Although the number of patients with atopic dermatitis continues to increase, the possibilities for effective treatment are also increasing every year. What is the treatment of people with AD nowadays? Are home treatments for atopic dermatitis effective? We ask our expert Hubert Godziątkowski, president of the management board of PTCA about it.
How big of a problem is AD? Is the number of patients really growing every year?
According to data provided by the Polish Society of Atopic Diseases (PTCA) in Poland, almost one million patients suffer from atopic dermatitis (AD). Indeed, atopic dermatitis is a multifactorial disease and has a very complex background. In some patients, genetic factors play the main role, gene expression takes place.
In this aspect, some people include atopic dermatitis in the group of civilization diseases. And answering the question, in fact, due to the poor quality of the environment, the deteriorating quality of the food we eat, and the decreasing resistance of the population to potential allergens and stressors, the number of diagnoses related to AD is increasing every year.
According to PTCA, “according to the latest research in Poland, atopic dermatitis currently affects almost 15% of kids. Every year, almost 20 percent. newborn babies are diagnosed with AD. The onset of AD development is usually between 3 and 6 months of age. In about 40 percent. children, the symptoms of the disease completely disappear with age. In the remaining patients, recurrences occur in adulthood. Due to the inborn nature of the disease, it may last for many years or even for a lifetime ”.
It is often accompanied by other forms of atopy. Patients with AD as part of the so-called Atopic march also have to deal with food, inhalation, contact allergies, allergic rhinitis, allergic conjunctivitis, urticaria or bronchial asthma, which affects 30%. atopic.
Well, can atopic eczema be a manifestation of, for example, a food allergy?
To answer this question, we should start with the question of what atopy is, because atopic dermatitis and atopy are not synonyms. Atopy (old Greek ατοπία) is a whole group of allergic diseases that result from an abnormal immune response. Simply put, the immune system begins to react too intensively to things it normally should not (such as pollen), or it recognizes its own tissues as being at risk. Low doses of antigens cause overproduction of immunoglobulin E (IgE), mainly directed against these allergens. This initiates an inflammatory reaction that may affect different organs.
Atopy can manifest as:
- bronchial asthma,
- seasonal or chronic hay fever
- hives
- allergic conjunctivitis,
- or finally atopic dermatitis – as a chronic dermatosis (skin disease).
According to this approach, atopic eczema is not a manifestation of any allergy. Atopic eczema is a dermatosis, i.e. a skin disease with characteristic inflammation. Allergens in relation to AD are the so-called triggers, i.e. factors exacerbating the course of the disease or shortening periods of remission. It should be remembered that in addition to food, air-derivative or contact allergens, there are also non-specific triggers that exacerbate the course of AD, such as stress, sudden changes in temperature or changes in the environment (environment).
In the group of children suffering from atopic dermatitis, less than 30% were additionally diagnosed with food allergies. As the age of the population increases, this percentage of allergy sufferers among people with AD is decreasing.
And here we come to another important issue: the diagnosis and treatment of AD. In order to properly treat atopic dermatitis, it is important to properly diagnose it, because it is not the same as an allergy. There are no markers or diagnostic tests that can be used to make an accurate diagnosis. Here, the experience of a specialist doctor (most likely a dermatologist) is of key importance. When making a diagnosis, a dermatologist relies mainly on assessing the patient’s condition and verifying the occurrence of the so-called major criteria, differential diagnosis (excluding other diseases with similar symptoms) and finally on a reliable family history.
A common and erroneous practice is to select the first-line treatment of AD with pharmaceuticals characteristic for the treatment of allergic conditions, e.g. antihistamines. Antihistaminics are neither first-line nor second-line therapies in the treatment of dermatoses. Therefore, such treatment often does not bring the effects of improving the patient’s condition, reducing inflammation or eliminating the main and most bothersome symptom of atopic dermatitis, which is pruritus. Therefore, it is important that the patient with AD is under appropriate dermatological care.
While atopic dermatitis is an allergic disease, the factor that differentiates it from allergy is a genetically determined dysfunction in the structure of the epidermis. That is why proper diagnosis and proper treatment are so important.
We already have the diagnosis. What is most important when talking about how to treat AD?
One thing is for sure: in order to manage AD and control the disease, it is important to understand its mechanisms.
Let’s focus on two key points:
- it is an incurable and chronic disease with periods of exacerbation and remission;
- the key is to pay attention to all potential aggravating factors, as well as to be proactive through the use of basic therapies (emollient regimen), regardless of the severity of the disease. In the period of remission, atopic skin is “apparently healthy” and proactive therapy should not be discontinued under any circumstances.
The main issue is to follow the doctor’s instructions. Still, among patients using various forums, there is a fear of using certain medications. Topical glucocorticosteroids (the so-called steroid ointments) are especially notorious. Such a phenomenon in the literature is called steroidophobia or corticophobia. While the use of inhaled corticosteroids to treat asthma no longer causes such anxiety, topical corticosteroids to the skin still cause fear. The same is the case with immunosuppressive drugs, modern and safe preparations that have an anti-inflammatory effect.
And here we come back to the fact that AD treatment should be dealt with primarily by a dermatologist who knows what doses of the drug and how long can be used directly on the skin with safety. This problem also applies to coping with pruritus, the mechanism of which is slightly different from that of allergic pruritus, and typical antihistamines will not work here.
So, speaking of what to do in the period of exacerbations: if we have the therapy prescribed, let’s follow it. A key aspect and a prerequisite for success in treatment is a good patient / caregiver-doctor relationship and communication. In situations where the results in the initially undertaken treatment path are not satisfactory, it is important to contact the attending physician, share your observations and observations, and ask for a treatment path correction. Changing the attending physician in the absence of rapid success is not the best solution.
The time when things get better and the patient goes into remission is another challenge and a key element of AD therapy. Appropriate management during this period may help to avoid repeated exacerbations of the disease.
How can future flare-ups of atopic dermatitis be prevented?
In fact, there is one answer that has been given before: proper systematic emollient care and avoiding exacerbation factors as much as possible is essential in preventing future AD exacerbations.
What is PTCA’s position on alternative treatments, such as starch baths, sea buckthorn oils or Egyptian black cumin oil?
There is virtually no such thing as ‘alternative treatments for AD’. As a rule, according to the current state of knowledge, today we have the following treatment methods available, the use of which depends on the severity / form of the disease. This:
- causal treatment – here we basically only identify and eliminate factors irritating and aggravating the course of the disease (triggers);
- symptomatic treatment – we have at our disposal emollient therapy (always used, regardless of the severity of the disease), anti-inflammatory treatment (local glucocorticosteroids, systemic corticosteroids, local calcineurin inhibitors), phototherapy, the method of wet and dry dressings (antipruritic effect) and modern biological therapies. The latter have recently been reimbursed in Poland for adult patients with severe AD (treatment with dupilumab).
Of course, there are still a number of activities supporting the treatment of AD, but remember that these are nursing and supportive activities and cannot replace the basic treatment of the disease. Among such activities, hypochlorite baths (bleach baths), whose task is to prevent infection, and the method of wet wraps (Wet Wrap Treatment), which has clinically proven effects to reduce the feeling of itching and significantly improve the quality of life of the entire family affected by AD, deserve special attention.
As for the aforementioned starch baths – in fact, this method was used in the past, but as I said earlier, it was rather a supportive procedure. Today, due to the high allergic potential of potato starch, it is not a method recommended by allergy specialists. If I had any suggestions for home remedies for soothing irritated skin, I suggest adding “jelly” to the bath, which is obtained by boiling the flaxseed seeds.
I know that nowadays, especially on the Internet, there is a fashion to use “natural products”, including the fashion to apply various natural oils directly to the skin. In fact, the most frequently mentioned oil are Egyptian black cumin, sea buckthorn oil, argan oil, hemp oil, linseed oil, etc. I personally warn against this type of experiment. As a rule, natural pressed oils have a high irritating potential (they often irritate the skin or sensitize), and additionally, it should be remembered that applying oleins directly to the skin over a long period of time leads to a significant loss of water (drying the skin), which is also a phenomenon of atopic skin. strongly undesirable.
Is there anything else we can say to AD patients?
From our perspective, nowadays patients and families suffering from atopic dermatitis live much easier than a few years ago. Thanks to the active activity of patient organizations, such as the Polish Society of Atopic Diseases, a lot is said about AD, problems and unmet needs of patients are also noticed by decision-makers. Recently, adult patients with severe AD can be treated free of charge under the drug program with a very effective, but also expensive biological drug, dupilumab. There are plans to implement such treatment for all patients with AD, regardless of age.
Manufacturers of dermocosmetics, thanks to cooperation with the patient’s organization, have the opportunity to listen to the patient’s voice and create even better and more effective preparations. In turn, patients and carers associated in the organization have their representatives and can speak with one strong voice.
On PTCA websites and social profiles, patients and caregivers can not only supplement their knowledge about the disease thanks to guides, publications (the “Atopy” quarterly), articles, infographics and studies, but also get real support by participating in closed support groups, using the hotline support or participation in support projects, where you can benefit from free meetings with dermatologists, get free psychological support or, for example, as part of testing projects, receive free “atopic” products. In PTCA’s resources you will find both basic knowledge, such as “How to properly apply emollient to the body”, and interactive maps where you can check which facilities provide free biological treatment.