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 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-g), which helps regulate allergic reactions. This defect may cause exaggerated immune and inflammatory responses in the blood and tissues of people with atopic dermatitis.

Faulty Regulation of Immunoglobulin E (IgE)

As already described in the section on diagnosis, 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.

Although atopic dermatitis runs in families, the role of genetics (inheritance) remains unclear. It does appear that more than one gene is involved in the disease. Research has helped shed light on the way atopic dermatitis is inherited. 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 same genes, show that in an estimated 80 to 90 percent of cases, atopic disease appears in both twins. 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.

Although scientists are working to develop safer vaccines, persons diagnosed with atopic dermatitis (or eczema) should not receive the current smallpox vaccine. According to the Centers for Disease Control and Prevention (CDC), a U.S. Government organization, persons who have ever been diagnosed with atopic dermatitis, even if the condition is mild or not presently active, are more likely to develop a serious complication if they are exposed to the virus from the smallpox vaccine.

People with atopic dermatitis should exercise caution when coming into close physical contact with a person
who has been recently vaccinated, and make certain the vaccinated person has covered the vaccination site or
taken other precautions until the scab falls off (about 3 weeks). Those who have had physical contact with a
vaccinated person’s unhealed vaccination site or to their bedding or other items that might have touched that site
should notify their doctor, particularly if they develop a new or unusual rash. During a smallpox outbreak, these vaccination recommendations may change. Persons with atopic dermatitis who have been exposed to smallpox should consult their doctor about vaccination.

Despite the symptoms caused by atopic dermatitis, it is possible for people with the disorder to maintain a good quality of life. The keys to quality of life lie in being well-informed; awareness of symptoms and their possible cause; and developing a partnership involving the patient or caregiving family member, medical doctor, and other health professionals.

When a child has atopic dermatitis, the entire family may be affected. It is helpful if families have additional support to help them cope with the stress and frustration associated with the disease. A child may be fussy and
difficult and unable to keep from scratching and rubbing the skin. Distracting the child and providing activities
that keep the hands busy are helpful but require much effort on the part of the parents or caregivers. Another
issue families face is the social and emotional stress associated with changes in appearance caused by atopic
dermatitis. The child may face difficulty in school or with 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 the 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. 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, and they do better when engaged in activities that keep the hands occupied. 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.

Here are some of the common skin features associated with Eczema: