Atopic eczema, also called atopic dermatitis and formerly often referred to as asthma eczema or infantile eczema, is a chronic inflammatory skin disease. It is characterized by dry skin, itching, and recurring eczema outbreaks.

The most important thing to understand is that atopic eczema is not just dry skin.

The skin is often dry, but the dryness is part of a larger biological process. The skin barrier functions more poorly, the immune system reacts differently, the composition of the skin's fats changes, and itching and inflammation can reinforce each other.

Therefore, good care is not just about making the skin look nice during an outbreak. It is also about protecting the skin when it looks normal.

Even between outbreaks, atopic skin can be more vulnerable than other skin. This is one of the reasons why consistent barrier care is so important.

In this article, you will get answers to

1. What atopic eczema is and what it looks like.

2. Why people get atopic eczema.

3. What filaggrin, ceramides, and the skin barrier mean.

4. How the immune system, the microbiome, and itching are connected.

5. What can trigger and worsen the eczema.

6. How atopic eczema is treated and what skincare can contribute.

7. How I recommend caring for atopic skin with Raz Skincare.

8. When medical treatment is necessary and how you prevent new outbreaks.

What is atopic eczema?

Atopic eczema is a chronic, recurring inflammatory skin disease. This means that the disease typically alternates between periods of active eczema and periods when the skin is calmer.

The most characteristic symptoms are dryness and itching. The skin can also be scaly, irritated, cracked, swollen, or thickened. During severe outbreaks, it can ooze or form crusts.

The itching can be so pronounced that it affects sleep, concentration, and quality of life. This applies to both children and adults.

Atopic eczema often begins in childhood, but the disease can continue into adulthood or begin later. Many people experience fewer symptoms with age, but it is not a disease that everyone necessarily outgrows.

Is atopic eczema the same as infantile eczema?

Not entirely.

Atopic eczema is the medical term for the disease. Infantile eczema is the term often used when atopic eczema appears in children.

Asthma eczema is an older name. It does not mean that everyone with atopic eczema has asthma.

If you have a child with eczema, I also recommend our separate guide to infantile eczema. Here we go through the conditions that are especially important for babies and children, including bathing, sleep, itching, clothing, and treatment.

What does atopic eczema look like?

The appearance depends on factors such as age, skin tone, disease activity, and how long the area has been affected.

With acute eczema, the skin can be swollen, irritated, and possibly oozing. With long-term eczema, repeated scratching can make the skin thicker and more leathery. This is called lichenification.

On light skin, inflamed areas often appear red. On darker skin, the eczema may instead be purple, grayish, brownish, or darker than the surrounding skin. Redness is therefore not always a reliable measure of the disease's severity.

In infants, the eczema is often seen on the cheeks, head, and outer sides of the arms and legs. In older children, the inside of the elbows and the back of the knees are typical areas. In adults, areas such as the hands, neck, and face can be affected.

However, eczema on the hands or face can have other causes. Therefore, we also have separate articles about hand eczema and facial eczema.

Why do people get atopic eczema?

There is no single cause for atopic eczema.

The disease develops through an interplay between genetic predisposition, the skin's barrier function, the immune system, and environmental influences.

Some people are born with a skin barrier that loses water more easily or reacts to irritants. In others, immunological factors play a larger role.

Atopic eczema also occurs more frequently in families where asthma, hay fever, or atopic eczema are also present.

But the disease is not necessarily allergic.

Is atopic eczema an allergy?

No, not in itself.

People with atopic eczema have an increased risk of certain allergic diseases, but that does not mean that the eczema is caused by a specific food or a specific allergen.

It is therefore also not a good idea to automatically remove milk, eggs, gluten, or other foods from the diet.

If there is a concrete suspicion of food allergy, it should be examined by a doctor. This is especially important in children, where unnecessary dietary restrictions can affect nutrition.

What actually happens in the skin with atopic eczema?

This is where it gets interesting.

Previously, atopic eczema was often explained as either a problem with the skin barrier or an overreaction in the immune system.

Today, we know that the two things are closely connected.

A weakened skin barrier can promote inflammation. At the same time, the inflammation can make the skin barrier even worse.

This creates a self-reinforcing process where several biological mechanisms influence each other.

1. The skin barrier is weakened

Imagine the skin's outermost layer, the stratum corneum, as a wall.

The skin cells are the bricks. Between them lies an organized mixture of fats, including ceramides, cholesterol, and free fatty acids, which act a bit like the mortar.

A well-functioning skin barrier helps keep water inside the skin and limit the influence of irritants, allergens, and microorganisms.

With atopic eczema, this protection functions more poorly.

This means that the skin loses water more easily while becoming more susceptible to external influences.

Therefore, skin barrier care is a fundamental part of managing atopic eczema.

2. Filaggrin – a small protein with very great significance

One of the most important proteins in the skin barrier is called filaggrin.

Filaggrin contributes to the skin's normal maturation and structure. When the protein is broken down, it also contributes to the formation of the skin's natural moisturizing factors, often called NMF (Natural Moisturizing Factor).

NMF helps the skin bind water.

Some people have genetic changes in the FLG gene, which codes for filaggrin. Certain so-called loss-of-function variants mean that the skin produces less functional filaggrin.

These gene variants significantly increase the risk of atopic eczema.

But here is an important point: You do not need to have a filaggrin mutation to get atopic eczema.

Far from all patients have such a mutation. Filaggrin is therefore an important part of the explanation, but not the whole explanation.

Furthermore, inflammation can affect the skin's production of barrier proteins, even in people without an FLG mutation.

This shows how closely genetics, the skin barrier, and the immune system are connected.

3. Ceramides and the skin's fats are altered

It is not just filaggrin that is important.

The skin's outermost layer contains a complex mixture of ceramides, cholesterol, and fatty acids. These lipids are necessary to build the tight structures between the skin cells.

With atopic eczema, one often sees changes in both the amount, composition, and organization of these fats.

This can make the barrier less effective.

This is important because otherwise, it is easy to think that atopic skin is simply lacking moisture.

The skin often lacks water, but the problem is also that it has a hard time retaining it.

Therefore, it makes sense to use skincare that both provides moisture and limits evaporation from the skin surface.

A thick, occlusive ointment can be useful because it puts a protective film on the skin. However, this does not mean that every plant oil automatically restores the skin's natural ceramide structure.

4. TEWL – when the skin loses too much water

TEWL stands for Transepidermal Water Loss.

It describes the amount of water that evaporates through the skin.

All humans have TEWL. It is completely normal.

But when the skin barrier is weakened, the evaporation can become greater.

The skin becomes dry and tight. It can become irritated more easily, and the irritation can increase the itching.

When you scratch, the barrier is damaged further.

It is the beginning of a vicious cycle that many with atopic eczema know all too well.

5. The immune system and type 2 inflammation

Atopic eczema is not just a disease of the skin's outermost layer.

It is also an immune-mediated inflammatory disease.

In particular, so-called type 2 inflammation plays a central role. Here, the signaling substances IL-4 and IL-13 are among the most important.

Signaling substances are also called cytokines. They act as chemical messages between immune cells and other cells in the body.

With atopic eczema, certain inflammatory signaling pathways are overactive.

IL-4 and IL-13 can, among other things, affect the maturation of skin cells and the mechanisms that maintain the skin barrier.

Thus, a mutual relationship arises:

Weakened skin barrier ↔︎ inflammation

Barrier problems can contribute to inflammation, and inflammation can worsen the barrier problems.

This is one of the explanations for why very rich skincare can be important without necessarily being sufficient.

An ointment can protect the skin surface. It cannot be expected to control significant immunological inflammation on its own.

6. The microbiome and Staphylococcus aureus

The skin is not sterile.

It is home to bacteria, fungi, and other microorganisms, which together make up the skin's microbiome.

A well-functioning microbiome is a natural part of the skin's protection.

With atopic eczema, one often sees changes in the composition of the microbiome. This is called dysbiosis.

One bacterium is particularly interesting: Staphylococcus aureus.

It is found much more frequently on atopic skin, especially in areas with active eczema, than on healthy skin.

Research also shows a correlation between colonization with the bacterium and the disease's severity.

But correlation is not the same as causation.

Atopic eczema is not caused by just one bacterium that needs to be removed. It is a complex interplay between the skin barrier, the immune system, and microorganisms.

Therefore, routine use of antiseptic or antibiotic products is also not recommended just because one has atopic eczema. Signs of actual infection must be assessed separately.

Why does atopic eczema itch so intensely?

The itching is not just a result of dry skin.

It is an active part of the disease's biology.

Inflammatory signaling substances can affect the sensory nerve fibers in the skin. Among others, IL-31 is important in research into itching in atopic dermatitis.

When the skin itches, we scratch.

Scratching can provide short-term relief, but it simultaneously damages the skin barrier and can reinforce the inflammation.

This is called the itch-scratch cycle:

Itching → scratching → barrier damage → inflammation → more itching.

This is also why itching does not always disappear just because you apply a rich cream to the skin.

If the itching is primarily driven by active inflammation, it may be necessary to treat the eczema itself medically.

Why is the skin dry, even when the eczema is gone?

In my opinion, this is one of the most important aspects of atopic eczema.

When the redness disappears, many think that the skin is healthy again and that they can therefore stop applying cream.

But skin that looks normal is not necessarily biologically normal.

In people with atopic eczema, the skin barrier can remain affected, even in areas without visible outbreaks.

Therefore, ongoing barrier care is important.

I usually say that consistency beats intensity.

It is often better to care for the skin consistently than to react only when it has become very dry, irritated, and itchy again.

What can worsen atopic eczema?

What triggers an outbreak in one person does not necessarily do so in another.

But there are some stressors that recur:

• Cold, dry winter air, and dehydration.

• Heat, sweat, and friction.

• Long, hot baths and frequent washing.

• Soap and cleansing products that strip the skin of oil.

• Perfume and other substances the skin does not tolerate.

• Wool or coarse textiles directly against the skin.

• Stress and sleep deprivation, which can amplify the experience of itching.

• Scratching and skin infections.

The goal is not to avoid everything. The goal is to find the stressors that actually matter for your skin.

It is also worth remembering that not all rashes on atopic skin are caused by the atopic disease. One can simultaneously develop irritant or allergic contact eczema, for example, toward certain skincare ingredients.

If the eczema changes character, keeps returning to the same area, or does not respond to the usual treatment, the doctor can assess whether there is a need for further examination, for example, a patch test for contact allergy.

Raz Signature Treatment for atopic eczema

If I could only choose one product, I would choose Repair Perfume Free.

For more than 20 years, I have worked with people with dry, sensitive, and eczema-prone skin. And one thing experience has taught me:

It is not just about providing moisture to the skin. It is about helping the skin retain it.

With atopic eczema, the skin barrier is often weakened. Water evaporates more easily, the skin becomes dry and vulnerable, and itching and irritation can help keep the vicious cycle going.

Therefore, I have developed my signature treatment around three different functions:

Repair protects. Repair Barrier Cream supports the reconstruction of the skin barrier. Ai helps care for itchy and irritated skin.

The three products can be used separately or combined according to the skin's needs.

1. Repair Perfume Free – my absolute first choice

Repair is Raz Skincare's absolute best-selling product for eczema-prone skin.

And after more than 20 years of experience, it is still the product I reach for first when the skin is very dry, cracked, and vulnerable.

Repair Perfume Free is an intensive, water-free ointment that forms a protective layer on the skin and reduces transepidermal water loss – also called TEWL.

This means that the skin can better retain its moisture while being protected against drying out, cold, and friction.

This is particularly important in atopic eczema, where the skin often loses more water than normal.

The amazing thing about Repair is precisely its simplicity. It does not try to do ten different things at once. It protects the weakened skin barrier and creates better conditions for the skin to maintain its natural moisture balance.

I prefer Perfume Free for atopic skin because it is free of perfume and essential fragrance oils.

However, it does contain lanolin, which some people may be allergic to. In case of known lanolin allergy, I recommend Repair Barrier Cream instead.

2. Repair Barrier Cream – when the skin barrier needs more (Coming soon)

Here, the skin's biology really gets interesting.

For atopic skin does not necessarily just lack moisture. It can also have a disturbed composition of the fats that normally keep the skin cells tightly together.

That is exactly the problem that Repair Barrier Cream is developed for.

Where Repair primarily protects the skin's surface, Repair Barrier Cream is formulated with ceramides, cholesterol, and fatty acids – three central building blocks in the skin's natural lipid matrix.

At the same time, it combines moisture-binding ingredients with, among other things, ectoin and panthenol, which support the skin's comfort and moisture balance.

Repair Barrier Cream is therefore my choice for the daily care of a weakened skin barrier – especially when the skin needs both moisture and lipids.

It can be used on its own, but I think the combination with Repair is particularly interesting:

Repair Barrier Cream provides moisture and barrier-supporting lipids, while Repair settles as a protective layer on top.

Two different mechanisms that complement each other.

And an important advantage: Repair Barrier Cream does not contain lanolin.

3. Ai Anti-Irritation – when itching and irritation take over

For many with atopic eczema, the itching is almost worse than the dryness itself.

You itch. You scratch. The skin barrier is damaged further. And then it all starts over.

Therefore, Ai Anti-Irritation has an important place in my signature treatment.

Ai is a light, mineral-rich liquid with mineral-rich salt brine from Læsø and extract of purple willow. It is developed for the care of skin with a tendency toward itching, redness, scales, and irritation.

Over the years, we have received much positive feedback from customers who experience that Ai helps their irritated skin feel calmer.

My preferred combination for itchy, eczema-prone skin is Ai first and then Repair or Repair Barrier Cream.

However, Ai is not necessary for everyone. With atopic eczema, the skin can be so sensitive that even otherwise well-chosen ingredients sting. Therefore, Ai should only be used on skin that tolerates the product, and not on open, oozing, or severely inflamed areas.

For children with active atopic dermatitis or infantile eczema, I would not make Ai a permanent part of their routine without an individual assessment. Or dilute it with 50% water.

Should I use all three products?

No. And that is actually an important part of my philosophy.

If the skin is very dry and cracked: Start with Repair Perfume Free.

If the skin needs daily moisture and support for the lipid barrier: Choose Repair Barrier Cream, optionally with Repair on top.

If itching, flaking, and irritation are significant: Consider Ai as a supplement, provided the skin tolerates it.

The most important thing is not the number of products. It is choosing the care that matches the skin's current condition.

My recommended skincare routine for atopic dermatitis

Morning

1. Cleanse only when necessary

Avoid long, hot baths and cleansing products that dry out the skin. Often, lukewarm water is sufficient. Consider my Powder to Mousse, which is packed with mild minerals and completely free of saponification; it may even be used on infants.

2. Ai as needed

If the skin is itching or feels irritated, Ai can be applied to areas where the skin tolerates it. Let the skin dry before applying the next product.

3. Repair Barrier Cream (Coming soon)

Distribute the cream on dry and vulnerable areas to provide moisture and support the skin's natural lipid barrier.

4. Repair Perfume Free

Finish with Repair on areas that need extra protection – for example, hands, inner elbows, behind the knees, or particularly dry patches of skin.

You do not need to use every step every morning.

Evening

In the evening, the focus is primarily on giving the skin rest and protecting it from dehydration through the night.

After a possible short, lukewarm bath, apply Repair Barrier Cream while the skin is still slightly damp.

On very dry areas, you can finish with a slightly more generous layer of Repair Perfume Free.

If Ai is included in the routine, apply it first and let it dry before applying the barrier care.

If you use physician-prescribed eczema medication, it must be used according to the doctor's instructions. Skincare is a supplement, not a substitute.

When can I expect results?

That depends on the condition of the skin.

Very dry skin may feel more comfortable after the first application of Repair because evaporation is limited and the surface is protected.

A more stable skin barrier, however, requires regular care over time.

And with active atopic dermatitis, it is important to remember that skin barrier problems and inflammation are not the same thing. Even the best barrier care cannot always control the immunological activity of the disease.

Therefore, medical treatment must be used when it is needed.

My most important advice is to continue daily barrier care, even when the skin looks good again.

Because with atopic dermatitis, the prevention of the next flare-up often begins long before you can see it.

And remember: Repair is still my first choice. The other products should not replace what already works. They should supplement it when the skin needs more.

Medical treatment – when is skincare not enough?

Here I want to be very clear.

One should not be so afraid of corticosteroid cream that a child or adult walks around with inadequately treated atopic dermatitis.

Moisturizing care is a central part of the treatment, but with active inflammation, more is often needed.

Topical corticosteroid treatment is a well-documented first-line treatment for eczema flare-ups. Strength, area of application, and duration of treatment must suit the patient and follow the doctor's instructions.

Correct application can effectively dampen inflammation and itching. Incorrect or prolonged use of overly strong preparations can cause side effects, but undertreated eczema also has consequences.

There are also steroid-free prescription options, including tacrolimus and pimecrolimus. In moderate to severe disease, the dermatologist may assess the need for other topical medications, light therapy, or systemic treatment, including targeted biological drugs and JAK inhibitors.

Dermatological guidelines support both regular moisturizing care and anti-inflammatory treatment when the disease requires it.

Skincare and medical treatment are therefore not competitors.

They solve different parts of the problem.

When should you contact your doctor?

Contact a doctor if the eczema is widespread, painful, significantly disrupts sleep, weeps, develops yellow crusts, or does not respond to your usual treatment.

In case of rapidly increasing painful rash with many identical blisters or small sores, especially if accompanied by fever or an affected general condition, seek urgent medical assessment. In rare cases, this may be a sign of eczema herpeticum, which requires prompt treatment.

Eczema around the eyes with eye pain or vision impairment should also be assessed quickly.

When can you expect results?

Are 1, 2, 3 days plenty? Because then I can't see or feel anything.

A fatty ointment can make very dry skin feel softer and less tight relatively quickly. BUT, a more stable skin barrier, on the other hand, requires persistent care.

I will therefore not promise that atopic dermatitis will disappear in three days. Even though many no longer experience the eczema being in a flare-up.

The goal is fewer flare-ups, less dryness and itching, better sleep, and longer periods of calm skin.

Maintenance – the mistake I often see

The skin looks nice.

You stop applying cream.

The skin gradually becomes drier.

The itching begins again.

And then it all starts over.

With atopic dermatitis, barrier care should not just be firefighting.

When the skin is more stable, the need for products may change, but regular care is still important. Some patients also need physician-prescribed, preventative anti-inflammatory treatment on areas with frequent relapses.

The best effort against the next flare-up sometimes begins before the flare-up is visible.

Frequently asked questions about atopic dermatitis

Can atopic dermatitis be cured?

Atopic dermatitis is a chronic disease, but the symptoms can often be controlled effectively. Many get significantly better with age. The goal of treatment is to keep the skin stable and limit flare-ups.

Are atopic dermatitis and asthma eczema the same thing?

Yes. Asthma eczema is an older term for atopic dermatitis. You don't need to have asthma to have the disease.

Is atopic dermatitis contagious?

No. Atopic dermatitis is not contagious. However, the skin can develop an infection that requires separate assessment.

Why does atopic dermatitis itch most at night?

The itching is caused, among other things, by the interaction between inflammation, skin barrier, and the nervous system. Heat in bed and fewer other sensory inputs can make the itching more noticeable at night.

Can stress worsen atopic dermatitis?

Yes, for some people, stress can worsen itching and eczema activity. This does not mean that the eczema is psychologically caused. The disease has a real biological and immunological background.

Is atopic dermatitis a food allergy?

No. Food allergies can occur simultaneously, but they do not automatically explain the eczema. Avoid major dietary changes without a specific medical assessment.

Should you use cream every day with atopic dermatitis?

Regular moisturizing and barrier care are recommended even between flare-ups. The frequency depends on the dryness of the skin and the product chosen.

Can I just use Repair Perfume Free?

Repair can be part of a simple cosmetic skincare routine if you tolerate the formulation. However, in case of active inflammation, medical treatment may be necessary. Repair is not a substitute for physician-prescribed treatment.

Can children use Ai Anti-Irritation?

I do not recommend Ai as standard care for children with active atopic dermatitis. The formulation may sting on damaged skin, and at-home dilution with water is not a documented safety protocol. For children, one should prioritize Repair, and if that is not enough, then dilute Ai with 50% water.

Can atopic dermatitis become infected?

Yes. Cracks and scratching increase the risk of infection. Increasing pain, weeping, yellow crusts, fever, or rapid worsening should be assessed by a doctor.

REMEMBER

You can always book a skin analysis with me, and I will be happy to help. You can read much more about my skin analysis and service at this link.

For pronounced, persistent, or recurring atopic dermatitis, I also recommend that you speak with your doctor or dermatologist. Skincare can help protect the skin barrier but should not replace necessary medical treatment.

And remember: The skin can indeed need care even when the eczema is no longer visible.

Hugs Raz

Curious for more?

If you want to read more or see where I get my knowledge from, here are some articles that I think are good.

1. Current Understanding of Pathophysiological Mechanisms of Atopic Dermatitis: Interactions among Skin Barrier Dysfunction, Immune Abnormalities and Pruritus

A thorough review of the interaction between the skin barrier, the immune system, and itching. It is particularly interesting because it shows how these three mechanisms affect each other and can maintain the disease.

2. Filaggrin and beyond: New insights into the skin barrier in atopic dermatitis and allergic diseases, from genetics to therapeutic perspectives

A 2024 review that explains the importance of filaggrin and puts genetic barrier defects in the context of inflammation and the microbiome. Good reading if you want to understand why atopic dermatitis is far more complex than just dry skin.

3. Increased loss-of-function filaggrin gene mutation prevalence in atopic dermatitis patients across northern latitudes indicates genetic fitness: A systematic review and meta-analysis

A comprehensive meta-analysis from 2024 that examines the prevalence of FLG mutations. It shows that the mutations are a significant risk factor, but also that far from everyone with atopic dermatitis has them.

4. The immunological and structural epidermal barrier dysfunction and skin microbiome in atopic dermatitis-an update

A 2023 overview article on the structure of the skin barrier, lipids, filaggrin, the immune system, and the microbiome. It provides a unified picture of how several biological processes contribute to atopic dermatitis.

5. Type 2 Inflammation Contributes to Skin Barrier Dysfunction in Atopic Dermatitis

This article explains why inflammation and skin barrier damage are connected. Particularly interesting is the review of how cytokines like IL-4 and IL-13 can affect the skin's structural proteins and lipids.

6. Atopic Dermatitis Itch: Scratching for an Explanation

A 2024 review on itching in atopic dermatitis. It covers the connection between the immune system, the skin, and the nervous system and explains why itching is not just caused by dryness.

7. Prevalence and odds of Staphylococcus aureus carriage in atopic dermatitis: a systematic review and meta-analysis

A large meta-analysis of the prevalence of Staphylococcus aureus in people with atopic dermatitis. It shows that the bacteria are far more common on atopic skin, especially during active flare-ups.

8. Skin microbiota in atopic dermatitis: victim or executioner?

A recent review on the skin's microbiome and its role in the disease. It is particularly interesting because it discusses how bacteria can both be affected by the eczema and themselves contribute to worsening it.

9. Emollients and moisturizers for eczema: abridged Cochrane systematic review including GRADE assessments

A systematic review of moisturizing products for eczema. It shows why regular moisturizing care is an important part of managing the disease, while also clarifying the limitations in documentation.

10. Guidelines of care for the management of atopic dermatitis in adults with topical therapies

The American Academy of Dermatology's evidence-based guideline from 2023. It reviews recommendations for, among other things, moisturizing products, corticosteroid creams, and other topical anti-inflammatory treatments.