Atopic dermatitis – commonly known as eczema – is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed skin. It is one of the most common skin conditions in Australia, particularly in children. Atopic dermatitis follows a relapsing-remitting pattern, with periods of flare and periods of relative calm.
The term "atopic" refers to a tendency towards allergic conditions; atopic dermatitis is closely linked with asthma, hay fever, and food allergies – a group often referred to as the "atopic march."
How common is Eczema?
Atopic dermatitis affects approximately 10–15% of children and 2–5% of adults in Australia. Many children improve significantly as they get older, though for some the condition persists into adulthood or first develops in adult life. It affects males and females equally.
Symptoms vary in severity and can affect any part of the body.
Common symptoms include:
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- Intense itching – often worse at night and can significantly disrupt sleep
- Dry, sensitive skin
- Red to brownish-grey patches of inflamed skin
- Small raised bumps that may weep fluid and crust over when scratched
- Thickened, cracked, or scaly skin
- Swollen or raw skin from scratching
In infants, eczema typically appears on the face and scalp. In older children and adults, it more commonly affects the inner elbows, backs of knees, neck, wrists, and hands.
Severe or poorly controlled atopic dermatitis can significantly affect quality of life, mental health, and sleep.
Atopic dermatitis is caused by a combination of a disrupted skin barrier and an overactive immune response:
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- Skin barrier dysfunction – the skin's outer layer does not retain moisture effectively, allowing irritants and allergens to penetrate and trigger inflammation. Mutations in the filaggrin gene, which is involved in maintaining the skin barrier, are a significant genetic risk factor
- Immune system overactivity – the immune system responds disproportionately to environmental triggers, driving chronic skin inflammation
- Genetics – atopic dermatitis runs in families; having a parent or sibling with eczema, asthma, or hay fever significantly increases risk
- Environmental triggers – including sweat, certain soaps and detergents, dust mites, pet dander, pollen, mould, and some foods can trigger or worsen flares
Atopic dermatitis is diagnosed clinically, based on the appearance and distribution of the rash, symptom history, and personal or family history of atopic conditions.
There is no specific blood test or skin test for diagnosis. A dermatologist or allergist may order:
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- Patch testing – to identify contact allergens that may be contributing to flares
- Skin prick testing or specific IgE blood tests – to assess for allergic sensitisation where relevant
- Skin swabs – if secondary bacterial infection (most commonly Staphylococcus aureus) is suspected
Treatment is stepwise, starting with foundational skin care and escalating to systemic therapies for moderate to severe disease.
Skin care and topical treatments
Regular moisturising with emollients is the foundation of atopic dermatitis management and should continue even when the skin is clear. Topical treatments include:
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- Topical corticosteroids – the mainstay of flare management; applied to affected areas to reduce inflammation
- Topical calcineurin inhibitors – such as tacrolimus (Protopic) and pimecrolimus (Elidel); non-steroidal options for sensitive skin areas and long-term use
- Topical JAK inhibitors – ruxolitinib cream (Opzelura) is a newer topical option for mild to moderate atopic dermatitis
Systemic treatments for moderate to severe disease
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- Cyclosporin — an immunosuppressant used for severe refractory atopic dermatitis where topical treatments have failed; typically used short-to-medium term due to side effects with prolonged use.
- Biologic therapies — dupilumab (Dupixent) targets the IL-4 and IL-13 pathways central to atopic dermatitis inflammation, available for adults, adolescents, and children. Tralokinumab (Adtralza) targets IL-13 specifically and is an alternative biologic option.
- JAK inhibitors (Janus kinase inhibitors) — abrocitinib (Cibinqo), upadacitinib (Rinvoq), and baricitinib (Olumiant) are oral targeted therapies used for moderate to severe atopic dermatitis in adults who have not responded adequately to other treatments.
Trigger management
Identifying and avoiding personal triggers, such as specific soaps, fabrics, foods, or environmental allergens, is an important part of long-term management.
The following specialty medications are available at Ace, a specialty pharmacy for Atopic Dermatitis.
Note: Topical treatments (emollients, topical corticosteroids, Protopic, Elidel) are central to atopic dermatitis management but are not specialty medications.
With Ace, you’ll benefit from:
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- Expert Support — Our dedicated team of health concierges is always available to answer your questions, provide guidance, and help you navigate your condition with confidence.
- Specialty Medication — We offer a wide range of specialty medications and support services, designed specifically for those living with chronic illnesses. Whether you’re looking for help managing a specific condition, or simply need access to the medications you need, we’ve got you covered.
- A Wide Range of Conditions — From diabetes to heart disease, and everything in between, we help manage a variety of special condition
Take control of your health and well-being, and start your journey to better health with Ace today.
Eczema-Specific Support
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- Eczema Association Australasia – Australia's peak patient organisation for eczema; information, support groups, and nurse helpline
- Eczema Association Australasia – Helpline
Allergy & Skin Health
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- ASCIA – Eczema/Atopic Dermatitis – information from the Australasian Society of Clinical Immunology and Allergy
- Healthdirect – Eczema
- Australasian College of Dermatologists – Find a Dermatologist
Clinical & Research Resources
