Atopic dermatitis is a chronic inflammatory skin disease that causes extreme dryness, itchy rashes, scaly patches, and blisters that can ooze, crust, and flake. It affects people of all ages, all over the world, and is associated with a number of other allergies, including allergic rhinitis or "hay fever," asthma, and food allergies. Atopic dermatitis is also linked to other diseases, such as anxiety and depression, and can have a significant negative impact on quality of life.
The good news? It's not contagious, and treatment has come a long way.
"Our knowledge of the disease and its impact on other aspects of health has become much more advanced in the last decade and a half," said Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego. "We really want to get the message out that we have a tremendous ability to care for our patients with atopic dermatitis in ways that we couldn't before."
What does atopic dermatitis look like?
The appearance of atopic dermatitis can vary from person to person. In individuals with a dark skin tone, for instance, the rash may appear purple, brown, or grey, while in those with a light skin tone, it can look pink, red, or purple. In adults, atopic dermatitis tends to develop on the face and neck, the hands, the elbows, and on the backs of the knees and the legs.
Why do people sometimes call it "eczema"?
Eczema refers to a group of inflammatory skin conditions made up of seven distinct types, each with its own set of symptoms. Atopic dermatitis is the most common type of eczema.
How many people have atopic dermatitis?
About 2.4% of the world's population is affected by atopic dermatitis, although this number varies from country to country. In the U.S., it is estimated that 31 million people have some form of the disease, or that about 1 in 10 Americans will experience atopic dermatitis at some point in their lives.
Can children have atopic dermatitis?
Yes. In fact, atopic dermatitis usually develops in childhood, and has been diagnosed in infants in the first weeks of life. About 12% to 15% of atopic dermatitis cases in the U.S. are diagnosed in children, and about 7% in adults, with 40% of adults having moderate to severe disease.
"Atopic dermatitis can start at any time," said Amy S. Paller, MD, chair of the Department of Dermatology at Northwestern University Feinberg School of Medicine in Chicago. "Most cases occur in the first years of life, but we also see it in young adults, in middle-aged adults, and in people 65 years of age and older."
Are some people more prone to atopic dermatitis?
The odds of developing atopic dermatitis are higher if you have a family history of atopic dermatitis, or if you have other allergies such as asthma, hay fever, or food allergies. Atopic dermatitis is also more common in non-Hispanic Black children and in women and girls compared with men and boys.
What about the itch?
The itching caused by atopic dermatitis can be severe, often making it difficult to sleep. In turn, this can cause fatigue and daytime sleepiness, interfering with performance at school or work. Scratching and rubbing the skin can cause it to thicken and crack, increasing the risk of serious bacterial and viral infection.
What causes atopic dermatitis?
The specific causes of atopic dermatitis are still being investigated. However, experts agree that atopic dermatitis is likely caused by a combination of genetic and environmental factors that lead to critical changes in the skin's outermost layer, or "epidermis," and in the immune system.
"I think we're still trying to understand the relationship between the immune system, the skin barrier, and other environmental triggers," Paller noted. "I think we all recognize very well now that it's very hard to sort out any primary problem."
What do we know so far?
Research shows that most people with atopic dermatitis have inherited a genetic mutation from a parent with the disease. This mutation compromises the skin's ability to act as a protective barrier. After exposure to various "allergic triggers" in the environment, the skin can become inflamed and itchy.
Common triggers include air pollution, tobacco smoke, mold and pollen, humidity, pet dander, fragrances, soaps, shampoos, and detergents, wool and synthetic clothing, and certain foods. In addition, atopic dermatitis can be triggered by stress or hormonal changes during pregnancy or menstruation. The disease also causes the immune system to become hyper-reactive, creating inflammation that compromises the skin's protective layer.
How is atopic dermatitis treated?
Once the diagnosis is confirmed, your doctor will work with you to create a personalized treatment plan that will ease symptoms such as itch, and prevent rashes from flaring up. This plan may include a medicated cream that you apply to your skin, ultraviolet light treatment or "phototherapy," an oral medication that works throughout the body, or any combination of these. Your doctor will also help you identify your allergic triggers, and discuss ways to avoid them.
Is there a cure?
Not yet. In some infants, atopic dermatitis resolves by the time they reach adulthood, and never returns. In others, the disease is lifelong, and may clear up for a period of time, even years, and then return. Why this happens and how to predict the course of atopic dermatitis remains a topic of ongoing research.
In the meantime, new, more effective treatments are helping to control the symptoms and vastly improve quality of life. "I'm happy to say that the medications coming out have been life-saving for our patients," Paller said. "We still have much to do, but we have certainly made tremendous advances in the past 5 to 8 years."
For more information about atopic dermatitis, here are some helpful online resources:
"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.
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