The Skin: Barrier or a Battlefield?
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 bacteria1. 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. However, 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 is most commonly diagnosed in early childhood and affects 15 to 20% of children worldwide2. But the high incidence hasn’t necessarily resulted in increased awareness or advanced treatment options. In fact, there remains a wide gap in public awareness, with many people mistaking it for nothing more than itchy skin or an allergic reaction. For the scientific community, there is still much to uncover about the disease, how it manifests, and how to help those who are affected.
Experts like Emma Guttman, M.D., Ph.D., professor of dermatology, clinical immunology, and medicine at the Icahn School of Medicine at Mount Sinai, note that more research is needed to understand the global burden of the disease and how its characteristics vary across groups of people. These variations may hold important clues as to how we can effectively treat atopic dermatitis.
Exploring the Cause
For many years, researchers thought that atopic dermatitis was due to a familial predisposition 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 Aileen Pangan, M.D., executive medical director, immunology, AbbVie. “It's a combination of abnormal activation of the immune system and impaired epidermal (the outermost layer of the skin) barrier function.”
Recent 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 this occurs in only a minority of patients, it confers the strongest risk for atopic dermatitis and has been associated with more severe disease.
Examining the Daily Experience of Atopic Dermatitis
The difficult reality of living with atopic dermatitis is what drives many scientists and researchers to expand our knowledge of the disease and uncover the biological mechanism of the disease.
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 of intense itching. Think about how you might feel trying to explain what a flare up of your disease is like on a date or to your partner.
People around you might fear 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 implications of living with moderate to severe atopic dermatitis can impact daily activities and make living a “normal life” nearly impossible.
The Next Frontier of Treatment
Until very recently, treatment options were limited to topical creams and immunosuppressants, and not all patients respond similarly to the same treatment plan. But this is beginning to change. Today, researchers are uncovering the biological mechanisms behind the disease and developing treatments that address the immune response.
As the scientific community begins to understand the underlying genetics and internal processes involved in AD across individuals, the possibility for a personalized approach to treatment comes more into focus.
“We’re confident that the bar will soon be raised for the treatment of atopic dermatitis. We are on the cusp of bringing real change to help people live their lives more fully,” Dr. Pangan says.
- “Skin and How It Functions.” National Geographic, 18 Jan. 2017, www.nationalgeographic.com/science/health-and-human-body/human-body/skin/.
- Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab 2015;66(suppl 1):8-16. doi: 10.1159/000370220.
- Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology and treatment. Immunol Allergy Clin North Am. 2015 Feb; 35(1): 161–183. doi: 10.1016/j.iac.2014.09.008
- Chrostowska-Plak D, Salomon J, Reich A, Szepietowski JC. Clinical aspects of itch in adult atopic dermatitis patients. Acta Derm Venereol. 2009;89(4):379-83. doi: 10.2340/00015555-0676.
- Holm EA, Esmann S, Jemec GBE. The handicap caused by atopic dermatitis – sick leave and job avoidance. J Eur Acad Dermatol Venereol. 2006, 20, 255–59. doi: 10.1111/j.1468-3083.2006.01416.x
- Fiveson, David et al. The Effect of Atopic Dermatitis on Total Burden of Illness and QoL on Adults and Children in a large managed care organization. J Manag Care Pharm 2002;8:333–342