An embarrassing itch and sometimes difficult to hide lesions. These are perhaps two of the most annoying symptoms that people suffering from atopic dermatitis have to live with, a chronic inflammatory skin disease that affects children, adolescents and adults with a slightly higher prevalence in women. Even though over 230 million people worldwide suffer from it, it remains one of the most underestimated diseases. Often dismissed only as a ‘matter of skin’, and? in reality a chronic, systemic and multidimensional inflammatory pathology that affects the skin but involves multiple aspects of the individual’s life, such as the quality of sleep and relational life. According to a recent survey of Italian specialist centers, there are over 35,000 adult patients followed in Italy, of which about 8,000 are suffering from the severe form of the disease. For them, the quality of life is heavily compromised because the ‘traces’ of atopic dermatitis are often visible.
From redness to itching: the symptoms of atopic dermatitis
All people suffer from more than one skin disease in their lifetime and it is estimated that at any one time around 25% of the European population suffers from at least one skin disease. Furthermore, the incidence of these diseases is constantly and progressively increasing due, mainly, to the aging of the population. These diseases are so frequent because the skin is the largest organ we have, it is constantly exposed to irritating, infectious and carcinogenic agents. Atopic dermatitis can manifest itself in different ways. The most common symptoms are redness, intense itching, peeling and eczematous lesions, sometimes accompanied by superficial exudation and infections. In children as well as adults, itching is one of the most disabling symptoms of atopic dermatitis because it is often uncontrollable and causes a constant need to scratch, resulting in abrasions, lesions, bleeding and infections.
Age-related disease
Symptoms and severity of the disease change with age. In the first years of life, the areas of the cheeks and chin, the fold of the neck, the arms and legs are mainly affected. After the first year of age, atopic dermatitis mainly affects the face, hands, folds of the elbows and knees. In adults, however, the disease can manifest itself especially on the eyelid and perioral regions, the neck and hands, where it is aggravated by contact with irritants. The climate can also affect the course of atopic dermatitis: it often tends to worsen in the spring season and to improve or regress in the summer.
Genetics, immunology and climate
Even though it occurs on the skin, atopic dermatitis is actually a complex disease that also has a genetic component. It is the most common form of eczema and is closely linked to asthma, chronic rhinosinusitis with nasal polyps and hay fever, all of which are caused by an underlying inflammation called type 2 inflammation. These conditions can also occur concurrently in the same individual. If one or both parents suffer from one of these diseases, there is a greater chance of developing diseases related to type 2 inflammation. The risk increases in a directly proportional way if both parents have one of these diseases. Genetic factors come into play (such as the mutation of genes that code for skin barrier proteins) and environmental factors (food allergens, aeroallergens or contact allergens, external irritants, infections, autonomic disorders, lipid metabolism disorders, sweating and stress) , but also the climate: living in temperate and subtropical areas (Mediterranean basin, Central America, South-East Asia) seems to increase the risk of developing this disease as well as living in particularly polluted cities.