Atopic dermatitis: Everything you need to know!

What causes atopic dermatitis?

Atopic dermatitis (AD) is driven by a combination of genetic, environmental, and immune system factors, such as

Genetic factors

Research highlights the role of genetic mutations, particularly in the filaggrin gene, which is crucial for maintaining the skin's protective barrier. A defective barrier allows moisture to escape, leaving the skin vulnerable to irritants and allergens​. Individuals with a family history of eczema, asthma, or hay fever are at higher risk of developing AD​​.

Environmental factors

Exposure to environmental allergens such as dust mites, mould, pet dander, and pollen can trigger or worsen AD​​. Urban living, with increased pollution and limited access to green spaces, is linked to higher prevalence rates. Additionally, temperature fluctuations, low humidity, and skin irritants (like harsh soaps) are common external triggers​.

Immune system dysfunction

AD is associated with an overactive immune response that leads to inflammation, damaging the skin barrier. This inflammation contributes to the hallmark redness, itching, and discomfort experienced during flare-ups​​.

What are the symptoms of atopic dermatitis?

Symptoms of atopic dermatitis vary significantly based on age, skin tone, and individual health.

Common symptoms are:

• Dry, cracked skin, which is one of the earliest and most persistent signs​.
• Itching (pruritus) that is often severe and can disrupt daily activities and sleep​.
• Rashes, which appear red in lighter skin, but may present as brown, purple, or gray patches​​ in darker skin.
• Lichenification, or thickening and hardening of skin due to repeated scratching​​.
• Oozing and crusting in inflamed areas that may leak fluid, increasing infection risk​.

Some symptoms of AD are age-specific:

Infants (0-2 years): Rash on the face, scalp, and body folds​.
Children (2-12 years): Rash typically appears in the folds of elbows, knees, and neck​.
Adults and teens: Affected areas include the hands, around the eyes, and neck​​.

Persistent scratching can lead to complications such as secondary skin infections, scarring, and pigmentary changes, particularly in people with darker skin​​.

What triggers atopic dermatitis flare-ups?

Understanding and avoiding triggers is essential to managing AD.

Allergens and irritants

Common irritants include soaps, detergents, wool, and synthetic fabrics. Exposure to allergens like pet dander, dust, and pollen often triggers flare-ups​​.

Food allergies

In children, food allergies (e.g., dairy, nuts, soy, wheat) can exacerbate symptoms​​. While dietary triggers are less common in adults, they can still play a role.

Environmental factors

Cold weather, low humidity, and excessive heat can dry out the skin, while sweating may exacerbate irritation​​.

Psychological stress

Stress is a significant factor in AD, with flare-ups often occurring during emotionally taxing periods​. Managing stress through relaxation techniques or counselling can reduce flare frequency.

How can atopic dermatitis be managed and treated?

Daily management of AD focuses on skin hydration, reducing inflammation, and avoiding triggers.

Skin care routine

Moisturizing regularly with fragrance-free emollients is essential to repair the skin barrier​​.

Warm (not hot) baths with gentle cleansers hydrate the skin, followed by immediate moisturizing to lock in moisture (the “Soak and Seal” method)​.

Keeping nails short and wearing cotton gloves at night helps prevent damage from scratching.

Lifestyle changes

Wear soft, breathable fabrics like cotton to reduce irritation. Avoid wool and synthetic fibres.

Maintain a clean, dust-free home environment and use air humidifiers to prevent dry skin.

Identifying triggers

Keeping a symptom diary can help patients recognize specific triggers, allowing for targeted avoidance​.

Medications

• Antihistamines relieve itching and promote sleep during flare-ups.
• Topical corticosteroids can reduce inflammation and itching during acute flare-ups​​.
• Non-steroidal options of calcineurin inhibitors can be used in sensitive areas like the face and neck​​.
• Newer biologics target immune pathways to reduce inflammation and prevent severe flare-ups​​.

Phototherapy

Ultraviolet (UV) light treatment can reduce symptoms in patients with moderate to severe AD​.

What are the long-term impacts and comorbidities of atopic dermatitis?

Atopic dermatitis can lead to several comorbidities, impacting overall health.

Asthma and hay fever

Many individuals with AD develop asthma or hay fever, reflecting the atopic march (progression from eczema to respiratory issues)​​.

Cardiovascular and bone health

Severe cases are linked to cardiovascular risks and osteoporosis, possibly due to chronic inflammation and steroid use​.

Mental health

AD significantly affects quality of life, with patients at higher risk of depression and anxiety due to chronic itching, sleep disruption, and social stigma​​.

How does atopic dermatitis differ in darker skin tones?

AD appears differently in darker skin, presenting as dark brown, purple, or greyish patches rather than red rashes​​. Post-inflammatory hyperpigmentation or hypopigmentation is also more common in darker skin, often lasting months after the flare subsides​​. Patients with darker skin may require targeted treatments to address pigmentary changes alongside standard AD therapies​​.

Key takeaways

Atopic dermatitis is a chronic but manageable condition affecting millions globally. Through comprehensive skin care, trigger avoidance, and appropriate treatments, patients can effectively control symptoms and improve their quality of life. Advances in biologics and other emerging therapies continue to offer hope for better outcomes, underscoring the importance of ongoing research and personalized treatment approaches.

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