Unraveling Atopic Dermatitis, with Lisa Swanson, MD

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Lisa Swanson, MD, discusses the pathogenesis of atopic dermatitis and why she does not recommend elimination diets for her pediatric patients.

Currently, researchers are learning more about the origins of atopic dermatitis (AD) and the factors contributing to its development. Although genetics play a crucial role, making some individuals more susceptible to atopic diathesis, something can occur in early infancy, possibly within the first year or 6 months of life, that can trigger the condition. Several studies indicate that AD incidence is lower in babies born vaginally compared to those delivered via C-section. Similarly, breastfed babies show a lower incidence than formula-fed ones. Additionally, pregnant women taking oral probiotics from a month before delivery to three months post-delivery also see reduced eczema risk in their babies. A study even found that longer NICU stays correlate with lower AD incidence.

In an interview with HCPLive,Lisa Swanson, MD, pediatric dermatologist at St Luke’s Children’s Hospital and Summer 2024 Conference Medical Director, explained that while these findings suggest that skin and gut flora disruptions contribute to the inflammatory process, there remains a lack of sufficient evidence necessary to recommend a global prevention strategy. For now, however, she is fascinated by the emerging trends from these studies.

Together, Swanson and Marc Serota, MD, explored the relationship between eczema and food allergies at the SDPA Annual Summer Dermatology Conference. She explained that it is rare for food allergies to cause eczema; instead, eczema may lead to food allergies. Research indicates that particles of food entering the skin through a compromised barrier can trigger abnormal immunologic responses, leading to allergies. A study found that children under three with facial eczema are at a higher risk of developing food allergies due to increased exposure to allergens through their broken skin barriers. Therefore, treating eczema effectively can help prevent food allergies.

She discourages elimination diets as they are rarely helpful and can deprive children of essential nutrients. Additionally, avoidance of certain foods has been linked to an increased risk of allergies. Eliminating foods can harm children more than help them.

The relationship between early life factors and the development of AD is still being unraveled. Although the onset of AD cannot be reversed once it begins, many children outgrow it or experience milder symptoms as they age. Additionally, treatment options have significantly advanced recent years, providing clinicians with effective tools to manage and improve the lives of children with atopic dermatitis.

Disclosures: Swanson is a consultant for Abbvie, Alphyn, Arcutis, Boehringer Ingelheim, Castle, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Novan, Pfizer, Sanofi-Regeneron, and Verrica.