Understanding the lifelong nature of atopic eczema.

Atopic eczema, also known as atopic dermatitis (AD), is a disease that usually begins in infancy and can progress to food allergies, asthma and allergic rhinitis.

“Atopic eczema is more than a skin condition; it is driven by a dysregulated immune system and may have long-term physical and psychological impacts. It can create significant costs for families and healthcare systems,” says Dr Dwayne Koot, pharmacologist and medical advisor at Sanofi South Africa.

a disease that begins early

Atopic eczema – one of the most common chronic inflammatory skin diseases – affects up to 20% of children globally. It often appears early in life. Around 45% of children with atopic eczema develop symptoms before six months of age, 60% before one year, and up to 85% before five years.

For many, atopic eczema is the first step in what researchers call the “atopic march,” the progression from skin barrier dysfunction to food allergies and respiratory diseases.

Studies show that infants with atopic eczema are six times more likely to develop egg allergy and eleven times more likely to develop peanut allergy than infants without atopic eczema.

By later childhood, as many as 40% of children with atopic eczema develop food allergies.

School-age children with early, persistent atopic eczema face higher risks of developing asthma and allergic rhinitis.

Read more about eczema.

beyond the skin

Atopic eczema is now recognised as a systemic disease linked to type 2 inflammation.

The hallmark symptoms are:

• itching
• dry and inflamed skin
• recurrent infections
• disturbed sleep.

These symptoms are not only uncomfortable but also disruptive to daily life.

“Children may struggle at school due to fatigue, and parents often miss work or are unproductive due to sleepless nights, medical appointments or caring for their sick child,” says Dr Koot.

“Because atopic eczema is so visible, children often face stigma. Studies show they are more likely to experience anxiety, depression and bullying. Up to one in three children with atopic eczema have anxiety or depression, compared with far fewer children without the disease.”

The economic impact is significant. In South Africa, while direct healthcare costs are relatively low (0.2% of healthcare spend), the total burden may be substantial when adding the much higher indirect costs and quality-of-life impacts.

early intervention matters

While research is ongoing, one study found that daily use of emollients from birth to protect the skin barrier may lower the risk of eczema by half for high-risk infants, with no safety concerns.

Additional research shows that the skin barrier is key in both atopic eczema and food allergies, and protecting it early in life may help prevent these conditions.

While allergen avoidance is still the main approach, new options such as immunotherapy and biologics are showing promise.

Recent findings emphasise that taking early, proactive action with advanced treatments can dramatically improve outcomes for patients. By moving beyond simply reacting to flare-ups to targeting the underlying immune balance and inflammation that drive eczema from its early stages, disease progression can be prevented.

A significant benefit of this early approach is its potential to halt the “atopic march”. By addressing skin barrier dysfunction and immune system changes early on, it may be possible to prevent or reduce the development of related allergies.

Early intervention is key to breaking the relentless “itch-scratch cycle”. Chronic itching, a hallmark of atopic eczema, not only causes immense discomfort, but also leads to skin damage and secondary complications like infections. Addressing the root causes of itching allows patients to experience comprehensive relief, regain normalcy and significantly improve their overall quality of life by reducing anxiety, depression, and social isolation associated with the disease.

a better quality of life

This proactive strategy also offers the promise of long-term disease control and modification. Tackling inflammation before visible skin lesions fully develop can inhibit the escalation of inflammatory responses and disrupt the recurring cycles of flares and remissions.

“The paradigm shift towards early systemic intervention represents a pivotal moment in atopic eczema care,” says Dr Koot. “It’s about empowering patients with strategies that offer not just immediate relief, but also the potential for sustained positive outcomes and a better quality of life by addressing the disease at its inception, rather than solely managing its symptoms after they become severe.”

working together

“Doctors need to see atopic eczema as a systemic disease that needs more than just symptom relief. Policymakers need to support early treatment, better access to specialist care, affordable medicines, and stronger investment in research and innovation. Families and patient groups play a key role in showing the true impact of atopic eczema and pushing for advanced, targeted therapies,” Dr Koot advises.

“Progress is possible, but it requires commitment from everyone,” he concludes.