2023-09-27 00:20:39
Immune-mediated diseases
Updated Wednesday, September 27, 2023 – 00:20
This chronic and inflammatory disease carries other psychological and social conditions in 50% of those who suffer from it. In recent years, notable progress has been made in its treatment, but some outstanding challenges still persist, both in its diagnosis and in its follow-up.
Access to new therapies for this condition is still unequal and slow
What happens when your skin rebels against you? The case of atopic dermatitis is much more than a skin rash. It is a daily fight against itch, pain and shame, and more common than you think. It is one of the most common inflammatory pathologies, which It affects 20% of children and 10% of adults. But, even so, there is great ignorance about the enormous impact that this disease has on the lives of patients.
“The skin is the way we relate to the environment and what happens with atopic dermatitis is that an immunological disorder occurs that causes this barrier to alter, react by thickening and fighting in a brutal way,” explains Pablo Coto, dermatologist at the Vital Álvarez Buylla Hospital in Mieres. A large part of the diagnoses occur at an early age, between three and twelve monthswhile in adults it is more complexbecause “sometimes it reappears after having disappeared as a child or because it is as an adult when they have their first episode,” he details.
The main symptom of this dysfunction is, without a doubt, itching, which causes the need to scratch the skin to try to relieve it, which triggers a continuous cycle of itching and scratching. This is the trigger for a series of consequences that affect daily activities such as sleep, work and studies. Not surprisingly, half of adults with this condition have sleep disturbances an average of 162 nights a year and at least 87% have problems falling asleep almost always.
The psychological toll that is paid carries a high price. “Anxiety, depression, isolation, frustration and even self-medication occur.with abuse of substances such as marijuana to make the itch go away,” says the expert. According to the Spanish Society of Allergology and Clinical Immunology, this type of problem occurs in up to 50% of patients. And not only that. We must Keep in mind that people with atopic dermatitis have a higher risk of developing other atopic disorders such as asthma, rhinitis or food allergies.
Beyond all of the above, Coto highlights the high degree of social trivialization that surrounds this disease, since Many people consider it mild and that it only affects the skin. He also believes that there is a “lack of education and reeducation of primary care doctors when treating patients” and that “sometimes it is diagnosed without having itin addition to the fact that they have managed to set up a soap business and other products that trivialize it,” he asserts.
While this problem has persisted over time, Coto warns that the incidence of the disease has tripled over the last few decades due to several factors. Among them, urbanization and hygiene theory, which suggests that less exposure to allergens in childhood may increase predisposition to disease. They have also had to do with, she says, the alteration of the intestinal microbiota due to changes in diet and medications, and the fact that the availability of treatments has led to an increase in diagnoses.
NOTABLE PROGRESS
The encouraging aspect lies in the great advances recorded, thanks to better knowledge of the disease. “Drugs have been developed that are monoclonal antibodiesand small molecules that attack or inhibit proteins specifically inherited in patients with atopic dermatitis and that give a high hope of living without it,” explains Coto.
For this reason, he believes that it is very important that an adequate identification be made, to refer the patient early to the specialist and find the ideal treatment: “You have to be aware that it can be okaythanks to therapeutic alternatives with which to modify the course of the disease without having to resign.”
This ambition, he clarifies, must be shared by the dermatologist: “You cannot be satisfied with relieving the patient, but you must go further and address the remission of the disease and fight for therapeutic alternatives, because they are rare drugs that, unfortunately, They do not have the same accessibility in all Spanish communities for economic reasons.“.
The discrepancy between what the doctor and the patient see continues to be one of the challenges to be faced. “Perhaps the dermatologist perceives that the affected body surface has gone from 30% to 10%, but does not take into account that that person’s priority is to relieve the symptoms, because they are still not sleeping and scratching,” he warns. That, he adds, is what highlights the need to incorporate common tools and records for evaluation and measurement of results and reported experiences.
He also perceives it as essential to improve psychosocial care for the sick, for which sees virtual worlds and the metaverse as a solution for the future. In fact, she has already led the first meeting with patients through a tool that, he hopes, will become the new ally in their fight against this disease.
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