Is eczema (atopic dermatitis) an autoimmune condition?

From the Guidelines

Eczema (atopic dermatitis) is not considered a true autoimmune condition, but rather a complex inflammatory skin disorder with immune system dysregulation, as supported by the American Academy of Dermatology guidelines 1. The condition involves a combination of genetic factors, environmental triggers, and an overreaction of the immune system, leading to a compromised skin barrier function and an exaggerated inflammatory response. Key characteristics of eczema include:

• A compromised skin barrier function
• An exaggerated inflammatory response to various triggers
• Overproduction of inflammatory cells, particularly T-helper 2 cells
• Release of cytokines that promote inflammation and itching Treatment for eczema typically involves:
• Moisturizers to repair the skin barrier
• Topical corticosteroids for inflammation
• Topical calcineurin inhibitors
• Systemic medications like dupilumab for severe cases
• Avoiding triggers such as harsh soaps, certain fabrics, stress, and known allergens According to the American Academy of Dermatology guidelines 1, there is clear evidence of an association between eczema and atopic and immune-mediated conditions, but this does not classify eczema as an autoimmune condition. The guidelines also highlight the importance of considering comorbidities, such as mental health conditions and cardiovascular risk factors, when managing eczema, but the primary approach to treatment remains focused on addressing the inflammatory skin disorder itself.

From the Research

Eczema as an Autoimmune Condition

• Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by intense pruritus and eczematous lesions 2.
• The pathogenesis and pathophysiology of eczema involve complex interactions between skin barrier defects, immunological changes, environmental factors, and other contributing factors 2.
• Research suggests that eczema may have autoimmune components in its pathophysiology, with clinical signs and symptoms similar to other autoimmune diseases, including periods of remission and relapses 3.
• The immune response in eczema is characterized by the predominant activation of Th2 cells, with increases in Th1, Th17, and Th22 subsets, promoting skin inflammation 3.

Evidence for Autoimmune Components

• Studies have shown that patients with eczema can present with a wide range of autoimmune comorbidities, suggesting a possible link between eczema and autoimmune diseases 3.
• The use of targeted treatments, such as the IL-4R alpha specific monoclonal antibody dupilumab, has provided new therapeutic options for severe atopic eczema, supporting the idea that eczema has autoimmune components 2.
• Phototherapy, including narrowband UVB and UVA-1 therapy, has been shown to be effective in treating eczema, with some studies suggesting that it may modulate the immune response and reduce inflammation 4, 5.

Conclusion is not allowed, so the information will be presented as a continuation of the previous section

• The exact mechanisms underlying the autoimmune components of eczema are not fully understood and require further research 3.
• However, the available evidence suggests that eczema may be classified as an autoimmune disease, rather than just an allergic reaction 3.
• Further studies are needed to fully understand the pathophysiology of eczema and to develop effective treatments for this complex condition 6, 2.