Atopic dermatitis (AD) is one type of eczema, a group of allergic-inflammatory skin conditions. The majority of children who will develop the condition do so within their first year. About 80% of children outgrow eczema by adolescence and adulthood, but a significant portion of sufferers may continue to experience symptoms throughout their adult life.
Atopic dermatitis is the most common form of eczema. It is an uncomfortable, inflammatory skin condition that is common in babies and children and is characterized by a dry and compromised skin barrier.
Foods, personal care product dyes and perfumes, clothing material, extreme temperatures, and environmental allergens are potential triggers.
A genetic mutation in filaggrin, the protein that determines skin barrier function and moisture, is present in about 50% of those with severe AD.
AD requires the consistent application of possibly a variety of treatments to manage the condition. Examples include moisturizing, food, perfume, and dye avoidance, wearing loose, cotton clothing, and using a combination of over-the-counter and prescription medications and topical ointments.
The severity of eczema and atopic dermatitis is multi-factorial. However, it appears to be heavily influenced by three main factors: genetics/family history, urbanization — which alters the balance of microorganisms in the environment, and environmental triggers (which include food proteins).
What is atopic dermatitis?
Eczema is a family of allergic-inflammatory itchy, rash skin conditions, of which atopic dermatitis is the most common. It affects 1 in 10 children and is influenced by the skin’s compromised ability to retain moisture. AD often shows up as redness, itching, dry patches, small legions, blisters, oozing, crusting, and scaling.
AD and eczema can be challenging skin conditions to manage. For many children, eczema is typically the first step in a process known as the atopic march.
This progression is defined as:
- Food allergies;
- Allergic rhinitis (hay fever);
What foods trigger or worsen atopic dermatitis or eczema?
When oral exposure to common food allergy proteins is not first or does not coincide with skin exposure, the risk of developing AD and eczema increases. Eggs, dairy, soy, wheat, shellfish, seafood, and nuts are the primary known potential food triggers. Even in children who are not positive for IgE-mediated food allergies, their atopic dermatitis may worsen from exposure to one or more of these foods. Extreme temperatures, environmental allergens, and body care products/chemicals/scents are also associated triggers. Any of these triggers may contribute to periods of worsened symptoms, known as flare-ups.
In about 50% of those with severe AD, mutations in the gene that codes for filaggrin — the primary protein involved in skin barrier health and moisture — are present. As a result, when the skin barrier is compromised, antigens — molecules or foreign particles from food or the environment — more easily pass through the skin barrier and elicit an immune response.
Tips to improve atopic dermatitis
AD often requires multiple, consistent treatments to see improvement. AD is associated with dry skin and a compromised skin barrier that enables antigens to enter the skin. Therefore, tips for managing it include removing potential triggers, improving the skin’s barrier, and reducing inflammation and histamine. Depending on the individual’s condition, severity, genetics, and risk factors, recommendations may include:
Following an elimination diet for 4-6 weeks, removing common food triggers such as egg, dairy, soy, wheat, and nuts to assess progress. Work with a healthcare provider on how to slowly and methodically reintroduce foods to identify individual triggers and tolerance.
Applying moisturizer to all areas of skin within 3-5 minutes of a bath or shower to lock in moisture.
Avoid hand washing with antibacterial and harsh soaps, which can further disrupt the skin barrier.
Moisturizing the skin at least twice a day.
Using a humidifier in the bedroom increases moisture in the air.
Applying wet wraps to severe patches.
Only use personal care and household products approved by the National Eczema Association, or at the very least, avoid perfumes and dyes in personal care products.
Using OTC and prescription creams and ointments as prescribed by your doctor.
Some practitioners may also recommend other treatments such as cryotherapy, phototherapy, injectable biologic medications, bleach baths, medical-grade honey, and acupuncture.
Wearing cotton clothing and avoiding synthetic or heavily-textured materials.
Taking antihistamines to reduce allergic responses.
Avoiding diagnosed IgE-mediated allergies indefinitely or until your doctor recommends otherwise is critical.
Atopic dermatitis is an uncomfortable skin condition common in children that may still be present in adults. Many factors influence the severity of symptoms, but some foods, common allergens such as dairy, eggs, wheat, soy, and nuts, are known potential triggers. Improving AD involves a multi-factorial approach, including removing triggers such as specific foods, improving the skin’s barrier and moisture, and reducing inflammation and the exaggerated allergic-immune response.
- Cleveland Clinic. Atopic Dermatitis.
- Immunity, inflammation, and disease. Hygiene practices: Are they protective factors for eczema symptoms?
- National Eczema Foundation. What is Eczema?
- National Eczema Society. Children and Eczema.
- Allergology international: official journal of the Japanese Society of Allergology. Filaggrin gene defects and the risk of developing allergic disorders.