Atopic dermatitis (AD) is a chronic inflammatory skin disease that can impair quality of life and place a significant burden on patients and families. Characterized by dry, red, itchy skin that can crack, ooze, and bleed, AD can affect people of all ages.^1,2

Atopic dermatitis can occur anywhere on the skin but is commonly found on the bends of the arms and backs of the knees.³ Because of the chronic nature of AD, daily management may be required.¹ AD can further be defined based on severity, ranging from mild to severe. 

The severity of AD is often gauged and deciphered by a patient’s physical symptoms and how much of the body is affected:¹

• Mild AD consists of areas of dry skin, infrequent itching, with or without small areas of redness.²

• Moderate AD consists of areas of dry skin, frequent itching, and redness with or without broken skin or localized skin thickening.²

• Severe AD consists of widespread areas of dry skin, incessant itching, and redness with or without broken skin, extensive skin thickening, bleeding, oozing, cracking and alteration of pigmentation.²
  

Patients with AD will experience acute worsening of their condition – this is often referred to as flares. When a flare occurs, the patient will experience reddening of the skin with lesions that can blister, ooze and crust.⁴ These flares can be extremely painful and are itchy and uncomfortable. They can lead to psychological distress and affect patients’ overall quality of life.⁵

Flares will affect patients differently depending on the severities of their AD. For example, patients that have mild and moderate AD will typically experience flares as exacerbations of AD after periods of clear skin. Whereas moderate and severe patients often experience their flares as worsening AD atop a constant baseline of disease activity.²

When it comes to people suffering from moderate-to-severe atopic dermatitis, physical symptoms are met with a significant impact on quality of life. This impact can be multi-faceted and become constant.⁴ Much of this impact can be directly linked back to the most common symptom of AD: itch.⁴ Based on a survey, itch due to AD can often be relentless and demanding with scratching, causing pain and skin damage.⁶

While the exact cause of atopic dermatitis is unknown, it is understood that genetic, immunological, and environmental factors can play a role.³ Some environmental factors are known to contribute to a patient flare including:³

• Certain soaps

• Clothing fabrics

• Deodorants

• Carpet fibers

• Dust

• Excessive sweating

• Low humidity

• Certain foods

• Stress

Atopic dermatitis is so much more than just dry, itchy skin. It can significantly impact the mental health of the sufferers.⁴ A survey has shown that AD can contribute to depression and anxiety.⁴ The symptoms of AD can lead to lack of sleep, which can also affect the caregivers, and cause a significant negative impact on quality of life.⁴

Atopic dermatitis is a chronic skin condition and therefore, can persist well into adulthood. It may be outgrown, but skin may still continue to be dry, irritable and sensitive. While many people living with AD will experience periods of relief and remission in their symptoms, some will never experience full relief from their symptoms.

With the support of dermatologists, physicians, and caregivers – as well as deeper public understanding of the condition and its effects – people living with AD can be empowered to live a healthy, normal life.

References

1. Eczema Society of Canada: ESC Atopic Dermatitis: A Practical Guide to Management 2020. Accessed at:  https://eczemahelp.ca/wp-content/uploads/2020/12/ESC_Atopic-Dermatitis-A-Practical-Guide-to-Management_HCP-Published-Guideline_2020.pdf

2. Eczema Society of Canada: ESC Atopic Dermatitis Patient Journey Report. Accessed at:  https://eczemahelp.ca/wp-content/uploads/2020/09/ESC-Atopic-Dermatitis-Patient-Journey-Report-2020.pdf

3. Eczema Society of Canada: ESC Managing Eczema Guide. Accessed at: https://eczemahelp.ca/wp-content/uploads/2020/12/ESC_Managing-Eczema-Guide_2020.pdf

4. Eczema Society of Canada: ESC ATOPIC DERMATITS QUALITY OF LIFE REPORT. Accessed at: https://eczemahelp.ca/wp-content/uploads/2019/02/ESC_Quality-of-Life-Report_Nov-2017-1.pdf

5. Drucker AM et al. J Invest Dermatol. 2017 Jan;137(1):26-30.

6. Margolis JS et al. JAMA Dermatol. 2014 Jun;150(6):593-600.

7. Eczema Society of Canada: ESC Itch in Atopic Dermatitis Survey. Accessed at: https://eczemahelp.ca/wp-content/uploads/2021/04/ESC-Itch-in-Atopic-Dermatitis-Survey-Report-2021-FIN.pdf

8. Zuberbier T, Orlow SJ, Paller AS, et al. Patient perspectives on the management of atopic dermatitis. J Allergy Clin Immunol. 2006;118(1):226-232.

9. Ramirez FD, Chen S, Langan SM, et al. Association of atopic dermatitis with sleep quality in children. JAMA Pediatr. 2019;173(5):e190025.

10. Li JC, Fishbein A, Singam V, et al. Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study. Dermatitis. 2018;29(5):270-277. 

11. Gregory AM and Sadeh A. Sleep Med Rev. 2012 Apr;16(2):129-36. 7.

12. Meltzer LJ and Mindell JA. Psychiatr Clin North Am. 2006 Dec;29(4):1059-76.