1.) What’s the link between AD symptoms and stress/mental health difficulties?
It may surprise some to learn that AD and mental health have a bidirectional relationship both scientifically and socially. Scientifically, AD is associated with inflammation, which when it becomes chronic, can increase the stress hormone (cortisol). Socially, people with AD may have a heightened self-awareness of their skin, leading them to withdraw from social events or interactions. They may fear judgement or negative comments about any visible skin issues. Over time, this self-imposed isolation could result in anxiety and even depression.
2.) How does AD affect self-esteem and body image?
The redness, scaling, oozing and uncontrolled bouts of skin scratching can lead an individual with AD to feel embarrassed or self-conscious, which can then distract those that they meet from the real person beneath the skin. I have clients with AD who are literally in tears, describing how they feel dirty and unattractive because of AD. Children with AD are often subjected to bullying, which we know can negatively impact their self-confidence, overall wellbeing and body image.
3.) What role does chronic itch play in mental health discomfort?
When levels of cortisol are elevated, as mentioned in question 1 due to increased levels of inflammation from AD, sleep, mood and concentration can be impacted negatively. Beyond the science, another thing I routinely hear from my clients that impacts mental health is a sense of helplessness. Helplessness during to an inability to cure or reliably control the symptoms of itch, which can lead to skin picking behaviors. All of this can enhance the chances of a patient with AD developing mental health discomfort.
4.) What is the impact of visible AD symptoms on social interactions?
Regrettably, the stigma associated with visible skin conditions can contribute to those with AD to develope avoidance behaviors. Beyond self imposed restrictions, an individual with AD might actually experience rejection in romantic relationships, business or casual interactions.
5.) What unique challenges do children and adolescents with AD face? How does it impact their academic performance and social development?
Its sad to see kids in my clinic that recount episodes of bullying due to their AD and how the perception of themselves and confidence they have is negatively impacted because of it. We know from studies that being bullied can have negative sequela on academic performance and social development (less friends and lower confidence). Keep in mind, the elevated levels of cortisol, associated with the inflammation of AD, can disrupt sleep, which can lead to fatigue, an inability to concentrate and poorer academic performance.
6.) What is the relationship between AD and work-related stress/productivity issues in adults? How does it affect one’s ability to manage family and social responsibilities?
In a similar manner to hiw AD in children can have poorer academic performance, a worker with AD who has higher levels of cortisol may have disrupted sleep resulting in less productivity at work. That’s not to mention the time away from work needed to see a physician to help an individual with AD. Another consideration is that many people with AD often have allergies. Those allergies can be limiting in the workplace and might require special accommodations that an employer may not be able or willing to make.
In regards to family and social responsibilities, the fatigue from sleep deprivation can impact mood and irritability leading to strain in personal relationships and cause individuals to contribute less to household chores and childcare.
7.) What are some medical treatments for AD, as well as the psychological benefits of these treatments?
We are fortunate to have many medical treatments options for AD. As you might imagine, as an individual’s AD improves so to does their mental health.
In general, I categorize treatments for AD into four buckets:
- Creams
- Pills
- Light therpay
- Injections
In terms of creams, topical steriods are main stay but we also utilize calcineurin inhibitors (a strong cream that does not contain any steriod) and moisturizers.
in terms of pills, oral steroids, antihistamines and antibiotics can be used to control inflammation, itching or infection, respectively.
In terms of light therapy, Ultraviolet light has been shown to reduce inflammation and can be an excellent and effective treatment to control AD.
Lastly, injections are revolutionizing AD therapy. Dupixient (dupilumab) targets an individual’s immune system and can significantly reduce inflammation and improve quality of life.
8.) What are some psychological therapies for AD (i.e., cognitive-behavioral therapy)?
Cognitive behavioral therapy (CBT) is an effective way to disrupt the well established mind-body connection associated with AD. CBT can assist an individual identify negative thoughts, neutralize and replace them with more effective coping strategies. By reframing negative impressions and thoughts many patients with AD have about themselves, CBT can support clients in finding ways to reduce avoidance behaviors and improve self esteem.
9.) What are some lifestyle changes and self-care practices effective in managing AD?
I always advise my AD patients to become skin smart. That means to start looking for fragrance-free moisturizers, avoiding harsh soaps, becoming cognizant of skin allergens or food triggers (such as gluten), try to get quality sleep and work on mindfulness and stress management.