Atopic Dermatitis Causes: What Triggers It and Who’s at Risk

Atopic dermatitis (AD) is more than occasional dry skin. It can cause persistent itching, inflamed skin, and dry, scaly patches that disrupt sleep, affect comfort, and impact confidence. Many people use the terms eczema and atopic dermatitis interchangeably, but there is an important difference. Eczema is a broad term for several skin conditions that cause irritation and inflammation, including contact eczema, hand eczema, and dyshidrotic eczema. Atopic dermatitis is the most common type of eczema and places a substantial psychological, social, and economic burden on patients, their families, and society.

What Is Atopic Dermatitis?

Atopic dermatitis (AD) is a chronic inflammatory skin condition. It develops when the skin barrier becomes weakened and the immune system overreacts to triggers, leading to dryness, constant itching, and recurring flare-ups. It often begins in childhood, but it can start or persist at any age.
No two people experience Atopic dermatitis in the same way. Clinically, atopic dermatitis is characterised by dry, intensely itchy skin, often accompanied by redness and thickening of the skin. These symptoms can have a major impact on quality of life. Persistent itch and visible skin changes may lead to sleep disturbance, anxiety, low mood, social withdrawal, and reduced productivity, highlighting the wider psychological and social burden of the condition.
The disease often begins with dry, rough patches that develop tiny blisters or oozing lesions and later thicken into lichenified (leathery) plaques. In fair skin the lesions appear erythematous (red) whereas in brown or black skin they may look ashen grey, purple or dark brown. These colour differences can make it difficult for clinicians to appreciate the severity of inflammation. People with darker skin are also more prone to papular or nodular lesions, hyperpigmentation, and scaly patches, particularly on the extensor surfaces.
During a flare, the skin barrier leaks moisture and becomes susceptible to skin infections. Frequent scratching can break the skin, allowing bacteria such as Staphylococcus aureus to invade (bacterial infection). In darker skin, healing may leave behind post‑inflammatory hyper‑ or hypopigmentation, which can be as distressing as the active rash. Itchiness often disrupts sleep; sleep disturbance and fatigue are common complaints among people with severe Atopic dermatitis.

Why Do People Get Atopic Dermatitis?

Researchers agree that Atopic dermatitis arises from a combination of skin barrier defects, genetic predisposition and an overactive immune response. Researchers have not identified a single cause of AD. Current evidence points to a combination of genetic predisposition, impaired skin‑barrier function and immune dysregulation. A review on AD pathophysiology notes that genetic factors, disruption of the epidermal barrier and abnormal immune responses are critical components of the disease.

Genetic predisposition and barrier defects

The outermost layer of skin (stratum corneum) acts as a waterproof barrier.  Loss‑of‑function mutations in the filaggrin (FLG) gene compromise this barrier, leading to dryness and allowing allergens and microbes to penetrate.  FLG mutations are the most prominent genetic risk factor; they occur in about 50% of European patients with Atopic dermatitis and 27% of Asian patients.  Interestingly, these mutations are less common in people of African descent, suggesting that other pathways contribute to the higher prevalence and severity of atopic dermatitis in brown or black skin.
Variants in immune‑related genes, including those encoding interleukin‑4 (IL‑4), IL‑13, and the IL‑4 receptor, also increase susceptibility. These cytokines drive a type 2 immune response that promotes skin inflammation, itching and increased IgE production. They also interfere with the maturation of skin cells (keratinocytes), contributing to a thinner epidermis and reduced antimicrobial peptide production. In some populations, polymorphisms of IL‑4Rα occur in up to 70% of people of African descent, helping to explain racial differences in disease phenotype.
Despite these genetic insights, most people with Atopic dermatitis do not carry a single causative mutation; the disease results from the cumulative effect of multiple genes and environmental exposures.

Immune dysregulation

The skin of people with Atopic dermatitis tend to have an overactive immune system that exhibits increased activity of T‑helper 2 (Th2) and Th22 cells, which secrete IL‑4, IL‑13 and IL‑31.  These cytokines impair keratinocyte differentiation, reduce production of antimicrobial peptides and intensify itching.  In Asian individuals, there is additional Th17 and Th22 activity, whereas people of African descent exhibit reduced Th1 and Th17 responses but similar Th2 up‑regulation. Such immunologic differences partly explain why lesions may be more popular or lichenified in darker skin and more scaly in lighter skin.

Risk factors for Atopic dermatitis

People with atopic dermatitis often have an overly reactive immune system that can become activated by certain triggers, leading to inflammation in the skin. Exposure to these triggers may increase the risk of developing atopic dermatitis, provoke flare-ups, and worsen the severity of symptoms. These triggers may include:

• Family history of atopy. Having close relatives with Atopic dermatitis, asthma or hay fever is one of the strongest risk factors. Genetic variants that weaken the skin barrier or alter immune responses can be inherited. Large cohort studies show that having a parent with asthma or hay fever increases the risk of persistent Atopic dermatitis.

• Risk is higher in children (up to 20% of children are affected by Atopic dermatitis) and tends to decline with age. 

• Black or African American children are more than three times as likely as white children to experience early or persistent Atopic dermatitis, while female children have a lower risk of early and persistent disease. Natural birth appears protective, whereas infants exposed to antibiotics or second‑hand smoke in the first year of life have higher odds of developing Atopic dermatitis.

• Other atopic conditions. People with Atopic dermatitis frequently have asthma or allergic rhinitis, and the presence of these conditions may predict more persistent or severe disease. Conversely, Atopic dermatitis can precede the development of allergic rhinitis and asthma, a progression often referred to as the atopic march.

• Environmental factors. Air pollution is another important risk factor. A meta‑analysis of 42 studies found that each 10 µg/m³ increase in particulate matter (PM₁₀) was associated with a 0.8% increase in atopic dermatitis‑related visits. Pollutants activate the aryl hydrocarbon receptor, generate oxidative stress and weaken the skin barrier.  Extreme temperatures and humidity fluctuations also modulate disease severity; for example, higher prevalence of Atopic dermatitis has been reported in colder, wetter regions of Spain compared with sunnier, warmer regions.  Second‑hand smoke and household exposures such as renovation dust or use of traditional brooms have been identified as triggers in rural children.

Lifestyle behaviours can either aggravate or alleviate Atopic dermatitis. 

• Smoking generates reactive oxygen species and impairs the immune system; both active smoking and second‑hand exposure are positively associated with developing Atopic dermatitis.

• Alcohol consumption disrupts the gut microbiome, increases vascular permeability and promotes inflammation.

• Stress is also a well‑recognised trigger: chronic psychological stress can activate the hypothalamic–pituitary–adrenal axis and exacerbate inflammatory skin diseases, including Atopic dermatitis. 

• Dietary patterns influence flares—common food allergies such as dairy, peanuts, eggs and gluten often precipitate immediate IgE‑mediated reactions or delayed eczematous responses. A diverse gut microbiome appears protective, whereas reduced microbial diversity correlates with increased susceptibility to allergic reactions and flare‑ups.

Common Triggers That Worsen Symptoms

Identifying personal triggers is key to preventing flare ups. The following factors commonly provoke symptoms of atopic dermatitis:

1. Irritants and harsh soaps. Fragrances, preservatives and parabens in skincare or cleaning products can irritate sensitive skin. Studies show that fragrances elicit immune responses and increase cytokine release. Parabens may act as endocrine disruptors and modulate IgE production. Opt for fragrance‑free, hypoallergenic cleansers and moisturisers, and avoid harsh soaps or detergents.

2. Allergens and certain foods. Besides environmental allergens (pollen, animal dander, dust mites), certain foods can provoke Atopic dermatitis. Research highlights dairy, peanuts, eggs and gluten as common triggers that cause immediate IgE‑mediated flares or delayed inflammation. Do not embark on elimination diets without medical guidance; seek allergy testing if you suspect food triggers.

3. Clothing and materials. Rough fabrics such as wool and synthetic fibres can increase friction and itching. Loose, breathable cotton clothing helps reduce irritation.

4. Temperature and humidity extremes. Sudden changes in temperature, hot baths or very dry air can worsen Atopic dermatitis.  Warm weather and humidity may help some people by producing vitamin D, but sweating itself can irritate the skin and promote flares. Use a humidifier in dry environments and keep your home well ventilated.

5. Pollution and second‑hand smoke. Exposure to particulate matter, household renovations and fuel fumes increases flares. Avoid smoking indoors and maintain good air quality.

6. Stress and lack of sleep. Chronic stress activates neuroendocrine pathways that drive itching and inflammation. Mindfulness, regular exercise and adequate sleep can break this cycle. Sleep deprivation itself heightens perception of itch and makes scratching harder to resist.

7. Skin infections. A compromised barrier permits bacterial or viral infections. Look for signs such as weeping, honey‑coloured crusts or rapidly spreading redness—these may require medical evaluation.

Keeping a symptom diary helps pinpoint which triggers are relevant to you. Avoiding known irritants and adopting a gentle skincare routine can dramatically reduce flare‑ups.

What Deficiencies or Conditions Are Linked?

Atopic dermatitis is often part of an atopic march, where skin disease in infancy precedes asthma and allergic rhinitis. Defects in the skin barrier allow allergens to penetrate, leading to systemic Th2‑skewed immune responses that predispose to airway inflammation. A Swedish case–control study reported that adults with Atopic dermatitis had nearly twice the odds of having autoimmune diseases (such as coeliac disease, inflammatory bowel disease, alopecia areata and vitiligo) compared with controls.  These associations suggest a shared underlying immune dysregulation rather than direct causation.
Nutritional deficiencies also play a role. Meta‑analyses show that people with Atopic dermatitis have significantly lower vitamin D levels than healthy controls, and supplementation (1 000–2 000 IU/day for 1–3 months) can improve severity scores in those who are deficient. Vitamin D enhances antimicrobial peptide (LL‑37) production and strengthens barrier function. However, evidence is mixed; routine supplementation in the absence of deficiency is not supported. Reduced diversity of the gut microbiome correlates with increased susceptibility to Atopic dermatitis; research into probiotics, prebiotics and microbiome transplants is ongoing.

Can Atopic Dermatitis Be Cured?

Atopic dermatitis is a chronic, relapsing inflammatory skin disorder characterised by dry skin (xerosis), intense itching and recurrent eczematous lesions. Because the disease results from a complex interplay of genetic predisposition, skin‑barrier dysfunction and immune dysregulation, there is currently no curative therapy. Instead, management aims to control inflammation, repair the barrier and prevent flare‑ups. Researchers note that disease‑modifying therapies that induce long‑term remission or a functional cure are still needed, highlighting that current treatments primarily alleviate symptoms rather than alter the natural course of Atopic dermatitis. Until such therapies become available, consistent skincare, trigger avoidance and appropriate use of topical or systemic medications and phototherapy remain the cornerstone of management.

Treatment Options for Atopic Dermatitis

There is currently no cure for Atopic dermatitis, but a combination of daily skin care, trigger avoidance and targeted therapies can control symptoms and improve quality of life. Management should be tailored to disease severity and individual triggers. Treatment aims to prevent and manage flares, repair and improve the function of the skin barrier, reduce inflammation and control itching. A comprehensive plan often includes several approaches:

• Basic skin care and emollients. Regular application of fragrance‑free moisturisers or ointments twice daily can improve barrier function. Moisturisers should be applied immediately after bathing to lock in moisture. Gentle cleansing with soap substitutes instead of regular soap is recommended.

• Topical medications. For mild to moderate flares, low‑ or medium‑potency topical steroids (corticosteroids) are first‑line therapy. Calcineurin inhibitors (tacrolimus and pimecrolimus) or phosphodiesterase‑4 inhibitors (crisaborole) offer steroid‑sparing options for sensitive areas like the face or eyelids. Topical treatments should always be used under medical guidance to minimise side effects.

• Phototherapy. Controlled exposure to ultraviolet light can improve Atopic dermatitis (eczema) by reducing inflammatory cells and altering cytokine production. Controlled studies show that these regimens are effective for chronic Atopic dermatitis. UVB phototherapy is particularly helpful for chronic stages of Atopic dermatitis and may be used when topical treatments alone are insufficient. Because treatment requires specialised equipment and frequent sessions, some patients now use home‑use narrowband UVB devices. Medical phototherapy devices such as UV Tactus enable patients to administer phototherapy at home, reducing the need for frequent clinic visits and time spent travelling. This can be especially valuable during flare-ups, when starting treatment promptly may help bring symptoms under control sooner rather than waiting for an appointment. Home phototherapy may also support ongoing maintenance or preventative care in selected patients, helping to manage recurring symptoms more conveniently and consistently.

• Systemic treatments:
  Biologics. Dupilumab (an IL‑4Rα blocker) and tralokinumab or lebrikizumab (IL‑13 antibodies) reduce type 2 inflammation and have revolutionised treatment for moderate‑to‑severe AD. Nemolizumab targets the IL‑31 receptor and focuses on relieving itch. These agents are given by injection and require monitoring by specialists. Newer biologic drugs targeting cytokines (IL‑4/IL‑13, IL‑31) have shown promise for moderate‑to‑severe Atopic dermatitis but are typically reserved for those who fail conventional therapy.
  Janus kinase (JAK) inhibitors. Oral JAK inhibitors (baricitinib, upadacitinib, abrocitinib) block multiple cytokine pathways and provide rapid relief.  Because these medicines suppress the immune system, they carry risks such as infection and blood clots; discussions with a dermatologist or immunologist are essential.

• Emerging therapies and probiotics. Microbiome‑targeted approaches, including topical probiotics to reduce Staphylococcus aureus colonisation and oral probiotics to restore gut diversity, show potential but require further study.

• Allergen immunotherapy. In selected cases, allergen immunotherapy (desensitization) may reduce the frequency of allergic reactions. 

In addition to these medical treatments, lifestyle measures such as stress reduction, wearing breathable fabrics, using a humidifier and avoiding scratching are crucial.

Practical skincare and lifestyle measures

• Identifying and avoiding triggers and allergens.

• Moisturising and barrier repair. Apply a rich, fragrance‑free emollient or ointment at least twice a day and immediately after bathing. Creams containing ceramides, urea or other barrier‑supporting lipids help restore the skin’s protective layer. Wet‑wrap therapy (applying damp gauze over moisturised skin and covering with dry clothing) can soothe severe flares.

• Gentle bathing. Take short lukewarm showers or baths using soap substitutes. Avoid hot water, which strips lipids and increases itching. After washing, pat (rather than rub) the skin dry and moisturise immediately. Take an oatmeal in your bath water to lock the moisture into your skin.

• Use a humidifier to prevent dry air environments.

• Wear comfortable clothing that isn’t tight or scratchy.

• Avoid scratching. Keep nails short, use cotton gloves at night and apply cold compresses to itchy areas. Consider antihistamines at bedtime if itching prevents sleep (ask your GP or dermatologist).

• Diet and gut health. Maintain a balanced diet rich in fruits, vegetables, omega‑3 fats and fermented foods. If you suspect food allergies, consult an allergist for testing; unnecessary restriction can lead to malnutrition. Early introduction of diverse foods in infancy may reduce allergy risk.

• Stress management. Incorporate relaxation techniques such as mindfulness, yoga or breathing exercises. Adequate sleep and regular exercise improve resilience to stress, reducing flare‑ups.

Avoid tobacco and excessive alcohol. Both smoking and alcohol disrupt the skin and immune system. Quitting smoking benefits both skin and overall health, and limiting alcohol helps maintain a healthy gut microbiome.
Atopic dermatitis symptoms often come and go throughout life, with periods of improvement followed by episodes of worsening. While the condition may be controlled, it does not usually disappear completely.
Regular use of a moisturiser at least twice daily can help reduce symptoms and support the skin barrier. However, even with consistent skincare, flare-ups can still occur. For that reason, it is important to know how to recognise and manage symptoms when they return.

When to See a Dermatologist

While many people manage Atopic dermatitis at home, there are times when professional guidance becomes essential. Seek medical advice if:

• Flares persist or worsen despite moisturisers and topical therapies.

• Itching interferes with sleep or daily activities; constant scratching can lead to sleep disturbance and emotional distress.

• You notice signs of skin infection—such as pus, crusting, fever or swollen lymph nodes.

• You have widespread or severe atopic dermatitis covering large areas of the body.

• You suspect a food allergy or experience systemic symptoms such as wheezing or swelling.

A dermatologist can provide personalised management, assess for associated conditions (asthma, hay fever, autoimmune disease) and discuss advanced treatments.  Early intervention may prevent complications and improve quality of life.

Conclusion

Atopic dermatitis is not merely “dry skin”; it is a complex interplay of genetics, immune dysregulation and environmental exposures. Understanding your risks, recognising personal triggers and adhering to a regular skincare routine can make living with Atopic dermatitis much more manageable. Scientific advances—from biologics that block IL‑4/IL‑13 to ultraviolet light treatment (phototherapy) and emerging JAK inhibitors—offer hope for those with refractory disease. While flares may still occur, working closely with your healthcare team and looking after your body and mind can help you regain control. Remember, you’re not alone. Millions of people worldwide navigate the daily challenges of Atopic dermatitis (eczema), and research continues to move the field forward.