Atopic eczema can affect far more than the skin. The condition can have an impact that may be less visible, from disrupted sleep and persistent itching to the everyday adjustments people make around the condition.
These less visible impacts are part of the wider conversation around atopic eczema and were highlighted through this year’s World Atopic Eczema Day, marked annually on 14 September to raise awareness of atopic eczema and its impact on people living with the condition. In 2026, the global theme, #BreakTheInvisibleBurden, draws attention to the physical, emotional and social burden that may not always be apparent from looking at someone’s skin. ¹
Atopic eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition. Symptoms can include persistent itching, dry or sensitive skin, inflammation, rashes, cracked or painful skin and periods when symptoms become worse, commonly referred to as flare-ups. ²˒³
But what appears on the skin is only part of the burden.
Research has linked atopic eczema with sleep disturbance, difficulty concentrating, emotional distress and an impact on daily activities and overall quality of life. ²˒⁴˒⁵
Living with atopic eczema can mean making everyday adjustments that are easy to overlook such as choosing clothes around affected skin, avoiding swimming or exercise during a flare, declining social plans, or getting through the day after itching has disrupted sleep. Individually, these decisions may seem small; over time, they can begin to shape how people with atopic eczema live. ²˒⁴˒⁵
Itch is among the most burdensome symptoms experienced by people with atopic dermatitis and can contribute to sleep disruption and broader impairment in daily life.²˒³ For someone living with the condition, this can influence very ordinary decisions: what feels comfortable to wear, whether to swim or exercise, whether to attend a social event during a flare, or how well someone functions after a night interrupted by itching.²˒⁴˒⁵ Over time, those adjustments can become so familiar that they are simply absorbed into everyday life.
Coping can quietly become the standard
People living with atopic eczema often develop routines that help them navigate their condition. They may learn which skincare approaches suit them, which fabrics feel comfortable, what tends to aggravate their symptoms and what they usually do when a flare occurs. ⁵ These routines can make the condition easier to manage. Over time, however, they can also make ongoing disruption feel ordinary.
Someone who has lived with persistent itching for years may regard it as part of everyday life. They may have become accustomed to choosing clothing around their skin, avoiding activities during a flare or accepting interrupted sleep as something that comes with the condition. Research into the psychosocial and quality-of-life burden of atopic dermatitis has documented effects on social interaction, daily activities, sleep and emotional wellbeing, in addition to visible physical symptoms. ²˒⁴˒⁵
“I often want patients to think beyond whether they have learnt to cope with their eczema,” says Johannesburg Dermatologist Dr Lushen Pillay. “The more useful question is how much the condition is still asking them to work around it. If it is affecting sleep, activities, confidence or everyday choices, that is part of the disease conversation too. ⁶
The impact of atopic eczema cannot always be understood by looking at the skin alone. Quality-of-life research has shown that clinical signs do not necessarily capture the full burden experienced by patients, reinforcing the value of understanding how the condition affects day-to-day life. ²˒⁴ The question is whether people may become so accustomed to adapting around their eczema that they stop recognising how much it continues to shape everyday life.
A broader conversation about disease control
The 2023 atopic dermatitis practice parameter developed by the Joint Task Force on Practice Parameters of the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology, published in 2024, sets out evidence-based recommendations for gaining and maintaining disease control and for selecting management approaches according to disease severity, treatment response and individual patient circumstances. ⁷
Separately, Clinical thinking around atopic dermatitis increasingly considers overall disease control, treatment goals and the impact of the condition on an individual’s life, rather than focusing only on the management of individual flare-ups. The 2024 AHEAD international expert consensus recommends a treat-to-target approach that incorporates clinical assessment, patient-selected treatment goals, long-term disease control and shared decision-making between patients and healthcare professionals. ⁸
Together, these publications support a broader conversation about what successful management can mean. For someone living with recurring symptoms, the discussion does not need to begin and end with what to do when the next flare arrives. It can also consider how frequently symptoms occur, how persistent the itching is, the impact on sleep and daily activities and whether the current management approach is providing an appropriate level of disease control. ⁷˒⁸
“Familiar symptoms can easily become the benchmark people use for what is normal for them,” says Dr Pillay. “But if eczema continues to interfere with someone’s life, it is worth discussing whether their current level of control is the level they should simply accept. ⁶
Atopic eczema varies considerably between individuals. Treatment goals and management decisions should therefore be individualised and discussed between the patient and an appropriately qualified healthcare professional. ⁷˒⁸
Treatment is not one-size-fits-all
There is no single treatment pathway for atopic eczema. The AAAAI/ACAAI Joint Task Force practice parameter describes a range of management approaches and recommends that treatment choices take account of factors including disease severity, previous treatment and individual response. ⁷
For people whose symptoms remain persistent or continue to interfere with daily life, the next step is a conversation with a healthcare professional about the condition as they actually experience it. ⁷˒⁸ That conversation can extend beyond what the skin looks like during an appointment. Frequency of flare-ups, severity and persistence of itching, disrupted sleep, difficulty concentrating and the impact of the condition on work, school, activities, confidence and social life can all help provide a fuller picture of disease burden and treatment goals. ²˒⁴˒⁵˒⁸
“The right care can help you spend more time living your life and less time managing atopic eczema,” says Dr Pillay. ⁶
Living with atopic eczema requires ongoing management. But persistent itching, disrupted sleep, recurring symptoms and everyday activities shaped around the condition are all worth discussing with a healthcare professional. ²˒³˒⁷˒⁸
You may live with atopic eczema, but your life should not have to be organised around it.
