Atopic dermatitis: more than “just a skin condition”

When Allie Lundy was 12, red itchy patches of dry skin appeared on her wrists and under her eyes. Because her sister had eczema as a baby, her mother recognized the signs. She took Allie to the doctor, and sure enough, they got the official diagnosis: atopic dermatitis (AD), the most common form of eczema. 

Although she had a close group of friends, Allie, who is now 31 and living in Victoria, B.C., still found herself being  bullied for her AD—she remembers a classmate asking her why she wouldn’t just go and wash her face. “It’s a very isolating condition,” she says. “It was something I always felt I had to try to hide.” And it only got worse. By high school, her eczema covered her from head to toe.

A lot changed after her diagnosis. She had to give up swimming because the chlorine irritated her skin. She had to change the clothes she wore (no wool or polyester), the sheets she slept in (cotton or bamboo only), the products she used (no fragrances) and, everywhere she went, she worried about the quality of the air or the cleanliness of the room as pollutants can aggravate AD. She also couldn’t go to friends’ houses if they had pets since pet dander is a common trigger for AD. “I always had to find different ways to have normal childhood experiences, like birthday parties, sleepovers and Halloween costumes,” she says. “People don’t realize how much your life revolves around your skin when you have eczema.”

Beyond the physical

Often the physical symptoms, which Allie describes as the deep pain of a bad sunburn combined with the relentless itch of a mosquito bite, cause an additional mental and psychosocial burden for patients. A survey by the Eczema Society of Canada found that 30 percent of children experienced anxiety related to their atopic dermatitis, 21 percent avoided social activities and 20 percent missed school. 

“The visual nature of the condition can be stigmatizing,” says Marissa Joseph, a physician at The Hospital for Sick Children in Toronto. The symptoms can affect a child’s self-esteem, wreak havoc on their sleep and lead to anxiety and depression, she says. “It’s also frustrating for parents who want to know what triggers to avoid and do everything right, but then their child gets a flare-up anyway. The problem is that atopic dermatitis is a chronic inflammatory condition that’s marked by good days and bad days.”

A common childhood occurrence

Joseph says it’s important for families to know that they’re not alone—AD affects two out of five Canadian children—and the condition is no one’s fault. AD is hereditary and occurs because proteins that maintain the skin’s barrier function don’t work properly. “The skin acts like a suit of armour and eczema causes cracks in that armour, making it vulnerable to outside allergens and irritants,” she says. While it most commonly manifests in infancy, it can also appear in adolescents and adults.

What parents can do

If you suspect your child has eczema, Joseph says to talk to your doctor because it’s a condition that can be well managed. The cornerstone of treatment, she says, is maintaining the skin barrier and keeping water in the skin to help prevent flare-ups. This can be achieved by bathing daily (not necessarily with cleanser) and applying bland emollients and prescription creams. “Moderate to severe symptoms may also require therapy, such as pills or injections,” she says. “The key is to speak with your doctor about an approach that is suitable for your child.”

To lighten the psychosocial burden, Allie recommends parents help their children figure out their own coping strategies. “It could be art, it could be music, it could be hiking—whatever helps their mental health,” she says. “It’s all about teaching them how to work through some of the challenges because they’re going to happen, no matter what. Having that extra support makes all the difference.”