The visible and non-visible consequences of a very common and little-known disease
Sometimes referred to as eczema, atopic dermatitis (AD), is a disease characterized by intense itching and redness of the skin. AD is a chronic disease, most common in childhood, most often self-limited until adolescence, but can extend into adulthood. AD can go far beyond itching, redness, scaling, excoriations, cracks and scabs. t is also a disease with invisible effects on the people who live with AD every day, effects such as sleep disturbance, depression, frustration, and anxiety.
European data indicate that there are about 440,000 people in Portugal with AD, of which 46% have moderate to severe forms of the disease.
Clinical manifestations
The diagnosis of this disease is essentially clinical. On average, the time between the first symptoms and the confirmation of the diagnosis is two years. To improve, it will be important to promote awareness of the disease among different health professionals and to speed up the referral of patients to the Dermatology Consultation.
AD can have different clinical manifestations. Dry skin and itching, which can be intense, especially at night, are present in 90% of patients. Red to gray-brown patches may also appear, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, in the creases of the elbows and knees, and in infants, on the face and scalp. Small, raised bumps that can leak fluid and form scabs when scratched are common and result from inflammation and trauma from itching.
Causes and Consequences
AD is a complex multifactorial disease whose disease mechanisms are still unclear. AD has its origins in genetic factors, the hypereactivity of the immune system, and the impaired barrier function of the skin. The relative importance of each of these factors will determine different aspects and severity of the lesions.
Living with AD can mean living with constant itching and irritation. Inflamed skin with red, flaky, rough patches is often a visible constant in the disease.
AD is associated with other diseases, including allergic rhinitis, asthma, allergic conjunctivitis, food allergies, nasal polyposis, and cardiovascular complications, all of which affect the person’s health and quality of life.
In addition to the physical manifestations described, the strong impact of AD on the quality of life of patients and on society should be highlighted. Some of the effects associated with this disease, such as sleep deprivation, anxiety and attention deficit, caused by the constant itching, lead on average to a 25% productivity deficit, with an impact on school and professional performance. According to a Portuguese study developed by NOVA IMS/Portuguese Society of Dermatology, in collaboration with the Portuguese Association of Atopic Dermatitis Patients, approximately half of the patients who suffer from this disease, have difficulty sleeping 3 or more nights a month. The same study showed that about 16% of patients report a reduction in their health status of more than 50%.
AD still means a great financial strain on patients, families, the healthcare system and society. As the severity of the disease progresses in a negative way, the costs increase. The study conducted by NOVA IMS/Portuguese Society of Dermatology showed that, on average, each patient with severe AD spends about 1800 euros per year because of their disease.
Types of Treatment
AD is a disease paradigm in which general skin care determines a reduction in the frequency and intensity of attacks. Good hydration, with appropriate moisturizing creams, combined with bathing care will significantly improve the skin condition of these patients. The aim is to maintain the integrity of the skin’s lipid layer. In other words, during bathing, we should not degrease the skin with prolonged bathing, very hot water, and soapy products. And after bathing we should replenish the skin’s fatty film by applying moisturizers. It is this film that will keep the skin moisturized and prevent allergens from entering the skin. Only about 50% of AD patients apply moisturizing creams daily. This is clearly too little considering the importance of this care, which unlike some treatments has no significant side effects.
The treatments used for this disease must be maintained over time and adjusted to the severity of the disease. They range from promoting the skin barrier with moisturizers and the use of soap-free hygiene products, to the application of creams with corticosteroids or other immunomodulators, to oral therapies with immunosuppressants. Recently, innovative biological treatments have emerged that, due to their efficacy and safety, have changed the evolution of AD.
The final message is one of hope… Although there is still a long way to go in discovering the true causes of this disease, it is important to stress that science has evolved to the point of defining the molecular pathways involved and finding selective, safe and effective biological treatments. The relief of the cutaneous manifestations of Atopic Dermatitis, as well as a better quality of life for patients, will continue to be a major priority and is getting closer and closer.
Professor Doutor João Maia Silva
Professor of Dermatovenereology, Lisbon Faculty of Medicine
Coordinator of the Dermatology Centre, CUF Descobertas Hospital
Member of the Portuguese Society of Dermatology and Venereology
