A is for Atopic March

A for Atopic March - Does Atopic Dermatitis march off to something else?We’re still at the letter A and the last one was on the confusing nomenclature of Eczema versus Atopic Dermatitis. This week (pardon last week’s absence, can’t promise it won’t happen again though as I’m so tied up with work, family and doing other things I enjoy) we’re onto Atopic March. Sometime last year, DrFelix.co.uk (a registered online UK doctor and pharmacy service) contributed a write-up on Atopic Triad, which covers eczema, asthma and allergic rhinitis (hay fever).

Atopy is a genetic tendency to develop certain allergies. Most commonly, Eczema, Asthma and Hay Fever. In fact, if either parent has at least one of the three, there is a high chance that their child will also develop the condition. In these three ailments, the body areas become inflamed and produce excess immunoglobulin E (IgE) in response to harmless stimuli such as dust or pollen.

It is very common for people who experience eczema to also have asthma and hay fever. The connection between these conditions can be summarised by one word: hypersensitivity.

The body including the skin and respiratory system are over sensitive towards certain substances and they overreact when exposed. Rashes on the skin and a congested nose are all ways in which the body is trying to protect itself from something that it deems to be harmful. Unfortunately, this overreaction can be very uncomfortable and unnecessary.

There are also other connections between the Eczema and the development of Asthma. 50-70% of children with Eczema go on to develop Asthma. Recent research undertaken by Washington University School of Medicine has discovered that Eczema damaged skin produces a protein called thymic stromal lymphopoietin (TSLP). TSLP has also been found to directly cause asthma symptoms. This research is still in its early stages and this mechanism has not yet been fully confirmed in humans, but it shows a promising new direction for pharmaceutical research that may be able to stop the development of secondary conditions in their tracks.

Byline: Dr Samuel Malloy, Medical Director at DrFelix.

We understand that atopic conditions are related, in the sense one’s hypersensitivity may manifest in other than skin. But what about the term Atopic March? Does one condition literally marches your child off to another?

While it is more commonly noted that Atopic Dermatitis (Eczema) progresses to asthma and hay fever, the progression is not the same for every child.

Some recent research on this:

Skin Barrier Dysfunction and Atopic March 1 – It was noted in the study that the atopic conditions should be viewed as causally related, as they are conditions related to the lack of filaggrin gene. Recent studies on skin barrier dysfunction suggest that if we can treat the skin defects early, there is a chance of stopping the progression to other atopic conditions.

The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma 2 – It was noted that the “concept of the atopic march has been supported by cross-sectional and longitudinal studies“; however, “whether AD in the march is necessary for progression to other atopic disorders remains to be defined”. The conclusion was that it is important to identify infants at risk as it presents a critical window of opportunity for therapeutic intervention.

Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder 3 – The associations (even though causality is not proven) showed that AD is linked to the whole body, not just the skin.

Thus, while we see a progression of atopic conditions in a majority of children with eczema, it may not be a “march” of one onto another – not all children undergo the progression, and a few conditions may co-exist. What looks certain (and practical) is that there is urgency to treat the skin during infants as untreated eczema increases risks in many ways > scratching resulting in infection, dry and ‘porous’ skin to more opportunities for sensitization. Extract from WorldAllergy.org below:

From WorldAllergy.org

Atopic March is frequently misunderstood as the development from minor symptoms over a mild disease expression towards more severe chronic manifestations. It also has been misinterpreted as the exclusive development from atopic dermatitis in infancy to airway disease, particularly asthma in school-age. These interpretations have been shown to underestimate the variations and heterogeneity of atopy development during the first decade of life.


  1. Clausen, ML., Agner, T. & Thomsen, S.F. Curr Treat Options Allergy (2015) 2: 218. doi:10.1007/s40521-015-0056-y

  2. Zheng T, Yu J, Oh MH, Zhu Z. The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. Allergy Asthma Immunol Res. 2011 Apr;3(2):67-73. https://doi.org/10.4168/aair.2011.3.2.67

  3. Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder Brunner, Patrick M.Bagot, Martine et al. Journal of Investigative Dermatology , Volume 137 , Issue 1 , 18 – 25

A is for Atopic Dermatitis

Atopic Dermatitis or Atopic Eczema

An A that is as confused as our nomenclature

Well, the first step of recovery is acknowledging the problem. Borrowing from Alcoholics Anonymous, their 1st of the 12 steps is We admitted we were powerless over alcohol – that our lives had become unmanageable.

In our case, it is difficult to fully acknowledge the problem when we don’t know what the problem is. The irony is that there is difficulty defining the problem – in fact, the very term “atopic dermatitis” seems to be somewhat a matter of contention.

Mostly, we understand atopic dermatitis to refer to a chronic skin condition characterized by itch (pruritus), dry skin and inflammation, which waxes and wanes (with flare-ups). It is a multi-factorial condition, with causes and triggers linked to autoimmune and genetic factors, defective skin barrier, staph aureus bacteria colonization and hypersensitivity to allergens (including environmental ones like inhaled allergens, food allergens and contact allergens).

The difficulty is that there are many forms of dermatitis, and there are overlaps in symptoms and treatment. Broadly speaking, we want a way to differentiate whether we get the skin inflammation/ rashes because it is linked to immunoglobulin E (IgE) (antibodies produced by the immune system which defend the body but our immune system can wrongly recognize harmless substances as something to fight against, thus leading to allergic reaction). For instance, there are other forms of dermatitis where IgE is not involved, notably irritant contact dermatitis (where your skin develops rashes because it is in contact with a substance over a prolonged period).

There was an article published1 in European Journal of Allergy and Clinical Immunology in August 2016 which suggested the use of the term atopic dermatitis in literature, to differentiate from eczema which is commonly used to cover all forms of inflammatory rashes. Quoting from the article that reviews the existing literature:

Atopic dermatitis is the most commonly used term and appears to be increasing in popularity. Given that eczema is a nonspecific term that describes the morphological appearance of several forms of dermatitis, we strongly suggest the use of a more specific term, AD, in publications, healthcare clinician training, and patient education.

On the other hand, another article2 published in the Acta Dermatovenerol Croat highlighted that the Nomenclature Review Committee Of The World Allergy Organization recommended the term “eczema”. As extracted from World Allergy Organization website,

The umbrella term for a local inflammation of the skin should be dermatitis. What is generally known as “atopic eczema/dermatitis” is not one, single disease but rather an aggregation of several diseases with certain characteristics in common. A more appropriate term is eczema.

…eczema in a person of the atopic constitution, should be called atopic eczema.

The non-allergic variety can also be described by terms like irritant/toxic contact dermatitis.

I wonder why it seemed to be difficult to agree on whether it ought to be atopic dermatitis or atopic eczema, but inserting atopic does help to clarify that the skin condition should be rooted in IgE. Atopy as defined by the World Allergy Organization is:

Atopy is a personal and/or familial tendency, usually in childhood or adolescence, to become sensitized and produce IgE antibodies in response to ordinary exposure to allergens, usually proteins. As a consequence, such individuals can develop typical symptoms of asthma, rhinoconjunctivitis, or eczema. The terms ‘atopy’ and ‘atopic’ should be reserved to describe the genetic predisposition to become IgE-sensitized to allergens commonly occurring in the environment and to which everyone is exposed but to which the majority do not produce a prolonged IgE antibody response.

The “good news” is no matter what you call it, the way to treat it is the same – finding out the triggers, avoidance, moisturizing, steroidal and non-steroidal options, and lifestyle changes to reduce inflammation and staph bacteria colonization. The bad news is we will continue to wonder at the back of our mind whether we are contributing to misleading literature if we fail to clearly define what we’re writing about – well, at least for an eczema/ atopic dermatitis blogger like me, I certainly struggle. A cartoon for it:

Atopic dermatitis or man? Both are as confused!

Atopic dermatitis or man? Both are as confused!


  1. Kantor R, Thyssen JP, Paller AS, Silverberg JI. Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of ‘atopic dermatitis’. Allergy 2016; 71: 1480–1485.

  2. Zbigniew Samochocki, Rożalski M, Rudnicka L, Atopic and Non-atopic Eczema. Acta Dermatovenerol Croat 2016 Jun;24(2):110-5.

A is for Anxiety – Atopic Dermatitis ABC

Anxiety for Parents with Eczema Children

Anxiety – was it the first emotion when Atopic Dermatitis was diagnosed in your baby?

This year’s series is Atopic Dermatitis ABC – a lighthearted, be-there-with-you companion where the ABCs will act as your eczema survival guide. In just 5 minutes, I came up with 15 words that start with A that are related to atopic dermatitis (AD). I disregarded all of them (not because they’re wrong since we’d get to what is atopic dermatitis, autoimmune, allergies and avoidance), but because I remembered when I first learnt of my baby’s eczema, it’s not the medical terms that come to mind. It’s ANXIETY, and it comes from the heart. Your heart, my heart, the hearts of all parents who suddenly find themselves in a challenging situation. Something like this.

Atopic Dermatitis - Anxiety in Parents with Eczema Babies

This needs no caption.

It is normal to feel anxious when something has gone wrong, when something is happening to your baby, and when you’re not sure what that something is (didn’t the delivery hospital say rashes are to be expected? and ok?) and when even when you know what that something is, you can’t cure it and you’re never sure when it would come back? If your heart has started beating faster like mine, it may be that all these feelings and thoughts are anxious ones that come when we’re not in control. And the most paradoxical part is atopic dermatitis is about controlling the eczema, since you can’t quite cure it.

Wait, do you agree with me?


Fortunately, we’re not self-deluded. In an October 2016 study published in the Asia Pacific Allergy1 by researchers at Inha University Hospital, South Korea, 78 children with their parents took part in a study to examine the family quality of life (QoL). The mean age of parents was 37 years old (majority 87% mothers), and the mean age of their children was 5+ years old, having atopic dermatitis for about 2 years. The tests included questionnaires (including Satisfaction with Life Scale survey) and using score card to measure eczema severity (SCORAD index).

It was found that a low family quality of life was related to the eczema severity, when the children with atopic dermatitis were girls and the negative emotionality of parents. Parents of children with AD is known to be associated with depression and stress in previous studies.

In another study2 more than a decade earlier, published in British Journal of Dermatology in Feb 2004, researchers examined the psychosocial well-being of parents caring for a young child with AD. Out of 187 parents, it was observed that parents of children with a higher severity of atopic dermatitis reported a significantly higher impact on family functioning and a greater financial burden. The results showed the need to focus on parental well-being and ability to cope with stress and social strain.

The latest study3 on this was published in Acta Derm Venereol in February 2017 which concluded that quality of life was affected mothers more as moms spent more time caring for the eczema child and carried out more household duties.


Here’s the test4 that you can take:

Below are five statements that you may agree or disagree with. Using the 1 – 7 scale below, indicate your agreement with each item by placing the appropriate number on the line preceding that item. Please be open and honest in your responding.
7 – Strongly agree
6 – Agree
5 – Slightly agree
4 – Neither agree nor disagree
3 – Slightly disagree
2 – Disagree
1 – Strongly disagree

____ In most ways my life is close to my ideal.

____ The conditions of my life are excellent.

____ I am satisfied with my life.

____ So far I have gotten the important things I want in life.

____ If I could live my life over, I would change almost nothing.

31 – 35 Extremely satisfied
26 – 30 Satisfied
21 – 25 Slightly satisfied
20 Neutral
15 – 19 Slightly dissatisfied
10 – 14 Dissatisfied
5 –  9 Extremely dissatisfied

I hope you end up on the satisfied end of the scale, but if not, don’t be anxious – 5 questions are not going to determine your life’s happiness. Your child’s eczema condition is. (One question, in this eczema context).


  1. Jang HJ, Hwang S, Ahn Y, Lim DH, Sohn M, Kim JH. Family quality of life among families of children with atopic dermatitis. Asia Pacific Allergy. 2016;6(4):213-219. doi:10.5415/apallergy.2016.6.4.213.

  2. Warschburger, P., Buchholz, H.TH. and Petermann, F. (2004), Psychological adjustment in parents of young children with atopic dermatitis: which factors predict parental quality of life?. British Journal of Dermatology, 150: 304–311. doi: 10.1111/j.1365-2133.2004.05743.x

  3. Acta Derm Venereol. 2017 Feb 16. doi: 10.2340/00015555-2633

  4. Ed Diener, Robert A. Emmons, Randy J. Larsen and Sharon Griffin as noted in the 1985 article in the Journal of Personality Assessment

Atopic Dermatitis ABC

Atopic dermatitis, well it starts with “A” – how uncanny to start this year’s blog series on Atopic Dermatitis ABC! I’ve got the inspiration to work on a ABC series from reading the book “The Middle Class ABC – a toilet loo book” which shared funny facts about the British middle class – I love its hand lettering and cartoons, and would love this year’s blog posts to be filled with more lighthearted moments. And even more disturbingly coincidental, the first page of the book is on A for Allergies!

A is for Allergies

Page from the book “The Middle Class ABC” by Fi Cotter Craig and Zebedee Helm

I’d be working on my blogging calendar over this weekend, and hope to bring you regular blog posts from next week. Have a lovely weekend, and anyone has a fave letter to work on, leave a comment!

Related Posts Plugin for WordPress, Blogger...