Atopic dermatitis is a chronic inflammatory disease that affects millions of people worldwide, with a strong impact on the quality of life of children and adults. A scientific review gathered recent evidence on one of the central mechanisms behind the disease: the relationship between oxidative stress and so-called type 2 inflammation. The work was published by the Qualis A Open Minds journal , owned by CPAH, the Heráclito Research and Analysis Center, under the technical management of Editora Atena.
The study is authored by Sabrina Lucietti Dick , Laura Berlitz , Maria Eduarda Ribas Bissani , Phelipe dos Santos Souza , and Claudia dos Santos Dutra Bernhardt .
A disease that goes far beyond dry skin.
Atopic dermatitis, also called atopic eczema, is a chronic and recurrent inflammatory skin disease with multifactorial causes. According to the authors, the condition usually begins before the age of five and may disappear after puberty in some patients, although there are also cases that appear later in adulthood.
In addition to visible skin symptoms such as eczema, intense itching, redness, and dryness, the review highlights the psychological impact of the disease. According to the researchers, children with atopic dermatitis often face stigma and fear of social interactions, which can lead to isolation, anxiety, and effects on self-esteem. In adults, the disease also significantly compromises quality of life.
How type 2 inflammation affects the skin
The central objective of the review was to clarify the immunopathological mechanisms that link oxidative stress to the type 2 inflammatory response in atopic dermatitis. To this end, the researchers conducted a qualitative and descriptive survey of the scientific literature, searching databases such as:
● BVS
● PubMed
● ScienceDirect
● Academia.edu
Articles published between 2006 and 2025, in both Portuguese and English, were considered.
According to the results, epidermal barrier dysfunction and reduced expression of a protein called filaggrin are central to the development of the disease. When this barrier is compromised, irritants from the environment penetrate the skin more easily and trigger an immune response known as type 2 inflammation, mediated primarily by three interleukins called IL-4, IL-5, and IL-13.
The self-reinforcing cycle
The central point of the review is how this process becomes a self-sustaining cycle. Interleukins IL-4 and IL-13 inhibit proteins responsible for maintaining the skin barrier, which induces so-called oxidative stress, defined by the authors as an imbalance between the production of reactive oxygen species and the body’s own antioxidant capacity.
This oxidative stress, in turn, further intensifies the inflammatory response, in a self-reinforcing cycle that amplifies symptoms such as eczema and itching. The review also points out that environmental factors, such as cigarette smoke, air pollutants, and particulate matter, contribute to this imbalance, as does chronic psychological stress, which can intensify the sensation of itching by activating immune system cells in the skin.
The role of antioxidants is still uncertain.
The review notes that the body has a regulatory antioxidant system, made up of enzymes and vitamins such as A, E, and C, capable of neutralizing some of the effects of oxidative stress. In patients with atopic dermatitis, however, this system is usually less efficient, making it difficult to control inflammation.
The authors cite studies that point to the therapeutic potential of antioxidant molecules as a complementary strategy in the treatment of the disease, but they make an important caveat: since the mechanisms involved are not yet fully understood, more research is needed before these approaches can be considered established treatment strategies.
Current treatments and their challenges
According to the review, the treatment of atopic dermatitis is mainly based on topical medications, such as corticosteroids and moisturizing creams, as well as calcineurin inhibitors. Topical corticosteroids remain the first-line treatment, but their prolonged use can cause local adverse reactions, such as thinning of the skin.
More recently, drugs specifically targeting type 2 inflammation have emerged, such as dupilumab, an antibody that blocks IL-4 receptors, reducing the inflammatory response mediated by these cells. However, the authors highlight that this type of medication faces challenges related to high cost, the need for regulatory approval, and potentially serious adverse effects such as allergic conjunctivitis, liver damage, and the risk of thromboembolism.
What the researchers conclude
The review concludes that atopic dermatitis is a chronic disease with a complex pathophysiology, in which skin barrier dysfunction and reduced filaggrin are central factors. This process facilitates the entry of environmental irritants, triggers the production of IL-4 and IL-13, and is aggravated by reactive oxygen species generated by both internal metabolic processes and external sources, such as the burning of fossil fuels.
The authors also emphasize that psychological factors, such as chronic stress, play a significant role in worsening the condition, and argue that future therapeutic strategies should be multidisciplinary, involving the control of the skin microbiome, the management of environmental and psychological triggers, and care focused on the quality of life of patients.
This text is for informational purposes only and is based on a scientific review of the mechanisms of atopic dermatitis. It does not replace consultation, diagnosis, or treatment prescribed by a dermatologist. Decisions regarding the use of medications, creams, or supplements should always be guided by a healthcare professional.
