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Atopic dermatitis (also known as AD), is the most common type of eczema, a skin condition that makes you itch and leaves red blotches, usually on your face, arms, and legs. Atopic dermatitis is a common and often persistent skin disease that affects a large percentage of the world's population. The rashes tend to flare and go away, but then come back again.

Atopic dermatitis typically begins in childhood, usually in the first six months of a baby’s life. Even though it is a common form of eczema, it may become severe and lifelong nuisance. Normally, AD disappears as a child grows older, but some adults could still suffer from AD flare ups.

“Atopic” refers to an allergy. Atopic dermatitis also usually exists alongside two other allergic conditions, which are asthma and hay fever (allergic rhinitis). People who have asthma, hay fever or have family members with AD are more likely to develop it.

Types of Atopic Dermatitis

  • Hand eczema: commonly triggered by exposure to chemicals that irritate the skin.
  • Contact dermatitis: which occurs only when the skin makes contact with certain substances. It comes in two types: Allergic contact dermatitis is an immune system reaction to an irritant like latex or metal. Irritant contact dermatitis starts when a chemical or other substance irritates your skin.
  • Dyshidrotic eczema: a blistering form of eczema that is found only on the fingers, palms, and soles of the feet. It is more common in women than men.

Signs & Symptoms of Atopic Dermatitis (eczema) include:

  • Dry skin
  • Itching that is exacerbated by the condition
  • Red or brownish-grey patches on the hands, feet, ankles, wrists, neck, upper chest, eyelids including in between elbows and knees lines area, at the face and scalp.
  • Small and raised bumps, which cause fluid leakage when scratched
  • Thick, cracked, and scaly skin
  • Reddish raw, sensitive or swollen skin as a result of scratching

How does Atopic Dermatitis happen and why?

There is no exact reason behind atopic dermatitis but research shows a combination of genetics and external factors that may be involved. A study published by Nature Genetics found that some people with eczema lack the proper proteins to build a strong barrier on the outer most layer of the skin (epidermis).

This group of people, especially those with atopic dermatitis may have partial or complete mutation on the gene responsible for creating a protein known as filaggrin. Filaggrin helps our bodies maintain a healthy, protective barrier on the epidermis.

Healthy Skin versus Atopic Dermatitis

This genetic mutation causes a lack of filaggrin in the epidermis layer which leads to a reduction in the ability to maintain the skin’s natural amount of water and thus results in dry skin which causes itchiness. Lack of filaggrin may also allow allergens to enter the skin which will then trigger an inflammatory response by the immune system, causing inflammation that again results in red, rash and itchy skin. This is the main reason why many people who suffer from atopic dermatitis tend to have extremely dry and infection-prone skin.

Healthy Skin versus Atopic Dermatitis

Statistics and Population

Atopic dermatitis (AD), affecting 2 to 3-fold in industrialized nations, impacting approximately 20% of children and 3% of adults worldwide.

Those who live in developed countries or colder climates seem to be more likely to develop AD.

Studies have found that 33% to 67% of children and young people with AD also have some food allergies. Moreover, general aspects of AD will affect between 8% to 18% of infants and young children.

Around 50% of people who suffer from atopic dermatitis develop symptoms within their first year of life, and probably as many as 95% experience an onset of AD when they are below five years of age. Around 75% of people with the childhood onset of the disease have seen their symptoms decrease before adolescence. The remaining 25% continue to have eczema during adulthood or may experience a relapse of symptoms after some years without experiencing any symptoms.

Around 50–75% of all children with early-onset atopic dermatitis are sensitive to allergens.

Examples of allergens include pets, house dust mites or even food allergens, whereas those with late-onset atopic dermatitis are often less sensitive to these allergens.

Atopic dermatitis is more than just a skin condition known as the “itch that rashes”. It is a disease caused by an overactive immune system that leads to inflammation in the body. It is also the main culprit behind internal inflammation that causes the symptoms to flare up. Besides that, scratching may lead to only temporary relief and may worsen the itching in the long run. This is called the itch-scratch cycle.

In healthy skin, the outer layer (epidermis) keeps foreign substances such as bacteria, viruses and allergens from entering the body. When you have atopic dermatitis, the outer layer of the skin is weaker and is more vulnerable to inflammation as a result of immune cells in the body. The damage done by scratching also contributes to the breakdown of skin cells which makes it easier for foreign substances to enter the body.

Once these foreign substances have broken through the skin barrier, immune cells alert the body that it is under attack. These immune cells travel to the lymph nodes at the dermis called as the second layer of the skin. Once they have entered the lymph nodes, these immune cells activate your body’s protectors, called T helper cells.

The immune cells release substances which cause redness and rashes on the skin. This will cause the inflammatory process to continue, so the skin reacts even when it looks clear. Even when the rash cannot be seen clearly, the underlying inflammation is still active beneath the skin. People tend to scratch when they feel itchy, and this further weakens the skin cells in the epidermis which allow more foreign substances to get in and this ultimately would increase the risk of infection.

Connection between Atopic Dermatitis & Respiratory System

Studies have shown that almost 50% - 70% of children and 7% - 9% of adults with severe atopic dermatitis will develop asthma.

Doctors and scientist came up with theories as to why a skin rash is associated with asthma. Does immune system disorders cause an overreaction to allergens that are in contact with the skin and lung airways or is it the defective skin and airways that trigger an excessive immune response?

A research by Dr. Kopan suggested that the problems started with the damaged or defective skin itself. The researchers found that cells in the damaged skin can secrete thymic stromal lymphopoietin (TSLP), a compound that is able to cause an immune response and due to the skin’s effectiveness in secreting TSLP into the blood system, the substance travels throughout our body, causing AD flares up. When it reaches our lungs, it then triggers the hypersensitive characteristics of respiratory problems which could lead to asthma attacks.

Let us learn more about what causes atopic dermatitis or flare-ups/ triggers, our Skin and more on how to reduce the effects of Atopic Dermatitis in our next Blog.

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