• Dr. Alla Arutcheva


Updated: Mar 26, 2019

Multifactoral Elucidation of Atopic Dermatitis

Eczema is a skin disorder that may result in multiple effects on quality of life. Eczema is not only skin diseases but it involves other body organs and systems. Eczema is a general term for many types of skin inflammation (mostly atopic dermatitis, contact irritant eczema and contact allergic eczema) and may appear anywhere on the body.

Hand eczema is a common dermatological disorder in adults. This complication has annual prevalence of 10% and may cover more than 4% of the population (1).

Irritant contact eczema is a localized reaction that includes redness, itching, and burning where the skin has come into contact with an irritant such as a detergent (soap, body wash), some acids or other chemicals and some fabric.

Allergic contact eczema is a red, itchy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as nickel, gold, latex, perfume, poison ivy or certain preservatives in creams and lotions. Most cases of contact dermatitis (irritant and allergic) go away on their own once the substance is no longer in contact with the skin.

Atopic dermatitis (AD) is the most common and sever type of eczema and has a genetic mutation in their skin protein called filaggrin (1).

Some people can have a combination of different types of eczema.

Chronic exposure to irritants, frequent washing hands, using disinfectants, wet-work conditions disturbs the natural skin barrier and causes inflammation.

Symptoms of Eczema

Signs and symptoms of eczema vary widely from person to person and include: • Dry, sensitive and swollen skin •

Itching, which may be severe, especially at night •

Red or brown patches •

Raised bumps with fluid •

Thickened, cracked, scaly skin

Atopic dermatitis/Eczema

Although the pathophysiology of or atopic dermatitis (AD) has not been fully elucidated, it is currently believed to be due to a combination of genetic predisposition, skin barrier dysfunction, immune dysregulation, and environmental factors (2).

Our skin is a reflection of the inner health. In recent decades, a growing body of evidence demonstrates that AD and any other ‘skin disease’, can be accompanied by a variety of systemic disorders. Multiorgan involvement can be possible common underlying mechanisms of AD.

Multifactorial Elucidation of Atopic Dermatitis

Gut‐skin axis

Several dermatoses, including eczema, appear to have a gut‐skin connection (3). Eczema may be seen as a possible manifestation of a systemic problem involving gut dysbiosis and increased intestinal permeability (leaky gut), which may occur even in the absence of gastrointestinal signs.

Conventional anti‐inflammatory and antimicrobial therapies for skin disorders provide only temporary symptomatic relief. However, underlying factors such as intestinal permeability (4) and dysbiosis are mostly ignored. In addition, antibiotic therapy contributes to the development of antibiotic‐resistant microbes (5), destroy normal intestinal flora (Lactobacilli and Bifidobacteria) and promote overgrowth of Candida species.

AD has been found to be three times more common in patients with celiac disease than others (6,7).

Eczema and skin rash have also been reported in the people with ‘non‐celiac gluten sensitivity’ (8,9).

Skin lesions and atopic dermatitis are significantly associated with inflammatory bowel disease (IBD) (10).

Small intestinal bacterial overgrowth (SIBO) is being linked to a list of human health problems, including skin conditions (11). SIBO treatment in these patients has led to marked clinical improvement (12). Possible reasons for skin lesion development in SIBO include nutritional deficiency; impaired lipid metabolism; impaired immune‐system functioning; increased intestinal permeability. Intestinal bacteria produce a toxin (LPS), which spread all over the body with subsequent damage to the skin structure and barrier function (13).

Liver and skin

Our liver has numerous vital functions. One of the liver’s important roles is breaking down and eliminating toxins in the body. In case of AD and other skin problems the liver is not functioning optimally, becomes congested and less effective at broken down and eliminating toxins. So, these toxins are forced to be eliminated via the skin that damage and inflame the skin and resulting in different skin diseases. The weak liver function impacts the skin and provoke itching, rash, vesicles and cracking of the skin (14,15). AD is highly associated with changes in lipid metabolism regulated by the liver (16 17). Hence, poor skin quality is an indicator of weak liver function.

Minimizing stress

Over 80 years ago, two dermatologists, Stokes & Pillsbury (18) proposed a connection between gastrointestinal disorders, depression, anxiety and skin conditions and called it gut‐brain‐skin axis (19). It was suggested that emotional states might al