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Image: Triocean/Getty ImagesAtopic dermatitis, a prevalent form of eczema, is an inflammatory skin condition affecting millions of individuals in the U.S. and worldwide. If you or someone you know deals with the dry, scaly, and blistering patches characteristic of this chronic disorder, you're not alone.
"Eczema flare-ups can be triggered by an overactive immune system, environmental influences, and even emotional stress," explains Jeremy Brauer, MD, FAAD, a board-certified dermatologist at Spectrum Skin and Laser in New York City. "This condition manifests differently for each person and can vary significantly depending on your skincare routine."
Managing this type of eczema is crucial to avoid discomfort, pain, and exacerbation of the condition. Continue reading to discover the three key stages of atopic dermatitis and expert recommendations for treatment.
The Three Phases of Atopic Dermatitis
Atopic dermatitis progresses through three unique stages. Below, we explain each phase and the best treatment strategies for each.
Acute Atopic Dermatitis
Acute atopic dermatitis refers to the initial appearance of the condition or the first stage of a flare-up for those who have already been diagnosed. While it might seem like the first stage should be mild, that's not always the case, as significant inflammation often triggers the flare-up right from the start.
What It Looks Like: Dr. Brauer explains, "Acute atopic dermatitis may present as vesicular, crusting, blistering, and oozing skin." You may also notice small red bumps, redness, burning, itching, and persistent irritation.
Recommended Treatment: Begin by identifying and eliminating any possible triggers for the flare-up. Then, treatment can begin. "Topical anti-inflammatory medications, including both steroidal and nonsteroidal options, are key in managing this," says Aya Ahram, DO, FAAD, a board-certified dermatologist at Hudson Dermatology & Laser Surgery.
Over-the-counter hydrocortisone or antihistamine products can help reduce your body’s heightened immune response. (If you're uncertain which to use, your doctor can prescribe the right product or guide you to the appropriate potency.)
A gentle, moisturizing skincare routine using products designed for sensitive, eczema-prone skin is also advised. Instead of itching or rubbing, cold compresses can alleviate the irritation. If the rash becomes infected, you’ll need a prescription for antibiotics.
Subacute Atopic Dermatitis
Often referred to as the "healing" phase of atopic dermatitis, this second stage tends to be much milder compared to the first. In some cases, your eczema may even begin in this phase, remaining relatively mild, or fluctuate between acute and subacute stages.
What It Looks Like: “Subacute atopic dermatitis resembles acute dermatitis, but the symptoms are typically less severe,” Dr. Bauer explains. “This phase is marked by dryness, scaling, and crusted skin.” You may still experience some irritation or itching, dry and cracked skin, flakiness, and lingering redness. However, the severe oozing, blistering, and pain aren't part of this phase.
Recommended Treatment: It’s essential to avoid any triggers that might push your eczema back into the acute phase or interfere with the healing of patches. From here, continue with the anti-inflammatory treatment plan advised by your doctor.
As you progress further into the healing phase, maintain a very gentle and deeply hydrating skincare regimen, applying thicker ointments to "hot spots" that require extra care. Be vigilant for potential infections so they can be addressed right away, and use cool compresses to calm your skin.
Antihistamines that alleviate itching and inflammation can also help prevent you from scratching the healing skin.
Chronic Atopic Dermatitis
As the name suggests, chronic atopic dermatitis is marked by prolonged flare-ups or persistent symptoms. This stage doesn't occur until you've been dealing with symptoms for three months or more. Along with the ongoing nature of these symptoms, there are also distinctive physical features linked to this stage of eczema.
What It Looks Like: Chronic atopic dermatitis is characterized by "lichenified" skin, which means thick, dry patches that appear leathery. You may also notice darkened areas (hyperpigmentation), deep cracks, and persistent itching. “If these lesions are scratched repeatedly over time, they can develop into nodule-like lesions,” Dr. Ahram explains.
Recommended Treatment: The treatment for chronic atopic dermatitis typically involves stronger topical steroids and nonsteroidal medications, Dr. Ahram says. “However, for more widespread cases, there are additional options such as injectable biologics, some of which are approved for use as early as six months old and can be life-changing,” she adds.
It’s important to continue the soothing skincare routine that incorporates deeply moisturizing creams and ointments, cool compresses to ease irritation, and antihistamines to reduce itching, while also avoiding known triggers. If you're struggling to manage flare-ups or discomfort, consulting a professional can help guide your treatment plan.
