What is Atopic Dermatitis?

Atopic dermatitis (also known as atopic eczema) is the most common type of eczema.1 The most obvious sign of atopic dermatitis is when the skin becomes inflamed leading to red, dry, itchy skin that can appear on any part of the body but often presents on creases of the elbows or behind the knees.1

Atopic dermatitis is a disease caused by an overreaction of the body’s natural defence system.2 Understanding what happens on the inside may help to better manage the symptoms of atopic dermatitis. Watch the video to learn more.

In the UK, approximately 1.5 million (3%) adults have atopic dermatitis and it affects men and women equally.3,4,5 One can get atopic dermatitis at any age, but most often it starts as a baby or in childhood, and if someone in the family has atopic dermatitis, one is more likely to develop the condition.3 Atopic dermatitis is a chronic condition, which means it can be a life-long disease.6

Atopic dermatitis is more than just a skin condition. It can affect someone’s sleep, ability to concentrate, personal relationships and confidence to socialise.7,8,9,10 People who have moderate or severe atopic dermatitis can also experience symptoms of anxiety and depression due to their disease.11 To find out more about the impact of atopic dermatitis, click here.

 

Understanding the Causes

Eczema that occurs chronically may be more than just a skin condition. It could be a disease called atopic dermatitis.

The most common type of eczema is atopic dermatitis, a chronic disease.1 If someone struggles with frequent flare-ups that just keep coming back, there may be a bigger story happening inside his or her body.12

With atopic dermatitis, even when the skin looks clear, the inflammation may still be active under the surface, and a next flare-up may be waiting to return.13 Some people, however, always show signs of the disease.

The most obvious sign of atopic dermatitis is dry, itchy skin. Flare-ups are different for every person and can appear all over the body. Some other common external symptoms include:

  • Redness
  • Oozing
  • Swelling
  • Scaly areas
  • Crusting
  • Thick skin14

Scratching the Surface

Atopic dermatitis is an immunological disease, which means it involves the immune system.2

With atopic dermatitis, the immune system is highly sensitive and can react to even the smallest irritants or substances that cause an allergic reaction.2 This reaction can cause excess inflammation underneath the skin, which may lead to frequent flare-ups.14 The rashes you see on the surface are just the visible signs of a deeper inflammatory disease.

1. ITCH
In people with atopic dermatitis, immune cells in the deeper layers of your skin send inflammatory signals to the surface, causing the itchy rash.14

2. SCRATCH

When you scratch, you can break down the outer layer of skin which allows germs, viruses and allergens to get in.15

3. DAMAGED SKIN

In response to these invaders, the immune system continues to send signals to the surface, causing even more redness and itching.15

4. RELEASE OF INFLAMMATORY SIGNALS

The more you scratch, the more your skin barrier breaks down, and the itch-scratch cycle continues.3

1. NHS Choices. Atopic Eczema (Atopic Dermatitis). Available at: https://www.nhs.uk/conditions/atopic-eczema/ (Accessed April 2018).
2. European Dermatology Forum. Guidelines to treatment. Available at:
http://www.euroderm.org/edf/index.php/edf-guidelines/category/5-guidelines-miscellaneous?download=36:guideline-treatment-of-atopic-eczema-atopic-dermatitis. (Accessed April 2018).
3. Medicine.net. Atopic Dermatitis. Available at: http://www.medicinenet.com/atopic_dermatitis/page3.htm . (Accessed April 2018).
4. Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab 2015;66 (suppl 1): 8–16.
5. Office for National Statistics. 2014 UK mid-year population estimate. Available at:
https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2015-10-29 (Accessed April 2018).
6. Leung D.Y.M, Nicklas R and Li J. Disease management of atopic dermatitis: an updated practice parameter. Joint Task Force on Practice Parameters, Ann Allergy Asthma Immunol, page 93(3 Suppl 2):S1-21, 2004.
7. NHS Choices. Atopic Eczema - Complications. Available at: http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Complications.aspx (Accessed April 2018).
8. Kurwa HA, Finlay AY. Dermatology in-patient management greatly improves life quality. Br J Dermatol 1995; 133: 575-578.
9. Silverberg JI, Garg NK, Paller AS et al. Sleep disturbances in adults with eczema are associated with impaired overall health: a US population-based study. J Invest Dermatol 2015; 135(1): 56-66.
10. Anderson RT, Rajagopalan R. Effects of allergic dermatitis on health-related quality of life. Curr Allergy Asthma Rep 2001; 1(4): 309-315.
11. Simpson et al. Patient burden of moderate to severe atopic dermatitis (AD): Insights from a phase 2b clinical trial of dupilumab in adults. Am Acad Dermatol, pp. 74(3):491-498, 2016.
12. Gittler JK, Shemer A, Suárez-Fariñas M, et al. Progressive activation of T(H)2/T(H)22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol 2012; 130: 1344–54.
13. Leung, DY, Boguniewicz, M, Howell, MD, Nomura, I & Hamid, QA New insights into atopic dermatitis. J. Clin. Invest. 113, 651–657 (2004).
14. Bieber T. Mechanisms of Disease. Atopic Dermatitis. N Engl J Med 2008; 358:1483-94.
15. Lio PA, Lee M, LeBovidge J, et al. Clinical management of atopic dermatitis: practical highlights and updates from the atopic dermatitis practice parameter 2012. J Allergy Clin Immunol Pract 2:361–369; quiz 370, 2014.