What is atopic dermatitis?
Atopic dermatitis is a genetically influenced allergic skin disease. It tends to be chronic and recurrent, with lesions that may spread across large areas of the body. The skin often becomes weepy and inflamed, and infections can worsen symptoms. People with this condition usually endure severe itchiness, which can disrupt sleep and impair daily functioning, profoundly affecting quality of life for both children and adults.
Each life stage shows different patterns. In infants, the disease frequently targets the folds and flexures, the face, and the extensor surfaces of the limbs, with episodes that often begin with a crying phase. In adults, atopic dermatitis follows a long-lasting course and tends to present with rougher skin, a more pronounced skin pattern, extreme dryness, and persistent itching. Flaking skin can be heavy enough that peeling is noticeable after a clinic visit.
Is atopic dermatitis linked to allergies?
Yes, in many cases. Up to about 80 percent of patients have allergic tendencies. Allergic rhinitis often accompanies bronchial asthma, and in children food allergies are common. There is growing discussion about links with eosinophilic esophagitis, a condition where eosinophils invade the lining of the esophagus and gastrointestinal tract.
Are eosinophils a type of white blood cell?
Yes. Eosinophils are a form of leukocytes, and in severe atopic dermatitis their numbers in the blood can be markedly elevated. They may reach around 30 percent in some cases, compared with typical ranges of about 5 to 6 percent, reflecting the activity of the disease.
What causes atopic dermatitis?
The disease arises from a combination of genetic predisposition and environmental factors. Families with a history of rhinitis, asthma, or atopic dermatitis raise the likelihood of a child developing an allergic breakthrough. The genetic component includes skin barrier defects due to mutations in proteins such as filaggrin, which leave the skin dry and more vulnerable to irritants. Many affected children are born with dry skin that responds poorly to environmental stressors.
What proportion of people carry this mutation?
Estimates place it around 30 percent among those with severe atopic dermatitis. This mutation is also more common in people with bronchial asthma. Rather than two separate causes, the disease results from predisposing factors plus environmental influences, including climate, allergens, humidity, dryness of air, geography, and dietary habits.
How does race affect the condition?
There are observable differences in immune responses among different populations, which can influence disease presentation. In some populations, severe atopic dermatitis is more common and may be associated with higher frequencies of certain protein mutations.
Will moving to a different climate fix the problem?
No. A climate change does not cure the condition, but it can alter its course. Some people may experience milder symptoms or longer remissions, while others may see fluctuations where improvement is followed by a relapse. A phenomenon known as the “swing” describes situations where skin symptoms ease while allergic respiratory conditions like rhinitis or asthma worsen. The disease often shifts between organs as the inflammatory process evolves.
What underlies atopic dermatitis?
The disease is now understood as a T2-dominated immune response. T2-related conditions include not only atopic dermatitis but also asthma, rhinitis, food allergies, eosinophilic esophagitis, and other allergic disorders. Evidence points to a systemic component in many patients, with allergic diseases affecting multiple organs. In some cases, this systemic involvement raises the risk of cardiovascular issues and other inflammatory conditions, such as rheumatoid arthritis or systemic lupus erythematosus, as well as gastrointestinal disorders like ulcerative colitis or Crohn’s disease. Vitiligo and alopecia may also occur in association with atopic dermatitis in some individuals.
Are eczema and atopic dermatitis the same?
No. Eczema is a broader term and is not synonymous with atopic dermatitis, nor is it the same as allergies. At times, patients confuse the two terms, but a careful examination by a specialist can distinguish them. There is also a condition sometimes confused with atopic dermatitis called nodular prurigo, which requires a dermatologist to differentiate it accurately.
Is there a definitive test for diagnosing atopic dermatitis based on the T2 immune response?
No single universal test exists. Diagnosis often involves allergy testing to identify clinically important allergens. Tests may include skin testing or laboratory assessments that measure specific immunoglobulin E antibodies to various allergens. The goal is to target relevant triggers, including inhaled allergens such as dust mites, pollen, and fungi, as well as food allergies.
Allergy testing should be performed by an allergist. Patients sometimes present with test panels that are not appropriate or necessary, leading to confusion. An adequately selected test set helps guide treatment rather than overwhelm the patient with inconclusive results.
Why is it said that some allergen tests are inadequate?
For example, IgG antibody testing for foods often has little clinical value. IgG antibodies mainly reflect past exposure and do not indicate active allergy. Some patients bring in expensive test packages and expect cures from them. This is misleading, as these results do not prove a real allergy and can complicate decision-making.
Why can test results vary between laboratories?
The accuracy of allergy testing depends on the quality and specificity of the methods used. Some tests may be non-specific or insensitive, leading to unreliable conclusions. With changing test systems, it is possible to obtain different results from different labs, underscoring the importance of choosing well-established, validated approaches under professional guidance.
Is allergen-specific immunotherapy still a cornerstone of allergic disease treatment?
Yes. The approach was discovered in 1911 and has been used worldwide ever since. While the basic concept remains, methods have evolved. Subcutaneous immunotherapy is now complemented by sublingual preparations, and treatment typically lasts three to five years and sometimes longer.
Can atopic dermatitis be cured permanently?
No. The aim is long-term remission rather than a complete cure. Since 2019, a biologic therapy called dupilumab has offered dramatic improvements for many patients. As a monoclonal antibody, it can substantially reduce symptoms for a large portion of affected individuals, dramatically improving daily life for some. The treatment involves regular injections, and costs can be a consideration in many settings.
There is ongoing work to recognize atopic dermatitis as a systemic disease, which could influence access to therapies and overall management. Some patients rely on protective skincare strategies to maintain the skin barrier, including the use of emollients to support barrier function during flare-ups.
Springtime allergies can worsen atopic dermatitis for many people. What practical steps help during pollen season? The primary recommendation is to improve the epidermal barrier with moisturizers and properly chosen skin care products. Individual plans developed with a clinician can help patients manage symptoms more effectively and reduce flare-ups.
As allergies become more widespread, would atopic dermatitis increase?
Many researchers anticipate a rise in allergic diseases overall, given environmental and lifestyle factors. More people live with various allergic conditions, suggesting that atopic dermatitis may become more common in the future. A comprehensive, patient-centered approach remains essential for managing this complex condition.