By Dr Murlidhar Rajagopalan
Atopic Dermatitis: Atopic dermatitis (AD) and eczema are terms often used interchangeably. However, they are not the same condition. While eczema is a broad term that describes diverse skin conditions that have similar inflammatory characteristics, AD is a specific eczema subtype that causes chronic (or long-lasting) and itchy skin rashes, typically linked with a genetic predisposition and an immune system dysfunction. In essence, AD manifests as red, itchy, dry and scaly skin that often has rashes and bumps.
While the condition is most common in young children, AD can occur at any age and, in some cases, persist into adulthood. Although irritating, the condition is not contagious. People with AD are, however, at risk of developing food allergies, asthma and hay fever.
The prevalence of AD varies globally, with some geographies recording higher cases. Around 223 million people were estimated to be living with AD in 2022. Of this, about 43 million are between the ages of 1 and 4. In essence, up to 20 per cent of children and up to 10 per cent of adults between 20 and 25 years are affected by AD. Nonetheless, the prevalence and disease burden varies substantially between countries, the reasons for which are still not understood properly.
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How environmental factors trigger atopic dermatitis
Similarly, the precise cause is not yet fully known, but it is thought to be triggered by an inherited tendency to produce IgE (immunoglobulin E) antibodies in reaction to common environmental proteins. Not all Atopics have high levels of IgE in their blood; the molecular mechanisms of atopic dermatitis are still being elucidated. Environmental triggers can be instrumental in the development and aggravation of AD. If those with a genetic predisposition are exposed to certain environmental factors, such as the weather, irritants, allergens and stress, it could trigger symptoms of AD or exacerbate an existing condition.
As AD is characterised by a vulnerable or compromised skin barrier, the person turns more susceptible to allergies, irritants and pollutants. If any such substance comes in contact with the skin, it could disrupt the skin’s outermost layer, causing water loss and triggering an inflammatory response. Due to this disruption, the skin’s ability to retain moisture is compromised, turning it dry, itchy and prone to more irritation.
Since the prevalence of the condition in the adult population is rising, healthcare providers are facing diagnostic challenges. Adult-onset AD could appear with milder symptoms or even mimic other skin conditions, leading to delayed diagnosis or misdiagnosis. Moreover, comorbidities or concurrent health problems in adults could complicate both diagnosis and management.
How does atopic dermatitis affect mental health?
The effects of the condition go beyond the physical state since it can have a significant impact on the patient’s mental health. As per studies, people with AD can be more prone to experiencing anxiety, depression and social isolation. To improve the person’s overall well-being, it is important to address mental health symptoms along with physical ones. The psychological impact can be mitigated by seeking the support of mental health professionals and healthcare providers while practising stress management alongside self-care techniques.
How can diet help manage atopic dermatitis?
In the management of AD, diet plays a role since food hypersensitivities and allergies could trigger or worsen symptoms. Some common food triggers include eggs, peanuts, cow’s milk, wheat, soy and fish. By eliminating these items from one’s diet, the symptoms of AD in some patients can be improved or controlled.
What are the treatment options for atopic dermatitis?
Currently, various treatment methods are used, which include oral steroids and topical steroid creams. However, any use of steroids, particularly oral ones, must be monitored carefully and only used when prescribed by a healthcare professional. Regular follow-ups with the healthcare provider are also required to ascertain appropriate steroid usage in the management of AD.
For adult-onset AD, it is essential to provide personalised treatment plans for effective management while considering the patient’s lifestyle, preferences and work-related exposures. Such an approach can help optimise treatment outcomes. Treatment options could comprise topical therapies, systemic medications and lifestyle modifications. Periodic follow-ups with healthcare providers are also vital to track the patient’s general progress and make any necessary changes.
Meanwhile, emerging therapeutic approaches are under development to manage the limitations of current treatments. Some innovative treatments that hold promising outcomes include biologics, small molecule drugs, gene therapy and microbiome-based therapies. In managing moderate-to-severe AD, biologics targeting specific proteins in the immune system that cause inflammation have shown efficacy and have been found to be safe in the long-term.
On the other hand, small molecule drugs offer targeted treatment but being immunosuppressive, they may have potential safety issues associated with them. Gene therapies also offer hope for correcting defective genes linked with AD, although the treatment is in its early stages. Lastly, microbiome-based therapies, such as probiotics, prebiotics and postbiotics, may have the possibility of restoring skin balance and alleviating symptoms of AD.
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Today, recent advances in the management of atopic dermatitis offer immense hope for people living with this chronic condition. Until a cure is found, patients could moisturise their skin regularly with creams, use prescribed medications, and follow other healthy skincare habits like keeping skin moisturised, using gentle products, applying sunscreen and staying hydrated to relieve itching and prevent any new outbreaks.
In the interim, healthcare providers are working hard to comprehend the condition’s complexities, providing personalised disease management, exploring innovative therapeutic approaches and addressing the associated mental health concerns while working closely with patients to boost their well-being and quality of life.
(The author is the head of the Department of Dermatology at the Apollo Hospitals. He is the member of several professional medical associations such as The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL), the International Member of European Academy of Allergy and Clinical Immunology (EAACI), the executive council of Skin Allergy Research Society and the Georg Rajka International Symposium on Atopic Dermatitis.)
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