Symptoms and Best Treatments for Atopic Dermatitis in Adults and Children United States 2025

Recognizing the Symptoms of Atopic Dermatitis in Adults and Children

Atopic dermatitis (AD), the most common form of eczema, is a chronic inflammatory skin disorder characterized primarily by dry, itchy, and inflamed skin patches. The condition can begin in infancy, persist through childhood, and often continue or recur in adulthood.

Key Symptoms

• Itching (Pruritus): The hallmark of AD, intense itching often precedes visible rash development, earning AD the description “the itch that rashes.” This symptom can cause discomfort, sleep disturbances, and quality of life challenges.
• Skin Rash: Patches of irritated skin usually appear red in individuals with lighter skin tones and may look darker, brown, purple, or gray in those with darker skin tones.
• Common Locations: Rashes often occur in flexural areas like the inside of elbows, behind the knees, wrists, and neck but can appear anywhere on the body.
• Skin Changes: Scaling, swelling, cracking, crusting, and sometimes oozing of clear fluid can be seen in affected areas.
• Chronic and Fluctuating Course: Symptoms may wax and wane with flare-ups, and affected skin can become thickened (lichenified) over time from persistent scratching.

Understanding What Triggers and Worsens Atopic Dermatitis

Atopic dermatitis arises from a combination of genetic factors affecting skin barrier function and immune dysregulation. People with AD often have defective skin barrier proteins, such as filaggrin, which makes their skin more vulnerable to dryness and irritation.

Common Triggers Include:

• Allergens: Pet dander, pollen, dust mites, and certain foods can provoke flare-ups.
• Irritants: Harsh soaps, detergents, fragrances, dyes, and chemicals often exacerbate symptoms.
• Environmental Factors: Dry air, fluctuations in temperature, and sweating can worsen the condition.
• Stress and Infections: Emotional stress and skin infections can trigger or intensify symptoms.
• Genetic Predisposition: A personal or family history of atopic diseases such as asthma and hay fever increases risk.

Because triggers can vary widely among individuals, identifying and avoiding personal aggravating factors through careful observation and medical consultation is crucial.

Diagnosing Atopic Dermatitis

Diagnosis primarily depends on clinical examination by a healthcare provider who considers the characteristic rash pattern, history of itching, chronicity, and associated personal or family history of allergies or atopic conditions.

• Clinical Evaluation: Careful skin examination assessing rash location, appearance, and distribution.
• History: Inquiry about onset, symptom fluctuations, and allergy history.
• Occasional Tests: Skin biopsy or cultures may be used to rule out infections or other skin disorders.
• Allergy Testing: Skin prick or patch testing can help identify allergens contributing to flare-ups but is not diagnostic for AD itself.

Accurate diagnosis helps distinguish AD from other skin conditions like contact dermatitis, psoriasis, or fungal infections.

General Principles of Managing Atopic Dermatitis Symptoms

Managing AD focuses on relieving symptoms, preventing flare-ups, and protecting the skin barrier. As a chronic condition, it requires ongoing care.

Essential Skin Care Strategies

• Moisturization: Applying moisturizers at least twice daily helps restore skin barrier integrity and reduces dryness.
• Gentle Products: Use fragrance-free, alcohol-free, dye-free cleansers and avoid irritants.
• Environmental Control: Employing humidifiers during dry seasons and avoiding extremes of temperature can help maintain skin hydration.
• Trigger Avoidance: Identifying and minimizing exposure to allergens and irritants reduces flare-ups.
• Proper Bathing Habits: Limit bath time and use lukewarm water; avoid harsh scrubbing.

Medical Treatments: Topical and Adjunctive Therapies

Topical Corticosteroids

Corticosteroid creams and ointments remain a mainstay to reduce inflammation and itching during flares. They vary in potency and should be used according to medical guidance to prevent adverse effects such as skin thinning.

Topical Calcineurin Inhibitors

Nonsteroidal immunomodulators like tacrolimus and pimecrolimus are alternatives, especially for sensitive areas (face, eyelids). However, they may cause localized burning and offer variable efficacy.

Novel Advances: Roflumilast Cream 0.15%

Recent development in topical therapy includes roflumilast cream, a once-daily phosphodiesterase-4 (PDE4) inhibitor approved for mild to moderate AD in patients aged six years and older. Clinical trials (INTEGUMENT-1 and INTEGUMENT-2) involving over 1,300 pediatric and adult patients in multiple countries, including the United States, revealed:

• Significant improvement in eczema severity and skin clearance within 4 weeks.
• Rapid relief from itch symptoms noted as early as 24 hours after first use.
• Excellent tolerability with low rates of local irritation or adverse effects.
• Moisturizing, fragrance-free cream formulation supports skin barrier protection.

These results highlight roflumilast cream as a promising nonsteroidal option that may improve adherence due to once-daily dosing and favorable safety profiles.

Oral Antihistamines and Other Supportive Treatments

While antihistamines may ease itching in some patients, they are generally adjunctive and not core AD treatments. In cases of secondary infection due to scratching, appropriate antimicrobial therapy is essential.

Managing Complications and Severity

Scratching breaks the skin barrier and risks bacterial infections characterized by pain, swelling, redness, and pus. Recognizing infection signs early and seeking medical intervention reduces complications.

In rare cases of severe or widespread AD, systemic treatments such as immunosuppressants or biologics may be considered under specialist care.

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

Since atopic dermatitis is generally a lifelong condition with intermittent flare-ups:

• Commitment to daily skincare routines is vital.
• Ongoing monitoring and adjustments by healthcare providers help optimize treatment.
• Awareness and management of triggers can reduce disease burden.
• Education about condition management enhances patient quality of life and comfort.

Parents, caregivers, and adult patients should maintain communication with their healthcare teams to manage evolving needs effectively.

Understanding the symptoms and treatment options for atopic dermatitis enables patients and families to navigate this chronic skin condition with better confidence and outcomes. Advances in topical therapies like roflumilast cream offer new hope for improved symptom control and 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: Availability and usage of treatments may vary by region and healthcare provider. Patients should consult their healthcare professionals to determine appropriate management tailored to their individual needs.