Itchy, red, rashy skin. You might have had it since you were a child, or you may have been recently diagnosed. You thought you had eczema, but your dermatologist said you have atopic dermatitis (AD). So which is it? Well… both. Eczema is a group of seven different types of rashes, one of which is atopic dermatitis. When your dermatologist tells you that you have atopic dermatitis, they are telling you the specific type of eczema that you have. It’s like going to a steakhouse and ordering a steak. Instead of saying I’d like a steak, you would tell them what particular type of steak you’d like, such as a filet mignon.
Atopic dermatitis is the most common form of eczema and results from the immune system working in overdrive in the skin. AD often presents in early childhood but can present at any time in life. We don’t know why someone gets AD, but we believe it is related to both genetic and environmental factors. Some people with atopic dermatitis have a defect in fillagrin, a protein that makes our skin a strong barrier. When Fillagrin isn’t working properly, our skin barrier is weakened, moisture can escape, and other things, like bacteria or ingredients in personal care products like your favorite lotion, can enter the skin. This is why AD patients are prone to infection and allergic contact dermatitis. In addition to genetics, things in the environment, like extreme heat or cold, certain personal care products like body wash or lotions, laundry detergents, clothing fabrics, and even air pollutants, may all contribute to the development of AD.
AD usually presents with dry, red, itchy areas of rash that can present anywhere on the body and come and go over time. Infants tend to have AD on their face and/or all over their body, while children tend to see rash more localized in the folds of the elbows or behind the knees. Adults can present differently and may involve the hands, feet, head, or neck. We’ve learned over time that AD is more of the spectrum of diseases that can present in various ways. The itching seen in AD can be a major problem that interferes with someone’s ability to sleep, work, and socialize. And as if itchy, rashy skin wasn’t enough, and some AD patients may have asthma or even seasonal allergies.
Atopic dermatitis is chronic, and there is no cure. However, there are treatments for AD that can control itch and clear the skin. Treatment of AD focuses on avoiding triggers or irritants for flares, wearing loose clothing and nonirritating fabrics, and managing stress. Over-the-counter antihistamines and moisturizers, supplements like probiotics, and prescription light therapy (phototherapy) may improve AD. Prescription medications include topical creams, oral medications, and injectables that target the immune system to control AD symptoms. Look for future podcasts that will go into treatment in more detail.
Trotter’s Take: Atopic dermatitis is a chronic, specific type of eczema that can present at any time in life. So yes, if you’re 45 and have a new chronic rash, it could be AD. The good news is that modern treatments can effectively control AD, so it doesn’t control you.
Listen to my conversation with Dr. Matt Zirwas for expert, insider tips on atopic dermatitis.
