Atopic dermatitis (AD), also known as eczema, is a chronic, relapsing condition that primarily affects the skin. Characterized by pruritus (itching) and dry skin, it can significantly impact the quality of life for those affected, including myself! In this post, we will dive into the causes, triggers, symptoms, and management strategies for atopic dermatitis. This post, and the episode of First Line on this topic, is meant for educational purposes only and is not meant to be medical advice. See your primary care physician or dermatologist for any concerns you have.
What is Atopic Dermatitis?
Atopic dermatitis is a common skin condition marked by chronic dryness and intense itching. It often starts in early childhood, typically between 3 and 6 months of age, and can improve as individuals grow older. In many cases, the condition resolves by puberty, but for others (like me), it continues into adulthood.
Eczema Prevalence, Causes, and Risk Factors
Atopic dermatitis affects about 8-12% of children and 6-9% of adults globally.
A significant portion of those affected has a family history of atopic diseases, including eczema, asthma, and allergies. Research has shown that 70% of individuals with atopic dermatitis have a family history of atopy, indicating a strong genetic link. I myself am diagnosed with eczema, asthma, and a peanut allergy. However, neither of my parents have been diagnosed with any of these conditions.
The Role of Genetics
Mutations in the FLG gene lead to a deficiency of filaggrin, an epidermal protein responsible for maintaining the skin’s barrier function. This deficiency makes the skin more prone to irritants and allergens, contributing to the development of atopic dermatitis.
Environmental and Social Risk Factors
There are several environmental and social causes or risk factors that can increase the risk of developing eczema (atopic dermatitis):
Low microbial exposure in early childhood
Urban living conditions
Diet high in sugars and unsaturated fatty acids
Frequent use of antibiotics in early childhood
Small family size
These factors can potentially disrupt the immune system and the skin's barrier function, increasing susceptibility to AD.
Common Triggers of Atopic Dermatitis
Atopic dermatitis is often triggered by environmental factors that lead to inflammation of the skin. Here are some common triggers:
Potential allergens like pollen, dust mites, and animal fur
Hot and either overly dry or humid climates
Stress
Skin irritation, including air pollutants
These triggers can worsen the skin condition, leading to flare-ups characterized by severe itching, dry skin, and inflammation.
How Triggers Affect the Skin
When the skin barrier is compromised, moisture is lost, leading to dry skin. The skin becomes inflamed, and immune cells infiltrate the affected area, causing irritation and hypersensitivity. This leads to the hallmark symptoms of atopic dermatitis—intense itching and dry, cracked skin.
Different Stages of Atopic Dermatitis
Atopic dermatitis manifests differently depending on age, with varying severity and locations of involvement.
Infantile Stage (Age < 2 years)
In infants, atopic dermatitis typically affects the face, head, and extensor surfaces of the extremities. It may also spread to the torso in some cases. My daughter is currently in this stage at the time I am writing this blog post; her eczema is limited to the extensor surfaces, so it's luckily a much milder form than I had as an infant.
Childhood Stage (Age 2–12 years)
The pattern of eczema often shifts to involve the flexural creases (areas like the elbows and knees), skin folds, and the extensor surfaces of the hands. Skin thickening with accentuated markings is common during this stage.
Adult/Adolescent Stage (Age > 12 years)
In adolescents and adults, atopic dermatitis presents as lichenified lesions—thickened, leathery patches of skin. These lesions are often found on the flexor surfaces of the extremities, particularly the antecubital fossae (inner elbow). Coin-shaped eczema may also appear.
Associated Skin Findings
Individuals with atopic dermatitis are often prone to other associated conditions:
Keratosis pilaris: Rough, keratinized bumps that appear over the arms and thighs, often mistaken for permanent goosebumps.
Dry skin: A persistent feature that may worsen during flare-ups.
Atopic triad: the co-occurrence of eczema, asthma, and food allergies in some individuals.
Prevention and Management of Atopic Dermatitis
Preventive Measures
While atopic dermatitis cannot always be prevented, certain measures can reduce the risk of developing the condition or minimize flare-ups:
Breastfeeding infants: It is recommended to breastfeed infants for at least six months to reduce the risk of developing allergies, including atopic dermatitis.
Introducing allergenic foods: Gradually introducing allergenic foods during infancy may help prevent sensitization to common allergens like peanuts and eggs.
Treatment Strategies
Treatment for atopic dermatitis typically focuses on managing flare-ups, reducing inflammation, and maintaining skin hydration. The approach depends on the severity of the condition.
Mild to Moderate Treatment
Daily, short baths (less than 10 minutes) to avoid skin dryness.
Moisturizers: Use of emollients to hydrate the skin and help repair the skin barrier.
Topical corticosteroids: These medications reduce inflammation and itching.
Low-potency: Hydrocortisone 1%
Medium-potency: Triamcinolone 0.1% (what I use!)
High-potency: Fluocinonide 0.05%
If corticosteroids are ineffective or cause side effects, calcineurin inhibitors (e.g., tacrolimus) may be an alternative treatment.
Severe Treatment
Oral steroids or systemic treatments like cyclosporine or methotrexate.
Wet wrap therapy, which involves wrapping the area with a moist bandage and then a dry bandage to retain moisture and promote healing.
Stress Management
Stress can worsen the symptoms of atopic dermatitis. Implementing stress management techniques, such as mindfulness, meditation, and relaxation exercises, can help reduce flare-ups and improve skin health.
Conclusion
Atopic dermatitis is a complex condition that involves both genetic and environmental factors. Understanding its triggers, symptoms, and treatment options can help those affected manage the condition more effectively. Working closely with a healthcare provider to create a personalized treatment plan is essential.
Frequently Asked Questions (FAQs)
1. What is the main cause of atopic dermatitis (eczema)?
Atopic dermatitis is primarily caused by a combination of genetic and environmental factors. Mutations in the FLG gene can contribute as well as environmental factors such as low microbial exposure, diet, and frequent antibiotic use during early childhood.
2. Can atopic dermatitis be cured?
Currently, there is no cure for atopic dermatitis, but the condition can be managed effectively with the right treatment. While the severity may decrease with age, especially during puberty, many people continue to experience flare-ups throughout life.
3. What are the common triggers for eczema flare-ups?
Common triggers for atopic dermatitis flare-ups include environmental allergens like pollen and dust mites, heat and extreme weather conditions (dry or humid climates), stress, skin irritation from harsh soaps or chemicals, air pollutants, and animal fur. Managing these triggers can help prevent flare-ups and reduce skin irritation.
4. How can I treat eczema at home?
For mild cases of eczema, many people can manage symptoms at home by moisturizing regularly with thick, fragrance-free creams or ointments, taking short baths (no more than 10 minutes) in lukewarm water to avoid drying out the skin, using over-the-counter hydrocortisone creams to reduce inflammation and itching, avoiding known triggers such as harsh soaps or extreme temperatures, and wearing breathable clothing made of cotton to reduce skin irritation. For all cases, but especially more severe cases, consult a healthcare provider.
5. Is eczema linked to other health conditions?
Yes, atopic dermatitis is often associated with the atopic triad, which includes eczema, asthma, and allergic rhinitis (hay fever). People with eczema may also experience food allergies and other types of allergies.