Is Eczema an Autoimmune Disease or Something Else?
Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MD
Eczema is a group of related conditions causing itchy, dry, inflamed skin that can appear red, purple, ashen, or dark brown, depending on skin tone. While eczema does involve the immune system, most scientists wouldn’t classify eczema as an autoimmune disease.
Autoimmune diseases occur when the body’s immune system attacks a specific part of the body in a targeted way, leading to inflammation, pain, or other symptoms. Atopic dermatitis (one type of eczema), in particular, may exist on a spectrum with autoimmune disease, and having it may increase your risk of autoimmune conditions.
Evgeniia Gordeeva / Getty Images
Understanding Eczema
Types
The group of skin conditions, sometimes called eczema, have some broadly similar symptoms and share some of the same causes. Some of the most prevalent types of eczema include:
Atopic dermatitis is the most common disease that causes chronic symptoms of dry, itchy, and discolored skin due to inflammation. It is also the most well-studied type of eczema.
Contact dermatitis (allergic contact dermatitis) can be brought on by environmental triggers (e.g., poison ivy, latex, nickel), but symptoms are often temporary.
Dyshidrotic dermatitis (dyshidrotic eczema) causes dry skin, burning sensations, and blisters.
Neurodermatitis (lichen simplex chronicus) causes itchy skin that can become thickened and discolored over time.
Nummular eczema (discoid eczema) creates small, rounded, itchy regions, especially on the arms and legs.
Seborrheic dermatitis causes dry, flaky skin on the scalp.
Stasis dermatitis is caused by poor circulation in the legs, leading to symptoms like skin discoloration and itchy, swollen legs.
Causes
The underlying causes of eczema are complex and not completely understood. However, researchers believe that the following contribute to eczema:
Genetic variations
Overreaction to external factors
Experts believe that eczema occurs, in part, from exaggerated responses to environmental factors and often group it with allergic conditions.
Triggers
Some important eczema triggers are:
Allergens in the environment (e.g., pet dander, dust mites)
Irritants from perfumes or soaps in personal care products
Stressful experiences
Winter weather, with low humidity and low temperatures
Some people also notice their symptoms worsen when they eat specific foods, but this connection isn’t well established.
Symptoms
Eczema caused by atopic dermatitis causes:
Color changes in skin, such as red, purple, ashen, or dark brown, depending on skin tone, and sometimes scaliness
Additionally, age can affect how eczema presents. Symptoms appear on the face, trunk, arms, and legs within the first year of life. Later in life, they arise in skinfolds, like the inside of elbows.
Sometimes, these areas become so itchy and scaly that they peel away, leading to bleeding. People with eczema usually have periods in which their symptoms flare up and worsen and other times when they are less severe.
Related: What to Know About Eczema
Autoimmune Diseases Explained
When your immune system is healthy, it helps protect you against invasions from dangerous microorganisms like viruses and bacteria. It does this through complex and coordinated communications and responses in your immune system.
Autoimmune diseases occur when part of the immune system mistakenly identifies part of your body as a threat, triggering an inappropriate immune response and targeting this part of your body. The area of the body attacked by the immune system will become painful and inflamed, and other symptoms, such as fatigue, recurring fever, and muscle aches, can occur.
Researchers are still trying to solve the problem of the immune system becoming inappropriately targeted towards part of your body.
Researchers are still trying to understand the causes of autoimmune diseases. They do know that it's a complex interaction of genetic and environmental factors that coincide to cause an inappropriate immune reaction.
In many cases, autoimmune diseases also may involve the development of antibodies against part of your body. These are different from the normal antibodies you might develop to fight an infection or help prevent you from getting sick after you've had a vaccine.
Is Eczema an Autoimmune Disease?
Autoimmune disease and eczema both involve abnormal and heightened immune responses that can lead to inflammation and other symptoms. However, most scientists would not classify eczema as an autoimmune disease.
Healthcare providers have historically classified eczema as part of the "atopic march," a specific progression of allergies that begins with begins with skin symptoms, then moves to gastrointestinal symptoms, and eventually causes respiratory symptoms.
The immune system does play a vital role in eczema, though. Like in many autoimmune diseases, a certain kind of immune cell called T cells can become overactive, releasing large amounts of immune-signaling molecules that should not be released. This release causes additional changes that lead to painful, itchy skin.
Knowledge about this topic is evolving. Some scientists think it may be more appropriate to think of atopic dermatitis as a spectrum with autoimmune disorders. This is because atopic allergies can be seen as stepping stones to autoimmunity.
If you have eczema (atopic dermatitis), you have a slightly increased risk of being diagnosed with an autoimmune condition. With severe eczema, your risk is about twice as high for an autoimmune disease as that of someone who doesn't have eczema. (Potential risks in other types of eczema aren't as well studied.)
This risk seems to be increased for certain autoimmune diseases but not others. Some autoimmune diseases you might be more susceptible to include rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, Sj?gren's syndrome, and autoimmune thyroiditis.
Can Eczema Be a Symptom of Autoimmune Diseases?
Usually, a healthcare provider wouldn't consider eczema a potential autoimmune disease symptom. However, it's possible to have both eczema and an autoimmune disease, but they're typically thought of as comorbid conditions—two different diseases occurring in the same person.
Certain autoimmune conditions, like Sj?gren's disease, may also cause skin symptoms similar to those found in eczema, like dry skin, as well as additional symptoms that are not found in eczema.
How to Treat and Manage Eczema
Topical Treatments
The cornerstone of treatment is using quality moisturizers (fragrance-free with high oil content) daily, even if you are not experiencing a flare-up. Ideally, you should do this right after you shower to help trap moisture.
Topical corticosteroids (those applied to your skin) are typically the first approach during a symptom flare-up. Depending on the severity of your flare-up, you might need to use a more potent dose of steroid for a more prolonged period. Examples of prescription topical treatments include:
Protopic (tacrolimus) or Elidel (pimecrolimus) are similar medications applied directly to the skin.
Eucrisa (crisaborole) is a newer medication applied to the skin to help decrease the amount of steroid cream you need.
Opzelura (ruxolitinib) is a topical medication intended for short-term use.
Systemic Medications and In-Office Treatment
A healthcare provider may prescribe systemic medications for eczema, which work throughout the body, such as:
Dupixent (dupilumab) or Adbry (tralokinumab): These are newer, injectable biologic medications that can help improve symptoms.
Rinvoq (upadacitinib) or Cibinqo (abrocitinib): These Janus-kinase (JAK) inhibitors are relatively new oral medications used for treatment-resistant disease if biologics have not worked or are not available.
Sandimmune (cyclosporine), Imuran (azathioprine), or Trexall (methotrexate): These are older and less expensive oral medications that suppress the immune system if other treatments have not helped or are not available.
A healthcare provider may recommend in-office treatment with phototherapy (light therapy) if other treatments have not helped relieve your symptoms.
Alternative Options
Most of these are not well-researched in terms of scientific studies, but some people find complementary approaches helpful. Some of these are:
Applying natural oils to the affected areas, such as sunflower seed oil or coconut oil
Using immunotherapy with an allergist, such as those used for food allergies or seasonal allergies
Using certain oral supplements, like vitamin D, evening primrose oil, or probiotics
Taking steps to reduce your stress, e.g., through massages, hobbies, meditation, and/or exercise
Additional Considerations
If you have co-occurring eczema and an autoimmune disease, ensure your healthcare team coordinates your treatment and has an up-to-date list of your medications. Some medications for autoimmune diseases work by suppressing certain parts of the immune system, so they may help with your eczema but, conversely, could also worsen it.
When to Contact a Healthcare Provider
Sometimes, bleeding skin from moderate to severe eczema can lead to infection. If you notice unusual symptoms like fever, puffy skin, or rash, contact a healthcare provider immediately, as you might need antibiotic treatment.
You should also contact a healthcare provider if you are having a flare and your standard control methods are not helping. You might need to change or escalate treatment. If your eczema interferes with your quality of life, talk to your healthcare provider about your options.
Summary
Eczema is a group of medical conditions causing itchy, inflamed skin. The term "eczema" is often used to refer to atopic dermatitis. Atopic dermatitis is caused by specific dysregulations and overactive responses in your immune system.
There is a lot of overlap between the immune dysregulations found in eczema and those found in autoimmune conditions. However, most scientists do not classify eczema as an autoimmune disease because the immune system response isn’t as targeted as it is in true autoimmune conditions. However, having eczema, at least atopic dermatitis, slightly increases the risk of autoimmune disease in the future.
Read the original article on Verywell Health.
