Medically reviewed by Dr. Elizabeth Liotta
When Elizabeth Falkner was in her early 30s, her career as a chef began to take off. Unfortunately, so did her atopic dermatitis (AD). Red, itchy lesions started forming on her legs and eventually spread to her hands. The stress and heat of the busy restaurant kitchen worsened her condition.
Falkner was approaching her professional peak, but her doctor warned she might have to stop cooking because of her AD. Unwilling to give up her dream, Falkner figured out how to manage her symptoms — and the stress that worsened them. More than 20 years later, she works to raise awareness about the physical and emotional effects of AD.
The most common type of eczema, AD is a chronic inflammatory disease that causes rashes all over the body. These rashes may weep and bleed and are usually intensely itchy. Women with AD may experience vulvar dermatoses that cause itching, burning and pain around the vulva.
According to Dr. Elizabeth Liotta, a dermatologist and a member of HealthyWomen's Women's Health Advisory Council, the skin of white people with AD can look red and scaly with visible scratch marks and oozing during an AD flare. People of color often experience light or dark spots that can remain for many weeks after the skin has calmed down, she explains.
Symptoms of AD bring unwanted attention
We all want to put our best face forward, but symptoms of AD can cause people with the disease to feel embarrassed when out in public. This is especially true for people whose AD shows up in places where it can't be hidden under clothing, leading to unwanted stares or, worse, comments.
"Patients with AD on the face or hands tend to have more problems with self-consciousness," Liotta said. Strangers who don't recognize AD may think it's an infectious disease, treating people with symptoms as if they're contagious.
This type of negative attention can take a major toll on self-esteem for people with AD. It can also lead to mental health challenges, including clinical depression, anxiety disorder and suicidal ideation. Although coping with AD can be difficult for everyone, women are significantly more likely than men to experience AD-related mental health issues.
People with AD may avoid leaving the house when their skin looks especially bad, which can lead to feelings of isolation and loneliness. Others worry that their AD may affect their ability to look professional, causing work-related anxiety. Coping mechanisms like reaching out to a friend or therapist who can help you reframe your worries can be very effective for relieving this type of social anxiety.
AD flares and stress: a vicious cycle
It's often hard for people with AD to know when their condition will flare up. This unpredictability can be extremely stressful, since you can't plan for something if you don't know when it's going to happen. What if your skin flares right before a big job interview or a first date, when it's important to make a good impression?
Unfortunately, stress is a major trigger of AD flares. Flares cause more stress, which in turn leads to more flares, and so on. Worrying that your AD might flare right before a job interview can actually cause your AD to flare, which stresses you out and leads to further flaring. A vicious cycle.
The cycle of stress and AD flares also pertains to itching. People with AD often report that stress makes their skin itchier, and one study found that psychological stress increased spontaneous scratching in patients with AD. This scratching worsens the condition, leading to even more itchiness.
Lack of sleep adds to stress
According to Liotta, trouble sleeping because of itching is another source of stress for many people with AD. "This will increase their physical stress, thus aggravating their skin condition," she said.
Nighttime itching may also cause a rift in relationships, explains Liotta. Continuous scratching can prevent the partner of a person with AD from sleeping well, leading to frustration and resentment. "This additional stress may cause their skin to flare more significantly," she said. Another vicious cycle.
Yet another frustrating cycle can develop between children with AD and the people who care for them. Parents are often exhausted and burned out from caring for their children with AD, especially when trying to protect them from fallout from the disease like self-consciousness and bullying. In turn, children with AD may experience flares related to their parents' distress.
Stigma surrounding AD affects mental health
In a culture that emphasizes physical beauty, some people with AD feel stigmatized due to their condition. Because AD is often very visible, and because society tends to shun what it doesn't understand, people with AD may find themselves the subject of unwelcome gawking or unkind words. The stigma around skin that appears less-than-perfect can make it hard for people with AD to feel accepted.
This stigma doesn't just affect people with AD, but also their caregivers. AD typically begins in childhood, meaning parents often bear the burden of negotiating their children's care. This includes helping them deal with social stigmatization, even as their own mental health might be suffering under the strain of caregiving.
Reducing stress and anxiety with AD
Luckily, there are steps people with AD can take to relieve stress and anxiety. For chef Falkner, physical activity helps keep the stress of her job from worsening her symptoms. Exercise may also help people with AD sleep better, Liotta said.
For people with AD who are comfortable in water, Liotta recommends soaking in a lukewarm bath to relax before applying steroid creams and/or moisturizers to damp skin. This technique, which increases absorption of medication and helps seal in moisture, can be especially soothing for children with AD, she said.
Both people with AD and their caregivers can benefit from talking with others who share their experience. Support groups can provide the opportunity for children with AD to socialize, helping to relieve some of the isolation they often experience. And building a network of people to lean on can help caregivers find people to support them when they're feeling overwhelmed. "Support groups may be helpful for parents to express their frustration and find good coping mechanisms for stress management," Liotta said.
Above all else, Liotta urges people with AD who are struggling with mental health issues to seek professional help. The internal effects of AD can be just as challenging as the external ones and should be treated accordingly.
Faulkner was able to come up with a plan for managing her AD that has allowed her to soar professionally and personally. You can, too.
This resource was created with support from Regeneron and Sanofi Genzyme.