Atopic dermatitis, also known as atopic eczema, is a common inflammatory skin condition. For many years eczema has been regarded as an allergic condition rather than an autoimmune one, nowadays the matter is up for debate.
Eczema is the most common childhood inflammatory skin disease, affecting 15% to 30% of all children. However, the disease is not uncommon during adulthood; some studies estimate its prevalence in adulthood, around 2% to 10%. Most patients improve with time. However, a meaningful percentage of patients develop another allergic disease throughout their lifetimes.
Eczema starts during early infancy in most cases. Many experts believe it to be the first disease in a progression of allergic diseases that includes food allergy, asthma, and allergic rhinitis (also known as hay fever). This atopic march theory suggests that atopic dermatitis might lead to the subsequent development of other allergic conditions.
By reading this article, you would obtain critical insights about this condition directly from a doctor.
Has eczema proven to be an autoimmune disease?
Up to this day, the most accurate answer to this question is: “perhaps.” Broadly put, there are 3 types of immune disease:
- Autoimmune disease: A condition in which the immune system reacts against the body’s healthy tissues producing an inflammatory response. Hashimoto’s thyroiditis is a thyroid disease in which the body literally destroys the thyroid gland in a perfect example.
- Allergy: There is an inappropriate and exaggerated immune response against a harmless substance called an allergen, pollen being the most famous example.
- Immunodeficiency: A condition in which the body is unable to fight infection. HIV is the most common example.
For many decades, the medical community was confident that atopic eczema was a form of allergy. In allergic conditions such as atopic dermatitis, contact with an allergen leads to the production of IgE antibodies that bind to an immune cell called mastocyte; this process is called sensitization. After sensitization, the antigen will attach to those IgE antibodies with every exposure producing a signal that leads to the release of inflammatory mediators by the mastocyte. Antibodies are specific to particular allergens. They can only bind to one type of allergen. A pollen antibody, for example, will only bind to pollen.
Recent studies prove that IgE antibodies are not specific for allergens but to human proteins. These autoreactive antibodies may promote or perpetuate skin inflammation making eczema an autoimmune skin disease. However, research hasn’t established if these autoantibodies are essential in the recurrence and chronicity of atopic eczema or an unimportant result of chronic inflammation. Until these doubts are resolved, the medical community won’t feel comfortable permanently labeling eczema autoimmune disease.
What is the root cause of it?
As it happens with many other immune diseases, the root cause isn’t completely understood. There are, however, two main hypotheses regarding the origin of eczema. The first one attributes the disease to an innately overactive immune system that causes inappropriate IgE sensitization to harmless substances, which in turn causes inflammation and a disturbance in the epithelial barrier of the skin. The second hypothesis proposes that the inadequate immune response is a consequence of a defect in the barrier that binds skin cells together. This barrier defect allows the entrance of allergens and the induction of allergy. The fact is that both an overactive immune system and a barrier defect are present in atopic dermatitis. The only question is what comes first.
Apart from those two leading causes, other factors might also play a role in the development of the disease. Here is a list with some of these factors:
- Skin infection: The skin of eczema patients has within a bacteria whose name is S. aureus. Infections by microorganisms such as S. aureus and herpes simplex virus tend to cause terrible eczema flare-ups in susceptible patients.
- Family history: Most eczema patients have first-grade family members with a history of either dermatitis, asthma, allergic rhinitis, or food allergy. Genome-wide association studies have identified specific genes in association with a rise in susceptibility to the disease.
- Hygiene: Some authors attribute the recent increase in the incidence of eczema to excessive hygiene during childhood. The reduction of exposure to specific antigens during early childhood causes the immune system to lose tolerance and recognize those antigens as potentially harmful later in life.
How does eczema affect your overall health?
Many eczema patients can manage flare-ups with adequate treatment, and in most cases, the disease disappears spontaneously after childhood. However, a recent study shows that in an important percentage of cases, symptoms persist into adulthood. Also, one of three eczema sufferers will develop another kind of allergy, such as allergic rhinitis or asthma at some point in their lives.
People with eczema are also at a higher risk of suffering from an autoimmune disease. A recent study published in the journal of allergy and immunology shows that eczema patients have an increased risk of rheumatoid arthritis and inflammatory bowel disease than the general population. The exact reason for this association isn’t fully understood.
The psychosocial burden that comes with a skin condition such as eczema cannot be overlooked. The typical eczema sufferer will experience periods of constant itching that can disrupt the daily activities as well as the quality of his sleep. Difficulty sleeping can lead to behavioral problems in children and fatigue and a decrease in productivity in adulthood. Eczema patients may also feel isolated from others, avoid going out in public, or continuously hiding their sore body areas. This may affect their relationships, eventually leading to anxiety and depression. Some studies also show that people with eczema are less likely to exercise for fear of flare-ups and engage in unhealthy activities like drinking and smoking.
Because of the defect in their epithelial barrier, eczema patients are more susceptible to a skin infection. Diseases like impetigo and cellulitis are frequent in eczema patients. They are likely to experience them several times throughout their lives. These infections also tend to be more severe in eczema patients than in the general population.
Can you reverse autoimmune diseases like eczema?
Autoimmune diseases are controllable, not reversible. With adequate measures and treatment, people with autoimmune diseases may spend months, even years, without any symptoms. However, patients are never completely cured because they are always at risk of relapse.
Let’s use inflammatory bowel disease as a disease as an example. Inflammatory bowel disease is an autoimmune disorder because of a dysregulated immune response that causes inflammation and damage to the small and large intestines. Patients with the disease complain of symptoms such as bloody diarrhea, constipation, and abdominal pain that can seriously impair their quality of life. The main objective of treatment is to prevent flare-ups. Modern drugs can control symptoms for extensive periods, substantially improving the quality of life. However, flare-ups can still happen in a totally unpredictable way.
In some cases, autoimmune diseases may even be resistant to treatment. For example, many patients with vitiligo, an autoimmune disease that targets the cells that give color to the skin, suffer from a refractory form of the disease that doesn’t respond to treatment.
There is no medical treatment that can cure eczema permanently. Topical corticosteroids can be very useful in curing flare-ups but not in preventing them. And although patients can follow effective preventive measures (more on this later), relapses are frequent. The good news is that, unlike most autoimmune diseases, atopic dermatitis disappears spontaneously in many cases.
The reason why some patients can mend their disease by the time they reach adolescence while others carry it into their adult years is still unknown.
Does autoimmune disease mean a weak immune system?
Autoimmune diseases and allergies do not produce a weak immune system or a higher risk of infection by themselves. The treatment of immune illnesses, on the other hand, weakens the immune system making the body more vulnerable to infection. If you think about it, this makes perfect sense.
The symptoms of both autoimmune disease and allergic disease, are nothing but a consequence of the inflammation due to an overactive immune system. Logically, the best way to treat these diseases is to suppress the activity of the immune system. Unfortunately, current treatments are unable to distinguish between harmful inflammation and protective inflammation and suppress both kinds.
Psoriasis, for example, is a disease in which the immune system attacks the skin producing itchy, salmon-colored, scaly plaques. In some cases, the disease also attacks the joints producing psoriatic arthritis. Psoriatic arthritis symptoms are disabling, but do no increase the risk of infection. However, psoriatic arthritis treatment is with methotrexate, which interferes with immune cell replication and antibody production. Studies show that people on methotrexate have a slightly higher risk of suffering from respiratory and skin infections than most people.
Some skin conditions increase the risk of infection without producing immunosuppression. This happens because the skin is the most critical barrier between the body and the outside world. If the wall is jeopardized, microbes can penetrate the body and cause infection more regularly. Bullous pemphigoid is an autoimmune skin disease that causes blistering in many multiple areas at the same time. When those blisters break, they leave an entire surface with no protection that can infect easily.
Most eczema cases do not require any systemic immunosuppressive therapy, only local anti-inflammatory creams that don’t have any whole-body effects. However, eczema patients are more susceptible to skin infections due to the impairment in their skin barrier.
What are the symptoms of eczema?
Atopic dermatitis has an intermittent course with random flares and remissions. Symptoms include:
- Crusty, Brown and red patches
- Intense itching
- Dry skin
- Thickened skin (because of constant scratching)
Eczema can affect the whole body, but it’s more common in elbows, knees, cheeks, and scalp.
What are the symptoms of dyshidrotic eczema?
Dyshidrotic eczema is a kind of dermatitis, which its main characteristic is the presence of blisters (or vesicles) in palms, fingers, and soles. Around 50% of dyshidrotic eczema patients also suffer from atopic dermatitis or another allergy. Although the cause of this disease is unknown, some exogenous factors such as contact with nickel, cobalt, bacterial infections, sweat, and emotional stress tend to trigger episodes.
The most common symptoms include:
- Itchy Skin
- Vesicles or blisters in soles and palms.
- The vesicles can grow to a large size and merge.
- After some time, the vesicles disappear without breaking.
Some patients experience spontaneous resolution after a few weeks without treatment. Similarly to atopic dermatitis, the disease follows an intermittent course of flares and remissions.
Can it be a sign of other illnesses?
Atopic dermatitis, as a disease, is not a sign of any underlying illness. It is just a risk factor for developing other allergic or autoimmune disorders in the future. However, similarly, some systemic diseases produce rashes that people can confuse for eczema flare-ups.
The most famous example of an eczematous-looking rash because of systemic disease is the butterfly rash seen in systemic lupus erythematosus. This severe autoimmune disease attacks every organ in the body, typically producing arthritis (joint pain) and kidney failure. This tell-sign of lupus is a red rash spread through the bridge of the nose and both cheeks adopting a butterfly shape.
Another famous example of a rash caused by a systemic illness is the rash due to dermatomyositis. Dermatomyositis is an autoimmune disorder that causes skin inflammation (dermato) and muscle inflammation (myositis). Less commonly, it can also attack the esophagus, the lungs, and the heart. Skin disease is the initial manifestation in most cases. Dermatomyositis causes an eruption in sun-exposed areas, particularly in the face and arms. As in eczema, the rash in dermatomyositis is extremely itchy.
What happens if it is left untreated?
Without treatment, eczema flare-ups can disappear by themselves, but in some cases, this might take months. Also, when eczema does not receive treatment, complications are more likely to arise. Some of these complications include:
- Infections: Untreated flare-ups are more likely to infection by bacteria, fungi, or viruses like herpes simplex virus. Superinfected eczema rashes adopt a yellow crusted appearance with swelling, sore skin with liquid oozing through the sores, and fever is another common symptom.
- Eye problems: Eczema causes itching around the eyelids, which in turn produces constant scratching. The eyes are exceptionally delicate. In the long run, scratching may cause complications such as keratoconus, cataracts, and retinal detachment.
- Neurodermatitis or lichen simplex: It is a neurodermatitis and a consequence of chronic scratching. Lichen simplex lesions are circumscribed, itchy, pigmented plaques that arise in areas of constant scratching. The plaques are hard to treat; it may take up to 3 months of aggressive topical therapy to remove them.
What are the possible complications of dyshidrotic eczema?
Infection is also a possible complication in dyshidrotic eczema. Secondary infection of blisters can lead to severe diseases like cellulitis and lymphangitis that require antibiotic treatment. Dyshidrotic eczema is also in association with an increase in the risk of herpes zoster.
Nail changes are also a common complication. These changes may include pitting, discoloration, thickening, and the appearance of transverse white lines. Some of these changes can reverse with treatment.
Why does your eczema keep coming back?
Eczema flare-ups are unpredictable. Eczema patients can flare up when they least expect it despite following all the right preventive measures. The recent discovery of autoreactive IgE mentioned earlier might be an essential factor in recurrence. Although the importance of autoimmunity contributes is still under debate, immunomodulatory treatments have shown great success in preventing flare-ups in some studies.
Certain triggers have proven to cause flare-ups; these triggers may vary from patient to patient. Here is a list of some of the most important ones:
- Weather: Extreme weather is an eczema trigger. It is no wonder that most eczema flare-ups happen during the early days of winter or summer. Cold weather produces dry air that dries up the skin, promoting eczema. Hot weather, on the other hand, causes sweat that irritates the skin producing flare-ups.
- Detergents: Particularly, the ones that include fragrances, the chemicals in many of these fragrances are potent skin irritants. Using fragrance-free detergents can help prevent flare-ups.
- Clothing: Certain fabrics, like wool, polyester, and silk, can trigger skin inflammation in atopic patients. Using cotton clothes or using an extra cotton layer under your wool or silk clothes can go a long way in preventing relapses.
- Foods: Certain foods can trigger eczema attacks in specific people. Some inflammatory ingredients include gluten, sugar, red meats, spices, and dairy. Try to pin down the foods that trigger your eczema and avoid them.
- Stress: Emotional anxiety and stress are common eczema triggers.
- Airborne allergens: Invisible allergens in the air can cause flare-ups. Substances like pollen, mold, and dust are some of the most common offenders. Keeping a clean home, dusting, and vacuuming once a week is almost mandatory for eczema patients.
How are autoimmune diseases diagnosed?
There are many autoimmune diseases, and there is a different way of making a definitive diagnosis for each one. The most common method of diagnosing an autoimmune disease is to discover autoreactive antibodies in blood tests. Most autoimmune diseases have a characteristic autoantibody that makes the diagnosis. Rheumatoid arthritis, for example, has autoantibodies called anti-citrullinated-protein antibodies that practically make the diagnosis.
Some autoantibodies exist in many autoimmune diseases. The presence of these antibodies indicates autoimmunity but does not provide a specific diagnosis. Anti-nuclear antibodies can be in many autoimmune diseases, including, for example, rheumatoid arthritis and lupus.
There is no specific laboratory test to diagnose atopic eczema. The basis of the diagnosis is on the doctor’s clinical suspicion, mainly relying on the patient’s signs and symptoms. Doctors rarely perform laboratory tests to diagnose dermatitis. High IgE levels in a blood sample may help the diagnosis in some cases.
What are the symptoms of autoimmune disease?
There are many autoimmune diseases, each one with particular symptoms. However, some of them have some traits in common, particularly in the beginning.
Diagnosing autoimmune diseases early is challenging because most of them start with mild, unspecific symptoms that may be attributed to stress, fatigue, or others, which are more common conditions. Some of the early signs of autoimmune disease include:
- Fatigue: This one is common to almost all autoimmune diseases.
- Joint swelling and Joint Pain: More common in rheumatoid arthritis and lupus.
- Abdominal pain or digestive issues: The first step of many autoimmune digestive diseases such as celiac disease and inflammatory bowel disease is having a leaky gut or increased intestinal permeability associated with these symptoms.
- Fever: This may be attributed to an infectious disease.
- Alopecia Areata: This means patchy hair loss. Alopecia areata is an autoimmune disease by itself but can also be the preamble of more severe diseases.
What is the treatment for autoimmune skin disease?
In general, the first step in treating autoimmune disease is using a topical immunosuppressive treatment, usually over the counter corticosteroid creams and gels. Doctors prefer to use topical treatments because they are not absorbed by the whole body and have fewer adverse effects. When over counter steroid creams fail, the next step is still topical treatment but with more potent immunomodulatory drugs such as tacrolimus and pimecrolimus creams that have higher efficacy than corticosteroids.
In some cases, such as severe eczema or more complicated autoimmune diseases like pemphigus that can even be life-threatening, more aggressive measures are required. By more aggressive, a doctor means oral therapy. Oral corticosteroids cause side effects like immunosuppression, weight gain, and crushing syndrome.
How do you calm down an eczema flare-up?
The mainstay of therapy for eczema flare-ups consists of topical corticosteroid therapy combined with moisturization and trigger avoidance. Initial treatment involves applying a hydrocortisone cream twice a day, and hydrocortisone is discontinued after the lesions disappear. Hydrocortisone is a low potency corticosteroid. Therefore, some cases may require stronger ones such as triamcinolone and betamethasone
Eczema patients usually benefit from short, lukewarm baths with a capful of an emulsified oil. After bathing, apply a moisturizing cream like white petrolatum to seal up the moisture and allow it to be absorbed by the skin.
Is there anything you can do if you are having symptoms of it?
This tool is an eczema symptoms checker. It will help you to determine how likely it is that your symptoms are because of this condition. It is free, and it would only take a few minutes.