Introduction
Eczema, also referred to as atopic dermatitis (AD), is a chronic inflammatory skin condition that mostly affects both children and adults. Eczema is a significant global health issue that results in a substantial burden to individuals with the condition and society. With a prevalence in children of 15-30% and 2-10% in adults, the skin condition is characterised by symptoms like red, dry, itchy, and inflamed skin (Birdi et al., 2020). Despite there being no cure for eczema, most people have managed this condition using prescribed medications such as topical corticosteroids, emollients, and oral treatments, including antihistamines and immunosuppressant tablets. Eczema is caused by a complex interplay between environmental, genetic, societal, and lifestyle factors, leaving affected individuals with inflamed skin and negative implications on their quality of life. Therefore, eczema, influenced by multiple factors, exerts significant effects on the social and psychological aspects of individuals’ lives, emphasising the imperative for comprehensive approaches to its management and treatment.
Causes
According to Musters et al. (2021), the pathophysiology of eczema is sophisticated and entails multiple interplay between genetic and external factors. The genetic element is highlighted by the identification of mutations in the filaggrin gene, a skin barrier protein. However, some individuals with eczema may not have filaggrin mutations, suggesting the involvement of other genes and environmental factors. The exposome is the totality of external factors individuals are exposed to throughout their lifespan (Musters et al., 2021). Exposomal influences play an integral role in the pathogenesis of eczema and are divided into nonspecific and specific exposures. Nonspecific exposures include natural and human factors, while specific exposures include environmental factors such as water hardness, pollution, ultraviolet radiation, humidity, allergens, and diet, and internal exposures like host cell interaction and microbiota of the skin and gut (Musters et al., 2021). For example, allergens such as mould, pollens, pets, and dust mites can lead to eczema. Eczema flares can also be caused by soy products, nuts and seeds, eggs, and dairy products. In addition, high and low humidity, as well as very hot and very cold temperatures, can bring out eczema. Other environmental causes of eczema include irritants such as disinfectants, shampoos, detergents, and soaps. Internal exposures, including microbes like the Staphylococcus aureus bacteria, certain fungi and viruses, can cause eczema. While genetic and environmental factors contribute to the development of eczema, other studies have explored the nature of environmental causes.
According to Luschkova et al. (2021), eczema is an environmental disease, with various factors such as biogenic, social and anthropogenic environmental factors contributing to its development. Social deprivation and stress negatively affect eczema symptoms. In recent decades, social change has resulted in a “Westernised” lifestyle related to the high prevalence of eczema in industrialised nations. Urbanisation results in a decrease in biodiversity and an increase in air pollution, which contributes to eczema symptoms (Luschkova et al., 2021). Individuals with eczema represent a vulnerable population burdened by increasing stress, air pollution, global warming, and climate change. For example, prenatal stress is associated with an increased risk of eczema, and stress is reported by patients as a trigger of exacerbating factors for eczema symptoms (Luschkova et al., 2021). Hence, the causes of eczema entail the interconnection between environmental, genetic, lifestyle, and societal factors; therefore, understanding such diverse factors is essential for the comprehensive management and treatment of eczema.
Effects
Eczema has significant effects on the affected individual’s well-being, both emotionally and physically. Symptoms of eczema include itchy, dry, and inflamed skin, which can be painful and distressing. Besides, such symptoms interfere with sleep and everyday life (Birdi et al., 2020; Ghio et al., 2021). For example, when the itching becomes bothersome, it can lead to irritability and fatigue, making individuals less productive. The continuous scratching linked to eczema can lead to skin breakage, exposing the skin to fungal, viral, and bacterial infections. The quality of life for individuals with eczema, particularly children, is compared to conditions such as cerebral palsy or cystic fibrosis, and eczema is noted to have an increased impact on health-related quality of life than diabetes and asthma (Ghio et al., 2021). Adolescents and young adults with eczema are susceptible to negative psychosocial effects. For instance, they are highly likely to experience increased levels of depression, anxiety and suicidal ideation and become victims of bullying, leading to reduced school performance. Such young people with visible eczema symptoms struggle to blend in with others since they feel different from their peers, thus negatively affecting their self-esteem.
Furthermore, according to a survey of 28 adolescents, many indicated that they faced social limitations in terms of choice of clothing, participation in activities, and social relationships (Ghio et al., 2021). Others avoided particular activities in order to prevent discomfort or judgment linked to their skin condition. Additionally, some individuals with eczema struggled to seek emotional support, leading some to depend on other people’s experiences shared through online blogs. According to Musters et al. (2021), eczema poses significant effects to society as a result of high medical costs, co-morbidities, and psychological effects. The Global Burden of Disease Study, which provides annually updated numbers regarding disease-related morbidity and mortality globally, indicated that eczema disease burden ranks 15th among all nonfactor diseases and has the largest disease burden among skin diseases, as measured by disability-adjusted life-years (Laughter et al., 2021). Research also highlights the effects of eczema on families, including financial burden. According to Ezzedine et al. (2020), family members of individuals with eczema are burned with dietary and household changes and costly or time-consuming treatment regimens that have a heavy financial impact. Thus, as individuals with eczema continue to manage their condition, it brings significant negative effects on their overall physical and emotional well-being and consequences to their families.
Conclusion
Eczema presents a complex challenge influenced by a multifaceted interaction of environmental, genetic, societal, and lifestyle factors. The causes of the skin condition range from environmental exposures to genetic mutation, which underscore the need for a comprehensive understanding for effectively managing and treating eczema. Its impacts extend beyond physical symptoms, considerably affecting the social and emotional well-being of individuals, especially children and adolescents. In addition, the condition’s burden on society, regarding psychological effects on families and healthcare costs, highlights the urgency for holistic strategies to manage the skin condition. Hence, as individuals continue to navigate the complexities of the causes and effects of eczema, collective efforts are required in order to improve the quality of life for those affected, as well as lessen the societal impacts of eczema.
References
Birdi, G., Cooke, R., & Knibb, R. C. (2020). Impact of atopic dermatitis on quality of life in adults: A systematic review and meta-analysis. International Journal of Dermatology, 59(4), e75–e91. https://doi.org/10.1111/ijd.14763
Ezzedine, K., Shourick, J., Merhand, S., Sampogna, F., & Taïeb, C. (2020). Impact of atopic dermatitis in adolescents and their parents: A French study. Acta Dermato-Venereologica, 100(17), adv00294. https://doi.org/10.2340/00015555-3653
Ghio, D., Greenwell, K., Muller, I., Roberts, A., McNiven, A., & Santer, M. (2021). Psychosocial needs of adolescents and young adults with eczema: A secondary analysis of qualitative data to inform a behaviour change intervention. British Journal of Health Psychology, 26(1), 214–231. https://doi.org/10.1111/bjhp.12467
Laughter, M. R., Maymone, M. B. C., Mashayekhi, S., Arents, B. W. M., Karimkhani, C., Langan, S. M., Dellavalle, R. P., & Flohr, C. (2021). The global burden of atopic dermatitis: Lessons from the Global Burden of Disease Study 1990-2017. The British Journal of Dermatology, 184(2), 304–309. https://doi.org/10.1111/bjd.19580
Luschkova, D., Zeiser, K., Ludwig, A., & Traidl-Hoffmann, C. (2021). Atopic eczema is an environmental disease. Allergologie Select, 5, 244–250. https://doi.org/10.5414/ALX02258E
Musters, A. H., Mashayekhi, S., Harvey, J., Axon, E., Lax, S. J., Flohr, C., Drucker, A. M., Gerbens, L., Ferguson, J., Ibbotson, S., Dawe, R. S., Garritsen, F., Brouwer, M., Limpens, J., Prescott, L. E., Boyle, R. J., & Spuls, P. I. (2021). Phototherapy for atopic eczema. The Cochrane Database of Systematic Reviews, 10(10), CD013870. https://doi.org/10.1002/14651858.CD013870.pub2
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