More than itchy skin: Breaking down the complexities of atopic dermatitis

A soft, outer organ wraps the human body. Stretching more than 20 square feet, it’s a shield and an insulator, protecting us from the sun, cold weather, and all types of germs and bacteria.¹ It’s the skin, and just like many other parts of the body, it can become a battlefield if the immune system malfunctions.

Most people have heard of eczema, a common skin condition that causes dry, itchy skin which may become swollen, cracked, and thickened over time. But the origin of its name – “ekzein,” Greek for “to boil” – brings to mind its most severe form, atopic dermatitis (AD).

Atopic dermatitis is a chronic, inflammatory skin disease that affects each individual differently. In its most severe form, it can affect the entire body, including the face, trapping a person in a vessel of itchy, painful, inflamed skin with no clear way out.

“Atopic dermatitis can interfere with nearly every part of a person’s life,” says Aileen Pangan, M.D., executive medical director, immunology, AbbVie. “Physicians who treat atopic dermatitis and the patients themselves say the condition can cause serious problems, both physically and mentally. This can also have an impact on their social lives.”
 

It is estimated that up to 10% of adults and 25% of children live with atopic dermatitis globally, although those rates vary by location. ^{2, 3} Between 20 and 46 percent of adults with atopic dermatitis have moderate to severe disease.⁴ That’s a fairly high number of patients. Yet many people have never heard of this condition, and treatment options remain somewhat limited.

Atopic dermatitis isn’t always diagnosed accurately or in a timely fashion due to a variety of factors, including where a person lives or the type of physician he or she visits. These variables have led to a lack of or inconsistent data about the true global burden of AD, including how widespread it is and how it affects different populations in unique ways. That information could hold critical clues for scientists who are developing treatments for the disease.

Still, despite the gaps in information about atopic dermatitis, the scientific community has made great strides toward improving care for people who are living with this challenging disease.

For many years, researchers thought that atopic dermatitis was due to allergic responses to environmental triggers. But the cause of the disease may go deeper than that.

“It’s become clearer that atopic dermatitis is more than just an exaggerated response to environmental allergens,” says Dr. Pangan. “It also results from a dysfunction or impairment in the epidermis – the outermost layer of the skin.”

Research has revealed that some people with atopic dermatitis have a genetic mutation that causes defective expression of a protein that is critical for normal skin function. Although the genetic mutation occurs in only a minority of patients, it confers the strongest risk for atopic dermatitis and has been associated with more severe disease. And, the more severe the disease, the more intense the itching and scratching can become – perpetuating a vicious cycle that can further exacerbate the disease.

The difficult reality of living with atopic dermatitis, for patients, is what drives many scientists and researchers to expand their knowledge of the disease and uncover its biological mechanism.

Imagine waking up in your bed and seeing blood on your sheets because you were scratching relentlessly in your sleep – or not being able to sleep at all because it feels like you’re lying on a bed of thorns. Think about being on a date, or having dinner with your partner, and trying to explain a flare-up you’re having at that moment.

People around you might be afraid that you’re contagious. Because your skin is so sensitive and irritated, it might require daily extensive routines of applying emollients, moisturizers, and other topical treatments. The logistical, social, and emotional issues linked to living with moderate to severe atopic dermatitis can make daily activities harder and make living a “normal” life nearly impossible.

“What we have heard from people with atopic dermatitis and the physicians who treat them is that those with moderate to severe disease are uncomfortable and may even have difficulty sleeping because of syptoms of their condition,” added Dr. Pangan. “Research has also shown that people with AD can feel embarrassed or ashamed of how their skin looks – leading to lower self-esteem and self-confidence.”

Until very recently, treatment options were limited to topical creams and immunosuppressants, and not all patients respond similarly to the same treatment plan. But the landscape is changing. Today, researchers are uncovering the biological mechanisms behind the disease and developing treatments that help address the immune response.

As the scientific community continues to better understand the underlying genetics and internal processes involved in atopic dermatitis across individuals, the possibility for a more targeted approach to treatment comes into focus.

“We’re confident that the bar will soon be raised for the treatment of atopic dermatitis. The scientific community is on the cusp of bringing real change to help people live their lives more fully,” Dr. Pangan says.