Atopic dermatitis is a common and complex condition, which can often be misdiagnosed as eczema or contact dermatitis by non-specialists. Excessive health information about the condition can lead to generalizations, with advice for a certain form of atopic dermatitis mistakenly applied to all types. Additionally, individuals with severe atopic dermatitis, characterized by painful skin rashes, are often discouraged from social activities due to the misconception that the condition is contagious.

In a three-part health talk show titled "Atopic Dermatitis Day: Healing and Hope Together," hosted by the Severe Atopic Dermatitis Association on Sept. 14 to commemorate World Atopic Dermatitis Day, Professor Kim Hyun-jung from the Department of Dermatology at Chungnam National University Sejong Hospital (CNUSH) addressed common misconceptions about atopic dermatitis. She also explained the characteristics of the condition, along with important treatment and management strategies for effectively living with severe atopic dermatitis.

Kim began by emphasizing the complexity of atopic dermatitis, a common chronic inflammatory skin condition that affects up to 20 percent of children and adolescents. She noted that a child has an 80 percent chance of developing atopic dermatitis if both parents have the condition, and a 50 percent chance if one parent is affected. However, beyond genetic predisposition, the disease is also influenced by environmental factors such as temperature, humidity, dust mites, mold, allergies, immunological abnormalities, and stress.

For this reason, healthcare professionals must gather specific information to properly assess a patient during their first appointment with an atopic dermatitis specialist. Key details include the patient's age of onset and family history of the disease. 

"Some people develop atopic dermatitis when they're young, some in middle school, and others as adults," Kim said. "It's important to know if family members, such as a parent or twin siblings, also have atopic dermatitis, as this helps determine genetic predisposition."

An accurate diagnosis of atopic dermatitis and knowing exactly when it was first diagnosed are crucial. In severe cases, effective treatments like biologics and JAK inhibitors can be considered, but eligibility requires a diagnosis of atopic dermatitis at least three years prior.

“We have many treatment options for atopic dermatitis, but to use them, an accurate diagnosis from a dermatologist is essential,” Kim said. "Many patients in our clinic lack that history and, unfortunately, must wait more than three years to receive these treatments."

Kim also addressed the issue of excessive “steroid phobia” surrounding steroid medications used to treat atopic dermatitis, which often results in infants and young children not receiving treatment as prescribed. 

“In some cases, it's crucial to use steroids promptly to control symptoms. If steroids are applied aggressively, you can prevent the condition from becoming chronic, but that window of opportunity is often missed,” she explained. "We should trust healthcare professionals to use and manage steroids appropriately," she advised.

Kim also highlighted the misconceptions surrounding atopic dermatitis and food, which can create issues for children during their formative years. While it is necessary to eliminate certain foods in cases of food-induced atopic dermatitis, not all cases are food-related, making it problematic to restrict foods like eggs, milk, and flour across the board. 

"Just because you have atopic dermatitis doesn't mean you can't eat anything," said Kim. "There are always many questions about atopic dermatitis and food, and keeping a food diary is a good way to track potential triggers."

The correct approach is to have a healthcare provider review your food diary and conduct tests to identify whether certain foods truly trigger atopic dermatitis symptoms before making dietary restrictions. Skipping this step and restricting foods indiscriminately can have serious consequences. "If you don't give your kids milk or eggs, they might not grow tall enough," Kim explained, stressing that it's a “myth” to eliminate certain foods from the diet without proper testing. "You shouldn't stop eating foods just because they're assumed to be harmful to atopic dermatitis patients unless testing confirms it."

To prevent misconceptions from interfering with treatment, healthcare professionals suggest that patients and their families take proactive steps to navigate the complexities of atopic dermatitis. 

Kim advises writing down all questions about the condition before visiting the doctor. 

"If you have questions like how long you need to take steroids, write them down and bring them to the clinic," she said. "Otherwise, you may forget important concerns during the appointment, but having them written down allows the doctor to address them more efficiently."

Kim also emphasized the importance of switching between biologics, such as Dupixent, which is a last-line treatment for severe atopic dermatitis, and JAK inhibitors like Olumiant or Cibinqo, depending on side effects or treatment response. "With Dupixent, you may experience hair loss, or you might see improvement," Kim explained. "If alopecia areata becomes too severe while using Dupixent, I believe it’s important to switch to Olumiant, a JAK inhibitor that can support hair growth."

“The most common side effect of Dupixent is conjunctivitis, followed by psoriasis. Very rarely, mycosis fungoides can occur. There are also instances where the hands and feet are so severely affected that they do not improve, or cases where only the face remains unresolved, in which JAK inhibitors can be effective,” Kim noted. 

She emphasized that it is crucial not only to switch between and within treatment classes when atopic dermatitis severity persists, but also to adjust the treatment based on the specific characteristics of each drug class.