Atopic dermatitis: “There is no cure for this chronic disease, but there are treatments that can minimize or even eliminate the manifestations” – Current Affairs

Atopic dermatitis: “There is no cure for this chronic disease, but there are treatments that can minimize or even eliminate the manifestations” – Current Affairs

What is atopic dermatitis and what are the main symptoms of this disease?

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is estimated to affect about 10 to 20% of the pediatric population worldwide, but can affect any age group. In these patients, the skin is typically very dry and rough, causing pruritus (itching), and eczema lesions that manifest as erythema (red skin) with pimples, scales, vesicles (small fluid bubbles), and scabs that appear in the skin. heavier forms become very thick skin, sometimes with cracks and wounds with crusts. Lesions in the first years of life mainly affect the face and arms and legs, but with age tend to become more chronic and limited to flexures of the arms and legs (flexures and popliteal regions), wrists and ankles, but with frequent involvement of the face (eyelids and lips) and neck, nipple and genital region.

What are the main complaints of patients?

The main complaint is pruritus (itching), sometimes of such intensity that it prevents sleep and concentration at school or work and makes you desperately scratch, causing additional skin wounds. This itching worsens at night, in the heat of the bed, in direct contact with woolen clothes or “coarser” fabrics or even when sweating, for example during sports. These patients also often report skin pain or other symptoms such as burning, discomfort, malaise, sometimes vaguely defined but very uncomfortable.

What is the impact of this disease on children / adolescents and their parents / guardians?

The impact of the disease on young children is the result of discomfort that prevents them from sleeping and causes frequent irritability. In older children, the disease has a large emotional impact due to the visibility of the lesions and the limitations it causes. Both children and parents and caregivers who face the disease on a daily basis report a loss of “joy”, “sleep” and “freedom” and an impact on building friendships, school and sports, which can lead to episodes of anxiety, worry and sadness. The effects of AD on an emotional level are therefore common, with feelings such as shame, anxiety and frustration. Sleep disorders, which affect most patients with moderate to severe forms, can lead to fatigue and disrupt daily life, including learning performance, or even cause absenteeism.

In adolescents, relationships, participation in leisure activities and sports can be significantly compromised. Choosing clothes that will hide lesions or avoid itching in contact with certain tissues can be a problem in the daily lives of these young people, who often see their sex lives threatened. Therefore, it is not uncommon for some of these patients to be isolated and develop psychiatric pathology.

Parents and the rest of the household are often affected by sleep deprivation due to the need to accompany their children at night. Parents are also concerned about the child’s integration into school / sports, clothing choices and child nutrition, either because of the more frequent association with food allergies and the risks involved, or because of general information that is often incorrect. , the possibility of worsening AD with certain foods. Significant time is needed for the proper performance of topical treatments and hydration of the body at the end of bathing, as well as the need to accompany children to consultations or accurate hospitalizations in the stages of exacerbation. In addition, AD often creates fear for the future of children, because the disease has a great psychological impact. The price of appropriate moisturizing creams and body care products, which are an absolutely necessary supplement to the treatment of these patients, but are not refundable, can significantly affect the family budget.

Is there a stigma associated with this disease? Because?

There may be some stigma due to the visibility of the lesions and the frequent need to scratch in public, which ultimately creates some discomfort in those around the patient and fear of infection through skin lesions. Correct public information about this disease, as has been the case with psoriasis for years, with its greater dissemination in schools and the media, would enable a better understanding of patients with AD and deconstruct this stigma associated with the disease. Available treatments that allow better control of skin lesions can also help patients overcome this stigma.

How to minimize the impact of frustration and anxiety, especially in teenagers?

One way to minimize the impact of the disease is to explain in a simple way what is happening on the skin so that the patient understands how to avoid aggravating factors and understands the benefits of treatment. This can be done in specialized consultations or in patient group meetings or “atopy schools” with access to patients and family members / carers where the disease is explained and how it can be dealt with and where lessons learned, attitudes and strategies for living better are shared. with AD and reduce the frustration of many of these patients. But the best way to minimize frustration is to offer patients the most effective treatments that control the signs and symptoms of the disease. Many of these patients suffer from other diseases that are often associated with AD, such as food allergies, eye pathology (allergic conjunctivitis), asthma or allergic rhinitis, diseases that can further complicate the lives of these patients. However, we have noticed that some patients need psychological or psychiatric support to cope with anxiety, frustration, depression, and even suicidal tendencies. In such situations, the importance of multidisciplinary cooperation of health professionals for the best patient care is evident.

Margarida Gonçalo, a dermatologist at the Centro Hospitalar e Universitário de Coimbra, about this disease.

Margarida Gonçalo, dermatologist at Coimbra Hospital and University Center

“data-title =” Margarida Gonçalo, dermatologist at the Centro Hospitalar e Universitário de Coimbra, on this disease. – Atopic dermatitis: “There is no cure for this chronic disease, but there are treatments that can minimize or even eliminate the manifestations” – SAPO Lifestyle>> Margarida Gonçalo, a dermatologist at the Centro Hospitalar e Universitário de Coimbra, about this disease.

Margarida Gonçalo, dermatologist at Coimbra Hospital and University Center

Are there any treatments available?

There is currently no cure for this chronic disease, which sometimes recedes with age or occurs only in adulthood, but there are treatments that can minimize or even eliminate the manifestations of AD In addition to moisturizers, topical treatments essentially include creams and corticosteroids. ointments that must be adapted to the type and location of the lesion, and local immunosuppressants.

In moderate to severe forms, conventional oral immunosuppressants may be added (which are often used, although some are not approved for this indication). However, it is necessary to pay attention to the contraindications of these drugs (active infections such as tuberculosis) and their harmful effects (hypertension and kidney damage, hematological or liver damage), especially in long-term treatment. Oral corticosteroids should be avoided, except for very short periods and usually for more rapid suppression of seizures. Phototherapy (controlled sun exposure or solarium-type appliances) can have certain benefits, but in the most severe forms of AD, this therapy has an irregular effect, which occurs slowly and the benefit is temporary.

In recent years, we have made available, only in hospitals, other more effective drugs with a better safety profile. Examples are biologics (monoclonal antibodies) that inhibit the action of Th2 cytokines and are given every 2 weeks as a subcutaneous injection given by a person or healthcare professional, similar to the administration of insulin for diabetes. Its high efficiency in a very significant percentage of patients with AD has enabled a complete change in their lives, but it forces them to maintain treatment for a long time, with the advantage that they do not need regular check-ups like the drugs we had before.

JAK inhibitors are another group of drugs that are very effective in AD and have already been approved in our country for AD. These are oral formulations in tablet form. They have a very fast onset of action, especially on itching, and are very effective in the long run. However, due to the immunosuppressive mechanism of action, they need to be assessed before taking the drug (exclusion of active infections) and periodically monitored for blood elements, cholesterol and liver function, although their side effects are relatively discrete.

These biologics and JAK inhibitors have opened up completely new perspectives for the treatment of patients resistant to previous treatments, and have also enabled increased medical knowledge about AD and its various forms, in order to move towards more effective individualized therapy. of each patient.

Why is it important to talk about this disease?

It is important to know the disease in order to demystify it, so that the general public would not allow the isolation of these patients and, above all, to inform patients about the existence of new therapies that are already available in our country that can change their lives. They should also know that dermatology is working to improve these and identify future therapies that could be even more effective or better tailored to their AD. So, there is a new hope for the future with a better quality of life and more normality for patients with AD, even with the most severe forms of the disease.

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