However, Atopic Dermatitis (AD) is often difficult to comprehend.
Because it is so polyetiological, with lots of allergens recognizable as IgE antibodies or not.

If you notice itchy eyes or runny nose suddenly starting in February,
you can understand cedar pollens are coming.

But as to AD, there are so many suspected allergens other than pollens.
What is the true culprit of the aggravation?
Even you know you are allergic to house dusts/dust mites, the major allergens of AD,
it’s quite difficult to estimate how much degree the dusts are involving now.

Is it because my cleaning has been insufficient?
How many mites are there affecting me in my bed or pillow?
Do I have to throw away these rag dolls I cherish?
The more they think, the more they’ll stray into a maze.
As long as we live in this world, we will never completely be free from dusts or mites.

Or, the true culprit might be a food I ate then, otherwise a beverage I drunk?
I also might have touched something bad.
No, no, probably because the place I visited was polluted…
A great many allergens can cause and worsen their rashes.
It is always a big question:
what is the allergen my body immune systems are responding now?

There may be more than 1 or 2 causes.
Current symptoms are a total result of any allergic responses until now.
A causal relationship is difficult to grasp even in one item, not to speak of two or more.
Nevertheless, we always want to know what is the cause.

In AD, patients’ skin shields are originally weak.
Lots of flaws easily allow outer substances to penetrate in and in.
Finally, such invaders will be memorized by immune systems as allergens.

Actually, AD patients, including me, are granted miserably fragile skin.
Just a light housework like cleaning or cooking immediately broke skin of hands.
Although no allergen is contained in detergents or water they used,
a primary irritation is enough to destroy AD skin.

If patients try to act the same as other people, they must destroy themselves.
It’s a severe fact, so ironical, isn’t it?
Normal people won’t understand just a simple washing is so hazardous for AD.
It’s sometimes very hard for AD ones to behave normally.

In AD, bad conditions first show up on their skin.
Overworking, eating excessively or unbalanced foods, electrical glares beyond nights,
irregular hours or late hours, shortness of sleep and mental stressors…
When a sleep-wake cycle is confused, the body’s physiological functions will decline.
Unsuitable food intake will lead to lack of proper nutritions to keep skin healthy.
Stressed nerves will be ruffled fairly.

Not only numerous allergens, but also other multiple factors affect AD.
What is the main cause of current symptoms?
How can I get out of this quagmire?
…very difficult to find out.
Those bad conditions are like a disaster, an unavoidable disaster for them.
Their weak skins are spoiled easily and take much more time to restore than people think.
Nevertheless, such long aftereffects are often regarded as a result of bad care.

As the cause is unknown, or as the known allergen can not be eliminated,
patients’ mind will be full of fear and anxiety anticipating endless downhill.
Along with the isolation from the society, patients get irritated, then their family are involved…
thus a chain of misfortune continue.

Scientifically, we can check serum antigen-specific IgEs, which show positive or negative,
and if positive, the levels of antibodies are indicated from class 0 to class 6.
Patch tests and prick/scratch tests are also useful to detect allergens.

In Japan, the biggest set which can be tested once is a 39 allergens IgE panel.
Through the progresses of technology, more and more items become induced.
Still, there are many allergens unable to be tested.
Besides, serum IgE results and actual skin symptoms sometimes don’t go in parallel.
It’s sad test negative does not guarantee no response.
And patch, prick and scratch tests are all be done on patients’ skin.
In patients’ rough skin full of eczema, such tests are hard and the results are unsure.

AD is widely known, but less understood.
AD patients always stand in adverse winds.

Although some AD persons just slightly feel dry/itchy,
others suffer in full body misery with heavy medications.
From very mild, mild, medium, severe, very severe, to the severest.
There are a great range of symptoms in AD that makes it vaguer.

Someone has severe eczema mainly on exposed areas, like face and hands,
another one’s lesions may be almost limited on hidden areas in cloths.
As we don’t go in public naked, the general picture will be easily mistaken.

The severity of eczema itself may be incomprehensible.
Skin rednesses are due to inflammatory capillary dilatations,
with ups and downs all the time.
Sporadic papules or nodules can look striking, although diffuse edematous skin might look flat.

AD affects beyond skins to their quality of lives in wide ranges.
In the severest patients, their lives are totally ruined,
though the mildest ones never care much about AD on the contrary.

AD symptoms rises and falls frequently even in one patient.
The degree of pain from skin damage or itch is just a subjective sensation.
Families and colleagues can only guess it from patients’ appearances.
Is their symptoms truly deserve the extra absences from school or work?
Doctors can not know it.
Just AD patients themselves really feel they can do it or not.
That’s why medical certifications are occasionally needed, but often troublesome.

Unlike bronchial asthma, AD is not an original cause of death.
However, secondary microbial infections through their rough skin can deprive their lives in severe cases.
Serious eye complications like a cataract or a detachment of the retina may also take place.
Recent heavy medications of general immunosuppressants, such as corticosteroids, cyclosporine and dupilumub, can cause serious adverse events.

Everybody can understand an asthmatic patient is in a certain respiratory discomfort when they have an attack.
But AD patients scratch as secretly as they can because they feel so ashamed to be seen such awkward actions.
Therefore others don’t understand their itch much.

Others may also think if patients can endure the itch enough not to scratch, their itch won’t be big.
It’s not their affairs.

The word sickness always associates with an hospitalization, an operation or constant needs of medications and seeing doctors.
In his/her better condition, an AD patient stands for a semi-invalid.
It may be possible for him/her to be half-away from hospitals,
or even can be unidentified from others to be AD.
Isn’t it ideal to be such an well AD?

I wish to overcome the incomprehensibility of this disease.