Is Eczema an Autoimmune Disease? Spoiler Alert: Nope

According to the National Institutes of Health (NIH), autoimmune disease occurs when the immune system makes a mistake and attacks the body’s own cells, tissues or organs and unfortunately the problem seems to be getting more common. Immunity is our body’s defense system: when our immune system is working properly, it fights off infections and cancers, whereas “autoimmunity” is when this process goes wrong.

In a recent study done by the American College of Rheumatology, researchers demonstrated that the most common biomarkers of autoimmunity (antinuclear antibodies) have been increasing in the U.S. population since the late 1980s, especially among young people.

But is eczema (clinically known as atopic dermatitis) an autoimmune condition?

“Patients frequently ask me that,” said Dr. JiaDe Yu, assistant professor of dermatology at Harvard Medical School. However, Dr. Yu explained that atopic dermatitis is a complex condition without a single cause; rather, a combination of factors interact to cause this skin disease. To better understand why this distinction matters, it helps to first define and explain what exactly constitutes an autoimmune disease.

An autoimmune disease is defined as a condition in which the immune system attacks the body’s own healthy tissues. Does the immune system of a person with eczema attack their own skin? The short answer is no. But why people often make this mistaken assumption is a bit complicated.

Symptoms of autoimmune diseases can come and go, cycling through periods of flare-ups and remission. To help control autoimmunity, treatments often focus on decreasing the immune system’s activity. To decrease immunity system activity generally, the primary mode of treatment is immunosuppressants. These are old school traditional medications that can come with many side-effects. As we gain understanding of the very specific part of the immune system that goes wrong, the medical community now uses immunomodulators that are more targeted to the problem and have less collateral damage.

To that end, yes, eczema and autoimmune conditions do have a lot in common. Examples of autoimmune conditions include:

• Rheumatoid arthritis, which results in the immune system attacking the joints, causing inflammation, swelling, pain and potentially permanent joint damage.
• Lupus, which causes the immune system to attack multiple tissue types throughout the body including joints, lungs, blood cells, nerves and kidneys. Symptoms include pain, fever, joint swelling, fatigue, rashes and more.
• Inflammatory bowel disease (IBD) like ulcerative colitis and Crohn’s disease. With these conditions, the immune system damages the lining of the intestines, leading to bouts of diarrhea, rectal bleeding, abdominal pain, fever and weight loss.
• Multiple sclerosis (MS), a disease caused by the immune system targeting nerve cells, leading to pain, vision problems, weakness, decreasing coordination and muscle spasms.
• Alopecia areata, in which cells in your immune system attack your hair follicles, causing hair to fall out.

Even though eczema and autoimmune diseases share commonalities, based on current medical knowledge and definitions, eczema is technically not autoimmune.

“It’s easy to see why you could characterize eczema as an autoimmune condition,” said Dr. Yu. The immune system plays a role in eczema, he said, and suppression of the immune system can help symptoms tremendously. But, he explained, while overactive or dysregulated immune functions contribute to eczema, they aren’t attacking a specific target in the body, the way, for instance, immune cells destroy the insulin-producing cells of the pancreas in the autoimmune condition type 1 diabetes.

Instead, our current understanding of eczema, said Yu, suggests that additional factors, such as things in the environment, skin barrier defects and skin bacteria like Staphylococcus aureus also play large roles in the development and persistence of atopic dermatitis.

Similarly, Dr. David Pariser, former president of the American Academy of Dermatology and professor of dermatology at Eastern Virginia Medical School, said, “We are learning more about immune system pathways in atopic dermatitis, but it’s not so much that you are ‘immune’ to yourself with atopic dermatitis; rather there are abnormal immune cell responses.” So eczema is not, Pariser explained, truly a disorder of immunity against one’s own tissues.

If eczema is not an autoimmune disease, what is it?

Atopic dermatitis, or eczema, said Dr. Yu, is the most common inflammatory skin disease, affecting 15-20% of children and 10% of adults. “It’s considered inflammatory,” he said, “due to the important role inflammation and the immune system play in its symptoms.” But inflammation and immune responses are not, he said, eczema’s only causes. Another skin condition in this category is seborrheic dermatitis, which causes stubborn dandruff and scaly, red patches on the scalp.

If all this talk of medical definitions and semantics has you scratching your head, you’re not alone. There is still some debate about whether certain elements of eczema do share attributes of an autoimmune disease or not and, certainly, new scientific discoveries could evolve and provide for clarity about this topic in the future.

In the meantime, perhaps the classification of eczema is not as important as how we learn to care for it; how we help ourselves and our skin, in our personal environments, and how to be healthy while also accepting that there’s no one way to label our individual dermatologic experiences.