The symptoms of atopic dermatitis can vary among individuals, but typically include dry, itchy skin and rashes appearing on specific areas like the face, inside the elbows, behind the knees, as well as on the hands and feet. Itching, in particular, is a significant symptom, leading to scratching and rubbing that can worsen inflammation and itchiness, especially during sleep when conscious control is diminished.
The appearance of affected skin depends on the extent of scratching and the possibility of secondary infections. It may present as red and scaly, thick and leathery, with small raised bumps, or even oozing fluid and forming crusts due to infection. Atopic dermatitis may also affect areas around the eyes, including the eyelids and eyebrows, resulting in redness and swelling from scratching. Additionally, some individuals may develop an extra fold of skin under their eyes or experience patchy loss of eyebrows and eyelashes due to rubbing or scratching.
Researchers have identified differences in the skin of those with atopic dermatitis that contribute to its symptoms. The outer layer of skin, the epidermis, serves as a protective barrier, but in individuals with atopic dermatitis, this barrier is compromised, leading to increased susceptibility to bacterial and viral infections.
Specific skin features associated with atopic dermatitis include the Dennie-Morgan fold, cheilitis (inflammation around the lips), hyperlinear palms, hyperpigmented eyelids, ichthyosis (dry, scaly skin), keratosis pilaris (rough bumps on the face, upper arms, and thighs), lichenification (thickened, leathery skin from constant scratching), papules (small raised bumps), and urticaria (hives).