What is Atopic Dermatitis?

Atopic dermatitis (AD) is a chronic skin condition. “Atopic” is the term from the Greek meaning “strange”. “Dermatitis” means that the skin is red and itchy. AD is associated with several well-recognized comorbidities: allergic rhinitis, asthma, and food allergies, along with increased rates of anxiety, depression, and suicidal ideation(1). Evidence suggests that the disease is also related to cardiovascular disease, coronary artery disease and hypertension (2).

Although atopic dermatitis can occur in any age, most often it affects infants and young children. Some children with atopic dermatitis outgrow it or have milder cases as they get older. Also, a person may get atopic dermatitis as an adult. But for most people, it’s a long-lasting problem that starts in childhood and comes and goes throughout life.

What are the symptoms?

In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, vesicle formation (minute blisters), cracking, weeping, crusting, and scaling.

Causes & Risk Factors

The cause of atopic dermatitis isn’t clear, but the disease seems to result from a combination of genetic (hereditary) and environmental factors. There seems to be a basic cutaneous hypersensitivity and an increased tendency toward itching.

Many of those affected seem to have either a decreased quantity of or a defective form of a protein called filaggrin (FLG) in their skin. FLG is a protein that facilitates the aggregation of keratin filaments supporting the barrier between the skin and the outside world. When the structural integrity of the outermost skin layer is compromised, as in those with a FLG mutation, pathogens, allergens, and toxins are able to pass through the hyperpermeable stratum corneum, creating chronic inflammation.

Urban living contributes to higher prevalence of AD in the cities when compared to the rural dwellers, which is likely due to increased air pollution, tobacco smoke, household irritants, such as soap, detergents, phthalates, dust mites and even water hardness, all damaging the natural barrier of skin.

Clinical consideration:

1. Compromised immune system: Patients with atopic dermatitis seem to have mild immune system weakness. They are predisposed to develop fungal foot disease and cutaneous staphylococcal infections, and they can disseminate herpes simplex lip infections (eczema herpeticum) and smallpox vaccination (eczema vaccinatum) to large areas of skin. 2. Food sensitivity and Gastrointestinal health. Gastrointestinal health is playing key role in the skin health. Evidence showed food sensitivity is a triggering factor for AD. Food

reaction defects the gastrointestinal function causing increased intestinal permeability facilitate allergen sensitization (3). Avoidance diets based on allergy assessments are an essential tool in the treatment of AD (4). Studies also showed the usage of antibiotics in early life caused long term effect on the gastrointestinal function and overall health. There is a significant 41% overall increased risk of developing AD in those who received at least 1 course of antibiotics in early life, and an additional 7% risk increase with each antibiotic course thereafter (5) .

3. Vit D: Low Vit D is also recognized risk factor in AD (6). Children of mothers with low levels of vitamin D during pregnancy are at higher risk of AD. People who have AD and low levels of vitamin D are more likely to get skin infections (7). The Lower vitamin D levels are, the severer AD symptoms are.(8)

4. Essential fatty acids: Essential fatty acid deficiency (EFAD) significantly affects skin function and appearance. Researchers investigated that a deficiency of the downstream metabolites of omega-6 or omega-3 essential fatty acid (eg. GLA and EPA, respectively ) might play a role in the development of AD. Biochemical evaluations in patients with AD have shown that increased concerntration in plasma phospholipids of the essential omega-7 fatty acid, linoleic acid; The concentration of the essential omega-3 fatty acid, alpha-linolenic acid (ALA), was also elevated, though not significantly, while all of its metabolites were significantly reduced. An animal study suggested that the development of AD like symptoms was completely prevented by supplementationwith linoleic acid but not with a-linolenic acid (9).

Naturopathic treatment:

From a naturopathic viewpoint, many tools could be used in terms of modulating the immune system. Good health can help ease allergy symptoms, and good health starts with nutrition. Addressing the food sensitivities is another good start to improve health and reduce allergy symptoms. This is best accomplished by the elimination and challenge diet. Beyond that, supplement, herbs, homeopathy and acupuncture are all useful tools and could be chose accordingly and individually.

Reference:

1. Yaghmaje P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428-433.

2. Silverberg JI. Association between adult atopic dermatitis, cardiovascular disease, and increased heart attacks in three population-based studies. Allergy. 2015;70(10):1300-1308.

3. Majamaa H, Isolauri E. Evaluation of the gut mucosal barrier: evidence for increased antigen transfer in children with atopic eczema. J Allergy Clin Immunol. 1996;97(4):985-990. 4. Kanny G. Atopic dermatitis in children and food allergy: combination or causality? Should avoidance diets be initiated? Ann Dermatol Venereol. 2005 Jan;132 Spec No 1:1S90-103.

5. Tsakok T, McKeever TM, Yeo L, Flohr C. Does early life exposure to antibiotics increase the risk of eczema? A systematic review. Br J Dermatol. 2013;169(5):983-991.

6. Borzutzky A, Camargo CA Jr. Role of vitamin D in the pathogenesis and treatment of atopic dermatitis. Expert Rev Clin Immunol. 2013;9(8):751-753.

7. Roider E, Ruzicka T, Schauber J. Vitamin d, the cutaneous barrier, antimicrobial peptides and allergies: is there a link? Allergy Asthma Immunol Res. 2013;5(3):119-28.

8. Searing DA, Leung DY. Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol Allergy Clin North Am. 2010;30(3):397-409.

9. Fujii M1, Nakashima H, Tomozawa J, et al. Deficiency of n-6 polyunsaturated fatty acids is mainly responsible for atopic dermatitis-like pruritic skin inflammation in special diet-fed hairless mice. Exp Dermatol. 2013 Apr;22(4):272-7. doi: 10.1111/exd.12120.