Atopic dermatitis is a disorder that causes redness and itching of the skin. It is one of the most common skin diseases and can affect up to 20% of the child population and 10% of adults. Atopic dermatitis is chronic and crises may occur in which the symptoms become more evident periodically. It is a complex pathology, where genetic, environmental and immune system control factors come together.
Symptoms of atopic dermatitis
They can vary greatly from one person to another, but the most common are the following:
- Dry Skin.
- Itching, which can be especially severe at night.
- Red to grayish-brown spots, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inner elbows, and knees. In babies it can also occur on the face and scalp.
- Small bumps or bumps that may ooze fluid and form scabs if scratched.
- Thickened, cracked and scaly skin.
- Raw, sensitive and inflamed skin.
The problem of adhesion
The treatment of atopic dermatitis is not simple and the lack of adherence or consistency is one of the main problems in the management of this disease. So much so that up to 58% of adults and up to 50% of the child population do not adequately follow the treatments. “This lack of adherence is one of the most important causes of failure and is one of the pending issues we have in medicine. There is no specific reason why a patient decides not to follow the treatment indicated and there must be something in the communication with the doctors that does not work” explains Dr. Antonio Torrelo, from the Hospital Infantil del Niño Jesús in Madrid, Spain. .
Although it is a complex issue, without a doubt in the case of atopic dermatitis there is a key element in this lack of adherence: corticophobia. 33% of patients prescribed topical corticosteroids never use them and only 40% achieve daily adherence for five days. And 75% show concern, although up to 48% do not know what its adverse effects may be.
“Corticophobia, like all irrational fears, is inexplicable. It is a very widespread resistance, which spreads easily because fear is easier to spread than hope. And although many are unaware of the adverse effects they may have, they prefer to avoid them despite the great benefits that their use brings” explains Dr. Torrelo, for whom one of the most important issues is undertreatment in the first years. “One is more afraid of treating a baby than a 50-year-old adult and it is a serious mistake. Children need treatment even more than adults. If we were effective in treating babies and young children, we would surely prevent many patients from having a bad childhood and who knows, a bad life in the future.”
Prevent the development of the disease
This adherence or consistency in following the entire treatment is essential to prevent the disease from developing into more serious stages. Little is still known about what causes it, with various theories, but what there is more consensus on is how to prevent its evolution. “Daily application of emollient creams from birth to 6 months reduces the risk of atopic dermatitis by 50%. “Systematic and consistent treatment of atopic dermatitis in children using topical and anti-inflammatory agents provides long-term control of atopic dermatitis,” comments Dr. Carle Paul, from the Toulouse University Hospital Center in France.
In the adult population, this continuous treatment is also of great importance, since it is a disease that has a high impact on quality of life. The problem is that there have been few advances in its treatment since 2002, although since 2017 the first drug for severe atopic dermatitis, dupilumab, has been approved. “In adults, when atopic dermatitis is moderate to severe, it can be considered a systemic disease. It is a new approach and work is now underway to develop new systemic medications that can offer long-term control of the disease,” adds Dr. Carle Paul.
Tips to prevent crises
One of the most common problems for people who have atopic dermatitis are crises in which their symptoms worsen. Adherence to treatments is essential to avoid their appearance, but there are also other things that can be done to prevent these episodes:
- Moisten skin at least twice a day. For this you can use creams or lotions that maintain moisture. Using Vaseline on your baby's skin can help prevent the onset of atopic dermatitis.
- Try to identify and avoid triggers that worsen the condition. Stress, soaps or pollen are some factors that can end up causing a crisis.
- Take shorter baths or showers. Limit baths and showers to 10 to 15 minutes and use warm water instead of hot.
- Use only mild soaps. Antibacterial soaps and deodorants can remove more natural oils and dry out the skin.
- Dry yourself carefully. After bathing, gently dry your skin with a soft towel and apply a moisturizer while your skin is still damp.
