My Genesis Blog

What is Atopic Dermatitis?

Atopic dermatitis (AD) often referred to as eczema, is an inflammatory skin condition in which patients have underlying skin barrier defects and a heightened immune response to irritants and allergens. AD is suffered by many children and adults alike worldwide [3].

AD is one of the common inflammatory skin diseases, affecting approximately 230 million people worldwide. AD was seen as a childhood disease, but recent studies have shown that the prevalence of AD affecting adults is approximately 5%–10%, and is increasing worldwide [10, 12].

AD presents itself with raised red skin lesions, that can be chronic or recurring along with an intense itch. Usually, there is localised swelling, papular presentation, scaling, and crusting. The condition can affect the quality of life amongst its sufferers from interrupted sleep, being unable to attend school or work whilst affecting these relationships can also impede on one’s mental health [1,8,10].

Babies younger than 1 years of age usually have AD on their cheeks, forehead, or scalp. It can affect the knees, elbows, and trunk whilst sparing the nappy area. As children age into adulthood AD usually affects the bends of the elbows, behind the knees, on the neck, or on the inner wrists and ankles.

In Canberra, eczema is a common complaint of many of our patients in winter with heating and the cold temperatures being one of the triggers most reported that exacerbate the condition. Many patients are at their wits end when they attend their consultations in clinic. Some people have recently started suffering with this condition whilst others have had it from birth.

What is the cause of AD?

Human skin is the largest organ of the body and is in constant contact with the external environment. Our skin is continually being exposed to external assaults that can contribute and exacerbate inflammatory skin conditions [3].

AD is a complex condition with multiple genetic and environmental factors contributing to its cause. It’s reported that the Filaggrin gene (filament-aggregating protein, FLG) mutation represents a very significant breakthrough in understanding the genetics in relation to AD. FLG is the single most significant genetic factor in AD that has been identified to date and plays a key role in epidermal barrier function contributing to skin hydration and integrity [5]. The risk of developing AD is reported to be higher in children if one parent has an allergic history and mothers with AD tend to pass on this genetic deposition more so than fathers of the offspring [11].

Reported impacts of air pollution on our skin’s health include some of the following: the activation of the AhR pathway, induction of oxidative stress, impairment of the skin barrier, and the stimulation of an inflammatory response [3].

AD and food intolerances are strongly associated, with 1/3 children suffering food intolerances. Staphylococcus aureus bacteria appears to contribute to AD whilst activating a type 2 immune response within the body [5,12].

Detergents, other agents causing mechanical skin damage, and air pollution are amongst numerous factors shown to negatively affect FLG expression in the skin. Increased air pollution has led to changes to our climates, contributing to negative effects on our skins barrier and allergic diseases. Scratching the skin has been reported to lead to mast cell expansion in the small intestine, greater intestinal permeability, and promotion of IgE food anaphylaxis [5].

Severity of AD is known to change with seasons, with many being worse off in winter. Climate variables such as temperature, humidity, pollen load, and sun exposure all have been shown to affect AD sufferers, and this is why in Canberra we see this skin condition quite regularly with the cold climate and the dryness in the air all affecting the skins barrier function overall [3,11].

Treatment:

Focal and supportive therapies are used to improve the quality of life of AD sufferers. Intensive emollient therapy in addition to avoiding harsh chemicals such as soaps and detergents is one way to assist with prevention of exacerbating the condition. Corticosteroids are considered the first-line treatment for acute attacks of AD due their anti-inflammatory actions on the skin [2,7].

Other preventive measures that will assist with irritating this condition further include wearing cotton clothes, using pH-balanced soaps, and taking short lukewarm showers [2].

UV therapy and LED are used as treatment aids in clinic for relieving the symptoms of the condition pertaining to the itchiness, redness, and inflammation.

Some research discusses the possible links to AD sufferers and dysbiosis of the gut. Dysbiosis can alter the immunity within the gut causing inflammation and in turn affecting the skin. Working on gut health has been seen to assist with AD sufferers with the use of probiotics and dietary fibre assisting to maintain homeostasis of the normal gut flora. The supplementation of probiotics for children and babies has also been reported to assist with preventing allergies and assisting with skin conditions like AD [6,7].

Vitamin D is an important nutrient for the skin. Vitamin D is known to maintain the barrier function of the skin. This supplement maintains the structural proteins in the stratum corneum and regulates glyceramides needed for the skin protection and hydration. Vitamin D stimulates the synthesis of filaggrin which is essential for our skin’s barrier, and this is why vitamin D can be a useful supplement when it comes to AD [4].

Omega 3 fatty acids are reported to assist with AD and inflammatory skin conditions and their symptom profile due to their anti-inflammatory effects [9].

The severity of the AD will greatly depend on the management and treatment of this condition. GPs, dermatologists, naturopaths, nutritionists, and skin specialists alike all have roles to play in the management of this condition therefore gaining support from these professionals enables the sufferer of AD to manage and access appropriate treatments available for their given presenting symptoms. A lot of the time delving deeper into why the condition is flaring can give us more insight and enable its sufferer’s better ways to manage this condition rather than just treating topically. The skin is often a presentation what is happening within our bodies and addressing not only topically to manage symptoms but also addressing imbalances internally can help to manage inflammatory skin conditions better.

Brooke Worthy

Dermal Clinician

BHSc (Dermal Sciences)

REFERENCES:

[1] Bradley, M., & Svensson, Å. (2022). Increased Knowledge-based Care is Indicated for Patients with Atopic Dermatitis. Acta Dermato-Venereologica, 102, adv00802. https://doi.org/10.2340/actadv.v102.4576

[2] El Achkar Mello, M. E., Simoni, A. G., Rupp, M. L., de Azevedo Simões, P. W. T., & de Souza Pires, M. M. (2023). Quality of life of pediatric patients with atopic dermatitis and their caregivers. Archives of Dermatological Research: Founded in 1869 as Archiv Für Dermatologie Und Syphilis, 1–6. https://doi.org/10.1007/s00403-023-02544-2

[3] Fadadu, R. P., Abuabara, K., Balmes, J. R., Hanifin, J. M., & Wei, M. L. (2023). Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. International Journal of Environmental Research and Public Health, 20(3). https://doi.org/10.3390/ijerph20032526

[4] Garibeh, E., Bondar, S. А., Tokarchuk, N. I., & Vyzgha, Y. V. (2022). Charactirestics of Vitamin D Level in Patients with Atopic Dermatitis. Medical Perspectives, 27(3), 108–114. https://doi.org/10.26641/2307-0404.2022.3.265954

[5] Hui-Beckman, J. W., Goleva, E., Berdyshev, E., & Leung, D. Y. M. (2023). Endotypes of atopic dermatitis and food allergy. Journal of Allergy and Clinical Immunology, 151(1), 26–28. https://doi.org/10.1016/j.jaci.2022.07.021

[6] Kurniawan, M., & Matthew, F. (2023). The Role of Dietary Fiber or Prebiotics in Atopic Dermatitis. World Nutrition Journal, 6(2), 10–19. https://doi.org/10.25220/WNJ.V06.i2.0003

[7] Lawton, S. (2014). Atopic eczema: the current state of clinical research. British Journal of Nursing, 23(20), 1061–1066. https://doi.org/10.12968/bjon.2014.23.20.1061

[8] Salfi, F., Amicucci, G., Ferrara, M., Tempesta, D., De Berardinis, A., Chiricozzi, A., Peris, K., Fargnoli, M. C., & Esposito, M. (2023). The role of insomnia in the vulnerability to depressive and anxiety symptoms in atopic dermatitis adult patients. Archives of Dermatological Research: Founded in 1869 as Archiv Für Dermatologie Und Syphilis, 1–6. https://doi.org/10.1007/s00403-023-02538-0

[9] Sawada, Y., Saito-Sasaki, N., & Nakamura, M. (2021). Omega 3 Fatty Acid and Skin Diseases. Frontiers in immunology, 11, 623052. https://doi.org/10.3389/fimmu.2020.623052

[10] Su, J., Gu, X., Li, J., Tao, J., Kang, X., Wu, B., Shan, S., ang, X., Chen, X., Xiao, Y., & Shen, M. (2023). Atopic dermatitis is associated with abnormal stool form: a population-based cross-sectional study in college students. Archives of Dermatological Research: Founded in 1869 as Archiv Für Dermatologie Und Syphilis, 1–8. https://doi.org/10.1007/s00403-023-02567-9

[11] Tsuchida, A., Itazawa, T., Matsumura, K., Yokomichi, H., Yamagata, Z., Adachi, Y., & Inadera, H. (2023). Season of birth and atopic dermatitis in early infancy: results from the Japan Environment and Children’s Study. BMC Pediatrics, 23(1), 78. https://doi.org/10.1186/s12887-023-03878-6

[12] Youjia Zhong, Samuel, M., Bever, H. van, & Huiwen Tham, E. (2022). Emollients in infancy to prevent atopic dermatitis: a systematic review and meta-analysis. Allergy, 77(6), 1685–1699. https://doi.org/10.1111/all.15116