Although atopic (infantile or flexural) dermatitis may begin at any age, it usually commences from about the sixth week onwards. It is characterized by a chronic, relapsing course. In the infantile phase lesions are present mainly on the head, face, neck, napkin area, and extensor aspects of the limbs. As the patient grows older and enters childhood, the eruption shifts to the flexural aspects of the limbs. Chronic atopic cheilitis may also be evident. Pruritus is intense and constant scratching and rubbing leads to lichenification and frequent bouts of secondary bacterial infection. Atopic eczema is commonly associated with dry skin (xerosis). Vesiculation is uncommon. there is an increased risk of dermatophyte and viral infections. The disease improves during childhood and, in over 50% of cases, clears completely by the early teens. approximately 75% of patients with atopic dermatitis have a family history of atopy and up to 50% have associated asthma or hay fever. The condition typically worsens in the winter months.
It is associated with an increased incidence of contact dermatitis, particularly affecting the hand. Other features that may be seen include ichthyosis (50%), nipple eczema, conjunctivitis, keratoconus, bilateral anterior cataracts, sweat-associated itching, wool intolerance, perifollicular accentuation, food intolerance and white dermatographism. 5 Infraorbital folds (DennieMorgan folds) are said to be characteristic of atopic dermatitis, particularly when double.