atopic dermatitis

File:Child with Eczema (34034003933).jpg

Symptoms refer to the sensations that people with AD feel, whereas signs refers to a description of the visible changes that result from AD.File:Pattern of atopic eczema varies with age.pngThe main symptom of AD is itching which can be intense. Some people experience burning or soreness or pain.

People with AD often have a generally dry skin that can look greyish in people with darker skin tones of colour. Areas of AD are not well defined, and they are typically inflamed (red in a light coloured skin or purple or dark brown in people with dark skin of colour).{{cite journal | vauthors = Kaufman BP, Guttman-Yassky E, Alexis AF | title = Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment | journal = Experimental Dermatology | volume = 27 | issue = 4 | pages = 340–357 | date = April 2018 | pmid = 29457272 | doi = 10.1111/exd.13514 | s2cid = 3379280 | doi-access = free | title-link = doi }} Surface changes include:

• scaling cracking (skin fissures)
• swelling (oedema)
• scratch marks (excoriation)
• bumpiness (papulation)
• oozing of clear fluid
• thickening of the skin (lichenification) where the AD has been present for a long time.

Eczema often starts on the cheeks and outer limbs and body in infants and frequently settles in the folds of the skin such as behind the knees, folds of the elbows, around the neck, wrists and under the buttock folds as the child grows.{{Cite book |url=https://www.worldcat.org/oclc/605909001 |title=Rook's Textbook of Dermatology |date=2010 |publisher=Wiley-Blackwell | vauthors = Rook A, Burns T |isbn=978-1-4443-1764-0 |edition=8th |location=Chichester, UK |chapter=Atopic dermatitis |oclc=605909001}} Any part of the body can be affected by AD.{{cite book | vauthors = Friedmann PS, Holden CA | chapter = Atopic Dermatitis |date= January 2004 | title = Rook's Textbook of Dermatology |pages=755–786 | veditors = Burns T, Breathnach S, Cox N, Griffiths C |place=Malden, Massachusetts, USA |publisher=Blackwell Publishing, Inc. |doi=10.1002/9780470750520.ch18 |isbn=978-0-470-75052-0 }}

Atopic dermatitis commonly affects the eyelids, where an extra prominent crease can form under the eyelid due to skin swelling known as Dennie-Morgan infraorbital folds.{{cite journal | vauthors = Kwatra SG, Tey HL, Ali SM, Dabade T, Chan YH, Yosipovitch G | title = The infra-auricular fissure: a bedside marker of disease severity in patients with atopic dermatitis | journal = Journal of the American Academy of Dermatology | volume = 66 | issue = 6 | pages = 1009–1010 | date = June 2012 | pmid = 22583715 | doi = 10.1016/j.jaad.2011.10.031 }} Cracks can form under the ears which can be painful (infra-auricular fissure).{{cite journal | vauthors = Langan SM, Irvine AD, Weidinger S | title = Atopic dermatitis | journal = Lancet | volume = 396 | issue = 10247 | pages = 345–360 | date = August 2020 | pmid = 32738956 | doi = 10.1016/S0140-6736(20)31286-1 | s2cid = 220873055 }}

The inflammation from AD often leaves "footprints" known as postinflammatory pigmentation that can be lighter than the normal skin or darker. These marks are not scars and eventually go back to normal over a period of months providing the underlying AD is treated effectively.{{Cite web | vauthors = Lambert A |date=9 February 2021 |title=Skin pigmentation and eczema |url=https://eczema.org/information-and-advice/living-with-eczema/skin-pigmentation/ |access-date=6 April 2023 |website=National Eczema Society }}

People with AD often have dry and scaly skin that spans the entire body, except perhaps the diaper area, and intensely itchy red, splotchy, raised lesions to form in the bends of the arms or legs, face, and neck.{{cite journal | vauthors = Berke R, Singh A, Guralnick M | title = Atopic dermatitis: an overview | journal = American Family Physician | volume = 86 | issue = 1 | pages = 35–42 | date = July 2012 | pmid = 22962911 | url = http://www.aafp.org/afp/2012/0701/p35.pdf | url-status = live | archive-url = https://web.archive.org/web/20150906111528/http://www.aafp.org/afp/2012/0701/p35.pdf | archive-date = 6 September 2015 }}{{cite web |date=21 January 2014 |title=Atopic Dermatitis |url=http://emedicine.medscape.com/article/1049085-overview#showall |url-status=live |archive-url=https://web.archive.org/web/20140210011334/http://emedicine.medscape.com/article/1049085-overview#showall |archive-date=10 February 2014 |access-date=3 March 2014 |work=Medscape Reference |publisher=WebMD |vauthors=Kim BS |veditors=Fritsch P, Vinson RP, Perry V, Quirk CM, James WD}}{{cite book |title=Encyclopedia of molecular mechanisms of diseases |vauthors=Brehler R |publisher=Springer |year=2009 |isbn=978-3-540-67136-7 | veditors = Lang F |location=Berlin |chapter=Atopic Dermatitis}}{{cite journal | vauthors = Baron SE, Cohen SN, Archer CB | title = Guidance on the diagnosis and clinical management of atopic eczema | journal = Clinical and Experimental Dermatology | volume = 37 | issue = Suppl 1 | pages = 7–12 | date = May 2012 | pmid = 22486763 | doi = 10.1111/j.1365-2230.2012.04336.x | s2cid = 28538214 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Schmitt J, Langan S, Deckert S, Svensson A, von Kobyletzki L, Thomas K, Spuls P | title = Assessment of clinical signs of atopic dermatitis: a systematic review and recommendation | journal = The Journal of Allergy and Clinical Immunology | volume = 132 | issue = 6 | pages = 1337–1347 | date = December 2013 | pmid = 24035157 | doi = 10.1016/j.jaci.2013.07.008 | doi-access = free | title-link = doi }}

The cause of AD is not known, although evidence indicates environmental, immunologic, bacterial{{Cite journal |last=Kedzierska |first=A. |last2=Kapińska-Mrowiecka |first2=M. |last3=Czubak-Macugowska |first3=M. |last4=Wójcik |first4=K. |last5=Kedzierska |first5=J. |date=December 2008 |title=Susceptibility testing and resistance phenotype detection in Staphylococcus aureus strains isolated from patients with atopic dermatitis, with apparent and recurrent skin colonization |url=https://pubmed.ncbi.nlm.nih.gov/18795934/ |journal=The British Journal of Dermatology |volume=159 |issue=6 |pages=1290–1299 |doi=10.1111/j.1365-2133.2008.08817.x |issn=1365-2133 |pmid=18795934}} and potential genetic factors.{{cite journal | vauthors = Grey K, Maguiness S | title = Atopic Dermatitis: Update for Pediatricians | journal = Pediatric Annals | volume = 45 | issue = 8 | pages = e280–e286 | date = August 2016 | pmid = 27517355 | doi = 10.3928/19382359-20160720-05 | type = Review }}

Since 1970, the rates of atopic dermatitis in the US and UK have increased 3-6 fold.{{Cite web |date=23 January 2023 |title=NIAID Researchers Identify Link Between Common Chemicals and Eczema {{!}} NIH: National Institute of Allergy and Infectious Diseases |url=https://www.niaid.nih.gov/news-events/researchers-identify-link-between-common-chemicals-and-eczema |access-date=23 November 2023 |website=www.niaid.nih.gov }} Even today, people who migrate from developing nations before the age of 4 years to industrialized nations experience a dramatic rise in the risk of atopic dermatitis and have an additional risk when living in urbanized areas of the industrial nation.{{cite journal | vauthors = Zeldin J, Chaudhary PP, Spathies J, Yadav M, D'Souza BN, Alishahedani ME, Gough P, Matriz J, Ghio AJ, Li Y, Sun AA, Eichenfield LF, Simpson EL, Myles IA | title = Exposure to isocyanates predicts atopic dermatitis prevalence and disrupts therapeutic pathways in commensal bacteria | journal = Science Advances | volume = 9 | issue = 1 | pages = eade8898 | date = January 2023 | pmid = 36608129 | pmc = 9821876 | doi = 10.1126/sciadv.ade8898 | bibcode = 2023SciA....9E8898Z }} Recent work has shed light on these and other data strongly suggesting that early life industrial exposures may cause atopic dermatitis.{{Cite web |date=26 March 2023 |title=Eczema's cause could be in the air we breathe |url=https://www.nbcnews.com/health/health-news/causes-eczema-air-breathe-new-science-suggests-rcna76427 |access-date=23 November 2023 |website=NBC News }} Chemicals such as (di)isocyanates and xylene prevent the skin bacteria from producing ceramide-sphingolipid family lipids. Early life deficiency in these lipids predictive which children will go on to develop atopic dermatitis.{{cite journal | vauthors = Chaudhary PP, Myles IA, Zeldin J, Dabdoub S, Deopujari V, Baveja R, Baker R, Bengtson S, Sutton A, Levy S, Hourigan SK | title = Shotgun metagenomic sequencing on skin microbiome indicates dysbiosis exists prior to the onset of atopic dermatitis | journal = Allergy | volume = 78 | issue = 10 | pages = 2724–2731 | date = October 2023 | pmid = 37422700 | pmc = 10543534 | doi = 10.1111/all.15806 }}{{cite journal | vauthors = Berdyshev E, Kim J, Kim BE, Goleva E, Lyubchenko T, Bronova I, Bronoff AS, Xiao O, Kim J, Kim S, Kwon M, Lee S, Seo YJ, Kim K, Choi SJ, Oh SY, Kim SH, Yu SY, Hwang SY, Ahn K, Leung DY | title = Stratum corneum lipid and cytokine biomarkers at age 2 months predict the future onset of atopic dermatitis | journal = The Journal of Allergy and Clinical Immunology | volume = 151 | issue = 5 | pages = 1307–1316 | date = May 2023 | pmid = 36828081 | doi = 10.1016/j.jaci.2023.02.013 | s2cid = 255078763 }}{{cite journal | vauthors = Rinnov MR, Halling AS, Gerner T, Ravn NH, Knudgaard MH, Trautner S, Goorden SM, Ghauharali-van der Vlugt KJ, Stet FS, Skov L, Thomsen SF, Egeberg A, Rosted AL, Petersen T, Jakasa I, Riethmüller C, Kezic S, Thyssen JP | title = Skin biomarkers predict development of atopic dermatitis in infancy | journal = Allergy | volume = 78 | issue = 3 | pages = 791–802 | date = March 2023 | pmid = 36112082 | doi = 10.1111/all.15518 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Yamamoto-Hanada K, Saito-Abe M, Shima K, Fukagawa S, Uehara Y, Ueda Y, Iwamura M, Murase T, Kuwano T, Inoue T, Ohya Y | title = mRNAs in skin surface lipids unveiled atopic dermatitis at 1 month | journal = Journal of the European Academy of Dermatology and Venereology | volume = 37 | issue = 7 | pages = 1385–1395 | date = July 2023 | pmid = 36897437 | doi = 10.1111/jdv.19017 | doi-access = free | title-link = doi }} These chemicals also directly activate an itch receptor in the skin known as TRPA1.{{cite journal | vauthors = Yadav M, Chaudhary PP, D'Souza BN, Ratley G, Spathies J, Ganesan S, Zeldin J, Myles IA | title = Diisocyanates influence models of atopic dermatitis through direct activation of TRPA1 | journal = PLOS ONE | volume = 18 | issue = 3 | pages = e0282569 | date = 2023 | pmid = 36877675 | pmc = 9987805 | doi = 10.1371/journal.pone.0282569 | doi-access = free | title-link = doi | bibcode = 2023PLoSO..1882569Y }} The industrial manufacturing and use of both xylene and diisocyanates greatly increased starting in 1970, which greatly expanded the average exposure to these substances. For example, these chemicals are components of several exposures known to increase the risk of atopic dermatitis or worsen symptoms including: wildfires, automobile exhaust, wallpaper adhesives, paints, non-latex foam furniture, cigarette smoke, and are elements of fabrics like polyester, nylon, and spandex.

Low humidity, and low temperature increase the prevalence and risk of flares in people with atopic dermatitis.{{cite journal | vauthors = Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP | title = The effect of environmental humidity and temperature on skin barrier function and dermatitis | journal = Journal of the European Academy of Dermatology and Venereology | volume = 30 | issue = 2 | pages = 223–249 | date = February 2016 | pmid = 26449379 | doi = 10.1111/jdv.13301 | s2cid = 12378072 | doi-access = free | title-link = doi }}

Genes that may contribute to AD are mainly those responsible for immune response (e.g. TH2 cytokine and JAK-STAT pathway genes) and skin barrier (e.g. filaggrin, claudin-1, loricrin).{{cn|date=January 2025}}

Immune response: Many people with AD have a family history or a personal history of atopy. Atopy is a term used to describe individuals who produce substantial amounts of IgE. Such individuals have an increased tendency to develop asthma, hay fever, eczema, urticaria and allergic rhinitis. Up to 80% of people with atopic dermatitis have elevated total or allergen-specific IgE levels.

Skin barrier: About 30% of people with AD have mutations in the gene for the production of filaggrin (FLG), which increase the risk for early onset of atopic dermatitis and developing asthma.{{cite journal | vauthors = Park KD, Pak SC, Park KK | title = The Pathogenetic Effect of Natural and Bacterial Toxins on Atopic Dermatitis | journal = Toxins | volume = 9 | issue = 1 | pages = 3 | date = December 2016 | pmid = 28025545 | pmc = 5299398 | doi = 10.3390/toxins9010003 | type = Review | doi-access = free | title-link = doi }}{{cite journal | vauthors = Irvine AD, McLean WH, Leung DY | title = Filaggrin mutations associated with skin and allergic diseases | journal = The New England Journal of Medicine | volume = 365 | issue = 14 | pages = 1315–1327 | date = October 2011 | pmid = 21991953 | doi = 10.1056/NEJMra1011040 | type = Review }} However, expression of filaggrin protein or breakdown products offer no predictive utility in atopic dermatitis risk.

People with atopic dermatitis also have decreased expression of tight junction protein Claudin-1, which deteriorates the bioelectric barrier function in the epidermis.{{Cite journal |last=Benedetto De |first=Anna |date=2010 |title=Tight Junction Defects in Atopic Dermatitis |journal=Journal of Allergy and Clinical Immunology |volume=127 |issue=3 |pages=773–786 |doi=10.1016/j.jaci.2010.10.018 |pmid=21163515 |pmc=3049863 }}

According to the hygiene hypothesis, early childhood exposure to certain microorganisms (such as gut flora and helminth parasites) protects against allergic diseases by contributing to the development of the immune system.{{cite journal | vauthors = Scudellari M | title = News Feature: Cleaning up the hygiene hypothesis | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 114 | issue = 7 | pages = 1433–1436 | date = February 2017 | pmid = 28196925 | pmc = 5320962 | doi = 10.1073/pnas.1700688114 | doi-access = free | title-link = doi | bibcode = 2017PNAS..114.1433S }} This exposure is limited in a modern "sanitary" environment, and the incorrectly developed immune system is prone to develop allergies to harmless substances.{{cn|date=January 2025}}

Some support exists for this hypothesis with respect to AD.{{cite journal | vauthors = Bieber T | title = Atopic dermatitis | journal = The New England Journal of Medicine | volume = 358 | issue = 14 | pages = 1483–1494 | date = April 2008 | pmid = 18385500 | doi = 10.1056/NEJMra074081 }} Those exposed to dogs while growing up have a lower risk of atopic dermatitis.{{cite journal | vauthors = Pelucchi C, Galeone C, Bach JF, La Vecchia C, Chatenoud L | title = Pet exposure and risk of atopic dermatitis at the pediatric age: a meta-analysis of birth cohort studies | journal = The Journal of Allergy and Clinical Immunology | volume = 132 | issue = 3 | pages = 616–622.e7 | date = September 2013 | pmid = 23711545 | doi = 10.1016/j.jaci.2013.04.009 | hdl-access = free | hdl = 2434/239729 }} Also, epidemiological studies support a protective role for helminths against AD.{{cite journal | vauthors = Flohr C, Mann J | title = New insights into the epidemiology of childhood atopic dermatitis | journal = Allergy | volume = 69 | issue = 1 | pages = 3–16 | date = January 2014 | pmid = 24417229 | doi = 10.1111/all.12270 | s2cid = 32645590 | doi-access = free | title-link = doi }} Likewise, children with poor hygiene are at a lower risk for developing AD, as are children who drink unpasteurized milk.

In a small percentage of cases, atopic dermatitis is caused by sensitization to foods{{cite journal | vauthors = di Mauro G, Bernardini R, Barberi S, Capuano A, Correra A, De' Angelis GL, Iacono ID, de Martino M, Ghiglioni D, Di Mauro D, Giovannini M, Landi M, Marseglia GL, Martelli A, Miniello VL, Peroni D, Sullo LR, Terracciano L, Vascone C, Verduci E, Verga MC, Chiappini E | title = Prevention of food and airway allergy: consensus of the Italian Society of Preventive and Social Paediatrics, the Italian Society of Paediatric Allergy and Immunology, and Italian Society of Pediatrics | journal = The World Allergy Organization Journal | volume = 9 | pages = 28 | year = 2016 | pmid = 27583103 | pmc = 4989298 | doi = 10.1186/s40413-016-0111-6 | doi-access = free | title-link = doi | type = Review }} such as milk, but there is growing consensus that food allergy most likely arises as a result of skin barrier dysfunction resulting from AD, rather than food allergy causing the skin problems.{{cite journal | vauthors = Brough HA, Nadeau KC, Sindher SB, Alkotob SS, Chan S, Bahnson HT, Leung DY, Lack G | title = Epicutaneous sensitization in the development of food allergy: What is the evidence and how can this be prevented? | journal = Allergy | volume = 75 | issue = 9 | pages = 2185–2205 | date = September 2020 | pmid = 32249942 | pmc = 7494573 | doi = 10.1111/all.14304 }} Atopic dermatitis sometimes appears associated with coeliac disease and non-coeliac gluten sensitivity. Because a gluten-free diet (GFD) improves symptoms in these cases, gluten seems to be the cause of AD in these cases.{{cite journal | vauthors = Fasano A, Sapone A, Zevallos V, Schuppan D | title = Nonceliac gluten sensitivity | journal = Gastroenterology | volume = 148 | issue = 6 | pages = 1195–1204 | date = May 2015 | pmid = 25583468 | doi = 10.1053/j.gastro.2014.12.049 | type = Review | doi-access = free | title-link = doi | quote = Many patients with celiac disease also have atopic disorders. About 30% of patients' allergies with gastrointestinal (GI) symptoms and mucosal lesions, but negative results from serologic (TG2 antibodies) or genetic tests (DQ2 or DQ8 genotype) for celiac disease, had reduced GI and atopic symptoms when they were placed on GFDs. These findings indicated that their symptoms were related to gluten ingestion. }}{{cite journal | vauthors = Mansueto P, Seidita A, D'Alcamo A, Carroccio A | title = Non-celiac gluten sensitivity: literature review | journal = Journal of the American College of Nutrition | volume = 33 | issue = 1 | pages = 39–54 | date = 2014 | pmid = 24533607 | doi = 10.1080/07315724.2014.869996 | hdl-access = free | type = Review | s2cid = 22521576 | hdl = 10447/90208 }} A diet high in fruits seems to have a protective effect against AD, whereas the opposite seems true for heavily processed foods.

Exposure to allergens, either from food or the environment, can exacerbate existing atopic dermatitis.{{cite journal | vauthors = Williams H, Flohr C | title = How epidemiology has challenged 3 prevailing concepts about atopic dermatitis | journal = The Journal of Allergy and Clinical Immunology | volume = 118 | issue = 1 | pages = 209–213 | date = July 2006 | pmid = 16815157 | doi = 10.1016/j.jaci.2006.04.043 | url = http://eprints.nottingham.ac.uk/861/2/revised_final_rostrum.pdf | access-date = 5 February 2019 | url-status = dead | archive-url = https://web.archive.org/web/20180719092709/http://eprints.nottingham.ac.uk/861/2/revised_final_rostrum.pdf | archive-date = 19 July 2018 }} Exposure to dust mites, for example, is believed to contribute to the risk of developing AD.{{cite journal | vauthors = Fuiano N, Incorvaia C | title = Dissecting the causes of atopic dermatitis in children: less foods, more mites | journal = Allergology International | volume = 61 | issue = 2 | pages = 231–243 | date = June 2012 | pmid = 22361514 | doi = 10.2332/allergolint.11-RA-0371 | doi-access = free | title-link = doi }}

The prevalence of atopic dermatitis in children may be linked to the level of calcium carbonate or "hardness" of household drinking water.{{cite journal | vauthors = Sengupta P | title = Potential health impacts of hard water | journal = International Journal of Preventive Medicine | volume = 4 | issue = 8 | pages = 866–875 | date = August 2013 | pmid = 24049611 | pmc = 3775162 | type = Review }}{{cite journal | vauthors = Jabbar-Lopez ZK, Ung CY, Alexander H, Gurung N, Chalmers J, Danby S, Cork MJ, Peacock JL, Flohr C | title = The effect of water hardness on atopic eczema, skin barrier function: A systematic review, meta-analysis | journal = Clinical and Experimental Allergy | volume = 51 | issue = 3 | pages = 430–451 | date = March 2021 | pmid = 33259122 | doi = 10.1111/cea.13797 | s2cid = 227245344 }} Living in areas with hard water may also play a part in the development of AD in early life. However, when AD is already established, using water softeners at home does not reduce the severity of the symptoms.

Colonization of the skin by the bacterium S. aureus is prevalent in those with atopic dermatitis.{{cite journal | vauthors = Goh CL, Wong JS, Giam YC | title = Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore | journal = International Journal of Dermatology | volume = 36 | issue = 9 | pages = 653–657 | date = September 1997 | pmid = 9352404 | doi = 10.1046/j.1365-4362.1997.00290.x | s2cid = 3112669 }} Abnormalities in the skin barrier of persons with AD are exploited by S. aureus to trigger cytokine expression, thus aggravating the condition.{{cite journal | vauthors = Nakatsuji T, Chen TH, Two AM, Chun KA, Narala S, Geha RS, Hata TR, Gallo RL | title = Staphylococcus aureus Exploits Epidermal Barrier Defects in Atopic Dermatitis to Trigger Cytokine Expression | journal = The Journal of Investigative Dermatology | volume = 136 | issue = 11 | pages = 2192–2200 | date = November 2016 | pmid = 27381887 | pmc = 5103312 | doi = 10.1016/j.jid.2016.05.127 }}

However, atopic dermatitis is non-communicable and therefore could not be directly caused by a highly infectious organism. Furthermore, there is insufficient evidence for the effectiveness of anti-staphylococcal treatments for treating S. aureus in infected or uninfected eczema.{{cite journal | vauthors = George SM, Karanovic S, Harrison DA, Rani A, Birnie AJ, Bath-Hextall FJ, Ravenscroft JC, Williams HC | title = Interventions to reduce Staphylococcus aureus in the management of eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 10 | date = October 2019 | pmid = 31684694 | pmc = 6818407 | doi = 10.1002/14651858.CD003871.pub3 | collaboration = Cochrane Skin Group }}

The role of S. aureus in skin irritation occurs via inflammation factors that induce itching, which may damage the skin, further driving inflammation, and facilitating the growth of S. aureus, thus promoting a chronic cycle.{{Cite journal |last1=Gallo |first1=Richard L. |last2=Horswill |first2=Alexander R. |date=May 2024 |title=Staphylococcus aureus: The Bug Behind the Itch in Atopic Dermatitis |journal=Journal of Investigative Dermatology |volume=144 |issue=5 |pages=950–953 |doi=10.1016/j.jid.2024.01.001|doi-access=free |pmid=38430083 }}{{Creative Commons text attribution notice|cc=by4|from this source=yes}}

Excessive type 2 inflammation underlies the pathophysiology of atopic dermatitis.{{cite journal | vauthors = Gandhi NA, Bennett BL, Graham NM, Pirozzi G, Stahl N, Yancopoulos GD | title = Targeting key proximal drivers of type 2 inflammation in disease | journal = Nature Reviews. Drug Discovery | volume = 15 | issue = 1 | pages = 35–50 | date = January 2016 | pmid = 26471366 | doi = 10.1038/nrd4624 | s2cid = 2421591 }}{{cite journal | vauthors = Akdis CA, Arkwright PD, Brüggen MC, Busse W, Gadina M, Guttman-Yassky E, Kabashima K, Mitamura Y, Vian L, Wu J, Palomares O | title = Type 2 immunity in the skin and lungs | journal = Allergy | volume = 75 | issue = 7 | pages = 1582–1605 | date = July 2020 | pmid = 32319104 | doi = 10.1111/all.14318 | doi-access = free | title-link = doi }}

Disruption of the epidermal barrier is thought to play an integral role in the pathogenesis of AD.{{cite journal | vauthors = Ständer S | title = Atopic Dermatitis | journal = The New England Journal of Medicine | volume = 384 | issue = 12 | pages = 1136–1143 | date = March 2021 | pmid = 33761208 | doi = 10.1056/NEJMra2023911 | s2cid = 232355341 }} Disruptions of the epidermal barrier allows allergens to penetrate the epidermis to deeper layers of the skin. This leads to activation of epidermal inflammatory dendritic and innate lymphoid cells which subsequently attracts Th2 CD4+ helper T cells to the skin. This dysregulated Th2 inflammatory response is thought to lead to the eczematous lesions. The Th2 helper T cells become activated, leading to the release of inflammatory cytokines including IL-4, IL-13 and IL-31 which activate downstream Janus kinase (Jak) pathways. The active Jak pathways lead to inflammation and downstream activation of plasma cells and B lymphocytes which release antigen specific IgE contributing to further inflammation. Other CD4+ helper T-cell pathways thought to be involved in atopic dermatitis inflammation include the Th1, Th17, and Th22 pathways. Some specific CD4+ helper T-cell inflammatory pathways are more commonly activated in specific ethnic groups with AD (for example, the Th-2 and Th-17 pathways are commonly activated in Asian people) possibly explaining the differences in phenotypic presentation of atopic dermatitis in specific populations.

Mutations in the filaggrin gene, FLG, also cause impairment in the skin barrier that contributes to the pathogenesis of AD. Filaggrin is produced by epidermal skin cells (keratinocytes) in the horny layer of the epidermis. Filaggrin stimulates skin cells to release moisturizing factors and lipid matrix material, which cause adhesion of adjacent keratinocytes and contributes to the skin barrier. A loss-of-function mutation of filaggrin causes loss of this lipid matrix and external moisturizing factors, subsequently leading to disruption of the skin barrier. The disrupted skin barrier leads to transdermal water loss (leading to the xerosis or dry skin commonly seen in AD) and antigen and allergen penetration of the epidermal layer. Filaggrin mutations are also associated with a decrease in natural antimicrobial peptides found on the skin; subsequently leading to disruption of skin flora and bacterial overgrowth (commonly Staphylococcus aureus overgrowth or colonization).

Atopic dermatitis is also associated with the release of pruritogens (molecules that stimulate pruritus or itching) in the skin. Keratinocytes, mast cells, eosinophils and T-cells release pruritogens in the skin; leading to activation of Aδ fibers and Group C nerve fibers in the epidermis and dermis contributing to sensations of pruritus and pain. The pruritogens include the Th2 cytokines IL-4, IL-13, IL-31, histamine, and various neuropeptides. Mechanical stimulation from scratching lesions can also lead to the release of pruritogens contributing to the itch-scratch cycle whereby there is increased pruritus or itch after scratching a lesion. Chronic scratching of lesions can cause thickening or lichenification of the skin or prurigo nodularis (generalized nodules that are severely itchy).

Another factor in the barrier failure and immunological dysregulation in people with atopic dermatitis may be due to decreases in tight junction protein Claudin-1. Inhibiting Claudin-1 expression in human keratinocytes has been show to both reduce tight junction function, as well as increase keratinocyte proliferation in vitro. It has also been discovered that this deteriorates the bioelectric barrier function in the epidermis.

Atopic dermatitis is typically diagnosed clinically, meaning it is based on signs and symptoms alone, without special testing.{{cite journal | vauthors = Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM, Davis DM, Krol A, Margolis DJ, Paller AS, Schwarzenberger K, Silverman RA, Williams HC, Elmets CA, Block J, Harrod CG, Smith Begolka W, Sidbury R | title = Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis | journal = Journal of the American Academy of Dermatology | volume = 70 | issue = 2 | pages = 338–351 | date = February 2014 | pmid = 24290431 | pmc = 4410183 | doi = 10.1016/j.jaad.2013.10.010 }} Several different criteria developed for research have also been validated to aid in diagnosis.{{cite journal | vauthors = Brenninkmeijer EE, Schram ME, Leeflang MM, Bos JD, Spuls PI | title = Diagnostic criteria for atopic dermatitis: a systematic review | journal = The British Journal of Dermatology | volume = 158 | issue = 4 | pages = 754–765 | date = April 2008 | pmid = 18241277 | doi = 10.1111/j.1365-2133.2007.08412.x | s2cid = 453564 | doi-access = free | title-link = doi }} Of these, the UK Diagnostic Criteria, based on the work of Hanifin and Rajka, has been the most widely validated.{{cite journal | vauthors = Williams HC, Burney PG, Pembroke AC, Hay RJ | title = The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation | journal = The British Journal of Dermatology | volume = 131 | issue = 3 | pages = 406–416 | date = September 1994 | pmid = 7918017 | doi = 10.1111/j.1365-2133.1994.tb08532.x | s2cid = 37406163 }}

Other diseases that must be excluded before making a diagnosis include contact dermatitis, psoriasis, and seborrheic dermatitis.

There are no established clinical methods using dietary or topical strategies to inhibit or prevent atopic dermatitis. Specific dietary plans during pregnancy and in early childhood, such as eating fatty fish (or taking omega-3 supplements), are not effective.{{cite journal | vauthors = Trikamjee T, Comberiati P, D'Auria E, Peroni D, Zuccotti GV | title = Nutritional Factors in the Prevention of Atopic Dermatitis in Children | journal = Frontiers in Pediatrics | volume = 8 | pages = 577413 | date = 12 January 2021 | pmid = 33585361 | pmc = 7874114 | doi = 10.3389/fped.2020.577413 | doi-access = free | title-link = doi }} Taking probiotics (for example Lactobacillus rhamnosus) during pregnancy and feeding probiotics to infants are strategies under research, with only preliminary evidence that they may be preventative.{{cite journal | vauthors = Sun S, Chang G, Zhang L | title = The prevention effect of probiotics against eczema in children: an update systematic review and meta-analysis | journal = The Journal of Dermatological Treatment | volume = 33 | issue = 4 | pages = 1844–1854 | date = June 2022 | pmid = 34006167 | doi = 10.1080/09546634.2021.1925077 }}{{cite journal | vauthors = Voigt J, Lele M | title = Lactobacillus rhamnosus Used in the Perinatal Period for the Prevention of Atopic Dermatitis in Infants: A Systematic Review and Meta-Analysis of Randomized Trials | journal = American Journal of Clinical Dermatology | volume = 23 | issue = 6 | pages = 801–811 | date = November 2022 | pmid = 36161401 | pmc = 9576646 | doi = 10.1007/s40257-022-00723-x }}

Using moisturizers daily in infants during the first year of life does not help to prevent atopic dermatitis, and might even increase the risk of skin infections.{{Cite report |url=https://evidence.nihr.ac.uk/collection/eczema-in-children-uncertainties-addressed/ |title=Eczema in children: uncertainties addressed |date=19 March 2024 |publisher=NIHR Evidence |doi=10.3310/nihrevidence_62438 }}{{cite journal | vauthors = Kelleher MM, Phillips R, Brown SJ, Cro S, Cornelius V, Carlsen KC, Skjerven HO, Rehbinder EM, Lowe AJ, Dissanayake E, Shimojo N, Yonezawa K, Ohya Y, Yamamoto-Hanada K, Morita K, Axon E, Cork M, Cooke A, Van Vogt E, Schmitt J, Weidinger S, McClanahan D, Simpson E, Duley L, Askie LM, Williams HC, Boyle RJ | title = Skin care interventions in infants for preventing eczema and food allergy | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 11 | pages = CD013534 | date = November 2022 | pmid = 36373988 | pmc = 9661877 | doi = 10.1002/14651858.CD013534.pub3 | collaboration = Cochrane Skin Group }}

No cure for AD is known, although treatments may reduce the severity and frequency of flares. The most commonly used topical treatments for AD are topical corticosteroids (to get control of flare-ups) and moisturisers (emollients) to help keep control.{{Cite web |title=What are Topical Treatments for Eczema and How Should They Be Used? |url=https://nationaleczema.org/eczema/treatment/topicals/ |access-date=22 June 2023 |website=National Eczema Association }} Clinical trials often measure the efficacy of treatments with a severity scale such as the SCORAD index or the Eczema Area and Severity Index.{{cite journal | vauthors = Chopra R, Silverberg JI | title = Assessing the severity of atopic dermatitis in clinical trials and practice | journal = Clinics in Dermatology | volume = 36 | issue = 5 | pages = 606–615 | date = 2018 | pmid = 30217273 | doi = 10.1016/j.clindermatol.2018.05.012 | series = Atopic Dermatits: Part II | s2cid = 52277845 }}

Daily basic care is intended to stabilize the barrier function of the skin to mitigate its sensitivity to irritation and penetration of allergens. Affected persons often report that improvement of skin hydration parallels with improvement in AD symptoms. Moisturisers (or emollients) can improve skin comfort and may reduce disease flares.{{cite journal | vauthors = Ridd MJ, Roberts A, Grindlay D, Williams HC | title = Which emollients are effective and acceptable for eczema in children? | journal = BMJ | volume = 367 | pages = l5882 | date = October 2019 | pmid = 31649114 | doi = 10.1136/bmj.l5882 | s2cid = 204882682 | hdl = 1983/2c0e2127-710c-46a9-bd5c-89574b11c9ee | url = https://research-information.bris.ac.uk/en/publications/2c0e2127-710c-46a9-bd5c-89574b11c9ee }} They can be used as leave-on treatments, bath additives or soap substitutes. There are many different products but the majority of leave-on treatments (least to most greasy) are lotions, creams, gels or ointments. All of the different types of moisturisers are equally effective so people need to choose one or more products based on what suits them, according to their age, body site effected, climate/season and personal preference.{{cite journal | vauthors = Ridd MJ, Santer M, MacNeill SJ, Sanderson E, Wells S, Webb D, Banks J, Sutton E, Roberts A, Liddiard L, Wilkins Z, Clayton J, Garfield K, Barrett TJ, Lane JA, Baxter H, Howells L, Taylor J, Hay AD, Williams HC, Thomas KS | title = Effectiveness and safety of lotion, cream, gel, and ointment emollients for childhood eczema: a pragmatic, randomised, phase 4, superiority trial | journal = The Lancet. Child & Adolescent Health | volume = 6 | issue = 8 | pages = 522–532 | date = August 2022 | pmid = 35617974 | doi = 10.1016/S2352-4642(22)00146-8 | hdl-access = free | s2cid = 249024141 | doi-access = free | title-link = doi | hdl = 1983/e4009d3c-127f-4aa9-bf71-e40401b33eee }} Non-medicated prescription moisturisers may also be no more effective than over-the-counter moisturisers.{{cite journal | vauthors = Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L | title = Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials | journal = The Journal of Allergy and Clinical Immunology | volume = 152 | issue = 6 | pages = 1493–1519 | date = December 2023 | pmid = 37678572 | doi = 10.1016/j.jaci.2023.08.030 | s2cid = 261610152 | hdl = 10576/50632 | hdl-access = free }}

The use of emollient bath additives does not provide any additional benefits.{{Cite book |url=http://www.ncbi.nlm.nih.gov/books/NBK594326/ |title=Evidence reviews for adding bath emollients to the management of atopic eczema in children under 12 years: Atopic eczema in under 12s: diagnosis and management: Evidence review A |date=2023 |publisher=National Institute for Health and Care Excellence (NICE) |isbn=978-1-4731-5235-9 |series=NICE Evidence Reviews Collection |location=London |pmid=37616434}}{{cite journal | vauthors = Santer M, Ridd MJ, Francis NA, Stuart B, Rumsby K, Chorozoglou M, Becque T, Roberts A, Liddiard L, Nollett C, Hooper J, Prude M, Wood W, Thomas KS, Thomas-Jones E, Williams HC, Little P | title = Emollient bath additives for the treatment of childhood eczema (BATHE): multicentre pragmatic parallel group randomised controlled trial of clinical and cost effectiveness | journal = BMJ | volume = 361 | pages = k1332 | date = May 2018 | pmid = 29724749 | pmc = 5930266 | doi = 10.1136/bmj.k1332 }}

Creams and ointments containing corticosteroids applied directly on skin (topical) are effective in managing atopic dermatitis.{{cite journal | vauthors = Lax SJ, Harvey J, Axon E, Howells L, Santer M, Ridd MJ, Lawton S, Langan S, Roberts A, Ahmed A, Muller I, Ming LC, Panda S, Chernyshov P, Carter B, Williams HC, Thomas KS, Chalmers JR | title = Strategies for using topical corticosteroids in children and adults with eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 3 | pages = CD013356 | date = March 2022 | pmid = 35275399 | pmc = 8916090 | doi = 10.1002/14651858.CD013356.pub2 | collaboration = Cochrane Skin Group }} Newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. Strong and moderate corticosteroids work better than weaker ones. They are also generally safe and do not cause skin thinning when used intermittently to treat AD flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment).{{cite journal | vauthors = Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, Roberts A, Stuart B, Williams HC, Thomas KS | title = The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review | journal = Skin Health and Disease | volume = 3 | issue = 5 | pages = e268 | date = October 2023 | pmid = 37799373 | pmc = 10549798 | doi = 10.1002/ski2.268 }}{{cite journal | vauthors = Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, Grindlay DJ, Muller I, Roberts A, Ahmed A, Williams HC, Thomas KS | title = Safety of topical corticosteroids in atopic eczema: an umbrella review | journal = BMJ Open | volume = 11 | issue = 7 | pages = e046476 | date = July 2021 | pmid = 34233978 | pmc = 8264889 | doi = 10.1136/bmjopen-2020-046476 }} Applying once daily is as effective as twice or more daily application.

In addition to topical corticosteroids, topical calcineurin inhibitors, such as tacrolimus or pimecrolimus, are also recommended as first-line therapies for managing atopic dermatitis.{{cite journal | vauthors = Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AW, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK | title = Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations | journal = Annals of Allergy, Asthma & Immunology | volume = 132 | issue = 3 | pages = 274–312 | date = March 2024 | pmid = 38108679 | doi = 10.1016/j.anai.2023.11.009 | doi-access = free | title-link = doi }} Both tacrolimus and pimecrolimus are effective and safe to use in AD.{{cite journal | vauthors = Cury Martins J, Martins C, Aoki V, Gois AF, Ishii HA, da Silva EM | title = Topical tacrolimus for atopic dermatitis | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 7 | pages = CD009864 | date = July 2015 | pmid = 26132597 | pmc = 6461158 | doi = 10.1002/14651858.CD009864.pub2 }}{{cite journal | vauthors = Devasenapathy N, Chu A, Wong M, Srivastava A, Ceccacci R, Lin C, MacDonald M, Wen A, Steen J, Levine M, Pyne L, Schneider L, Chu DK | title = Cancer risk with topical calcineurin inhibitors, pimecrolimus and tacrolimus, for atopic dermatitis: a systematic review and meta-analysis | journal = The Lancet. Child & Adolescent Health | volume = 7 | issue = 1 | pages = 13–25 | date = January 2023 | pmid = 36370744 | doi = 10.1016/S2352-4642(22)00283-8 | s2cid = 253470127 }} Crisaborole, an inhibitor of PDE-4, is also effective and safe as a topical treatment for mild-to-moderate AD.{{cite journal | vauthors = McDowell L, Olin B | title = Crisaborole: A Novel Nonsteroidal Topical Treatment for Atopic Dermatitis | journal = The Journal of Pharmacy Technology | volume = 35 | issue = 4 | pages = 172–178 | date = August 2019 | pmid = 34861031 | pmc = 6600556 | doi = 10.1177/8755122519844507 }}{{Cite journal | vauthors = He Y, Liu J, Wang Y, Kuai W, Liu R, Wu J |date=6 February 2023 | veditors = Pimpinelli N |title=Topical Administration of Crisaborole in Mild to Moderate Atopic Dermatitis: A Systematic Review and Meta-Analysis |journal=Dermatologic Therapy |volume=2023 |pages=1–9 |doi=10.1155/2023/1869934 |issn=1529-8019| doi-access = free | title-link = doi }} Ruxolitinib, a Janus kinase inhibitor, has uncertain efficacy and safety.

When topical (on skin) treatments fail to control severe AD flares, medications taken by mouth (systemic treatment) can be used.

Conventional oral medications for AD include systemic immunosuppressants, such as ciclosporin, methotrexate, azathioprine, and mycophenolate.{{cite journal | vauthors = Davis DM, Drucker AM, Alikhan A, Bercovitch L, Cohen DE, Darr JM, Eichenfield LF, Frazer-Green L, Paller AS, Schwarzenberger K, Silverberg JI, Singh AM, Wu PA, Sidbury R | title = Guidelines of care for the management of atopic dermatitis in adults with phototherapy and systemic therapies | journal = Journal of the American Academy of Dermatology | volume = 90 | issue = 2 | pages = e43–e56 | date = February 2024 | pmid = 37943240 | doi = 10.1016/j.jaad.2023.08.102 }}{{cite journal | vauthors = Paolino A, Alexander H, Broderick C, Flohr C | title = Non-biologic systemic treatments for atopic dermatitis: Current state of the art and future directions | journal = Clinical and Experimental Allergy | volume = 53 | issue = 5 | pages = 495–510 | date = May 2023 | pmid = 36949024 | doi = 10.1111/cea.14301 | doi-access = free | title-link = doi }}{{cite journal | vauthors = Flohr C, Rosala-Hallas A, Jones AP, Beattie P, Baron S, Browne F, Brown SJ, Gach JE, Greenblatt D, Hearn R, Hilger E, Esdaile B, Cork MJ, Howard E, Lovgren ML, August S, Ashoor F, Williamson PR, McPherson T, O'Kane D, Ravenscroft J, Shaw L, Sinha MD, Spowart C, Taams LS, Thomas BR, Wan M, Sach TH, Irvine AD | title = Efficacy and safety of ciclosporin versus methotrexate in the treatment of severe atopic dermatitis in children and young people (TREAT): a multicentre parallel group assessor-blinded clinical trial | journal = The British Journal of Dermatology | volume = 189 | issue = 6 | pages = 674–684 | date = November 2023 | pmid = 37722926 | doi = 10.1093/bjd/ljad281 }} Antidepressants and naltrexone may be used to control pruritus (itchiness).{{cite journal | vauthors = Kim K | title = Neuroimmunological mechanism of pruritus in atopic dermatitis focused on the role of serotonin | journal = Biomolecules & Therapeutics | volume = 20 | issue = 6 | pages = 506–512 | date = November 2012 | pmid = 24009842 | pmc = 3762292 | doi = 10.4062/biomolther.2012.20.6.506 }}

Newer medications, such as monoclonal antibodies and JAK inhibitors, are highly effective for managing atopic dermatitis, but modestly increase the risk of conjunctivitis. These include dupilumab (Dupixent), tralokinumab (Adtralza, Adbry), abrocitinib (Cibinqo), baricitinib (Olumiant) and upadacitinib (Rinvoq).{{cite journal | vauthors = Chu AW, Wong MM, Rayner DG, Guyatt GH, Díaz Martinez JP, Ceccacci R, Zhao IX, McMullen E, Srivastava A, Wang J, Wen A, Wang FC, Brignardello-Petersen R, Izcovich A, Oykhman P, Wheeler KE, Wang J, Spergel JM, Singh JA, Silverberg JI, Ong PY, O'Brien M, Martin SA, Lio PA, Lind ML, LeBovidge J, Kim E, Huynh J, Greenhawt M, Gardner DD, Frazier WT, Ellison K, Chen L, Capozza K, De Benedetto A, Boguniewicz M, Smith Begolka W, Asiniwasis RN, Schneider LC, Chu DK | title = Systemic treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials | journal = The Journal of Allergy and Clinical Immunology | volume = 152 | issue = 6 | pages = 1470–1492 | date = December 2023 | pmid = 37678577 | doi = 10.1016/j.jaci.2023.08.029 | doi-access = free | title-link = doi }} Among monoclonal antibodies, dupilumab and tralokinumab are approved to treat moderate-to-severe eczema in the US and the EU.{{cite web |date=28 March 2017 |title=FDA approves new eczema drug Dupixent |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |url-status=live |archive-url=https://web.archive.org/web/20170328204026/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm549078.htm |archive-date=28 March 2017 |access-date=29 March 2017 |publisher=US Food & Drug Administration}}{{Cite web |date=17 September 2018 |title=Dupixent |url=https://www.ema.europa.eu/en/medicines/human/EPAR/dupixent |access-date=22 March 2023 |website=European Medicines Agency }}{{cite web |date=20 April 2021 |title=Adtralza EPAR |url=https://www.ema.europa.eu/en/medicines/human/EPAR/adtralza |access-date=9 July 2021 |website=European Medicines Agency (EMA)}} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.{{cite web |date=27 December 2021 |title=Drug Approval Package: ADBRY |url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2022/761180Orig1s000TOC.cfm |access-date=6 March 2022 |publisher=US Food & Drug Administration}} Lebrikizumab is also approved in the EU for treating moderate-to-severe AD{{Cite web |title=Ebglyss |url=https://www.ema.europa.eu/en/medicines/human/EPAR/ebglyss |access-date=15 April 2024 |website=European Medicines Agency|date=21 November 2023 }} but in the US its approval was declined due to manufacturing issues.{{Cite web |title=FDA Rejects Lilly's Eczema Treatment Over Third-Party Manufacturing Issues |url=https://www.biospace.com/article/fda-rejects-lilly-s-eczema-treatment-over-third-party-manufacturing-issues/ |access-date=3 October 2023 |website=BioSpace|date=2 October 2023 }} Abrocitinib and upadacitinib have also been approved in the US for the treatment of moderate-to-severe eczema.{{cite press release |title=U.S. FDA Approves Pfizer's Cibinqo (abrocitinib) for Adults with Moderate-to-Severe Atopic Dermatitis |website=Pfizer Inc. |date=14 January 2022 |url=https://www.pfizer.com/news/press-release/press-release-detail/us-fda-approves-pfizers-cibinqor-abrocitinib-adults |access-date=16 January 2022}}{{cite press release |url=https://news.abbvie.com/news/press-releases/us-fda-approves-rinvoq-upadacitinib-to-treat-adults-and-children-12-years-and-older-with-refractory-moderate-to-severe-atopic-dermatitis.htm |title=U.S. FDA Approves Rinvoq (upadacitinib) to Treat Adults and Children 12 Years and Older with Refractory, Moderate to Severe Atopic Dermatitis |website=AbbeVie |access-date=6 March 2022}} Nemolizumab (Nemluvio) was approved to treat atopic dermatitis in December 2024.https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761391s000lbl.pdf

Allergen immunotherapy may be effective in relieving symptoms of AD, but it also comes with an increased risk of adverse events.{{cite journal | vauthors = Yepes-Nuñez JJ, Guyatt GH, Gómez-Escobar LG, Pérez-Herrera LC, Chu AW, Ceccaci R, Acosta-Madiedo AS, Wen A, Moreno-López S, MacDonald M, Barrios M, Chu X, Islam N, Gao Y, Wong MM, Couban R, Garcia E, Chapman E, Oykhman P, Chen L, Winders T, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel J, Wang J, Wheeler KE, Schneider L, Chu DK | title = Allergen immunotherapy for atopic dermatitis: Systematic review and meta-analysis of benefits and harms | journal = The Journal of Allergy and Clinical Immunology | volume = 151 | issue = 1 | pages = 147–158 | date = January 2023 | pmid = 36191689 | doi = 10.1016/j.jaci.2022.09.020 | s2cid = 252656283 | doi-access = free | title-link = doi | hdl = 10576/44628 | hdl-access = free }} This treatment consists of a series of injections or drops under the tongue of a solution containing the allergen.{{cite journal | vauthors = Tam H, Calderon MA, Manikam L, Nankervis H, García Núñez I, Williams HC, Durham S, Boyle RJ | title = Specific allergen immunotherapy for the treatment of atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 2 | pages = CD008774 | date = February 2016 | pmid = 26871981 | pmc = 8761476 | doi = 10.1002/14651858.CD008774.pub2 | hdl-access = free | hdl = 10044/1/31818 }}

The skin of people with AD can easily get infected, most commonly by the bacteria Staphylococcus aureus. Signs of this include oozing fluid, a yellow crust on the skin, worsening eczema symptoms and fever. Antibiotics are commonly used to target overgrowth of S. aureus but their benefit is limited, and they increase the risk of antimicrobial resistance. For these reasons, they are only recommended for people who not only present symptoms on the skin but feel systematically unwell.{{Cite web |date=2 March 2021 |title=Secondary bacterial infection of eczema and other common skin conditions: antimicrobial prescribing. NICE guideline [NG190] |url=https://www.nice.org.uk/guidance/ng190/chapter/Recommendations |access-date=26 July 2024 |website=National Institute for Health and Care Excellence}}

The role of vitamin D on atopic dermatitis is not clear, but vitamin D supplementation may improve its symptoms.{{cite journal | vauthors = Dębińska A, Sikorska-Szaflik H, Urbanik M, Boznański A | title = The role of vitamin D in atopic dermatitis | journal = Dermatitis | volume = 26 | issue = 4 | pages = 155–161 | year = 2015 | pmid = 26172483 | doi = 10.1097/DER.0000000000000128 | type = Review | s2cid = 35345939 }}{{cite journal | vauthors = Kim G, Bae JH | title = Vitamin D and atopic dermatitis: A systematic review and meta-analysis | journal = Nutrition | volume = 32 | issue = 9 | pages = 913–920 | date = September 2016 | pmid = 27061361 | doi = 10.1016/j.nut.2016.01.023 | type = Systematic Review and Meta-Analysis }}{{cite journal | vauthors = Hattangdi-Haridas SR, Lanham-New SA, Wong WH, Ho MH, Darling AL | title = Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children | journal = Nutrients | volume = 11 | issue = 8 | pages = 1854 | date = August 2019 | pmid = 31405041 | pmc = 6722944 | doi = 10.3390/nu11081854 | doi-access = free | title-link = doi }}

There is no clear benefit for pregnant mothers taking omega 3 long-chain polyunsaturated fatty acid (LCPUFA) in preventing the development of AD in their child.{{cite journal | vauthors = Venter C, Agostoni C, Arshad SH, Ben-Abdallah M, Du Toit G, Fleischer DM, Greenhawt M, Glueck DH, Groetch M, Lunjani N, Maslin K, Maiorella A, Meyer R, Antonella M, Netting MJ, Ibeabughichi Nwaru B, Palmer DJ, Palumbo MP, Roberts G, Roduit C, Smith P, Untersmayr E, Vanderlinden LA, O'Mahony L | title = Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology | journal = Pediatric Allergy and Immunology | volume = 31 | issue = 8 | pages = 889–912 | date = November 2020 | pmid = 32524677 | pmc = 9588404 | doi = 10.1111/pai.13303 | veditors = Peters R }}{{cite journal | vauthors = Trikamjee T, Comberiati P, D'Auria E, Peroni D, Zuccotti GV | title = Nutritional Factors in the Prevention of Atopic Dermatitis in Children | journal = Frontiers in Pediatrics | volume = 8 | pages = 577413 | date = 12 January 2021 | pmid = 33585361 | pmc = 7874114 | doi = 10.3389/fped.2020.577413 | doi-access = free | title-link = doi }}

Several probiotics seem to have a positive effect, with a roughly 20% reduction in the rate of AD.{{cite journal | vauthors = Makrgeorgou A, Leonardi-Bee J, Bath-Hextall FJ, Murrell DF, Tang ML, Roberts A, Boyle RJ | title = Probiotics for treating eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 11 | pages = CD006135 | date = November 2018 | pmid = 30480774 | pmc = 6517242 | doi = 10.1002/14651858.CD006135.pub3 }}{{cite journal | vauthors = Rusu E, Enache G, Cursaru R, Alexescu A, Radu R, Onila O, Cavallioti T, Rusu F, Posea M, Jinga M, Radulian G | title = Prebiotics and probiotics in atopic dermatitis | journal = Experimental and Therapeutic Medicine | volume = 18 | issue = 2 | pages = 926–931 | date = August 2019 | pmid = 31384325 | pmc = 6639913 | doi = 10.3892/etm.2019.7678 }}{{cite journal | vauthors = Umborowati MA, Damayanti D, Anggraeni S, Endaryanto A, Surono IS, Effendy I, Prakoeswa CR | title = The role of probiotics in the treatment of adult atopic dermatitis: a meta-analysis of randomized controlled trials | journal = Journal of Health, Population, and Nutrition | volume = 41 | issue = 1 | pages = 37 | date = August 2022 | pmid = 35978397 | pmc = 9386980 | doi = 10.1186/s41043-022-00318-6 | doi-access = free | title-link = doi }} Probiotics containing multiple strains of bacteria seem to work the best.{{cite journal | vauthors = Chang YS, Trivedi MK, Jha A, Lin YF, Dimaano L, García-Romero MT | title = Synbiotics for Prevention and Treatment of Atopic Dermatitis: A Meta-analysis of Randomized Clinical Trials | journal = JAMA Pediatrics | volume = 170 | issue = 3 | pages = 236–242 | date = March 2016 | pmid = 26810481 | doi = 10.1001/jamapediatrics.2015.3943 | doi-access = free | title-link = doi }}

In people with celiac disease or nonceliac gluten sensitivity, a gluten-free diet improves their symptoms and prevents the occurrence of new outbreaks.

Use of blood specific IgE or skin prick tests to guide dietary exclusions with the aim of improving disease severity or control is controversial. Clinicians vary in their use of these tests for this purpose, and there are very limited evidence of any benefit.{{cite journal | vauthors = Roberts K, Gilbertson A, Dawson S, Turner N, Ridd MJ | title = Test-guided dietary exclusions for treating established atopic dermatitis in children: A systematic review | journal = Clinical and Experimental Allergy | volume = 52 | issue = 3 | pages = 442–446 | date = March 2022 | pmid = 34862822 | doi = 10.1111/cea.14072 | hdl-access = free | s2cid = 244872550 | hdl = 1983/693f4124-283d-4a11-adb3-21e1916330be | url = https://research-information.bris.ac.uk/en/publications/693f4124-283d-4a11-adb3-21e1916330be }}

Health professionals often recommend that people with AD bathe regularly in lukewarm baths, especially in salt water, to moisten their skin.{{cite journal | vauthors = Lio PA | title = Non-pharmacologic therapies for atopic dermatitis | journal = Current Allergy and Asthma Reports | volume = 13 | issue = 5 | pages = 528–538 | date = October 2013 | pmid = 23881511 | doi = 10.1007/s11882-013-0371-y | s2cid = 40875822 }} Dilute bleach baths may be helpful for people with moderate and severe eczema, but only for people with Staphylococcus aureus.{{cite journal | vauthors = Bakaa L, Pernica JM, Couban RJ, Tackett KJ, Burkhart CN, Leins L, Smart J, Garcia-Romero MT, Elizalde-Jiménez IG, Herd M, Asiniwasis RN, Boguniewicz M, De Benedetto A, Chen L, Ellison K, Frazier W, Greenhawt M, Huynh J, LeBovidge J, Lind ML, Lio P, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Begolka WS, Schneider L, Chu DK | title = Bleach baths for atopic dermatitis: A systematic review and meta-analysis including unpublished data, Bayesian interpretation, and GRADE | journal = Annals of Allergy, Asthma & Immunology | volume = 128 | issue = 6 | pages = 660–668.e9 | date = June 2022 | pmid = 35367346 | doi = 10.1016/j.anai.2022.03.024 | s2cid = 247847598 | doi-access = free | title-link = doi }}

Avoiding large-diameter woolen clothing or scratchy fibres is usually recommended for people with AD as they can trigger a flare.{{cite journal | vauthors = Jaros J, Wilson C, Shi VY | title = Fabric Selection in Atopic Dermatitis: An Evidence-Based Review | journal = American Journal of Clinical Dermatology | volume = 21 | issue = 4 | pages = 467–482 | date = August 2020 | pmid = 32440827 | doi = 10.1007/s40257-020-00516-0 | s2cid = 218761019 }}{{Cite web |date=11 February 2020 |title=Clothing and eczema |url=https://eczema.org/information-and-advice/triggers-for-eczema/clothing-and-eczema/ |access-date=10 April 2023 |website=National Eczema Society }} Safe alternatives are clothes made from fabrics with smaller diameters and smooth fibers. These include super- and ultrafine merino wool and fabrics with anti-microbial textile finishes. Wearing silk is also safe but does not improve symptoms of AD.{{cite journal | vauthors = Thomas KS, Bradshaw LE, Sach TH, Cowdell F, Batchelor JM, Lawton S, Harrison EF, Haines RH, Ahmed A, Dean T, Burrows NP, Pollock I, Buckley HK, Williams HC, Llewellyn J, Crang C, Grundy JD, Guiness J, Gribbin A, Wake EV, Mitchell EJ, Brown SJ, Montgomery AA | title = Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial | journal = Health Technology Assessment | volume = 21 | issue = 16 | pages = 1–260 | date = April 2017 | pmid = 28409557 | pmc = 5410632 | doi = 10.3310/hta21160 }}

Living with AD requires a high level of self-management (for example avoiding triggers) and adherence to treatments (regularly applying medication). Good self-management contributes to better disease outcomes and quality of life.{{cite journal | vauthors = Ridd MJ, King AJ, Le Roux E, Waldecker A, Huntley AL | title = Systematic review of self-management interventions for people with eczema | journal = The British Journal of Dermatology | volume = 177 | issue = 3 | pages = 719–734 | date = September 2017 | pmid = 28432696 | pmc = 5637890 | doi = 10.1111/bjd.15601 }}{{cite journal | vauthors = Teasdale E, Muller I, Sivyer K, Ghio D, Greenwell K, Wilczynska S, Roberts A, Ridd MJ, Francis N, Yardley L, Thomas KS, Santer M | title = Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies | journal = The British Journal of Dermatology | volume = 184 | issue = 4 | pages = 627–637 | date = April 2021 | pmid = 32531800 | doi = 10.1111/bjd.19299 | hdl = 1983/05ffa4c9-3868-469d-97b6-ac467bdf95b3 | hdl-access = free }} However, worries about topical treatments, misconceptions about the condition, unclear information and unsuitable communication from doctors can make living with AD more difficult.

People with AD often do not regard eczema as long-term condition and hope they will outgrow or cure it. This can cause worse adherence to the necessary long-term treatment. Doctors should not imply that it is a short-term condition and should emphasise that even though it cannot be cured it can be controlled effectively.{{Cite report |url=https://evidence.nihr.ac.uk/alert/eczema-misconceptions-hinder-long-term-treatment/ |title=Addressing misconceptions about eczema could help people manage their condition over the long term |date=9 December 2020 |publisher=NIHR Evidence |doi=10.3310/alert_42973 }}

Appropriate communication from doctors can support self-management. Doctors need to address concerns about treatments and provide clear and consistent information about the condition. Treatment regimens can be confusing, and written action plans may support people in knowing which treatments to use where and when.{{cite journal | vauthors = Thandi CS, Constantinou S, Vincent R, Ridd MJ | title = Where and how have written action plans for atopic eczema/dermatitis been developed and evaluated? Systematic review | journal = Skin Health and Disease | volume = 3 | issue = 3 | pages = e213 | date = June 2023 | pmid = 37275422 | pmc = 10233085 | doi = 10.1002/ski2.213 | s2cid = 257729897 }} A website supporting self-management has been shown to improve AD symptoms for parents, children, adolescents and young adults.{{Cite journal |date=11 April 2023 |title=Online support improved eczema symptoms in children and young people |url=https://evidence.nihr.ac.uk/alert/online-support-improved-eczema-symptoms-in-children-and-young-people/ |journal=NIHR Evidence |type=Plain English summary |publisher=National Institute for Health and Care Research |doi=10.3310/nihrevidence_57579|s2cid=258094184 }}{{cite journal | vauthors = Santer M, Muller I, Becque T, Stuart B, Hooper J, Steele M, Wilczynska S, Sach TH, Ridd MJ, Roberts A, Ahmed A, Yardley L, Little P, Greenwell K, Sivyer K, Nuttall J, Griffiths G, Lawton S, Langan SM, Howells LM, Leighton P, Williams HC, Thomas KS | title = Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials | journal = BMJ | volume = 379 | pages = e072007 | date = December 2022 | pmid = 36740888 | doi = 10.1136/bmj-2022-072007 | pmc = 11778922 | hdl-access = free | s2cid = 254367009 | hdl = 1983/6003736c-fa64-47a6-9ca7-984ba6a3bad1 }}

Phototherapic treatment involves exposure to broad- or narrow-band ultraviolet (UV) light. UV radiation exposure has been found to have a localized immunomodulatory effect on affected tissues and may be used to decrease the severity and frequency of flares.{{cite journal | vauthors = Tintle S, Shemer A, Suárez-Fariñas M, Fujita H, Gilleaudeau P, Sullivan-Whalen M, Johnson-Huang L, Chiricozzi A, Cardinale I, Duan S, Bowcock A, Krueger JG, Guttman-Yassky E | title = Reversal of atopic dermatitis with narrow-band UVB phototherapy and biomarkers for therapeutic response | journal = The Journal of Allergy and Clinical Immunology | volume = 128 | issue = 3 | pages = 583–93.e1–4 | date = September 2011 | pmid = 21762976 | pmc = 3448950 | doi = 10.1016/j.jaci.2011.05.042 }}{{cite journal | vauthors = Beattie PE, Finlan LE, Kernohan NM, Thomson G, Hupp TR, Ibbotson SH | title = The effect of ultraviolet (UV) A1, UVB and solar-simulated radiation on p53 activation and p21 | journal = The British Journal of Dermatology | volume = 152 | issue = 5 | pages = 1001–1008 | date = May 2005 | pmid = 15888160 | doi = 10.1111/j.1365-2133.2005.06557.x | s2cid = 22191753 }} Among the different types of phototherapies only narrowband (NB) ultraviolet B (UVB) exposure might help with the severity of AD and ease itching.{{cite journal | vauthors = Musters AH, Mashayekhi S, Harvey J, Axon E, Lax SJ, Flohr C, Drucker AM, Gerbens L, Ferguson J, Ibbotson S, Dawe RS, Garritsen F, Brouwer M, Limpens J, Prescott LE, Boyle RJ, Spuls PI | title = Phototherapy for atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 10 | issue = 10 | pages = CD013870 | date = October 2021 | pmid = 34709669 | pmc = 8552896 | doi = 10.1002/14651858.CD013870.pub2 | collaboration = Cochrane Skin Group }} However, UV radiation has also been implicated in various types of skin cancer, and thus UV treatment is not without risk.{{cite journal | vauthors = Jans J, Garinis GA, Schul W, van Oudenaren A, Moorhouse M, Smid M, Sert YG, van der Velde A, Rijksen Y, de Gruijl FR, van der Spek PJ, Yasui A, Hoeijmakers JH, Leenen PJ, van der Horst GT | title = Differential role of basal keratinocytes in UV-induced immunosuppression and skin cancer | journal = Molecular and Cellular Biology | volume = 26 | issue = 22 | pages = 8515–8526 | date = November 2006 | pmid = 16966369 | pmc = 1636796 | doi = 10.1128/MCB.00807-06 }} UV phototherapy is not indicated in young adults and children due to this risk of skin cancer with prolonged use or exposure.

While several Chinese herbal medicines are intended for treating atopic eczema, there is no evidence showing that these treatments, taken by mouth or applied topically, reduce the severity of eczema in children or adults.{{cite journal | vauthors = Gu S, Yang AW, Xue CC, Li CG, Pang C, Zhang W, Williams HC | title = Chinese herbal medicine for atopic eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2013 | issue = 9 | pages = CD008642 | date = September 2013 | pmid = 24018636 | pmc = 10639001 | doi = 10.1002/14651858.CD008642.pub2 }}

Atopic dermatitis significantly impairs the quality of life of affected individuals.{{cite journal | vauthors = Fasseeh AN, Elezbawy B, Korra N, Tannira M, Dalle H, Aderian S, Abaza S, Kaló Z | title = Burden of Atopic Dermatitis in Adults and Adolescents: a Systematic Literature Review | journal = Dermatology and Therapy | volume = 12 | issue = 12 | pages = 2653–2668 | date = December 2022 | pmid = 36197589 | pmc = 9674816 | doi = 10.1007/s13555-022-00819-6 }}{{cite journal | vauthors = Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D | title = The PRISMA 2020 statement: an updated guideline for reporting systematic reviews | journal = BMJ | volume = 372 | pages = n71 | date = March 2021 | pmid = 33782057 | pmc = 8005924 | doi = 10.1136/bmj.n71 }} The impact of AD extends beyond physical symptoms, encompassing substantial humanistic and psychosocial effects. Its burden is significant, especially given the high indirect costs and psychological impacts on quality of life.{{cite journal | vauthors = Marron SE, Cebrian-Rodriguez J, Alcalde-Herrero VM, Garcia-Latasa de Aranibar FJ, Tomas-Aragones L | title = Psychosocial Impact of Atopic Dermatitis in Adults: A Qualitative Study | journal = Actas Dermo-Sifiliograficas | volume = 111 | issue = 6 | pages = 513–517 | date = 1 July 2020 | pmid = 32401725 | doi = 10.1016/j.ad.2019.03.018 | doi-access = free | title-link = doi }}

According to the Global Burden of Disease Study, AD is the skin disease with the highest disability-adjusted life year burden and ranks in the top 15 of all nonfatal diseases. In comparison with other dermatological conditions like psoriasis and urticaria, AD presents a significantly higher burden.

While AD remains incurable, reducing its severity can significantly alleviate its burden. Understanding the extent of the burden of AD can aid in better resource allocation and prioritization of interventions, benefiting both people with atopic dermatitis and healthcare systems.{{cite journal | vauthors = Silverwood RJ, Mansfield KE, Mulick A, Wong AY, Schmidt SA, Roberts A, Smeeth L, Abuabara K, Langan SM | title = Atopic eczema in adulthood and mortality: UK population-based cohort study, 1998-2016 | journal = The Journal of Allergy and Clinical Immunology | volume = 147 | issue = 5 | pages = 1753–1763 | date = May 2021 | pmid = 33516523 | pmc = 8098860 | doi = 10.1016/j.jaci.2020.12.001 }}

Atopic dermatitis significantly decreases the quality of life by affecting various aspects of people's lives. The psychological impact, often resulting in conditions like depression and anxiety, is a major factor leading to decreased quality of life. Sleep disturbances, commonly reported in people with AD, further contribute to the humanistic burden, affecting daily productivity and concentration.

Economically, AD imposes a substantial burden on healthcare systems, with the average direct cost per patient estimated at US $4411 and the average indirect cost reaching US $9068 annually. These figures highlight the considerable financial impact of the disease on healthcare systems and people with the condition.{{cite journal | vauthors = Pedersen CJ, Uddin MJ, Saha SK, Darmstadt GL | title = Prevalence and psychosocial impact of atopic dermatitis in Bangladeshi children and families | journal = PLOS ONE | volume = 16 | issue = 4 | pages = e0249824 | date = 16 April 2021 | pmid = 33861780 | pmc = 8051797 | doi = 10.1371/journal.pone.0249824 | bibcode = 2021PLoSO..1649824P | doi-access = free | title-link = doi }}{{Cite web |title=World Bank Country and Lending Groups – World Bank Data Help Desk |url=https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups |access-date=14 January 2024 |website=datahelpdesk.worldbank.org}}

Atopic dermatitis also has a marked impact on productivity. The total number of days lost annually due to these factors is about 68.8 days for the general AD population, with presenteeism accounting for the majority of these days. The impact on productivity varies significantly with the severity of AD, with more severe cases resulting in higher numbers of days lost.{{cite journal | vauthors = Avena-Woods C | title = Overview of atopic dermatitis | journal = The American Journal of Managed Care | volume = 23 | issue = 8 Suppl | pages = S115–S123 | date = June 2017 | pmid = 28978208 | url = https://pubmed.ncbi.nlm.nih.gov/28978208/?dopt=Abstract }}

Atopic dermatitis leads to the highest loss in disability-adjusted life years compared to other skin diseases in the Middle East and Africa.{{cite journal | vauthors = Elezbawy B, Fasseeh AN, Fouly E, Tannira M, Dalle H, Aderian S, Abu Esba LC, Al Abdulkarim H, Ammoury A, Altawil E, Al Turaiki A, Albreiki F, Al-Haddab M, Al-Lafi A, Alowayesh M, Al-Sheikh A, Elsayed M, Elshamy A, Eshmawi M, Farag A, Hamadah I, Hedibel M, Kannenberg S, Karam R, Metni M, Raboobee N, Steinhoff M, Abaza S, Farghaly M, Kaló Z | title = Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region | journal = Dermatology and Therapy | volume = 13 | issue = 1 | pages = 131–146 | date = January 2023 | pmid = 36445612 | pmc = 9823172 | doi = 10.1007/s13555-022-00857-0 }} Patients with AD in these regions lose approximately 0.19 quality-adjusted life years (QALYs) annually due to the disease. Egypt experiences the highest QALY loss and Kuwait the lowest.

The average annual healthcare cost per patient varies is highest in the United Arab Emirates, estimated at US $3569, and lowest in Algeria at US $312. These costs are influenced by the economic status of each country and the cost of healthcare. Advanced treatments like targeted therapies and phototherapy are among the main cost drivers.

Indirect costs, primarily due to productivity loss from absenteeism and presenteeism average about 67% in these countries. Indirect costs in Saudi Arabia are the highest in the area, estimated at US $364 million. Factors like mental health impact, side effects of treatments, and other indirect costs such as personal care products are not fully accounted for in these estimates, suggesting that the actual burden might be even higher.

To mitigate the burden of AD, experts recommend strategic actions across five key domains: capacity building, guidelines, research, public awareness, and patient support and education. Key measures include increasing the number of dermatologists, establishing evidence-based treatment guidelines, investing in patient education, and enhancing public awareness to reduce stigma.{{cite journal | vauthors = Elezbawy B, Farghaly M, Al Lafi A, Gamal M, Metni M, Visser W, Al-Abdulkarim H, Hedibel M, Fasseeh AN, Abaza S, Kaló Z | title = Strategic Approaches to Reducing the Burden of Atopic Dermatitis in the Middle East and Africa Region | journal = Value in Health Regional Issues | volume = 42 | pages = 100987 | date = July 2024 | pmid = 38703753 | doi = 10.1016/j.vhri.2024.100987 | doi-access = free | title-link = doi }} Improving access to effective treatments and conducting further research on AD's impact are also crucial for reducing the disease's clinical, economic, and humanistic burdens in the MEA.

Since the beginning of the 20th century, many inflammatory skin disorders have become more common; AD is a classic example of such a disease. Although AD was previously considered primarily a childhood disease, it is now recognized as highly prevalent in adults, with an estimated adult prevalence of 3–5% globally. It now affects 15–30% of children and 2–10% of adults in developed countries, and in the United States has nearly tripled in the past 30–40 years.{{cite journal | vauthors = Saito H | title = Much atopy about the skin: genome-wide molecular analysis of atopic eczema | journal = International Archives of Allergy and Immunology | volume = 137 | issue = 4 | pages = 319–325 | date = August 2005 | pmid = 15970641 | doi = 10.1159/000086464 | s2cid = 20040720 }} Over 15 million American adults and children have AD.{{cite web | url = http://www.uchospitals.edu/online-library/content=P01675 | title = Atopic Dermatitis | date = 1 January 2015 | work = www.uchospitals.edu | access-date = 2 April 2015 | archive-url = https://web.archive.org/web/20150408150538/http://www.uchospitals.edu/online-library/content%3DP01675 | archive-date = 8 April 2015 }}

A number of false and conspiratorial claims about AD have emerged on the internet and have been amplified by social media. These conspiracy theories include, among others, claims that AD is caused by 5G, formaldehyde in food, vaccines, and topical steroids. Various unproven theories also claim that vegan diets, apple cider vinegar, calendula, and witch hazel can cure AD and that air purifiers reduce the risk of developing AD.{{cite journal | vauthors = O'Connor C, Murphy M | title = Scratching the surface: a review of online misinformation and conspiracy theories in atopic dermatitis | journal = Clinical and Experimental Dermatology | volume = 46 | issue = 8 | pages = 1545–1547 | date = December 2021 | pmid = 33864398 | doi = 10.1111/ced.14679 | hdl-access = free | s2cid = 233278383 | hdl = 10468/11402 }}

Leukotriene receptor antagonists, such as montelukast, might be a useful for the treatment of AD but their effectiveness has not yet been proven by research.{{cite journal | vauthors = Chin WK, Lee SW | title = A systematic review on the off-label use of montelukast in atopic dermatitis treatment | journal = International Journal of Clinical Pharmacy | volume = 40 | issue = 5 | pages = 963–976 | date = October 2018 | pmid = 29777328 | doi = 10.1007/s11096-018-0655-3 | s2cid = 21753181 }}{{cite journal | vauthors = Ferguson L, Futamura M, Vakirlis E, Kojima R, Sasaki H, Roberts A, Mori R | title = Leukotriene receptor antagonists for eczema | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 10 | pages = CD011224 | date = October 2018 | pmid = 30343498 | pmc = 6517006 | doi = 10.1002/14651858.cd011224.pub2 }}{{cite journal | vauthors = Toledo LM, Rodriguez R, Sivesind TE, Vakirlis E, Kojima R, Dellavalle RP | title = From the Cochrane Library: Leukotriene Receptor Antagonists for Eczema | journal = JMIR Dermatology | volume = 7 | pages = e50434 | date = April 2024 | pmid = 38607671 | pmc = 11053388 | doi = 10.2196/50434 | doi-access = free | title-link = doi }}

{{Reflist}}

{{Medical resources

| ICD10 = {{ICD10|L|20||l|20}}

| ICD9 = {{ICD9|691.8}}

| ICDO =

| DiseasesDB=4113

| OMIM = 603165

| MedlinePlus = 000853

| eMedicineSubj = emerg

| eMedicineTopic = 130

| eMedicine_mult = {{eMedicine2|derm|38}} {{eMedicine2|ped|2567}} {{eMedicine2|oph|479}}

| MeshID = D003876

}}

{{Commons category|Atopic dermatitis}}

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{{Allergic conditions}}

{{Diseases of the skin and subcutaneous tissue}}

{{Hypersensitivity and autoimmune diseases}}

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Category:Type I hypersensitivity

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