Is eczema an autoimmune disease?

By Jaja Tangwiwat

Eczema is a common non-contagious inflammatory skin disease, affecting 15-20% of children and 10% of adults. The skin condition is described as ‘inflammatory’, as people who have eczema tend to have an overactive immune system. When triggered by a substance inside or outside the body, the immune system responds by producing inflammation. This inflammatory response is what causes the itchy and rash-like symptoms common to several types of eczema. 

So, is eczema an autoimmune disease? The short answer is no. 

An autoimmune disease is defined as a condition where the immune system attacks the body’s own healthy tissue, such as diabetes type 1, where the body’s immune system targets and destroys insulin producing cells in the pancreas . Conversely, when a person has eczema, their immune response does not attack their own skin. Furthermore, although dysregulation of the immune response and inflammation play a key role in the symptoms of eczema, they are not the skin condition’s only cause. Eczema is also often caused by a combination of genetic, environmental factors, a weak skin barrier and many other additional factors. This is why eczema can not be technically categorized as an autoimmune disease. 

However, there are present correlations between the two. Similarly to autoimmune diseases, doctors frequently prescribe immunosuppressants (e.g. cyclosporine, azathioprine and methotrexate) to treat moderate to severe cases of eczema in children. These work by helping to control or suppress the immune system in order to improve symptoms by reducing the inflammatory process in the skin. 

Moreover, a heightened severity of eczema could lead to increased susceptibility of that person to an autoimmune disease and visa versa. A study from the Perelman School of Medicine at the University of Pennsylvania found that adults with atopic dermatitis (AD), a type of eczema, have a 34% increased risk of developing new onset inflammatory bowel disease (IBD) compared with individuals who do not have the skin condition, and children have a 44% increased risk. This newly found information could affect the treatment given by doctors, as “for patients with AD and another autoimmune disease, some currently available medications can exacerbate symptoms of their other disease or can help treat two immune diseases at the same time.”, said senior author Joel M Gelfand, MD, the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in the department of Dermatology at Penn.

Although the initial question of this article is extremely fascinating to ponder, the real significance of the association between the two lies in the further research that can be done to improve treatment of patients that have both autoimmune diseases and eczema. 

Bibliography

Chiesa Fuxench, Zelma C., et al. “Inflammatory Bowel Disease Linked to Atopic Dermatitis.” Www.pennmedicine.org, 19 Sept. 2023, www.pennmedicine.org/news/news-releases/2023/september/inflammatory-bowel-disease-linked-to-atopic-dermatitis#:~:text=PHILADELPHIA%20%E2%80%93%20Adults%20with%20atopic%20dermatitis. Accessed 24 July 2024.

Echeverri, Andrés F., and Gabriel J. Tobón. Autoimmune Diabetes Mellitus (Type 1A). Www.ncbi.nlm.nih.gov, El Rosario University Press, 18 July 2013, www.ncbi.nlm.nih.gov/books/NBK459476/.

Elsgaard, Stine, et al. “Drug Survival of Systemic Immunosuppressive Treatments for Atopic Dermatitis in a Long-Term Pediatric Cohort.” International Journal of Women’s Dermatology, vol. 7, no. 5, Dec. 2021, pp. 708–715, https://doi.org/10.1016/j.ijwd.2021.07.005. Accessed 2 May 2022.

National Eczema Association. “An Allergist Explains How to Identify Your Eczema Triggers.” National Eczema Association, 3 June 2018, nationaleczema.org/blog/beyond-the-eczema-rash/#:~:text=People%20with%20eczema%20tend%20to.

Nelson, Steve. “Is Eczema an Autoimmune Disease? Spoiler Alert: Nope.” National Eczema Association, 4 Apr. 2022, nationaleczema.org/blog/is-eczema-autoimmune-disease/.

NIAMS. “Atopic Dermatitis.” National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2022, www.niams.nih.gov/health-topics/atopic-dermatitis.

Warner, Daisy. “How Does Eczema Impact the Immune System?” Www.medicalnewstoday.com, 29 Nov. 2023, www.medicalnewstoday.com/articles/how-does-eczema-impact-the-immune-system.