Atopic Dermatitis

 Dermatitis or eczema are terms that refer to a class of conditions that cause skin inflammation. There are several types including contact, seborrheic, and atopic dermatitis. Atopic dermatitis occurs when the skin’s protective layer is damaged. When there are gaps in the barrier layer of the skin, not only does the skin lose moisture but these gaps limit our protection from allergens and microorganisms.

 Atopic dermatitis may appear on the neck, elbows, knees, ankles, hands or face and is characterized by dry, itchy patches on the skin that may blister, peel, or crack. Consistently rubbing and scratching affected areas over a period of time may result in the hardening or thickening of the skin. Atopic dermatitis is prevalent among females, among those of African American descent, and among people who have a family history of dermatitis, hay fever, or asthma. (Cleveland Clinic, 2020; National Institute of Health (NIH), 2022). 

Causes

Medical research has not clearly identified a cause for atopic dermatitis; however, the research does indicate that genetics, an overactive immune system, and environmental factors (e.g. air pollutants) contribute to the development of this condition (NIH, 2022).

Diagnosis

It’s important to consult with a physician to determine which type of eczema you have. Each form of eczema has it own triggers and treatment regimen (National Eczema Association, 2024). A physician may request blood tests to ascertain if there are any other conditions that may be contributing to symptoms, a skin biopsy to determine the specific type of eczema, and an allergy test to identify triggers of the condition.

The Appearance of Eczema in Melanin Rich Skin

Diagnosing eczema in persons of color is more challenging because the condition presents differently in darker skin tones. In lighter skin, atopic dermatitis may appear as red patches, but in darker skin the patches appear dark purplish, brown, or gray. In addition, individuals with melanin rich skin are more likely to display small bumps on the chest, back, arms, and legs. Sometimes these bumps surround hair follicles and have the appearance of goosebumps. Discoloration caused by eczema related inflammation is also more noticeable in darker skin tones. As a result of scratching inflamed skin, more melanin is released, and this leads to hyperpigmentation. Conversely, individuals may also experience hypopigmentation- light oval shaped, scaly patches- when the eczema related flare up is resolving. Typically, both conditions will clear up over time; however, it may take longer for hyper/hypopigmentation to clear up in darker skin tones (Eczema in Skin of Color, 2024).

Treatment

The Mayo Clinic has outlined several treatment options for individuals suffering with atopic dermatitis including creams and ointments, oral medications, injectables, wet dressings, and light therapy.

 Creams and ointments: These products can be over-the-counter or medical grade. Over the counter moisturizers should be hydrating and include barrier ingredients such a butters, oils with fatty acids, ceramides, niacinamides, or glycerin. This is not an extensive list, but a good place to start when evaluating products. A doctor may prescribe a cream/ointment that includes corticosteroids or calcineurin inhibitors (e.g. Protopic, Elidel). Each of these has their own side effects. Overuse of corticosteroids may result in skin thinning and hypertension may develop as a result of using calcineurin inhibitors (Safarini, Keshavamurthy, & Patel, 2023).

Oral Medications: Physicians may also prescribe oral medications for severe cases of atopic dermatitis such as cyclosporine, methotrexate, prednisone, mycophenolate and azathioprine. Like most medications, these drugs have known side effects, and you should consult your physician to ensure that these medications are appropriate for your specific condition. 

Injectables: For those who have severe or moderate eczema and have not responded to other treatments, injectables such as Dupixent and Adbry are treatment options. According to the Mayo Clinic (2023), these drugs are safe and effective for symptom relief from atopic dermatitis.

Wet Dressing: A physician may recommend this technique to keep the skin hydrated as well as absorb the topical medication (American Academy of Dermatology Association (AAD), 2023). For this treatment, first apply topical corticosteroid cream to the affected area and then wrap the affected skin in a layer of wet or damp bandages.

Light Therapy: This treatment is used when the individual gets no relief from topical treatments or experience frequent flare ups. Light therapy includes brief exposure to natural sunlight or ultraviolet light. Treatments typically occur for 2 to 3 sessions per week for an extended period. If you are unable to keep your appointments, please consult your physician. Do not use tanning beds, sun lamps, or sitting out in the sunlight. Known side effects include hyperpigmentation, pre-mature skin aging, and increased risk of skin cancer.

Summary

There are many different forms of eczema. Thus, it’s important to consult a physician to know which type you have, especially since treatment regimens vary based on the specific condition. Atopic dermatitis is most prevalent in persons of African American and Hispanic descent. Nevertheless, in darker skin tones this condition is more difficult to diagnose because of the variation in presentation from their lighter skin counterparts. Treatments for atopic dermatitis include daily moisturizing, oral medications, injectables, wet dressings, and light therapy.

References

American Academy of Dermatology Association (2023, October 10). Eczema Types and Treatments. https://www.aad.org/public/diseases/eczema/types

Cleveland Clinic (2020, October 29). Dermatitis. https://my.clevelandclinic.org/health/diseases/4089-dermatitis#overview

Eczema in Skin of Color (2024). What is Eczema in Skin of Color? https://eczemainskinofcolor.org/what-is-atopic-dermatitis-ad/

Mayo Clinic. (2024, May 15). Atopic Dermatitis (Eczema). https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273 

National Institute of Health. (2022, November). Atopic Dermatitis.

https://www.niams.nih.gov/health-topics/atopic-dermatitis

Safarini OA, Keshavamurthy C, Patel P. (2023 Nov 12). Calcineurin Inhibitors.  https://www.ncbi.nlm.nih.gov/books/NBK558995/