Eczema is the term used to describe a variety of inflammatory skin conditions, otherwise known as dermatitis. Several types of dermatitis involve an immune system ‘overreaction.’ There is some research to suggest that it may be linked to autoimmunity, but a concrete conclusion is yet to be reached.
There are seven types of eczema:
- Atopic dermatitis – a more common form of eczema, causing inflammation, itchiness, and dry skin.
- Contact dermatitis – also referred to as allergic contact dermatitis, brought about by environmental triggers.
- Neurodermatitis – creates small patches of itchy, scaly skin (also known as discoid eczema).
- Dyshidrotic eczema – can cause rashes, blisters, and the sensation of burning.
- Nummular eczema – also known as nummular dermatitis, and appears as small, rounded lesions, particularly on the arms and legs.
- Seborrheic dermatitis – this inflammatory type of eczema primarily affects the scalp.
- Stasis dermatitis – this type of eczema causes discoloration to the skin on the legs, appearing similar to varicose veins.
What is an Autoimmune Disease?
When we have an appropriate ‘immune response,’ our body is accurately perceiving exposure to a potentially harmful substance, and the immune system gets to work, attacking the substance to remove it.
Conversely, an autoimmune disease is a condition in which a person’s immune system attacks their body’s own (perfectly healthy) tissues. Although an eczema sufferer’s immune system is not behaving in this way and attacking their skin, this common assumption is understandable for several reasons.
The symptoms of autoimmune diseases often come and go, and sufferers commonly go through periods of remission and relief in between bouts of flare-ups. There are no known cures for autoimmune diseases, and treatments typically center around reducing the overactivity of a sufferer’s immune system. The primary course of treatment for reducing immune system activity is immunosuppressants (old-school medications that can bring about a host of unpleasant side effects). As researchers gain a greater understanding as to how the immune system works and which part of it is not working correctly in the case of autoimmunity, more targeted treatments, such as immunomodulators, can be used, which thankfully cause fewer side effects.
If we look at some of the more common types of autoimmune diseases, we can see the correlations with eczema, particularly rashes, and inflammation, that understandably cause people to assume a link:
- Lupus – in which the immune system attacks multiple body tissue types, including in the joints, nerves, blood cells, lungs, and kidneys. Symptoms include joint swelling, fatigue, and rashes.
- Inflammatory bowel disease (IBD) – such as Crohn’s disease and ulcerative colitis, these conditions cause the immune system to attack the intestinal lining, resulting in abdominal pain, diarrhea, rectal bleeding, weight loss, and more.
- Rheumatoid arthritis – as the immune system attacks the joints, leading to inflammation, pain, swelling, and sometimes permanent damage to the joints.
- Multiple sclerosis (MS) – this disease causes the immune system to attack nerve cells, resulting in decreased coordination, muscle spasms and weakness, vision problems, and more.
- Alopecia areata – with this disease, the hair follicles are attacked, causing hair loss
Despite autoimmune diseases and eczema sharing some similar symptoms, according to current research and medical definitions, eczema is not technically defined as an autoimmune disease.
That said, a study published in the Journal of Autoimmunity does state that atopic dermatitis (AD) may begin as an allergic reaction but progress into an autoimmune response.
Some types of eczema appear to have closer links to autoimmune disease than others.
According to the American Academy of Dermatology Association (AADA), one of the most common types of eczema is Atopic dermatitis (AD) which is caused by multiple factors. Researchers believe that the cause of AD stems from a combination of genetics, immune system sensitivity, and environmental factors. It is acknowledged that some evidence does suggest that autoimmunity may be a factor.
The genetic trait that relates to AD is believed to cause their skin to lose its moisture too quickly, compromising the skin barrier. This leads to dry, poorly protected skin, and a heightened risk of developing AD, particularly when regularly exposed to irritants, pollutants, smoke, cold and/or damp climates, and prolonged periods of stress.
A 2021 study found that autoimmunity may play a role in the development of AD, suggesting that it may begin with an allergic response and subsequently progress into an autoimmune reaction. The nature of flare-ups and remission periods supports this theory.
There also appears to be a correlation between autoimmunity and eczema, with a population-based study finding higher rates of AD among those who also suffer from autoimmune conditions.
Is eczema a symptom of autoimmune disease?
In short, yes. Autoimmune conditions can cause skin rashes and irritations, including eczema, although these are not definitive symptoms of autoimmune disease because eczema can occur with or without the presence of an immune system disorder.
It is also possible to suffer from an autoimmune disease and eczema as two separate conditions, although it is likely that one or both conditions could be exacerbated by the other. Any condition that causes inflammation and increased immune system sensitivity are likely to worsen the symptoms of eczema.
What else can cause eczema?
Researchers believe that eczema occurs as a result of the skin barrier being compromised, allowing water to escape more easily, and causing the skin to become dehydrated.
In addition to diseases directly related to autoimmunity, other factors can trigger the immune system to overreact in different ways. These include:
- Allergens, such as foods, insect bites, stings, insect feces, etc.
- Irritants, such as smoke, artificial fragrances, cleaning products
- Some bacteria or viruses
- Friction, such as from accidents, itchy fabrics, etc.
- Dysbiosis (an imbalance in the gut and/or skin microbiome)
- Actions that disrupt the skin’s ability to protect and hydrate itself, such as overly hot baths, frequent hand washing, or use of hand sanitizers, etc.
So far, the research into eczema suggests that genetics likely play a role. This is due to a gene mutation having been identified as a possible cause of the dysfunction of the skin barrier associated with eczema. The mutation occurs in the filaggrin gene, a gene that plays a role in the maturation of skin cells.
While the cause of eczema is broadly considered to be genetic, the condition does appear to be exacerbated by certain foods and other environmental factors.
As Jess Grelle, SVP of Innovation at leading clean-food company Safe + Fair says, ‘While gluten and other irritants may not be the cause of allergy-type reactions, they are best avoided if you suffer with any one of a wide range of conditions; be it asthma, eczema, migraines, or an autoimmune disease, you may find that eating a diet full of clean, low-allergen foods helps to keep your symptoms to a minimum.’
According to a 2012 study, individuals whose diets are lacking in essential fatty acids and other certain nutrients can be more prone to dry skin and eczema.
Some medications used to treat autoimmune diseases can also cause eczema. For example, a study found that one of the medications commonly used to treat Crohn’s disease caused almost a third (29.6%) of users to develop some form of eczema, with 18. % developing chronic atopic eczema.
While some evidence does contribute to the theory that there may be some causal overlaps, the majority of the research to date concludes that only correlations are to be found between eczema and autoimmunity. In other words, eczema may be exacerbated by immune system issues and vice versa, and eczema may be more common in those that suffer from autoimmune conditions, but neither directly causes the other.