Atopic dermatitis (AD) is an inflammatory condition of the skin with genetic and environmental factors contributing to its etiology. Symptoms of intense irritation resulting in an uncontrollable urge to scratch cause abrasions which bleed and can lead to infection. AD is thought a result of abnormalities in the epidermis (skin) and the immune system.
AD, combined with allergic rhinitis and asthma, is part of triad of allergic conditions and may also include food allergies and allergic conjunctivitis. These conditions are associated with an IgE response by the body. Symptoms can be combined with other allergic symptoms – such as rhinitis and asthma.
Atopic dermatitis is often seen in childhood and is associated with a strong genetic predisposition - if one parent has AD the chances are more than 50% risk of development for their offspring. This increases up to 80% if both parents are atopic. The genetic alterations of the skin can include a loss of function mutations of a protein (filaggrin), needed for natural skin moisturisation - (Filament Aggregating Protein). This is seen in up to 30% of AD sufferers and predispose to allergic rhinitis, keratosis pilaris and ichthyosis vulgaris. AD can also result in sufferers feeling self-conscious, embarrassed and reduced self-esteem.
Atopic dermatitis is a chronic condition of the skin
Chronic atopic dermatitis can be difficult to treat as symptoms are exacerbated by infection, stress, changes in temperature and food sensitivities.
With chronic atopic dermatitis, the skin density thins resulting in degradation of its protective barrier function, reducing its ability to retain moisture and resist infection.
Skin can be dry and scaly, bleed and weep. Itching is intense and abrasions painful. Clothing and foot wear may cause further irritation.
Atopic dermatitis can be affected by changes in weather – extreme heat may result in increase in infection, and cold temperatures cause the skin to become dry. Food hypersensitivities (most commonly eggs, milk, peanuts and wheat) can further exacerbate symptoms.
Barrier protection of the skin
The skins has an important physical barrier which offers protection against external threats such as infectious agents (bacteria and fungii), chemicals, toxins and allergies. Internally, it protects against water loss and helps with maintaining skin balance.
Barriers of protection
- The lipid (sebum) barrier. One of the most important components of the skin is the lipid barrier found in the outermost layer. It is a lipid matrix composed of cholesterol, free fatty acids and ceramides. The lipids are changed in the skin of sufferers of AD.
- Tight junctions, located in the granular layer (below the stratum corneum), form a barrier both internally and externally.
- Antimicrobial peptides, produced in the deeper layers of the skin, are transported to the stratum corneum where they protect as a first line of defence against potential pathogens. Balancing the immune response, killing pathogens and wound healing. Skin flora works in synergy with antimicrobial peptides to protect the skin.
In AD, defects in the functioning of these barriers allows allergens and irritants to enter the skin. This results in inflammation, acute and/or chronic skin lesions, dryness and thinning skin. A decrease in the skin’s natural antimicrobial peptides in the epidermis contributes to colonization of bacteria, particularly, Staphylococcus aureus, worsening inflammation and leading to secondary infection. Scratching further increases inflammatory medicators.
Managing symptoms of Atopic dermatitis
Along with identifying, reducing or eliminating allergens, avoiding triggering factors and prescription medication, establishing a daily skin care routine can help with symptom management. Moisturisers improve barrier function and frequent application on the skin (at least twice a day) with therapeutic products can help reduce symptoms. Choose products containing the following therapeutic ingredients:
Colloidal oatmeal (Avena sativa) offers skin protection, antipruritic (stops the itch), and an anti-inflammatory action.
Glycyrrhiza glabra (licorice) contains the active ingredient, Glycyrrhetinic acid, which offers antioxidant and anti-inflammatory activity and was shown in studies to ameliorate symptoms of AD.
Plant oils containing high amounts of linoleic acid help with the essential lipid barrier layer and many offer anti-microbial, antioxidant, anti-inflammatory and antipruritic actions. Helianthus annus (sunflower seed oil), Cocos nucifera (coconut oil), Simmondsia chinesis (jojoba oil), Avena sativa (oat oil), Argania spinosa (argan oil) and Olea europaea (olive oil) are good choices.
Shea butter is extracted from the Vitellaria paradoxa tree and supports the lipid barrier layer as a ceremide precursor. It also offers anti-inflammatory and antioxidant actions. Shea butter has a thick, greasy texture which can help skin hydration.
Calendula officinalis L. (marigold) offers anti-inflammatory action.
Curcumin derived from the curcuma longa (turmeric) plant, offers antioxidant and anti-inflammatory action.
Matricaria recutita L. (German chamomile) offers an anti-inflammatory action, bactericidal and fungicidal activity and can support wound healing.
Althaea officinalis L. (marshmallow) offers anti-inflammatory action.
Hypericum perforatum L. (St. John's wort) offers anti-inflammatory action and was shown to reduce skin colonization by Staphylococcus aureus and improve the condition of the skin in patients with mild to moderate atopic dermatitis.
Honey, known for its therapeutic properties, offers antibacterial and anti-inflammatory action and is also beneficial in promoting wound healing and tissue regeneration.
Aloe vera (Aloe barbadensis) gel provides anti-inflammatory, anti-pruritic and antibacterial action and offers healing properties.
Tea tree oil (melaleuca oil) is an essential oil derived from the Australian plant Melaleuca alternifolia offering broad spectrum antimicrobial activity and anti-inflammatory properties.
Albizia lebbeck possesses anti-inflammatory activity.
Complementary therapies offer an adjunct to pharmaceutical prescriptions and should be discussed with a health- care provider on suitability of use.
References
- Atopic Dermatitis Atopic Dermatitis - StatPearls - NCBI Bookshelf (nih.gov)
- Sphingolipid - an overview | ScienceDirect Topics
- Skin barrier function - PMC (nih.gov)
- Endogenous Antimicrobial Peptide Expression in Response to Bacterial Epidermal Colonization https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711782/
- Glycyrrhetinic Acid - Genemedics
- Glycyrrhizin ameliorates atopic dermatitis-like symptoms through inhibition of HMGB1 - PubMed (nih.gov)
- Natural Oils for Skin-Barrier Repair: Ancient Compounds Now Backed by Modern Science - PubMed (nih.gov)
- Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796020/
- Complementary and alternative medicine treatments for common skin diseases: A systematic review and meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362305/
- Medicinal plants used in treatment of inflammatory skin diseases https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834722/
- Evaluation of the anti-inflammatory activity of the aqueous and ethanolic extracts of the leaves of Albizzia lebbeck in rats https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4833457/
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