Atopic dermatitis is a chronic skin disease that can cause loss of sleep, skin damage, negative self-image, anxiety, and depression.
Known as the most common chronic inflammatory skin disease, atopic dermatitis (AD) — also commonly known as eczema — burdens patients both physically and emotionally and is so much more than just dry, itchy skin. The disease can cause significant sleep loss, anxiety, and depression, and can substantially impact the quality of life of sufferers and caregivers.
“Think about a time you had a short-term itch, like an insect bite you couldn’t stop scratching. Maybe it woke you up or kept you awake at night for a few days,” says Dr. Rachel Netahe Asiniwasis, a dermatologist practising in Regina, SK. “People with AD live with itching long term and on many areas of their body. It doesn’t just go away naturally. And when it comes to sleep, think about a time that you lost a night of sleep. Imagine having that recurring throughout your life and how that would impact you at work, school, and home.”
Literature aside, I see the impact of itch on my patients suffering from AD every day.
Characterized as dry skin with patches that are red and often intensely itchy, AD is estimated to affect 11 percent of children and 7 percent of adults.1
In AD, the skin develops red, scaly, and crusted bumps, which are extremely itchy. AD has various levels of severity — mild, moderate, and severe. The severity of AD is based on the physical symptoms and how much of the body’s surface is affected.1 For example, moderate AD is often associated with broken skin or skin thickening, while severe AD causes more widespread dryness, incessant itching and inflammation, extensive skin thickening, oozing, and cracking. Scratching can lead to skin damage and bleeding. 2
Doctors don’t know exactly what causes AD, which is the most common type of dermatitis, but believe that it’s a combination of genetic and environmental factors. People with AD often have a family history of allergies or asthma or may develop allergies or asthma themselves.3
Dr. Asiniwasis says that chronic itch hasn’t yet received the level of attention of other conditions, such as chronic pain. “Peer-reviewed literature has demonstrated that the depth of impact that itch has on quality of life can be comparable to that of chronic pain, although more information is needed in this field. It’s time to start more conversation around this topic,” she says. “Literature aside, I see the impact of itch on my patients suffering from AD every day.”
The relentless physical symptoms of AD — persistent itching, pain, and skin damage— can significantly impact sleep, mood, and even self-esteem. The dis-ease can lead to difficulty with attention, negative effects on social and intimate relationships, poor school and work performance, and negative self-image. AD is regularly associated with anxiety and depression,4 which may cause sufferers to avoid social activities or miss work or school due to their disease. It can also make it difficult to participate in exercise or sports.
One of the main effects of AD, which in turn has a large impact on quality of life, is loss of sleep. The Eczema Society of Canada found that more than half (55 percent) of Canadians with severe AD reported being woken up every night due to itching. Caregivers and families of those with severe AD also suffer from a loss of sleep, as well as feelings of helplessness, guilt, and depression. Doctor and pharmacy visits, skincare routines, and lifestyle modifications can be draining to the point where caregivers have reported sleep disturbance, exhaustion, and social isolation.
“Caring for someone with AD can be challenging, with a significant physical and mental toll. Challenges caregivers face often go unnoticed,” says Dr. Asiniwasis, adding that caregivers should seek support, including asking family members for help and talking to their health care provider about how they can simplify management routines.
AD should never be dismissed as “just a skin problem,” says Dr. Asiniwasis. “Especially when moderate to severe and poorly controlled, AD is extremely debilitating on so many levels — physical, mental, psycho-social, and financial. It’s time to start the conversation and recognize this common disease and push for awareness, education, support groups, and medical treatments.”
While there are treatments and solutions available for the physical symptoms of AD, more work needs to be done to raise awareness of the psychosocial impacts the disease has on patients and their caregivers. With more awareness as well as the support of dermatologists, physicians, patient groups, caregivers, and members of the public, people living with AD can be empowered to live a healthy, normal life.
1Eczema Society of Canada: ESC Atopic Dermatitis Patient Journey Report. (2020) https://eczemahelp.ca/wp-content/uploads/2020/09/ ESC-Atopic-Dermatitis-Patient-Journey-Report-2020.pdf
2Eczema Society of Canada: ESC Itch in Atopic Dermatitis Survey. (2021) https://eczemahelp.ca/wp-content/uploads/2021/04/ESC-Itch-in-At-opic-Dermatitis-Survey-Report-2021-FIN.pdf
3Avena-Woods, Carmela. (2017). Overview of Atopic Dermatitis, American Journal of Managed Care, 23(8). https://www.ajmc.com/view/ overview-of-atopic-dermatitis-article
Eczema Society of Canada: Atopic Dermatitis Quality of Life Report. (2017) https://eczemahelp.ca/wp-content/uploads/2019/02/ESC_Quali- ty-of-Life-Report_Nov-2017-1.pdf
4Capozza, Korey, Gadd, Hayley, Kelley, Keri et al.(2020). Insights From Caregivers on the Impact of Pediatric Atopic Dermatitis on Families: “I’m Tired, Overwhelmed, and Feel Like I’m Failing as a Mother,” Dermatitis, 31(3), 223-227. https://journals.lww.com/dermatitis/Full-text/2020/05000/Insights_From_Caregivers_on_the_Impact_of.9.aspx