Affecting more than 230 million people globally, according to the World Health Organization, atopic eczema is still routinely dismissed as nothing more than a mild, uncomfortable rash.
In reality, moderate to severe atopic dermatitis is a complex, systemic inflammatory condition driven by an overactive immune response and a breached skin barrier.
The physical distress of raw, inflamed skin is only part of the story; constant, unyielding itching triggers severe sleep deprivation, chronic fatigue, and psychological strain, creating a daily struggle that affects every dimension of a patient's life.
What is atopic eczema?
"Atopic eczema, also known as atopic dermatitis, is a chronic inflammatory skin disease that causes dry, itchy, and inflamed skin," explains Dwayne Koot, medical manager at Sanofi South Africa.
"It usually begins in childhood, although it can develop at any age. Symptoms may improve for a time and then flare again."
At its core, atopic eczema involves both a compromised skin barrier and an overactive immune response driven by type 2 inflammation.
A weakened outer skin layer allows allergens and irritants to enter easily, triggering immune pathways that cause swelling, redness, and relentless itching. This creates a self-reinforcing cycle that makes flares persistent and difficult to manage.
What does atopic eczema look like?
The physical appearance of eczema varies across skin tones.
On lighter skin, affected areas typically appear red or pink. On darker skin, flares often present as dark brown, grey or purple patches, sometimes accompanied by raised bumps.
Beyond visible symptoms, such as scaling, raw skin and fluid-filled bumps, lies the risk of secondary infections.
Golden crusting can signal a bacterial infection, while clusters of blisters accompanied by a fever may indicate eczema herpeticum, a serious viral complication requiring immediate medical care.
The burden of eczema extends far beneath the skin's surface. Constant itching leads to severe sleep disruption, resulting in chronic fatigue, poor concentration and lower productivity.
Over time, these daily strains accumulate. Dermatologists use the term Cumulative Life Course Impairment to describe how chronic conditions build up over a lifetime, impairing childhood development, altering career paths, disrupting relationships and creating financial stress for families.
The visibility of skin lesions also causes profound psychological distress, often leading to social isolation, anxiety and depression.
Why eczema in young children deserves attention
Eczema in young children deserves particular attention due to the "atopic march".
This concept describes how early-onset eczema can act as an initial entry point for other allergic conditions later in life, such as food allergies, allergic rhinitis and asthma.
"But it does not mean that a child will necessarily go on to develop them. Persistent or severe eczema in children should be assessed and treated appropriately to control symptoms and limit its effect on daily life," says Koot.
Treatment depends on severity
Because there is currently no cure, effective management focuses on reducing inflammation, soothing itching and preventing flares.
While mild cases may respond to consistent skin hydration and topical therapies, poorly controlled or moderate-to-severe disease often requires advanced intervention, including phototherapy or systemic treatments targeting specific immune pathways.
"If you or someone in your family is living with eczema that remains poorly controlled despite treatment, speak to a healthcare professional about whether the current approach is working and what step-up therapies are available," says Koot.
"Eczema is not just a rash that itches. Its impact can be substantial and accumulate over a lifetime even when it is not visible to others. Atopic eczema is not contagious. A better understanding of the disease can help people recognise when they need medical care and feel empowered to ask for it."
alyssia.birjalal@nationalmg.co.za