Saturday , October 1 2022

Intersection of atopic dermatitis, subdiagnosis and confusion with other diseases


An intense and almost intolerable mania seems to be the most accurate and recurrent description that is heard from patients who suffer and suffer Atopic dermatitis (AD). In turn, the description itself appears to be part of a frequent disorder of the skin, which complicates things even further, because it distances it from the precise and early diagnosis.

Sometimes patients with AD are confused – and the worst is that they are being treated – with diseases such as Prurigo, psoriasis, scabies or drug reactions.

Atopic dermatitis is a chronic immune-mediated disease that is systemic, incurable and visible on the skin, with an aggregate potential for debilitating effects on patients' quality of life.

"AD has multiple faces, depending on the age of the patient, but its main symptom is pruritus, accompanied by extremely dry and reactive skin," explained Dr. Cristina Pascutto, dermatologist and current chairman of Argentina's Dermatology Society. .

For the same inflammatory process of the skin, 7 out of 10 patients have other diseases (comorbidities) such as asthma, rhinitis and allergic conjunctivitis, chronic rhinorezistence, nasal polyps and food allergies.

For 6 out of 10 adults with moderate to severe variation, the itching is intense or intolerable.

There is consensus and support between two Argentinian scientific societies to raise awareness of this condition affecting the skin. In this respect, Argentina's Association for Allergology and Clinical Immunology (AAAeIC) and Argentina's Dermatology Society (SAD) united their knowledge and information within World Day of Atopic Dermatitis, which is commemorated today, November 27.

AD is usually considered a condition of childhood, as it affects between 5 and 20% of children, of which between 10% and 40% have a serious form. However, in 3 out of 10 cases it continues after puberty, and in fact, some patients feel the very first symptoms only to adults.

"Some people get scared sleeping or trying to sleep, it's hard for parents who see their child suffer or for a man or woman to see their partner in that situation." However, who else has his life traversed by itch, rash, redness and pain, "said the doctor Gabriel Gattolin, President of the Association for Allergy and Clinical Immunology of Argentina (AAAeIC).

"When the patient goes into consultation for the first time, he is asked if he or she has any kind of manifestation in the respiratory tract and is also asked about family history, in addition to confirming, of course, the existence of skin lesions or extremely dry skin, said Pascutto specialist.

Gattolin admitted that "the patient's pruritus is the main reason for asking for consultation, however, redness, swelling, cracking, thickness and excision of the skin condition a complex, often severe and difficult to treat image."

Under this condition, there is what is called a cycle between itch and scratch, which generates even more itching. First, immune cells send signals to inflame the surface of the skin and this makes it stiff. When scratched, the skin's skin barrier is broken, allowing the entry of viruses, bacteria and allergens. This, in turn, reactivates the cells of the immune system, which transmit signals that produce more itching, redness and rashes.

There are factors that contribute to the outbreak and should be avoided: -stress
– food allergens (egg, milk, wheat, soybeans, peanuts, others)
-Aeroallergens (dust mites, weeds, animal epithelia, fungi, others)
-Iritans such as skin glue, wool cloth, or synthetic fiber
– It has water
-Fat soap and aggressive detergents
-Climate with extreme temperatures, humidity or excessive dryness
Skin infections by certain microorganisms

How to treat her, how to do it

The DAS found that the most important recommendation wastaking care of the skin and controlling dry skin, restoring the skin barrier by using appropriate hygiene products and emollients suitable for this type of skin to avoid scratching, exacerbating lesions and over-infestations.

This is a multifactorial disease in which treatment should aim at improving skin barrier (skin integrity), avoiding dehydration and treating inflammation.

Compounds and oat foods also help because it is a natural anti-inflammator for the skin. Ultraviolet rays collaborate, so it's recommended to be exposed to the sun but before 10 or 18 hours because the most abrasive rays can dehydrate the skin and be counterproductive.

Developing new drugs aimed at inhibiting inflammatory processes with a good safety profile opens up a promising prospect for the near future, said Pascutto dermatologist.

Some numbers they shared with Infobae SAD and AAAeIC serve to measure the severity of this disorder and its direct impact on the everyday life of this inflammatory skin disease.

Pruritus occurs both day and night, so that 8 out of 10 patients with moderate to severe atopic dermatitis suffer from sleep disorders and more than half report that itching interrupts their sleep of 5-7 nights a week.

Those who suffer Moderate to severe ADs are absent from work triple the rest of the people. On average, adolescents lose 26 days of class per year for this condition at a rate of 3.5 days per episode. During an exacerbation outbreak, half (50%) of adolescents said they had protective measures to be seen in public, and 36% showed a decrease in self-confidence.

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