Atopic dermatitis (AD), commonly referred to as eczema, has been an increasingly prevalent cause of suffering in U.S. adults. Previously associated with children, this chronic inflammatory skin condition appears in the form of widespread rashes and patches of itchy skin and affects people of all ages. Although the etiopathogenesis of AD remains incompletely understood, research is underway to investigate the complex mechanisms of the condition and identify new systemic therapies.
In order to better understand the effects of atopic dermatitis and improve treatment options, the Asthma and Allergy Foundation of America (AAFA) led a national study to determine the prevalence and distribution of AD and its severity in the U.S. adult population. AAFA’s recent study revealed a high prevalence and disease burden of AD, with an estimate of 16.5 million adult cases and 6.6 million of those meeting moderate to severe disease criteria. Severity was shown to determine the rate of outpatient care with low rates for the majority of patients with AD and higher rates of urgent care, ED and hospital visits. Racial, socio-economic and healthcare accessibility disparities proved to reduce the rates of outpatient treatment while increasing urgent care, ED and hospital utilization.
The key differentiation between atopic dermatitis and other skin diseases is its allergy-related nature, which makes it more difficult to classify in terms of cause, prevention, and treatment. While there is no cure for AD, its strong relation to individual and/or family history of asthma, hay fever, and other allergic tendencies may provide a good starting point for management and treatment. With 7.3% of U.S. adults living with AD, it is important to note that the condition can surface in later years with a peak incidence time in adults over the age of 50.
Atopic Dermatitis and Mental Health
Not only does AD affect people of all ages with varying underlying causes, but it was also found to increase the risk of mental health disorders in both adults and children. The recent study conducted by the AAFA found a significant association between adult atopic dermatitis and depression and anxiety. Positive associations with suicidal ideation and an increased prevalence of depressive symptoms were also discovered in adults, while children showed a higher risk of depression. Additionally, adults with AD had higher rates of mental health complications than patients with psoriasis – another common inflammatory skin condition.
Managing Atopic Dermatitis
Many people struggle with the symptoms of AD, such as dry, scaly skin and itchy patches, but treatment can prove difficult as the condition is persistent and various treatment plans may be needed to achieve control. Even then, symptoms may flare up and require additional measures. Since AD can worsen without treatment, it is essential to recognize the condition early and prescribe the most efficacious management plan. Treatment options include corticosteroid creams, calcineurin inhibitors, antibiotic creams and in more severe cases, doses of oral corticosteroids such as prednisone. Recently, the FDA approved a new injectable medication, Dupixent, for people with severe AD symptoms who do not respond well to other treatment options.
With a significant impact on the quality of life of patients, it is important to recommend lifestyle changes and other self-care measures to supplement medical treatment. Frequent moisturizing of the skin, application of over-the-counter anti-itch creams, and oral allergy medications have proven to lessen the severity of symptoms. Protecting the skin with bandages from further irritation and ensuring a mild skincare routine and environment are also beneficial options for management. To ensure improved quality of life, stress and anxiety should be treated through psychological support from counselors and support groups.
Increased AD awareness in the population will allow for the timely diagnosis and treatment of adults suffering from AD, leading to a higher success rate of treatment. Although the latest developments in our understanding of atopic dermatitis are promising, further research is necessary to develop systemic therapies and provide optimal treatment options for all affected patients.