Stages of Atopic Dermatitis: What Do They Mean?

Atopic dermatitis, the most common type of eczema, has three distinct stages: acute, subacute, and chronic.

Many dermatologists use these terms with patients to help them understand their symptoms, says JiaDe (Jeff) Yu, MD, a dermatologist at Massachusetts General Hospital in Boston, where he oversees a specialized atopic dermatitis clinic for adults and children, and a spokesperson for the National Eczema Association.

“The stages relate to disease severity, and the disease severity dictates what types of therapies we’re going to recommend to a patient,” says Theodora Karagounis, MD, a dermatologist and assistant professor at the New York University Grossman School of Medicine in New York City, where she studies the link between gut health and skin health, particularly in the context of eczema.

It’s important to note that atopic dermatitis doesn’t necessarily go through those three stages in that order. For instance, some people may develop a rash at the acute stage, move on to the healing stage, and regress back to the acute stage, while others may have ongoing, persistent symptoms.

Read on to learn more about the three stages of atopic dermatitis, the symptoms associated with each stage, and treatment options.

Think of when you first experience an atopic dermatitis flare-up and your symptoms are at their worst. This is known as the acute phase, says Dr. Yu.

• Intense itching
• Small, rough bumps (especially in darker skin tones)
• Extreme redness (especially in lighter skin tones) or areas that are dark brown, gray, or purple (especially in darker skin tones)
• Warm and swollen skin
• Fluid-filled blisters that ooze and form a crust

“This can be anywhere on the body and brought on by various triggers, such as stress, illness, scratching, allergen exposure, or when dermatitis is untreated for a long time,” says Yu.

Typically, atopic dermatitis flare-ups run their course in about three to five days when adequate treatment is used, says Karagounis.

After the acute stage, people with atopic dermatitis often move into the subacute stage. That’s when the skin begins to heal from a flare-up.

“Subacute is when your skin is calming down,” says Karagounis. “There are still signs of skin disease there — you can still see redness and some scaling — but it’s no longer as itchy and irritated.”

• Some dryness, flaking, or scaling
• Lessened itching
• Sensitivity to touch
• Lessened redness or discoloration

It’s important to continue any treatment that’s been prescribed to you to make sure the flare-up stays under control, notes Karagounis. If you don’t complete your treatment, avoid triggers, or tend to your skin carefully, your symptoms could reenter the acute stage.

The chronic stage of atopic dermatitis is the most common stage, says Yu. “Most of the time, dermatitis is spent in the chronic stage, with various triggers that can bring old or new patches back into the acute stage,” Yu says. For people with chronic eczema, flare-ups can last for months.

The symptoms in this stage differ a bit from those of the acute and subacute stages. According to Yu, they can include the following:

• Chronic patches of skin that are itchy and slightly redder or more discolored than nonsymptomatic skin
• “Lichenified” skin, meaning the skin lines are accentuated from repeated scratching
• A darkening of an area of the skin that has had repeated flare-ups

“These occur due to months or years of repeated itching, scratching, and rubbing,” Yu explains. “These areas can then flare up [in the acute stage].”

• Medicated creams and ointments, such as topical steroids
• Medications that fight infection, such as antibiotics
• Pills to help control inflammation, such as oral steroids
• Injectable treatments, such as biologics
• Light therapy, such as phototherapy

Treatment often varies from person to person and can depend on the atopic dermatitis stage and symptom severity. “It’s really quite tailored and individualized. Some factors would push me toward seeing someone who has more chronic dermatitis and needs oral medication, or others are healing and need gentle moisturizing,” Karagounis says.

During the acute stage, for instance, a dermatologist may recommend prescription medicine to calm your skin. Topical steroids in particular are often the frontline defense in this stage, Yu and Karagounis agree. “I liken it to a raging fire,” Yu says. “Topical moisturizers aren’t enough to put it out, so you really need stronger medications like topical steroids to put out the fire.”

In the subacute stage, the so-called fire is often under control, and treatment is focused on soothing the skin with gentle moisturizers and lower-strength medicated creams or ointments, he notes.

Atopic dermatitis has three stages: acute (flaring), subacute (healing), and chronic (persistent). Symptoms and treatment options for each stage often vary. Your dermatologist can help you determine the stage of your symptoms and the right treatment for you.