Seen Here: ATOPIC ECZEMA: MORE THAN SKIN DEEP. The burden of atopic eczema goes beyond what the eye can see. Persistent itching, sleepless nights, emotional strain and everyday activities put on hold can quietly shape the lives of those living with this chronic skin condition. This World Atopic Eczema Day 2026, the message is clear: #BreakTheInvisibleBurden. Being able to cope does not necessarily mean symptoms are under control. Every person’s experience matters, and the impact on sleep, confidence and quality of life deserves to be part of the conversation. Because living with eczema should not mean organising your entire life around it. Photo Credit: Supplied
Persistent itching, sleepless nights and the quiet sacrifices people make every day highlight why managing atopic eczema means looking beyond visible symptoms.
- JOHANNESBURG, 23 October 2026 — For millions of people living with atopic eczema, the burden of the condition extends far beyond what can be seen on the skin. Behind the redness, dryness and inflammation may lie disrupted sleep, emotional exhaustion, reduced confidence and a daily routine shaped by the constant need to manage symptoms.
As South Africa joins the global conversation around World Atopic Eczema Day 2026, the message is clear: the impact of this chronic inflammatory skin condition cannot be measured by visible symptoms alone.
This year’s global theme, #BreakTheInvisibleBurden, highlights the physical, emotional and social challenges that people with atopic eczema may experience, many of which remain unnoticed by those around them.
Atopic eczema, also known as atopic dermatitis, can cause persistent itching, dry and sensitive skin, painful cracks, inflammation and recurring flare-ups. Yet for many people, the most disruptive effects are not always immediately apparent.
A night interrupted by relentless itching can affect concentration the following day. A flare-up may mean reconsidering what to wear, postponing exercise or avoiding a social gathering. Over time, these seemingly minor adjustments can accumulate, influencing how people work, study, socialise and experience everyday life.
The challenge, therefore, is not simply to address what appears on the skin, but to understand the full extent of the condition’s impact.
When itching becomes an everyday struggle
Itching is among the most burdensome symptoms associated with atopic dermatitis. Research has linked the condition to sleep disturbances, difficulties with daily activities and a diminished quality of life.
For someone experiencing persistent symptoms, the consequences can extend well beyond physical discomfort.
Interrupted sleep may leave a person exhausted before the day begins. Concentrating at work or school can become more difficult, while discomfort and self-consciousness may influence social interactions and participation in activities that were once enjoyable.
Even routine decisions can become complicated. Clothing may be selected according to which fabrics feel least irritating. Swimming, exercise or outdoor activities may be avoided during flare-ups. Social plans may be cancelled because symptoms are uncomfortable or difficult to conceal.
Individually, these adjustments may appear insignificant. Collectively, however, they can place considerable demands on a person’s time, energy and emotional wellbeing.
According to research examining the burden of atopic dermatitis, the condition can affect several dimensions of life simultaneously, reinforcing the importance of recognising both its visible symptoms and its less apparent consequences.
The result is an experience that may be difficult for others to appreciate, particularly when the skin appears relatively clear during a consultation or social interaction.
The danger of becoming accustomed to discomfort
For many people, living with atopic eczema involves developing routines to minimise discomfort and anticipate flare-ups.
They may learn which skincare products suit their skin, which fabrics feel comfortable, what tends to aggravate their symptoms and how best to respond when their condition worsens.
These strategies can be valuable parts of everyday management. However, becoming skilled at coping does not necessarily mean the condition is adequately controlled.
Someone who has experienced itching for years may gradually begin to regard interrupted sleep as normal. Another person may routinely decline invitations during flare-ups or avoid certain activities without considering how much the condition is influencing their decisions.
Over time, the adjustments become habitual, and the burden can become difficult to recognise even for the person experiencing it.
Johannesburg dermatologist Dr Lushen Pillay says patients should consider not only how well they have learnt to manage their symptoms, but also how much the condition continues to interfere with their lives.
“I often want patients to think beyond whether they have learnt to cope with their eczema,” Pillay says. “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.”
The distinction is important: coping with a condition and achieving an appropriate level of disease control are not necessarily the same thing.
A person may have developed effective ways to manage recurring symptoms while continuing to experience a substantial impact on their quality of life.
Why the skin tells only part of the story
Atopic eczema can vary considerably in severity and presentation. Visible inflammation may fluctuate, and symptoms can change over time.
Consequently, the appearance of the skin during a medical appointment may not fully reflect the difficulties a person experiences between consultations.
Research into quality of life and atopic dermatitis has documented effects on sleep, emotional wellbeing, social interaction and daily functioning that cannot always be captured by assessing visible skin symptoms alone.
This makes open communication between patients and healthcare professionals particularly important.
Patients may benefit from explaining how frequently flare-ups occur, how persistent the itching is, whether sleep is regularly interrupted and how symptoms affect their work, education, relationships or leisure activities.
These details can provide a more comprehensive understanding of the condition than a description of its appearance alone.
They can also help patients and healthcare professionals identify treatment goals that reflect the person’s individual circumstances and priorities.
Rethinking what successful disease control means
The management of atopic eczema has increasingly emphasised the importance of looking beyond individual flare-ups towards a broader understanding of disease control.
The 2023 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, provides evidence-based recommendations for managing atopic dermatitis according to factors such as disease severity, treatment response and individual patient circumstances.
Separately, the 2024 AHEAD international expert consensus supports a treat-to-target approach that incorporates clinical assessment, patient-defined goals, long-term disease control and shared decision-making between patients and healthcare professionals.
Together, these approaches reinforce the importance of individualised care and ongoing assessment.
Rather than focusing exclusively on what to do when the next flare-up occurs, conversations about treatment can also explore how frequently symptoms return, how much discomfort they cause and whether the current management approach adequately addresses the person’s everyday needs.
For patients, this may mean discussing concerns they have previously considered too ordinary or inevitable to mention.
For healthcare professionals, it means recognising that a patient’s experience of the condition includes much more than what can be observed during a consultation.
Pillay says people should not automatically accept persistent disruption simply because they have become familiar with it.
“Familiar symptoms can easily become the benchmark people use for what is normal for them,” he says. “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.”
Finding the right approach to treatment
There is no single treatment pathway suitable for everyone living with atopic eczema.
Management decisions depend on several factors, including the severity of the condition, previous treatments, individual response and the person’s particular needs. Treatment options and goals should be discussed with an appropriately qualified healthcare professional.
For people whose symptoms persist or continue to disrupt daily activities, seeking a review may provide an opportunity to reassess their current approach to care.
That conversation should extend beyond the appearance of the skin during a flare-up. Persistent itching, recurring symptoms, disturbed sleep, difficulty concentrating and limitations on everyday activities are all relevant to understanding the overall burden of the condition.
Patients can also discuss what they would like treatment to help them achieve, whether that involves fewer disruptions to sleep, greater comfort during exercise, improved participation in social activities or better control of recurring symptoms.
The aim is to ensure that management decisions reflect the individual’s experience rather than relying solely on visible signs of disease.
As Pillay explains: “The right care can help you spend more time living your life and less time managing atopic eczema.”
Breaking the invisible burden begins with awareness
World Atopic Eczema Day provides an opportunity to recognise the experiences that may remain hidden behind a condition commonly associated with visible skin symptoms.
The #BreakTheInvisibleBurden theme encourages a wider understanding of atopic eczema, acknowledging that its effects can reach into sleep, relationships, emotional wellbeing, work and the everyday decisions that shape a person’s life.
Greater awareness may also help challenge the assumption that someone whose skin looks relatively clear is necessarily free from discomfort or disruption.
For people living with the condition, it is an opportunity to reflect on the impact of their symptoms and raise concerns that may have become part of their normal routine.
For families, friends and colleagues, it is a reminder that the burden of a chronic skin condition may not always be visible.
And for healthcare professionals, it reinforces the value of listening to patients’ experiences when assessing disease control and discussing treatment goals.
Atopic eczema may require ongoing management, but persistent itching, disrupted sleep and recurring interference with everyday life should not simply be dismissed as unavoidable.
Recognising these effects is an important step towards more informed conversations about care and quality of life.
People may learn to live with atopic eczema, but that does not mean their lives should have to revolve around it.
Editor’s note: This article forms part of the More Than Skin atopic eczema awareness campaign, supported by AbbVie, in recognition of World Atopic Eczema Day. It is intended for general awareness purposes and does not constitute medical advice. Anyone experiencing symptoms or concerned about their current disease control should consult a qualified healthcare professional.
Editorial verification note: The article’s medical references and the dermatologist’s quotations should be verified and approved before publication. The supplied spokesperson quotations were identified as proposed and subject to approval.
#WorldAtopicEczemaDay #BreakTheInvisibleBurden #AtopicEczema #SkinHealth #MoreThanSkin #HealthAwareness
