Patients with AD have a modified skin barrier and this allows the entry of external agents that cause the onset of the inflammatory process, itching, scratching and the development and perpetuation of lesions … It is a disease that begins in the immune system, being linked to other inflammatory diseases such as asthma or rhinitis.
Atopic dermatitis is considered by many to be a childhood disease, half of which are diagnosed in the first year of life.1and 25% progress to adulthood. In childhood, it affects between 15 and 20% of children, which is why it is considered the queen of pediatric dermatology.
Ana Martín Santiago, head of the dermatology service at Son Espases University Hospital in Palma de Mallorca, points out genetic and environmental factors as the main causes that determine that a child has this pathology. “The etiopathogenesis of the disease is very complex, but fortunately it has been studied and we know it more and more, which allows us to intervene to improve it.”
Although atopic dermatitis is usually classified as mild, moderate, and severe, the level is not static and may change over time. A child with mild atopic dermatitis may no longer manifest or, due to environmental circumstances, progress to a serious degree. According to the dermatologist, “this will depend on the extension, persistence over time, response to treatment and the type of lesions at a given time.”
Severe atopic dermatitis can be when it is very widespread at a certain time or when there is a recurrence that requires constant treatment. One of the characteristics of moderate to severe dermatitis is that it causes severe itching that prevents the baby from sleeping. “The impact on family dynamics is extraordinary.” If a small child does not sleep, the family does not sleep either. They are more anxious children, with psychological disorders and who may have socialization problems. They can even be harassed. The disease is associated with many comorbidities. What we see are eczema, but behind it is an itch that prevents them from leading a normal life. With severe outbreaks they cannot go to school, they become superinfected and sometimes they have to be admitted. All this affects the child’s school performance and emotional development. It is also a financial cost for the family, as parents sometimes cannot go to work. In addition, she has to bear the costs of daily skin care creams, which are not funded by social security. It is a disease with a lot of impact “, says Martín Santiago.
Children with atopic dermatitis lose school on average between 10 and 24 days a year due to the disease1. In addition, over 27% of 8- to 17-year-olds suffered harassment, a percentage that rises to 38% in those children with serious illnesses2. 30% of parents say that the disease has a great impact on other members of the household living with the affected person3. Over 50% feel unhappy or depressed.
The impact on family dynamics is extraordinary. If a small child does not sleep, the family does not sleep either.
It is essential that this pathology be monitored by a professional so that the child has constant control. This check-up can be done by a pediatrician to a dermatologist or even sometimes an allergist, depending on the course of the disease. “There are many network frauds and many children are under-treated. Prescribed medications are safe if the recommendations of professionals are followed. The fear of using them means that the patient is not treated properly and progresses to a more severe atopic dermatitis “, the specialist emphasizes.
To try to alleviate the outbreaks of this disease there are a number of guidelines that patients must follow. It is about taking care of the skin barrier with hydration through special soaps and creams and the use of cotton and yarn clothing. It is also important to avoid excessive sweating and showering after exercise.
The symptoms of atopic dermatitis resolve in many cases when boys reach puberty. However, those patients with severe atopic dermatitis, whose symptoms began at an early age, who have a family history and respond poorly to treatment, are more likely to continue to suffer from the disease after adolescence. At this stage, adolescents suffer a significant psychological impact, accompanied by anger, loss of confidence and shame. When the symptoms are obvious, he can condition them even in the choice of clothes to wear, they do not want to wear shorts or T-shirts and avoid going to the beach or the pool, all affecting their social relationships.
There is an unmet medical need in the treatment of severe and moderate dermatitis in children. The systemic treatments available to date are immunosuppressive drugs, used despite the fact that they have not approved the pediatric population in Europe for this disease. “Experience tells us that these treatments are effective, but do not have a good safety profile. We need an effective and safe treatment “, says Martín Santiago.
With the arrival of new treatments, the prospects of this disease, in most chronic cases, are promising. In the near future, it is expected that organic products, which have already been approved and have been shown to be effective and safe in adults, will also prove effective in children.
“The future is already here,” says the dermatologist, “there are molecules that act in a specific way based on the disease and intervene directly in the etiopathogenesis. There are already biological medicines for adults and it is expected that, in a short time, their administration will be extended to children, which will change their lives “.
1 International study of life with atopic eczema ”(ISOLATE).
2 Spanish Society of Allergology and Clinical Immunology (SEAIC). (2015). Allergological report.
3 Zuberbier (2006). Patient perspectives on the management of atopic dermatitis