Research & Education

Atopic Dermatitis


Atopic dermatitis (AD) is a chronic skin condition and type of eczema with the operative word being atopic. Atopy is the tendency to develop asthma and hay fever in addition to dermatitis. It is associated with other conditions such as food allergies and chronic rhinitis as well. The extremely dry scaly and itchy skin can eventually devolve into a weeping bloody situation that makes this normally protective barrier very prone to bacterial infections most commonly staph. The condition can start in early infancy and while many times the symptoms can significantly decrease over time or even disappear in many cases can last a lifetime.

Causative factors

The pathophysiology of the condition is complex and unfortunately ill-defined but what is known is that there appears to be a genetic component to the disease. Additionally an immune imbalance exists in this population affecting the sub-types of T-cells primarily Th1 and Th2. In healthy individuals these T-cells are normally in balance but in those with atopic dermatitis the Th2 cell type will dominate the Th1 cell type.

There is also evidence to support the hygiene hypothesis as a suggested cause of atopy. The hypothesis simply states that a lack of early childhood exposure to infectious agents symbiotic microorganisms like probiotics and parasites fails to provide the necessary exposure to pathogens that is required to teach the immune system to launch its defense responses against infectious organisms. This lack of exposure increases susceptibility to allergic diseases by suppressing the natural development of the immune system. Because of this we fail to induce a healthy Th1 response early in life so as we grow up we are more prone to developing Th2 induced diseases like atopic-related conditions.

Specific pathogenic microbes have also been associated with the development of distinct forms of atopic conditions as well indicating a possible clinical need for pathogenic identification as part of the development of a treatment protocol. For instance both E. coli and Clostridium difficile may be involved with the pathophysiology of eczema.

Because of the development of an immune imbalance we now know that individuals with atopic conditions have an increased risk of contracting a variety of viral borne conditions and infections.

Nutrition support

Therapeutically there are many alternatives to the typical course of steroidal medications and anti-inflammatories. Probiotics for instance have displayed a dramatic and remarkable ability to positively affect atopic dermatitis as well as helping as a prophylactic agent.

Vitamin D supplementation also has been shown to dramatically improve the symptoms of the condition as well.

Borage oil is made from the seeds of the ubiquitous borage plant and is naturally high in the essential omega-6 fatty acid GLA. When used topically borage oil was shown to help mitigate the symptoms of AD.  The scientific literature is filled with research that suggests the preventative properties of omega-3 fatty acids in breast milk as a possible prophylactic for atopy including allergies.

Atopic dermatitis like many autoimmune or immune imbalanced conditions has high morbidity is complex and is difficult to treat. As the rates of these conditions continue to rise in the general population perhaps a focus on proper gestational nutrition with essentials like vitamin D probiotics and omega-3 fatty acids can help reduce this trend.

by Michael Fuhrman D.C.