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ECZEMA / ATOPIC DERMATITIS

Eczema is the common term referring to skin irritation, and the most common type of eczema is atopic dermatitis. Atopic dermatitis is a highly prevalent chronic inflammatory skin condition that affects up to 1 in 5 children and 2% of adults worldwide.1 Eczema presents as red and flaky rashes often involving the cheeks, elbows, and knees. It commonly causes highly itchy skin, especially at night. Children with eczema have difficulty sleeping, which can lead to anxiety, learning difficulties, and impaired quality of life for both children and their parents. Fortunately, childhood eczema improves in approximately 80% of cases2 but that still leaves many adults who continue to have eczema.  

 

What Causes Eczema?

The pathogenesis of eczema is believed to be multifactorial in nature, with main contributors being genetic predisposition, poor skin barrier function, and a revved up inflammatory response.3 In addition, environmental factors such as exposure to allergens and cigarette smoke can have a profound influence on disease severity.

  

Table 1 – Factors Involved in Pathogenesis of Eczema

 

Factors in Eczema

Description

Defective skin barrier

People with eczema tend to have a defective skin barrier, often in part caused by a genetic mutation in a skin protein called filaggrin, predisposing the skin to dryness and irritation.4

Hyperactive inflammatory response

A hyperactive immune response leading to inflammation in the skin causes the redness and swelling seen in eczema.4

Genetics

People with a family history of eczema may be genetically susceptible and have an increased risk for eczema, asthma, and other allergic conditions.5 Exact patterns of hereditability in eczema are not yet known.6

Deficient natural antibacterial substances on the skin

Researchers have shown that many people with eczema have a deficiency in naturally produced antibacterial substances, which may increase the risk for skin infections.7

Disrupted skin microbiome

Normally, trillions of bacteria referred to as the skin microbiota, reside on the skin in harmony. However, in people with eczema, this healthy balance can become disrupted with an overgrowth of Staphylococcus aureus.8

Eczema Symptoms

People with eczema tend to have dry skin with chronically itchy and flaky areas along with redness and swelling. What is often referred to as the “itch-scratch” cycle, scratching can further irritate the skin, leading to swelling, oozing, and weeping.9When the skin is scratched, irritated, and inflamed, the skin barrier is weakened, increasing the risk for superimposed infections.10 The most commonly affected body areas vary depending on age. In babies and infants, eczema commonly affects the cheeks, knees, inner elbow creases, and wrists. In older children, teenagers, and adults, eczema usually presents on the neck, inner elbows, and back of the knees.  Although eczema is significantly more common in childhood and usually improves with age, it can still persist into adulthood or even appear for the first time in some adults.   

 

Risk Factors

Age

Eczema is most common in young children and typically improves with age.  However, it can affect adolescents and adults as well.1

Climate

The combination of cold winter months and increased indoor heating can dry out the skin and worsen skin barrier function. Research has shown that cold temperatures and low humidity are associated with a higher incidence of eczema.11 On the other hand, some people experience worsening in eczema with wet climates, highlighting the variability in symptoms from person to person.12

Genetics

Although the heritability of eczema is still not exactly understood, a genetic component is thought to be involved in some people. Genetically abnormal or deficient skin proteins called filaggrin have been identified in up to 50% of people with eczema.13, 14

Skin Allergens

Environmental allergens, such as animal dander, dust mites, pollen, and latex, can cause contact dermatitis in some individuals, which leads to irritation and increased risk for eczema.15

Diet

Diet can have a profound effect on eczema flares, and up to one third of children with eczema have a known food sensitivity or allergy.16 The top five most common food allergies in people with eczema are eggs, dairy, gluten, soy, and peanuts.17

Cigarette Smoke

Exposure to cigarette smoke significantly increases the risk for eczema, including prenatal exposure to secondhand cigarette smoke.18, 19

  

Products, Bathing, and Clothing

Irritating products applied to the skin, such as soaps and alcohols, can cause dryness, strip the skin of its natural oils, and perpetuate symptoms of eczema. Parents of children with eczema are advised to use soap judiciously and immediately apply moisturizer after bathing.20 Products applied to the skin must be carefully selected to avoid irritating chemicals, such as fragrances and preservatives.15 In addition, clothing made from wool or other rough fabrics can increase itchiness and worsen eczema.12

Stress and Sleep

There is a two-way connection between psychological stress and eczema. Eczema can lead to increased stress, while stress itself can worsen eczema symptoms.21 Due to increased itch at night, sleep deprivation can have a profound effect on quality of life.22

 

Treatment Approaches

Management of eczema requires constant attention, careful selection of products, and avoidance of triggers. Eczema tends to be a chronic condition in many people and can be notoriously difficult to treat.

 

Table 2 – Treatment Approaches in Eczema23, 24

Factors in Eczema

Typical Treatment Approach

Overactive immune system and inflammation

Reduce inflammation

Defective skin barrier

Improve skin barrier with moisturization and avoid irritating ingredients

Itch

Decrease itch

Increased susceptibility to infection

Antimicrobial agents when necessary

Environmental factors

Avoidance of irritating soaps and hot baths, use of humidifier, and smoking cessation25, 26

 

View Kamedis products for relief of dry, red, itchy and irritated skin

 

 References

 

  1. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16.
  2. Dangoisse C. [Atopic dermatitis]. Rev Med Brux. Sep 2011;32(4):230-234.
  3. Rerknimitr P, Otsuka A, Nakashima C, Kabashima K. The etiopathogenesis of atopic dermatitis: barrier disruption, immunological derangement, and pruritus. Inflamm Regen. 2017;37:14.
  4. Czarnowicki T, Krueger JG, Guttman-Yassky E. Skin barrier and immune dysregulation in atopic dermatitis: an evolving story with important clinical implications. J Allergy Clin Immunol Pract. Jul-Aug 2014;2(4):371-379; quiz 380-371.
  5. Asher MI, Montefort S, Bjorksten B, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. Aug 26 2006;368(9537):733-743.
  6. Brown SJ, McLean WH. Eczema genetics: current state of knowledge and future goals. J Invest Dermatol. Mar 2009;129(3):543-552.
  7. Hata TR, Gallo RL. Antimicrobial peptides, skin infections, and atopic dermatitis. Semin Cutan Med Surg. Jun 2008;27(2):144-150.
  8. Kong HH, Oh J, Deming C, et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. May 2012;22(5):850-859.
  9. Pavlis J, Yosipovitch G. Management of Itch in Atopic Dermatitis. Am J Clin Dermatol. Dec 28 2017.
  10. Ashbaugh AG, Kwatra SG. Atopic Dermatitis Disease Complications. Adv Exp Med Biol. 2017;1027:47-55.
  11. Engebretsen KA, Johansen JD, Kezic S, et al. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol. Feb 2016;30(2):223-249.
  12. Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol. Jul 2013;133(7):1752-1759.
  13. Cabanillas B, Novak N. Atopic dermatitis and filaggrin. Curr Opin Immunol. Oct 2016;42:1-8.
  14. Akiyama M. FLG mutations in ichthyosis vulgaris and atopic eczema: spectrum of mutations and population genetics. Br J Dermatol. Mar 2010;162(3):472-477.
  15. Schena D, Papagrigoraki A, Tessari G, et al. Allergic contact dermatitis in children with and without atopic dermatitis. Dermatitis. Nov-Dec 2012;23(6):275-280.
  16. Zuniga R, Nguyen T. Skin conditions: common skin rashes in infants. FP Essent. Apr 2013;407:31-41.
  17. Bergmann MM, Caubet JC, Boguniewicz M, Eigenmann PA. Evaluation of food allergy in patients with atopic dermatitis. J Allergy Clin Immunol Pract. Jan 2013;1(1):22-28.
  18. Molin S, Ruzicka T, Herzinger T. Smoking is associated with combined allergic and irritant hand eczema, contact allergies and hyperhidrosis. J Eur Acad Dermatol Venereol. Dec 2015;29(12):2483-2486.
  19. Yang YW, Chen YH, Huang YH. Cigarette smoking may modify the risk of depression in eczema among adults: a preliminary study using NHANES 2005-2006. J Eur Acad Dermatol Venereol. Sep 2011;25(9):1048-1053.
  20. Uehara M, Takada K. Use of soap in the management of atopic dermatitis. Clin Exp Dermatol. Sep 1985;10(5):419-425.
  21. Peters EM, Michenko A, Kupfer J, et al. Mental stress in atopic dermatitis--neuronal plasticity and the cholinergic system are affected in atopic dermatitis and in response to acute experimental mental stress in a randomized controlled pilot study. PLoS One. 2014;9(12):e113552.
  22. Chang YS, Chou YT, Lee JH, et al. Atopic dermatitis, melatonin, and sleep disturbance. Pediatrics. Aug 2014;134(2):e397-405.
  23. Saeki H, Furue M, Furukawa F, et al. Guidelines for management of atopic dermatitis. J Dermatol. Oct 2009;36(10):563-577.
  24. Dimitriades VR, Wisner E. Treating pediatric atopic dermatitis: current perspectives. Pediatric Health Med Ther. 2015;6:93-99.
  25. Oak JW, Lee HS. Prevalence rate and factors associated with atopic dermatitis among Korean middle school students. J Korean Acad Nurs. Dec 2012;42(7):992-1000.
  26. Kimata H. Cessation of passive smoking reduces allergic responses and plasma neurotrophin. Eur J Clin Invest. Feb 2004;34(2):165-166.
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