Etiology of Atopic Dermatitis

Read more about Variable Presentations in Atopic Dermatitis

Various environmental, genetic, and social factors have been investigated to determine whether they contribute to the risk of developing atopic dermatitis. Numerous studies conclude that the most important of these are a family history of atopy and loss of function mutation in the FLG gene. Both are strongly associated with atopic dermatitis.

Other factors have been studied but show either no correlation or insufficient evidence to support a contribution to the development of atopic dermatitis. These include

• High birth weight (Sources: PLoS Med, The Journal of Pediatrics)
• Allergenic food introduction
• Socioeconomic position
• Postnatal antibiotic exposure (in the first year after birth)
• Maternal vitamin D status
• Exposure to tobacco smoke
• Antenatal infection
• Altered gut microflora
• Phthalate exposure
  

The complexity in the causes, symptoms, and disease course of atopic dermatitis means that primary prevention efforts are difficult to study.

The fact that not all infants with FLG gene mutations develop atopic dermatitis suggests that primary prevention may be possible.

Some studies show that emollients begun in the neonatal period may reduce the incidence of atopic dermatitis in infants who are at high risk for atopy.

• A systematic review and meta-analysis showed that emollient therapy can be used for the prevention of atopic dermatitis.
• Application of moisturizer to neonates prevents development of atopic dermatitis.
• Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention.

Determining the environmental factors that complement genetic components is a topic of current research efforts.