What are the stages of atopic dermatitis?
Atopic dermatitis is more common in infancy and childhood. It affects each child differently, in terms of both onset and severity of symptoms.
In infants, atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin. The skin may become infected. Once the infant becomes more mobile and begins crawling, exposed areas such as knees and elbows may also be affected. An infant with atopic dermatitis may be restless and irritable because of the itching and discomfort of the disease. Many infants get better by 18 months of age, although they remain at greater than normal risk for dry skin or hand eczema later in life.
In childhood, the rash tends to occur behind the knees and inside the elbows; on the sides of the neck; and on the wrists, ankles, and hands. Often, the rash begins with papules that become hard and scaly when scratched. The skin around the lips may be inflamed, and constant licking of the area may lead to small, painful cracks in the skin around the mouth. Severe cases of atopic dermatitis may affect growth, and the child may be shorter than average. The disease may go into remission. The length of a remission varies, and it may last months or even years. In some children, the disease gets better for a long time only to come back at the onset of puberty. At puberty, hormones, stress, and the use of irritating skin care products or cosmetics may cause the disease to flare.
A number of people who developed atopic dermatitis as children also experience symptoms as adults. However, it is unusual (but possible) for the disease to show up first in adulthood. The pattern in adults is similar to that seen in children. That is, the disease may be widespread or limited to a more restricted form. In some adults, only the hands or feet may be affected and become dry, itchy, red, and cracked. Sleep patterns and work performance may be affected, and long-term use of medications to treat the atopic dermatitis may cause complications. Adults with atopic dermatitis also have a predisposition toward irritant contact dermatitis. This is especially true if they are in occupations involving frequent hand wetting or hand washing or exposure to chemicals. Some people develop a rash around their nipples. These localized symptoms are difficult to treat, and people often do not tell their doctor because of modesty or embarrassment. Adults may also develop cataracts that are difficult to detect because they cause no symptoms. Therefore, the doctor may recommend regular eye exams.
National Institutes of Health
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