Aggravating factors in atopic dermatitis

Aggravating factors can worsen atopic dermatitis and impair response to treatments.

Unavoidable factors that aggravate atopic dermatitis include weather changes, low environmental humidity, intercurrent illness (eg upper respiratory tract infection) and stress. Aggravating factors that can be avoided or managed include overheating, skin irritants, allergens and infections.

Minimise contact with irritants such as:

• soap, shampoo, bubble bath
• rough clothing, wool and sheepskin, carpet, sand, grass
• heavily chlorinated pools or spas.

Although many young children with atopic dermatitis also have food allergies, they are rarely the main cause of atopic dermatitis. Food allergies nearly always cause urticaria, not dermatitis. In the absence of strong evidence indicating food allergy, modifying the diet (eg changing infant formulae, introducing restrictive diets) has little benefit in children or adults.

Some foods (eg citrus fruits, strawberries, tomatoes, tomato-based sauces) irritate the skin around the mouth—this is not a food allergy. For messy or untidy eaters (eg young children), apply a greasy barrier to the face and hands before these foods are eaten, to protect the skin and minimise irritation.

Environmental allergens (eg house dust mite, grasses, pollens, animal dander) can aggravate atopic dermatitis in adults and children (usually in those older than 2 years)—consider this if the patient has prominent facial or periorbital involvement, and accompanying respiratory atopy.

Contact dermatitis (eg allergy to components of topical corticosteroids) can complicate the management of atopic dermatitis. Avoid unnecessary additives in topical products (eg fragrances, tea tree oil, lanolin, topical anaesthetics).