The basis of predisposition to almost every disease lies in a persons genetics.

In
the case of 20% of children and 10% of adults across the world, genetic code
predetermines atopic dermatitis (Atopic Dermatitis, 2016). Atopic dermatitis, or AD,
falls under the wide umbrella of eczema. It is characterized by scaly and red skin
accompanied by weeping fluid and bouts of itchiness. (National Institute of Arthritis and
Musculoskeletal and Skin Diseases, 2014). Information on the disease in the past had
only extended to the known factors that cause it. These are allergens such pollen, dander,
dust mold, and even drastic changes in temperature. Genetic analysis, however, provides
the connection between these allergens and elevated atopic dermatitis symptoms. By
studying and cataloging the genetic anomalies in atopic dermatitis patients, specifically
those with severe cases that contain recurrent infections, personalized medicine can be
created to assist this group of people who otherwise would not receive effective
treatment.

I. Although the exact cause of atopic dermatitis has yet to be determined, genetics
has been cited as a prominent factor of the severity and rarity of the disease.
A. Genetic mutations in DNA and RNA have either direct or regulatory
effects on the expression of atopic dermatitis.
1. The direct expression can be pinpointed when conducting
genetic analysis, which is why the most common gene mutation in
AD patients has already been identified. It is the mutation of the
FLG gene, which is prominent in 20-30% of patients with AD
(Atopic Dermatitis, 2016).
2. Regulatory expression is more difficult to identify when
conducting genetic analysis. Most are found through biomarkers
for AD such as levels of bacterial and viral infection. These are
usually caused by changes in cytokine or interleukin amounts,
which are, in turn, caused by the genetic regulators (Ong & Leung,
2016).
B. AD severity and rarity is dictated by a patients levels of itchiness,
infection, and overall discomfort.
1. Atopic dermatitis causes itching as a result of the bodys
extreme immune response to a patients environment. This extreme
response stems from immune system mutations (Mathias et. al,
2013). In addition to the bodys regulatory response to these non-
toxic allergens, AD patients may also suffer from nervous system
genetic mutations which stimulate the brain to itch whether the
action is necessary or not (Boguniewicz & Leung, 2011).
2. Because of AD patients urge to itch and their immune
system mutations, some are predisposed to contract bacterial or
viral infection (Ong & Leung, 2016).
3. Other effects of atopic dermatitis include sleep disruption
(Boguniewicz & Leung, 2011) and change in skincare regimen,
which could be as simple as switching moisturizer or as severe as
taking diluted acid baths (Arkwright, Motala, Subramanian,
Spergel, Schneider, Wollenberg, 2013). Both sleep disruption and
 change in routine could potentially decrease the quality of life and
amount of comfort in the lives of AD patients.
II. The other implications of AD must also be considered when genetic research is
being conducted, the most wide-reaching being bioterrorism.
A. Certain bioterrorism relies on genetic mutations in order to make an
impact or threat.
1. AD predisposes its victims to bacterial or viral infection.
Any exposure to these infections, such as a smallpox vaccine,
could lead to a patient developing more severe forms of eczema or
other infections. A small portion of those with eczema is
predisposed to developing eczema vaccinatum and the vaccinia
virus when exposed to smallpox, both of which have the potential
to be fatal (Ong & Leung, 2016). The genetic code of each AD
individual determines the likelihood of obtaining the disease.
2. Smallpox vaccinations are given to members of the military
before being deployed. If these members come into contact with an
AD individual who has the predisposition for eczema vaccinatum,
there is a high likelihood that the disease will be contracted, and
also a likelihood that it will be passed on to other members of the
AD individuals family that may share that predisposition
(Schwartz, 2007).
B. Despite the historical background of the smallpox virus, the disease still
poses a threat to those with eczema or AD.
1. Because of the risk of disease and the unknown genetic
material of AD patients, eczema individuals have not received the
smallpox vaccine, and therefore are susceptible to contracting the
disease and developing the vaccinia virus.
2. Smallpox was officially eradicated in 1979. Since then,
military members about to be deployed have been the only
individuals to receive smallpox vaccination in the U.S. The U.S.
military knows of the threat of smallpox bioterrorism as the only
strains of the disease are held by the United States and Russia
(Inglesby, 2014).
3. The gap in the population of those who have been given the
smallpox vaccine would not be as worrisome if bioterrorism was
not a threat. Hypothetically, if smallpox were to be used as a
bioterrorism weapon, military personnel with eczema are the most
threatened. They could be directly exposed to the disease in the
field and not know if they are predisposed to contract vaccinia
virus. In addition, all military members risk spreading smallpox
virus to their families upon returning home, which in turn could
spread it into school and offices across the country. This increases
the chances of an AD individual contracting vaccinia virus (Engler,
Kenner Leung, 2002).
III. This leaves genetic researchers to continue pinpointing the genetic anomalies that
are apparent in atopic dermatitis individuals. Additional research avenues and
preventative treatments could be developed with the goal of specialized medicine
in mind for each individual.
A. Subgrouping atopic dermatitis patients based on their susceptibility and
severity could lessen the threat of bioterrorism.
1. There is only a small portion of people susceptible to the
vaccinia virus among those who have eczema and AD, but the
exact number and nature of this groups genetic code is unknown
(Ong & Leung, 2016). By finding a commonality or a biomarker
for their predisposition, the amount of people that could potentially
be hurt by smallpox bioterrorism may drastically decrease.
2. The shrinking population of those who are predisposed to
vaccinia allows for greater protection of those individuals.
Emergency preparation and containment could be made for those
with the genetic code that puts them at risk in the case of smallpox
bioterrorism.
B. Through genetic research, each individual with AD can be categorized
with their own genetic code, allowing for specialized medicine and
treatment to assist them in living with a greater quality of life.
1. The Internet is privy to providing home remedies and
recommendations to those who do not know the exact nature and
cause of their disease (Lifestyle and Home Remedies, 2014). With
specialized medicine and personalized treatment, those without
severe or rare types of AD do not risk attempting potentially
harmful treatments without knowing the consequences. They can
instead know their level of severity and plan their regimens
dictated to their personal preference, with the help of a
professional (Wein & Conti, 2013).
2. Those with more severe and rare cases may also have new
options presented to them if genetic research were to be continued.
New oral and topical medications could be made that cater to
specific genetic needs that are exhibited in subgroups of
individuals. Those with bacterial infections or those at risk for
contracting those infections could lessen their phenotypic
expression with new medication (Wein & Conti, 2013).
3. Continuing research on less conventional methods of
treating AD could also open up new avenues for those struggling
with the disease. Sleep therapy (Boguniewicz & Leung, 2011) and
phototherapy (Phototherapy, n.d.) could be perfected and
specialized to each patient depending on their varying levels of
discomfort.