Atopic Dermatitis (Eczema)

Understanding Atopic Dermatitis

Atopic dermatitis (AD), commonly referred to as eczema, is a chronic inflammatory skin condition characterized by itchy, inflamed, and often dry skin.

This disorder, which frequently begins in childhood, can persist into adulthood and significantly affects the quality of life for sufferers. Understanding the causes, symptoms, and treatment options for atopic dermatitis is essential for effective management and improving patient outcomes.

Atopic dermatitis is a kind of allergic skin disease that leads to itchy skin and dry, scaly rashes. An estimated 31.6 million people in the United States have eczema; that is 10% of the population. It is more common for children, though it may affect any age group.

Treatments by health professionals include moisturizers, antihistamines, and topical corticosteroids to alleviate symptoms by preventing reoccurrence. In this blog, we will explore the causes, symptoms, treatment, and medication involved in atopic dermatitis.

What is Atopic Dermatitis?

Atopic dermatitis is a chronic skin condition activity characterized by dry, itchy, and inflamed skin. It impairs the barrier function of the skin, making it more difficult for the skin to retain moisture and protect itself against allergens, irritants, or infections.

Roughly 1 child in 4 develops atopic dermatitis; most develop it before age five. [1] The majority of children who have atopic dermatitis tend to outgrow the disease, but about 2-3% of adults continue to experience it. Eczema can flare up, which may last for weeks. [2]

Causes and Risk Factors

The exact cause of atopic dermatitis remains unknown, but it is believed to result from a combination of genetic, environmental, and immunological factors. A defective skin barrier plays a crucial role, allowing allergens and irritants to penetrate the skin, leading to inflammation and itchiness. Genetic predisposition is significant, as individuals with a family history of atopic diseases such as asthma, hay fever, or eczema are more likely to develop AD. Environmental factors, including exposure to harsh soaps, allergens, and stress, can exacerbate the condition.

What are the Causes of Atopic Dermatitis?

There is not just one cause of eczema; it often involves a combination of causes in its development. These include the following:

• Overactive Immune System

Atopic dermatitis develops when an overactive immune system triggers an inflammatory response in the skin, which shows as dry, itchy skin, or irritation of some type. Allergens or irritants can trigger this.

• Genetics

One may get eczema from a family history of eczema, asthma, or allergies. [4] A gene for eczema is known as filaggrin, which plays a very critical role in helping the skin maintain moisture. Individuals with a filaggrin deficiency have drier skin, thus experiencing contributing flare-ups.

• Environmental Triggers

The following are environmental factors that may trigger symptoms of eczema:

• Extreme weather conditions, such as dry air, heat, or cold temperature [5]
• Soaps and shampoos containing harsh lotions
• Irritating fabrics like wool and polyester
• Disinfectants and surface cleaners
• Perfumes from candles or products used for personal care.
• Metals like nickel (in jewelry or utensils)
• Certain foods and their juices, such as citrus fruits and meats

• Stress

Stress can be an emotional factor in flare-ups, too. For some, the itching and rash become worse once this stress begins, while for others, what is happening with the eczema creates anxiety and, in turn, gets worse.

Symptoms

Atopic dermatitis manifests differently in various age groups but is universally marked by intense itching and dry, scaly skin. In infants, symptoms often appear as red patches on the face and scalp. As children grow, eczema may develop in the creases of elbows and knees. Adults may experience thicker, darker patches typically located on the hands, feet, and neck. Flare-ups are common and often occur due to triggers like stress, weather changes, or exposure to certain fabrics.

What are the Symptoms of Atopic Dermatitis?

Symptoms of eczema may vary from one individual to another and may affect any region of the body. [3] Certain common symptoms of the disease are:

• Dry, cracked skin
• Intense itching – also called pruritus
• Rashes, which may appear differently depending on skin tone:
  • Red or pink on lighter skin
  • Brown, purple, or grey on darker skin
• Small, raised bumps that may ooze or crust over
• Skin that becomes thickened or leather-like due to chronic scratching
• Darkening of the skin around the eyes
• Raw, sensitive patches from repeated scratching

Common areas of the body where signs of eczema may appear:

• Hands, elbows, neck, knees, ankles, and feet
• Face, particularly cheeks and around the lips
• In and around the ears

Other less common areas include:

• Nipples, breasts, and genitals for example the vulva or penis

Is Eczema Contagious?

No, eczema is not contagious. You cannot “catch ” it from someone who has eczema through physical contact or otherwise.

What Does an Eczema Rash Look Like?

Eczema rashes may look different depending on your skin color. If you have lighter skin, rashes are often pink, red, or purple. On darker skin, they might be brown, gray, or purple. Sometimes, these rashes will scale over time or develop small bumps.

What are the Complications of Atopic Dermatitis?

Eczema complications might include the following:

• Asthma and hay fever: The majority of people with eczema develop one of these conditions. [6]
• Food allergies: Eczema is related to food allergies, and hives are very often present.
• Chronic itchy skin: It may lead to thick, leathery patches. The patches may develop into this due to scratching.
• Skin infections: Scratching encourages bacterial or viral infections.
• Sleep disturbances: Itching frustrates sleep.
• Irritant hand dermatitis: This is the most frequent cause of skin irritation due to repeated washing of hands.
• Mental health problems: It might include anxiety or depression caused by eczema.

Diagnosis

Diagnosis of atopic dermatitis is predominantly clinical, based on the patient’s history and skin examination. Dermatologists look for classic signs such as rash distribution, chronicity, and itchiness. In some cases, patch tests or allergy testing may be conducted to identify potential triggers. It is crucial to differentiate atopic dermatitis from other skin conditions like psoriasis or contact dermatitis, which can present with similar symptoms.

Treatment and Management

Managing atopic dermatitis involves a multifaceted approach targeting various aspects of the condition. First-line treatment includes skincare routines emphasizing moisturization to repair the skin barrier. Topical corticosteroids are commonly prescribed to reduce inflammation during flare-ups. For severe cases, systemic treatments like phototherapy or immunosuppressants may be required. Identifying and avoiding triggers is vital, as is maintaining hydration and using hypoallergenic products. Emerging treatments, including biologics, show promise in offering relief to those with moderate to severe AD.

Atopic Dermatitis Treatments and Medications

Treatment and medications for atopic dermatitis are aimed at symptom alleviation, flare management, and optimization of skin health. The most often-used options are described below:

• Topical Corticosteroids

These anti-inflammation creams and ointments are applied to the skin in order to reduce inflammation, redness, and itchiness. A range of strengths is available, from mild over-the-counter to stronger versions that a physician may prescribe. [7]

• Oral Medications

For more serious cases of eczema, systemic treatments include corticosteroids or immunosuppressants. Their administration may be oral or through injections, but their use is limited due to side effects such as worsening symptoms when stopped abruptly.

• Antibiotics

Antibiotics are necessary, especially in instances when eczema is complicated by bacterial infections. These medications clean up the infection but do not treat eczema by itself.

• Antihistamines

These can be helpful in controlling itching, especially at night, since they do tend to make the patient sleepy.

• Barrier Repair Moisturizers

It can help restore the skin’s barrier with regular use of some topical moisturizers, which prevents loss of moisture and reduces irritation.

• Topical Calcineurin Inhibitors

These are steroids that suppress the action of the immune system locally and hence help in controlling inflammation, thereby preventing flare-ups.

• Phototherapy

Phototherapy, or light therapy, may be recommended for patients with moderate to severe atopic dermatitis that does not respond to treatment with topical medications. The most common type of phototherapy used is a kind of ultraviolet (UV) light applied directly to the skin in measured amounts. [8] 

It helps to decrease inflammation and itching. Typically, phototherapy is carried out in a healthcare setting and requires repeated sessions to achieve optimal results.

• Advanced Therapies in Severe Eczema

For chronic and more serious forms, doctors recommend Biologics – these are newer medicines targeting specific proteins that play roles directly in the immune system. [9] The FDA has thus far approved two biologics for the treatment of eczema:

• Dupilumab (Dupixent) [10]
• Tralokinumab-ldrm (Adbry)

These are often prescribed to reduce flare-ups and inflammatory processes; some of these medications have minor side effects, including redness at the site of injection.

Newer treatments include topical JAK inhibitors and PDE4 inhibitors, which target the inflammation molecularly; thus, many patients are relieved. [11]

How Can I Treat Atopic Dermatitis at Home?

Home care can help alleviate symptoms and flare-ups of eczema. The following are some easy steps:

• Take baths in lukewarm water to relieve itching and irritation.
• Apply your moisturizer within three minutes after bathing while the skin is still damp to lock in moisture.
• Use creams, lotions, or shea butter to moisturize daily.
• Air-dry or pat your skin dry with a towel; avoid rubbing.
• Wear soft fabrics, such as cotton. Avoid scratchy fabrics, such as wool.
• Avoid sudden changes in temperature or activities that may cause you to sweat.
• Use mild soaps or non-soap cleansers to avoid stripping your skin of natural oils.
• Keep your fingernails trimmed to avoid scratching and breaking the skin.

Natural treatments like aloe vera, coconut oil, and apple cider vinegar could ease symptoms. However, always do a patch test site first.

Lifestyle and Home Remedies

In addition to medical treatments, lifestyle modifications can significantly impact managing atopic dermatitis. Regularly applying emollients and using lukewarm water for baths can prevent skin dryness. Wearing soft, breathable fabrics and avoiding rapid temperature changes help minimize irritation. Stress management techniques such as yoga or meditation can reduce flare-ups, highlighting the importance of comprehensive care.

Identify and Avoid Your Triggers

Everybody’s eczema triggers are different. Here are some common ones:

• Rough fabrics, such as wool.
• Dry skin, or skin infections
• Heat, sweat, and drastic temperature fluctuations
• Stress and emotional triggers
• Cleaning products, dust mites, and pet dander
• Pollen, mold, and smoke
• Some foods (for example, eggs, cow’s milk)

Talk to your healthcare provider about the ways to identify your triggers and manage flare-ups appropriately.

Psychological Impact

The chronic nature and visibility of atopic dermatitis can lead to significant psychological distress. Many sufferers experience anxiety, depression, and social withdrawal due to self-consciousness about their skin’s appearance. Children with AD may face bullying or teasing, impacting their self-esteem and mental health. Addressing the psychosocial components is crucial for holistic treatment.

Ongoing Research

Research into atopic dermatitis continues to evolve, with numerous studies aimed at understanding its pathophysiology better and improving treatment options. Scientists are exploring the role of the microbiome in atopic skin, investigating how the balance of microorganisms on the skin’s surface affects inflammation and immunity. New treatments, such as biologics and JAK inhibitors, are under investigation, showing potential in targeting specific pathways involved in the inflammatory process.

Conclusion

Atopic dermatitis is a complex condition that requires comprehensive management strategies. While there is currently no cure, understanding the causes, identifying triggers, and implementing effective treatment and lifestyle strategies can significantly reduce symptoms and improve quality of life for patients. Continued research and innovation hold promise for delivering more effective therapies and potentially curative options for this pervasive and challenging condition.

This comprehensive discussion highlights the importance of recognizing atopic dermatitis as a serious health concern, not only due to its physical manifestations but also due to its impact on mental health and daily life. With ongoing advancements in medical research, there is hope for better solutions and increased awareness of this condition, paving the way for improved outcomes for those affected.

The Bottom Line

Atopic dermatitis, also known as eczema, is a chronic skin condition. While it is not possible to cure it, proper management is definitely achievable with the right combination of various treatments, home care, and preventive measures.

If you need help managing eczema or other skin concerns, you can reach out to us at UV Treat. Our expert team will provide expert guidance and product recommendations.