The definite causes of atopic dermatitis, most common in young children, remain uncertain; however, in recent years, research has pointed toward some interesting theories that may explain what drives this condition.
By Carol Marrs, DCNP
Atopic Dermatitis is a frustrating, itchy, inflammatory skin condition. Most common before the age of 5, it affects approximately 20% of children worldwide, and to much dismay, the incidence seems to be climbing¹. Today, the definite causes of atopic dermatitis remain uncertain; however, in recent years, research has pointed toward some interesting theories that may explain what drives this condition.
First, there is the theory that atopic dermatitis might be caused by defects in the epidermal layers of skin². The epidermis is the most outer layer of our skin, which acts as a barrier to keep out environmental irritants, allergens, and germs. The epidermis also helps our skin maintain moisture by preventing water loss. Therefore, defects in this layer of skin make it easier for irritants to enter the skin, creating inflammation and itching. At the same time, water is more easily lost through the defective barrier, which leads to skin dryness. Dry and irritated skin itches, and once scratched, the skin barrier is further compromised, and becomes even more itchy. This leads to what is known as an “itch-scratch-cycle” that can be hard to break. This theory of atopic dermatitis highlights the need for a good skin moisturizing routine, and the use of products which help protect the skin barrier and fend off intruders.
Second is the theory of immune dysregulation². Our skin has its own protective immune system which regularly fights off viruses and bacteria. Patients with atopic dermatitis have been found to have defects within their skin immune system, making their skin more susceptible to invasion by germs. This theory may help explain why so many patients with atopic dermatitis get frequent skin infections, and why they sometimes respond more favorably when we add an oral or topical antibiotic to their conventional anti-inflammatory regimen during flare-ups. This theory also highlights the value that some patients get from using bleach baths a few times each week. Bleach baths help reduce the amount of bacteria that normally resides on our skin. These bacteria can become more problematic when the immune system of the skin is compromised, leading to flares of atopic dermatitis. Bleach baths are frequently used as a preventative and maintenance measure for stable patients with atopic dermatitis.
It will be exciting to see what future research uncovers about atopic dermatitis, and the potentially new treatment methods that will come about based on these theories. For the most up-to-date, evidence-guided treatment of your atopic dermatitis, make an appointment with one of our providers.
1. Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999; 103:125.
2. Weston WL, Howe, W. Pathogenesis, clinical manifestations, and diagnosis of atopic dermatitis (eczema). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on April 3, 2016.)