A multitude of observations and study results show that atopic dermatitis is a so-called multi-factorial inheritance disorder. This means that the cause of the development as well as the appearance of the skin condition is a combination of genetic factors and environmental influences.
The cause may start with the weaning of babies off breast milk and the substitution of cow milk. The body (and the immune system) must of course adapt to this change, and there are often digestive reactions as well as related hormonal, neurologicial and naturally psychosomatic impacts. Furthermore, the causes can be allergy related and well as reactions to environmental contaminants and stress. As said, the condition likely involves a genetic predisposition to eczema, but the actually trigger of the skin condition may happen when one is an infant, a child, a teenager or even an adult.
When one suffers with atopic dermatitis, the immune system is out of balance and hypersensitive. Rather than only attacking substances harmful to the body, the body overreacts to harmless environmental irritations. Additionally, those who have the skin problem often also suffer with extremely dry skin which is caused by a disfunction in the protective and slightly acidic mantle of the skin. The skin looses moisture, becomes chapped and/or cracked and so is less able to protect itself from environmental influences. The unbearable itching which goes along with the dermatitis results in small scratches and cuts, a pathway for bacteria to enter the skin wherein eczema can result (eczema = a non-contagious inflammation of the dermis). The eczema appears red and swollen, often with weeping wounds and/or flaking skin. It's also very itchy, and this can naturally result in a viscous circle which can prevent healing.
One of the most common signs of the skin disease is extremely dry skin, the cause of which is false coding of an enzyme as a result of mutation. The skin is simply not able to produce enough natural oils to keep itself soft and supple. The cause: the activity of necessary enzymes seems to either be lessened and/or dysfunctional.
There are many potential allergens such as foods, house dust and pollen that we all encounter daily, but the body (specifically the immune system) of those who suffer with dermatitis can respond too aggressively. The cause of atopic dermatitis is a specific group of white blood cells – normally their function is to fight harmful pathogens, but in this case they overreact to the allergens or environmental irritations. This interplay between various immune system signalling proteins (cytokines) can lead to an inflammatory protective reaction in the skin. In addition, mast cells may release additional histamine, a cytokine which causes inflammation. The immune response thus grows and results in the itchy and irritated skin so well-known to those with the skin condition.
The intensely itchy skin is normally the main problem for those with the skin condition known as atopic dermatitis or eczema. The itchiness of the skin plays a central role in all phases of the skin problem. The itchy skin can lead to scratching – this can simply be because the skin is too dry. The result is a viscous circle of itching, scratching and irritation, making the atopic dermatitis worse. The symptoms are often worse at night, and that can mean poor-quality or lost sleep depending on the severity of the itching. Lack of sleep naturally leads to psychological stress. Relieving the itch is thus very important.
The fact that many who have atopic dermatitis often also suffer with allergies and sensitivities to certain substances is important to keep in mind. Possibilities include a reaction to dust of any kind (especially house dust), pollen, sunlight, animal fur or feathers. As the skin of people with the skin condition is very dry, it's also very sensitive to the external environment. In addition to the allergic reactions mentioned, it is also more susceptible to physical irritations such as contact with wool or other rough fabrics. Although the skin irritation is not caused by an allergy, itching and eczema can still be the result. As said, food reactions due to sensitivity or allergy also commonly are an important factor.
Skin infections are an additional cause, normally for a worsening of the condition. There can be a connection between dermatitis and the herpes simplex virus wherein a reaction results in eczema, sometimes accompanied by blisters. The first exposure to the virus can lead to a rather strong reaction with fever – this is sometimes treated with intravenous fluid. The skin of atopic dermatitis sufferers can also be widely infected with the Staphylococcus aureus bacteria, leading to a worsening in the condition of the skin and so making it more vulnerable to further infection – again, a vicious circle making it very difficult for the skin to heal.
The social aspect of the skin condition should also be remembered. The appearance of the red, itchy and irritated skin is naturally noticed by others, along with the frequent scratching. An outbreak of atopic dermatitis can thus lead to social isolation – this is also true for children. There's also the misplace fear of infection that many people have, causing avoidance and a fall in self-esteem for the atopic dermatitis sufferer. Children can feel especially left out and different than others their age as those with the skin condition also often seem to develop faster than their peers. The result is an extreme feeling of isolation, especially for children more affect by the skin problem.
A general rule: children of parents with atopic dermatitis are three times more likely to develop the condition.
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