Atopic dermatitis (AD) is a uniquely challenging condition for the treating allergist and patient. I say this as a doctor who treats AD and as someone who has lived with it nearly my entire life. The following points reflect both my own experience and those of my many AD patients who have entrusted me with their care.
AD is known as the itch that rashes. But it doesn't just itch, it hurts — and why wouldn't it? The active lesions are open wounds. Eczematous hands are often fissured at the joints, leading to pain with typical hand motions. In general, eczema occurs at the intertriginous zones, potentially causing discomfort with every flexion and contraction. An ocean swim for an eczema patient is likely to be unbearably painful (not salt in one wound but salt in a few hundred microscopic wounds).
AD pain is not just physical but causes a fair amount of psychological distress.From my own experience and from discussions with patients, bullying and teasing due to AD is common and seldom forgotten. Patients with facial — and particularly perioral — flares are self-conscious, have scaling and erythema extending beyond the vermilion border, and can't kiss a romantic partner without discomfort.
