Atopic dermatitis, a skin problem that has psychological effects

What happens when your skin rebels against you? The case of atopic dermatitis is much more than a skin rash. It's a daily fight against itch, pain and shame, and more common than you think. It is one of the most common inflammatory pathologies, affecting 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 in which 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 brutally,” explains Pablo Coto. , dermatologist at the Vital Álvarez Buylla Hospital in Mieres. Most of the diagnoses occur at an early age, between three and twelve months, while in adults it is more complex, because “sometimes it reappears after having disappeared as a child or because it is an adult when they have their first episode,” 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 in vain, 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, these types of problems occur in up to 50% of patients.. And not only that. It must be taken into account 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 re-education of primary care doctors when treating the patient” and that “sometimes it is diagnosed without having it, in addition to the fact that a soap and other products business has been set up. that trivialize it,” he asserts.

While this problem has persisted over time, Coto warns that the incidence of the disease has tripled in recent 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 it, he 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 antibodies and 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 you can be well, thanks 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 the person's priority is to alleviate the symptoms, because they are still not sleeping and scratching,” he warns.. This, 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 he sees virtual worlds and the metaverse as a solution for the future.. In fact, he 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.