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| Atopic Dermatitis and
Quality of Life
Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a high quality of life. The key to quality of life lies in education, awareness, and developing a partnership among patient, family, and doctor. Good communication (see “Tips for Working With Your Doctor”) is essential, both within the family and among the patient, the family, and the doctor. It is important that the doctor provide understandable information about the disease and its symptoms to the patient and family and demonstrate any treatment measures recommended to ensure that they will be properly carried out. When a child has atopic dermatitis, the entire family may be affected. It is important that families have additional support to help them cope with the stress and frustration associated with the disease. The child may be fussy and difficult, and often is unable to keep from scratching and rubbing the skin. Distracting the child and providing as many activities that keep the hands busy is key, but requires much effort and work on the part of the parents or caregivers. Another issue families face is the social and emotional stress associated with disfigurement caused by atopic dermatitis. The child may face difficulty in school or other social relationships and may need additional support and encouragement from family members. |
Adults with atopic dermatitis can enhance their quality of life by caring regularly for their skin and being mindful of other effects of the disease and how to treat them. Adults should develop a skin care regimen as part of their daily routine, which can be adapted as circumstances and skin conditions change. Stress management and relaxation techniques may help decrease the likelihood of flares due to emotional stress. Developing a network of support that includes family, friends, health professionals, and support groups or organizations can be beneficial. Chronic anxiety and depression may be relieved by short-term psychological therapy. Recognizing the situations when
scratching is most likely to occur may also help. For example, many patients
find that they scratch more when they are idle, so structured activity that
keeps the hands occupied may prevent further damage to the skin. Occupational
counseling also may be helpful to identify or change career goals if a job
involves contact with irritants or involves frequent hand washing, such as
kitchen work or auto mechanics.
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Current Research Research on atopic dermatitis is active. Scientists, including some supported by NIAMS and other institutes of NIH, are working to better understand what causes the disease and how it can be managed, treated, and, ultimately, prevented. Some promising avenues of research are described below. Genetics: Although atopic dermatitis runs in families, the role of genetics remains unclear. It does appear that more than one gene is involved in the development of the disease. Researchers suspect that atopic dermatitis may be caused by environmental factors acting in people who are genetically predisposed to the disease. Research has helped shed light on the patterns of inheritance of atopic dermatitis. Studies show that children are at increased risk for developing the disorder if there is a family history of other atopic disease, such as hay fever or asthma. The risk is significantly higher if both parents have an atopic disease. In addition, studies of identical twins, who have the exact same genes, show that in an estimated 80 to 90 percent of cases, if one twin has an atopic disease, the other does also. Fraternal (nonidentical) twins, who have only some genes in common, are no more likely than two other people in the general population to both have an atopic disease. These findings suggest that genes play an important role in determining who gets the disease. Biochemical Abnormalities: Scientists suspect that changes in the skin’s protective barrier make people with atopic dermatitis more sensitive to irritants. Such people have lower levels of fatty acids (substances that provide moisture and elasticity) in their skin, which causes dryness and reduces the skin’s ability to control inflammation. Other research evidence points to a
possible defect in a type of white blood cell called a monocyte. In people with
atopic dermatitis, monocytes appear to play a role in the decreased production
of an immune system hormone called interferon gamma (IFN- Faulty Regulation of Immunoglobulin E (IgE): IgE is a type of antibody that controls the immune system’s allergic response. An antibody is a special protein produced by the immune system that recognizes and helps fight and destroy viruses, bacteria, and other foreign substances that invade the body. Normally, IgE is present in very small amounts, but levels are high in 80 to 90 percent of people with atopic dermatitis. Researchers suspect that IgE may play a role in the disease. In allergic diseases, IgE antibodies are produced in response to different allergens. When an allergen comes into contact with IgE on specialized immune cells, the cells release various chemicals, including histamine. These chemicals cause the symptoms of an allergic reaction, such as wheezing, sneezing, runny eyes, and itching. Scientists originally thought the release of histamine played an important role in the development of atopic dermatitis. However, the release of histamine and other chemicals alone cannot explain the typical longer term symptoms of the disease. Research is underway to identify factors that may explain why too much IgE is produced and how it plays a role in the disease. |
Immune System Imbalance:
Researchers also think that an imbalance in the immune system may
contribute to the development of atopic dermatitis. It appears that the part of
the immune system responsible for stimulating IgE is overactive, and the part
that makes IFN- Hyperactivity of one type of immune cell in the skin, called a Langerhans cell, may be involved in atopic dermatitis. Langerhans cells are responsible for picking up viruses, bacteria, allergens, and other foreign substances that invade the body and delivering them to other cells in the immune defense system. Langerhans cells appear to be hyperactive in the skin of people with atopic diseases. Certain Langerhans cells are particularly potent at activating white blood cells called T cells in atopic skin, which produce proteins that promote allergic response. This function results in an exaggerated response of the skin to tiny amounts of allergens. Treatments: Scientists are also
focusing on identifying new treatments for atopic dermatitis, including
biologic agents, fatty acid supplements, and new forms of phototherapy.
Researchers are working to understand how ultraviolet light affects the skin
immune system in healthy and diseased skin. They are also investigating
biologic agents, including several aimed at modifying the response of the
immune system. A biologic agent is a new type of drug based on molecules that
occur naturally in the body. One promising treatment is the use of the proteins
IFN- Researchers also continue to look for immunosuppressive drugs that may help treat severe atopic dermatitis. Clinical trials are underway with a drug called FK506, which is applied to the skin rather than taken orally. Two anti-inflammatory drugs called phosphodiesterase inhibitors, currently in clinical trials, also appear promising as treatments for atopic dermatitis. These drugs affect multiple cells and cell functions and may prove to be an effective alternative to corticosteroids in the treatment of atopic dermatitis. Several experimental treatments are being evaluated that attempt to replace substances that are deficient in people with atopic dermatitis. Evening primrose oil is a substance rich in gamma-linolenic acid, one of the fatty acids that is decreased in the skin of people with atopic dermatitis. Studies to date using evening primrose oil have yielded contradictory results. Clinical trials with another substance, a dietary fatty acid supplement called eicosapentenoic acid, have resulted in only slight improvement. There is also a great deal of interest in the use of Chinese herbs and herbal teas to treat the disease. Studies to date do show some benefit, but not without concerns about toxicity and the risks of suppression of the immune system. |
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), which helps
regulate allergic reactions. This defect may cause exaggerated immune and
inflammatory responses in the blood and tissues of people with atopic
dermatitis.