Atopic Dermatitis

Atopic dermatitis (eczema) is a condition that results in red and itchy skin. A person with atopic dermatitis has a gene variation which affects the skin’s ability to retain moisture and protect the body from irritants and allergens. “The primary risk factor for atopic dermatitis is having a family history of eczema, allergies, hay fever or asthma.”(1)

Atopic dermatitis affects 18 million people in the U.S., including 9.6 million children, according to Allergy & Asthma Network. More than 90% of people affected experience itching on a daily basis and between 47 and 60% of children with atopic dermatitis have sleep disturbances because of it.(2)

Half of patients with moderate to severe atopic dermatitis also have asthma, hay fever, or food allergies. In children the rash frequently occurs on the scalp, knees, and elbows. In adults the rash is usually seen on wrists, elbows, knees, face, and neck.(3)

Treatment for atopic dermatitis is geared to improving the quality of life for patients. Avoiding triggers is a first step, according to the American Academy of Allergy, Asthma, & Immunology. Irritants can include soaps, detergents, fragrances, and smoke. House dust mites are also associated with atopic dermatitis. In some cases, particular foods can trigger a reaction.(3)
“Treatment of atopic dermatitis may involve a combination of nonpharmacologic and pharmacologic interventions.”(2)

Non-pharmacologic treatments may include skin moisturizers, “wet-wrap therapy,” where a damp dressing is applied to the affected area, and phototherapy. Pharmacologic treatments may include topical corticosteroids and topical calcineurin inhibitors.(2)

In 2017, The Food and Drug Administration approved a new, injectable biologic drug, Dupixent, to treat people with whose atopic dermatitis is not controlled by other treatment options.(4)

The clinical usefulness of subcutaneous immunotherapy is a source of controversy in the allergy world and is the subject of current studies. A 2016 study including 251 patients with atopic dermatitis sensitized to house dust mite treated with subcutaneous immunotherapy (SCIT) resulted in improvement in symptoms. Of the patients with severe atopic dermatitis, 90.6% showed a favorable clinical response. Of patients with mild to moderate atopic dermatitis, 63.7% showed a favorable clinical response.(5)

(1) Mayo Clinic, Atopic Dermatitis (Eczema), https://www.mayoclinic.org/

(2) Allergy and Asthma Network, Atopic Dermatitis, https://allergyasthmanetwork.org/

(3) American Academy of Allergy, Asthma, & Immunology, Eczema (Atopic dermatitis) Overview, https://www.aaaai.org/

(4) Food and Drug Administration, FDA Approves New Eczema Drug Dupixent, https://www.fda.gov/

(5) Nahm, D. M.D., Kim, M., M.D., National Institute of Health, Clinical Efficacy of Subcutaneous Allergen Immunotherapy in Patients with Atopic Dermatitis, https://www.ncbi.nlm.nih.gov/