microcirculation, and with moderate and severe disease, low magnesium and changes in calcium metabolism. This is no reason to start supplements on your own: your doctor decides what you actually need.
What atopic dermatitis looks like
During a flare
The skin in the patches swells and turns bright red, small and larger blisters appear, the skin weeps, and then crusts and scales form. This usually comes with intense itching, burning or tingling.
In the chronic stage
The skin becomes dry and thick, and its natural lines look coarser. Doctors call this lichenification.
Where to look at different ages
The picture changes with age. In babies the rash often appears on the cheeks, scalp and the outer sides of the arms and legs. In older children it moves to the creases of the elbows and knees, the wrists, ankles and neck. In adults the face, neck, hands and skin folds are affected more often. There are exceptions, so the location alone is not a diagnosis.
How it affects daily life
A rash on visible skin, itching and unpredictable relapses can limit everyday activity, work and social life. So at the appointment we talk not only about the skin, but also about how you are living with it.
Conditions that look similar
Eczema closely resembles atopic dermatitis because the mechanisms are close. Allergic contact dermatitis, seborrheic dermatitis, psoriasis and fungal skin infections can look similar too. They are treated differently, so a diagnosis from a photo or a friend's advice is unreliable.
Diagnosis at the Trichology Institute
Atopic dermatitis is recognized mainly by how it looks and how it has behaved over time: no single test confirms it. The workup starts with a dermatologist's consultation.
- A conversation. When it started, what triggers flares, what has already been tried, any drug allergy, other diseases, skin and atopic diseases in the family. Bring your medical records and the names of the products you have used.
- An examination of all the skin. The doctor assesses the color, shape, number and location of the lesions, the clinical form, and how active and severe the process is. The choice of treatment depends on this.
- Special methods when needed. Digital dermatoscopy, examination under a fluorescent lamp, dermatological tests and, when necessary, a skin biopsy. They help tell dermatitis from conditions that look like it.
- Lab tests. With chronic skin diseases the doctor may order a complete blood count, blood chemistry, markers of systemic inflammation, a coagulation panel and other tests. The list is individual. Samples can be taken at the clinic; see Laboratory diagnostics.
A child or adult with atopic dermatitis sometimes needs several specialists. If food allergy or asthma is suspected, or there are digestive complaints or a child's growth is delayed, you may need an allergist, gastroenterologist or pediatrician, and the doctor will tell you so plainly.
Treating atopic dermatitis
The goal is to calm inflammation and itching, reach lasting remission, prevent new flares and get you back to normal life. The doctor makes the plan individually, taking into account age, stage, severity, how widespread the rash is, other diseases and how well you tolerate medicines. If you are pregnant, planning a pregnancy or breastfeeding, say so at the first visit.
Less contact with triggers
The doctor helps identify the allergens that matter and organize food and home life. Restrictions should have a reason behind them, so do not cut out foods at random, especially for a child. We also avoid unnecessary medicines: the more drugs, the higher the risk of reactions to them.
Daily skin care
This is the foundation of treatment, not an extra: short, cool showers or baths, mild cleansers, dermatological shampoos and regular moisturizing.
Topical treatment
Skin products are chosen by stage: for weeping skin, soothing lotions or wet dressings; for acute inflammation, anti-inflammatory pastes and ointments; for dry chronic inflammation, ointments and creams. The main drug groups are:
- topical corticosteroids, which calm inflammation effectively but need supervision. Long, unsupervised use can lead to skin thinning, visible small blood vessels, excess hair growth and loss of response to the drug. There are age limits for children;
- topical calcineurin inhibitors, which contain no steroids and help reduce the need for them.
A steroid ointment should not be started without a prescription or stopped on your own. The doctor decides on the drug, the area and how long to use it.
Systemic treatment
Systemic drugs are usually needed for moderate and severe disease. Depending on the case, these are antihistamines, systemic corticosteroids only for sharp flares and in short courses, antibiotics or antivirals only for infection, and treatment of coexisting problems. Only a doctor prescribes all of these; they should not be started or stopped on your own.
What our doctor's research showed
In Yuliya Kachuk's thesis research, metabolic agents were added to conventional treatment: a drug acting on nitric oxide metabolism, antioxidants and magnesium. Compared with conventional treatment, this shortened treatment time and reduced the number of relapses. This is a research finding, not a promise to every patient.
Create a treatment plan
Children, outlook and follow-up
Atopic dermatitis in children
The department's dermatologists see children and work together with pediatricians and other specialists; products for sensitive children's skin are chosen individually. More on the Pediatric consultations page.
More than the skin itself shapes the course of the disease. The outlook is worse with early onset, long heavy treatment with many drugs, tension in the family and loss of faith in recovery. That is why parents need a clear plan and a doctor they can ask questions.
Outlook
The disease is chronic: quiet periods alternate with flares. Combined treatment can greatly improve the course, bring lasting remission and raise the quality of life of patients and their families. But flares can return, and no one can guarantee they never will.
Follow-up
At follow-up visits the doctor checks the skin and adjusts treatment and care. During systemic treatment lab results are monitored as well.
We see patients by appointment at 17 Danylevskoho St, Kharkiv. Consultation fees are in the price list.
Also on our site: Alopecia areata, Hair loss in children, Nail disorders, Post-acne.
Doctors
Prices
| Consultation of a dermatologist / children’s dermatologist | 1000 UAH |
Frequently Asked Questions
It is a chronic disease that tends to relapse, so the honest goal of treatment is different: make it much milder, reach lasting remission and have fewer flares.
In many children the skin calms down with age, but this cannot be predicted in advance. Skin care and medical follow-up still matter during quiet periods.
No. It is an inflammatory disease linked to heredity and the immune response, not an infection. A child with dermatitis does not need to be kept away from other children.
Only a complication can be contagious, such as a herpes infection on the skin. In that case the doctor will explain what to do at home and at school or daycare.
Topical corticosteroids are among the main treatments. Modern fluorine-free products are considered effective and fairly safe when used as prescribed. The danger lies in long, unsupervised use and in applying them to especially sensitive skin: skin thinning, visible small blood vessels, excess hair growth and loss of response to the drug are possible.
The sensible approach is neither to overuse them nor to refuse them out of fear, because untreated inflammation lasts longer. The doctor decides on the product, the area and the duration, and for children, especially young ones, the choice is made separately.
It is better not to do this without your doctor. Improvement does not always mean the inflammation has gone, and after an abrupt stop the skin can get worse again. The doctor will tell you when and how to finish treatment. This applies especially to pills and injections, which should not be stopped on your own.
Daily care and moisturizing continue during remission too.
Food allergens matter mainly in early childhood; in older children and adults, household allergens become more important. Therapeutic nutrition is chosen individually and only when there is a reason, and a strict diet "just in case" is not needed.
Do not cut out foods at random: unnecessary restrictions can harm a child. If you suspect an allergy, discuss it with the doctor; you may need an allergist and a pediatrician. If lips swell or breathing becomes difficult after eating, call an ambulance immediately.
Heredity matters, but it does not decide everything in advance. Severe forms develop more often when the inherited tendency combines with other risk factors.
If your little one develops dry skin and an itchy rash, show the child to a doctor rather than treating from your own experience.
Yes. A short, cool bath or shower with mild cleansers is part of daily care, followed by moisturizing. Long hot baths are best avoided.
If the skin is weeping or shows signs of infection, ask the doctor how to care for it at that time: during a flare, prescribed soothing lotions or wet dressings may be needed.
Discuss this with your doctor.
Skin with atopic dermatitis is vulnerable, and microbes settle on it easily. Yellow crusts, pus, and growing pain and swelling may mean a bacterial infection. Many small blisters and sores, especially with fever, may mean a widespread herpes infection, which needs treatment right away.
In either case, see a doctor promptly. Antibiotics or antivirals are prescribed by the doctor. Do not try to handle this with a steroid ointment: during an infection it can do harm.
In our doctors' research, low magnesium was found in moderate and severe disease, and metabolic agents as part of combined treatment gave better results than conventional treatment alone. But these were prescribed by a doctor for a specific reason, not supplements people chose for themselves.
Vitamins and dietary supplements can themselves contribute to allergic skin reactions. So do not start them without a consultation.
Atopic dermatitis, allergic rhinitis and bronchial asthma belong to the same group of atopic conditions and can occur together. Coughing, wheezing or shortness of breath should be shown to a pediatrician, primary care doctor or allergist.
In Professor Serbina's study, atopic conditions were the most common coexisting diseases in patients with alopecia areata (see Comorbidity in alopecia areata). If you are being treated for hair loss, tell the doctor about your dermatitis: some topical hair products can make it worse.
Everyone reacts differently. Some patients report that their skin, including the scalp, gets worse after time in the sun, and this can be hard to tell apart from itching caused by sweating in the heat. See Scalp aging and associated conditions.
So do not treat tanning as therapy. Tell your doctor how your skin behaves in summer and decide together how to protect it.
