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| Exacerbating
Factors
Many factors or conditions can make symptoms of atopic dermatitis worse, further triggering the already overactive immune system in the skin, aggravating the itch-scratch cycle, and increasing damage to the skin. These exacerbating factors can be broken down into two main categories: irritants and allergens. Emotional factors and some infections can also influence atopic dermatitis. Irritants are substances that directly affect the skin and, when used in high enough concentrations with long enough contact, cause the skin to become red and itchy or to burn. Specific irritants affect people with atopic dermatitis to different degrees. Over time, many patients and their families learn to identify the irritants most troublesome to them. For example, wool or synthetic fibers may affect some patients. Also, rough or poorly fitting clothing can rub the skin, trigger inflammation, and cause the itch-scratch cycle to begin. Soaps and detergents may have a drying effect and worsen itching, and some perfumes and cosmetics may irritate the skin. Exposure to certain substances, such as chlorine, mineral oil, or solvents, or to irritants, such as dust or sand, may also make the condition worse. Cigarette smoke may irritate the eyelids. Because irritants vary from one person to another, each person has to determine for himself or herself what substances or circumstances cause the disease to flare. Allergens are substances from foods, plants, or animals that inflame the skin because the immune system overreacts to the substance. Inflammation occurs even when the person is exposed to small amounts of the substance for a limited time. Some examples of allergens are pollen and dog or cat dander (tiny particles from the animal’s skin or hair). When people with atopic dermatitis come into contact with an irritant or allergen they are sensitive to, inflammation-producing cells come into the skin from elsewhere in the body. These cells release chemicals that cause itching and redness. As the person scratches and rubs the skin in response, further damage occurs. Some doctors and scientists believe that certain foods act as allergens and may trigger atopic dermatitis or cause it to become worse. Other researchers think that food allergens play a role in only a limited number of cases of atopic dermatitis, primarily in infants and children. An allergic reaction to food can cause skin inflammation (generally hives), gastrointestinal symptoms (vomiting, diarrhea), upper respiratory tract symptoms (congestion, sneezing), and wheezing. The most common allergenic (allergy-causing) foods are eggs, peanuts, milk, fish, soy products, and wheat. Although the data remain inconclusive, some studies suggest that mothers of children with a family history of atopic diseases should avoid eating commonly allergenic foods themselves during late pregnancy and (if breast feeding) while they are breast feeding the baby. Although not all researchers agree, some think that breast feeding the infant for at least 4 months may have a protective effect for the child. Currently, no reliable laboratory test identifies a food allergy, including skin or blood tests. If a food allergy is suspected, it may be helpful to keep a careful diary of everything the patient eats, noting any reactions. Identifying the food allergen may be difficult if the patient is also being exposed to other allergens, and may require supervision by an allergist. One helpful way to explore the possibility of a food allergy is to eliminate the suspected food and then, if improvement is noticed, reintroduce it into the diet under carefully controlled conditions. If this causes no symptoms or if there has been no improvement in 2 weeks of eliminating that food, other foods may be eliminated in turn. |
Changing the diet of a person who has atopic dermatitis may not always relieve symptoms. A change may be helpful, however, when a patient’s medical history and specific symptoms strongly suggest a food allergy. It is up to the patient and his or her family and physician to judge whether the dietary restrictions outweigh the impact of the disease itself. Restricted diets often are emotionally and financially difficult for patients and their families to follow. Unless properly monitored, diets with many restrictions can also contribute to nutritional problems in children. Other types of allergens called aeroallergens (because they are present in the air) may also play a role in atopic dermatitis. Common aeroallergens are dust mites, pollens, molds, and dander from animal hair or skin. These aeroallergens, particularly the house dust mite, may worsen the symptoms of atopic dermatitis in some people. Although some researchers think that aeroallergens are an important contributing factor to atopic dermatitis, others do not think that they are significant. Scientists also don’t understand the way aeroallergens affect the skin—whether the aeroallergen is inhaled by the patient or the aeroallergen actually penetrates the patient’s skin. No reliable test is available that determines whether a specific aeroallergen is an exacerbating factor in any given individual. If the doctor suspects that an aeroallergen is contributing to the symptoms a person is experiencing, the doctor may recommend ways to reduce exposure to the aeroallergen. For example, the presence of the house dust mite can be limited by encasing mattresses and pillows in special dust-proof covers, frequently washing bedding in hot water, and removing carpeting. However, there is no way to completely rid the environment of aeroallergens. In addition to irritants and allergens, other factors—such as emotional issues, temperature and climate, and skin infections—play a role in atopic dermatitis. Although the disease itself is not caused by emotional factors or personality, it can be made worse by stress, anger, and frustration. Interpersonal problems or major life changes, such as divorce, job changes, or the death of a loved one, can also make the disease worse. Often, emotional stress seems to trigger a flare of the disease. Bathing without proper moisturizing
afterward is a common factor that triggers a flare of atopic dermatitis. The
low humidity of winter or the dry year-round climate of some geographic areas
can make the disease worse, as can overheated indoor areas and long or hot
baths and showers. Alternately sweating and chilling can trigger a flare in
some people. Bacterial infections can also trigger or increase the severity of
atopic dermatitis. If a patient experiences a sudden flare of illness, the
doctor may check for a viral infection (such as herpes simplex) or fungal
infection (such as ringworm or athlete’s foot). More information on skin
infections is presented in the next section.
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