On the biological underpinnings of the atopic march, also called the atopic triad, and what people with eczema need to know.
Published On: Nov 17, 2017
Last Updated On: Jul 15, 2021
After a night partying with a female stranger, Nasir Kahn wakes up to find her deceased and is charged with her murder, but his streetwise lawyer is determined to get him acquitted. That’s the storyline behind the Emmy-nominated HBO crime drama “The Night Of.”
Those who’ve seen it know that there is something unique about the lawyer character, John Stone. He has a raging case of atopic dermatitis, the most common form of eczema. In fact, his skin condition seems to be a primary subplot on the show. Stone is shown scratching his eczemic skin with chopsticks, paying his dermatologist a visit and assuring people it’s not contagious.
But that’s not the only show to shine a spotlight on severe atopic dermatitis. In fact, “The Night Of” is based off of the British miniseries “Criminal Justice,” which aired on the BBC network between 2008 and 2009.
Peter Moffat, the man who wrote “Criminal Justice,” created a character with atopic dermatitis with a specific purpose in mind. He wanted to bring awareness to the disease that afflicts more than 10 percent of the world population—himself included.
“I pictured this character to be one of those low-life, unattractive lawyer types with dandruff and the one suit they wear every day in court with shiny elbows because they’ve worn it so often,” says Moffat, who himself was a “lawyer type” before he took up writing full time, having served as a barrister in the British court system. Barristers stand apart from American attorneys in the sense that they wear black robes and colonial wigs during trials.
“At first, I felt a bit guilty and worried I was deducing this disease by attaching it to those characteristics,” Moffat admits. “But suddenly, millions of people in Great Britain are watching this character I created who has severe atopic dermatitis and asking questions about it.
“And the same thing happened with ‘The Night Of,’ he continues. “I’ve been following the social media response, and one tweet I really loved said, “The Night Of’ is the story of a guy’s eczema…with a murder subplot.’ I thought that was brilliant.”
Moffat has been living with eczema for as long as he can remember, dating back to the time when he was 5 years old playing sports in his backyard. His mother noticed a rash creep up on the backs of his knees, and promptly took him to a physician.
“The doctor said I had infantile eczema, and as I grew up, it would no longer continue to bother me. I went away feeling really reassured,” Moffat recalls. “But then nothing changed. There were steroids, cortisone ointments, homemade stuff—none of which made any significant difference. Fifty years later, my severe eczema is still here.”
Just like the character John Stone, atopic dermatitis wreaks havoc on Moffat’s feet. “I try to wear flipflops or sandals to get as much air as possible to them, but people stare at them when I’m in public, which is fine with me. I don’t care what they think. But it tells me what a real problem it can be for those who are less confident in their public life,” he says.
“They cover up what they shouldn’t be covering up, which I think is bad physically for the management of this disease and also bad emotionally because they feel they have to keep it private. And neither of those things are good.”
He recalls a time when he was riding the subway in London and witnessed two parents look down at his feet with disgust and move their child away from him. “It was obvious to me that they thought this was a contagious disease,” Moffat says.
“Also, it was November in London, when it was a bit cold, and they must have thought I was a bit deranged for wearing flipflops. I wanted to tell them, ‘Listen, guys, it’s fine. This is what it is. You can’t catch it from anyone.’ But my response instead was to carry on doing the same thing I was doing.”
Moffat believes his main triggers are stress, central heating and, oddly enough, potato peels. “Even just thinking about it I can feel it coming on,” he says. “Here comes the rash, and then you are scratching it, and that speeds it up more.
“I know intellectually that it’s bad to scratch, but despite what I know, I can’t help but do it. When I wake up, I can’t believe how much I’ve scratched myself in my sleep. Even my wife wakes up in the night from me scratching, so it’s not just the sufferers who are impacted.”
Ironically, his wife, a fellow writer and barrister was also living with eczema until the birth of their first child, when it mysteriously went away. “It cleared up overnight and never came back,” Moffat says. “That’s interesting to me because it suggests some kind of hormonal component to this disease, which I know not to be true or think not to be true.
“But the lack of medical clarity about what I’ve been living with for the past 50 years is unsettling,” he continues. “I’m longing for a unified perspective from the medical profession and an understanding and awareness from the public on what this disease means for people and what’s really going on. I think the more awareness we raise and the more we talk about this disease, we’ll be able to change that.”
Moffat’s motivation to raise awareness around this disease is what led him to join the Understand AD: A Day in the Life program. Sponsored by Sanofi US and Regeneron Pharmaceuticals, Inc. in partnership with the National Eczema Association, Understand AD is an awareness program created to educate people about uncontrolled moderate-to-severe atopic dermatitis.
“I want other people who have this disease to not be afraid to speak up about it and not feel embarrassed by it,” Moffat says. “I want them to feel more normal than they are sometimes allowed to feel. If you can be open about it, talk about it with your friends and family. Wear flipflops on the [subway] if you want to, and don’t let the world say you can’t.”
For more information about Moffat and the Understand AD: A Day in the Life program, visit www.UnderstandAD.com.