Symptoms vary from person to person, but common signs of atopic dermatitis include:

• Intense itching that may worsen at night
• Red, inflamed patches of skin
• Dryness, flaking, or scaly texture
• Thickened skin in areas of repeated scratching
• Oozing or crusting during flares
• Location differences by age: in infants, eczema often appears on the face and scalp; in children and adults, it more commonly affects the creases of the elbows, knees, neck, and hands

Atopic dermatitis typically comes and goes in cycles, with periods of flares and periods of remission. Without proper treatment, scratching and chronic inflammation can lead to skin thickening, pigmentation changes, and risk of infection.

Atopic dermatitis is a multifactorial condition, meaning several factors contribute:

• Genetic predisposition: Many people with eczema have a family history of allergies, asthma, or hay fever (the “atopic triad”).
• Skin barrier dysfunction: A key underlying issue is a weakened skin barrier, often due to mutations in the filaggrin gene. This makes the skin less able to retain moisture and more susceptible to irritants, allergens, and microbes.
• Immune system imbalance: Overactivation of the immune system leads to chronic inflammation and itching.
• Environmental triggers: Cold weather, harsh soaps, fragrances, dust, sweat, and stress can trigger flares.
• Allergies: Food or environmental allergies may contribute in some patients, though they are not always the cause.

Understanding your unique triggers helps guide a more effective, personalized treatment plan.

At Peak Skin Center, diagnosis begins with a detailed medical history and physical exam. Our board-certified dermatologist and team of providers look for hallmark patterns of eczema, assess distribution, and review symptom history.

While there is no single lab test for atopic dermatitis, sometimes additional evaluations are performed:

• Skin swabs to check for secondary infections like staph bacteria
• Allergy testing if environmental or food triggers are suspected
• Skin biopsy in atypical cases to rule out other conditions

Because eczema can mimic or overlap with other rashes (such as contact dermatitis or psoriasis), a professional dermatologic evaluation ensures the right diagnosis and the most effective treatment.

There is no single cure for eczema, but treatment focuses on reducing inflammation, controlling itching, repairing the skin barrier, and preventing infections. At Peak Skin Center, we design customized treatment plans that may include:

Topical Therapies

• Moisturizers and emollients: Daily use restores hydration and strengthens the skin barrier. Thick creams or ointments are preferred over lotions.
• Topical corticosteroids: Used during flares to calm redness, itching, and inflammation.
• Topical calcineurin inhibitors (tacrolimus, pimecrolimus): Non-steroidal options for sensitive areas like the face and eyelids.
• Newer non-steroidal creams: Crisaborole and ruxolitinib may be recommended for certain patients.

Light Therapy (Phototherapy)

Controlled exposure to narrowband UVB light can reduce inflammation, itch, and bacteria on the skin. Phototherapy is often used for moderate to severe eczema that does not respond adequately to topicals.

Oral Medications

For patients with widespread or severe eczema, systemic treatments may be considered:

• Oral antihistamines: To help reduce nighttime itching and improve sleep.
• Short courses of oral corticosteroids: Sometimes used for severe flares, but not ideal long-term.
• Oral immunosuppressants: Medications such as cyclosporine, methotrexate, or azathioprine may be prescribed in select cases, under close monitoring.
• Targeted oral therapy (upadacitinib): Upadacitinib is an oral Janus kinase (JAK) inhibitor approved for moderate to severe atopic dermatitis in certain patients. It works by blocking specific pathways in the immune system that drive inflammation. For some patients who do not respond well to other systemic treatments, it offers an effective oral option.

Biologic Therapies

Dupilumab was the first FDA-approved biologic for atopic dermatitis and has transformed treatment for many patients. It works by targeting specific immune pathways (IL-4 and IL-13) that drive eczema inflammation. Benefits include:

• Significant reduction in itching and skin lesions
• Improved sleep and quality of life
• Steroid-sparing effect for long-term disease management

Other biologic and targeted therapies are emerging, offering new hope for patients with difficult-to-treat eczema.