Dry and red skin. Intense and constant itching: with critical periods and others in which the disease seems to have receded. Atopic dermatitis is the most common inflammatory problem that can affect the skin. In Italy it concerns approximately fifty thousand people, including adults and children. And almost all of them, despite the various opportunities available, are not satisfied with the care they receive in hospitals. A problem that probably derives from the lack of awareness of the disease among patients, which leads many of them not to be treated adequately.
Atopic dermatitis, how to keep the disease under control
by Letizia Gabaglio
Atopic dermatitis: few Italian patients treated adequately
This is the snapshot that emerges from a survey conducted by the Italian Society of Dermatology and Venereology (SIDeMaST) on almost 650 compatriots entrusted to the care of 27 public dermatology facilities spread throughout the country. Almost half of them were affected by atopic dermatitis, the others by other skin diseases characterized by sharing some symptoms.
The research found that, up to that point, nearly one third of patients had not received any treatment. While among those who had started a therapeutic path, very few were satisfied: less than 3 out of 100. In almost one case out of two (44.3 percent) men and women said they had used anti-inflammatory creams for local application: cortisone and calcineurin inhibitors, which is the therapeutic standard for milder forms. While only 7 percent of them received systemic therapy: an opportunity to cure moderate or severe forms, together with phototherapy.
The novelty represented by systemic therapies
A figure that denotes difficulties in the transfer of the most recent scientific evidence into clinical practice. “Atopic dermatitis is not always the same in the various stages of life and can often be underestimated or not subjected to a correct diagnosis – he explains. Gabriella Fabbrocinidirector of the complex operational unit of clinical dermatology of the Federico II University of Naples, one of the authors of the article published in the Journal of Clinical Medicine -. For the management of the disease it is important to intervene not only when acute manifestations appear, as is often the case. But by controlling the underlying inflammation through the use of oral medications that have a systemic action. Biological drugs and JAK inhibitors offer opportunities to be evaluated with great attention because they allow immediate symptom relief by modifying the course of the disease in a lasting way “.
For a correct diagnosis it is better to contact the reference centers
The low level of knowledge of atopic dermatitis explains the difficulties faced by those who try to arrive at a response to their symptoms, as demonstrated by the latest work. More than one in four patients among those who participated in the study had in fact received another diagnosis, before going to one of the 27 reference centers involved in the survey. And, conversely, more than one in three of those who had another skin disease had received an inappropriate diagnosis of atopic dermatitis.
Indisputable data, which demonstrate “the need to conduct information campaigns aimed at the general population and scientific activities aimed at developing knowledge of the disease even within the medical profession”, is what is written in black and white by the specialists coordinated by Katy Perrydirector of the complex operating unit of dermatology of the Gemelli polyclinic and full professor at the Catholic University of the Sacred Heart in Rome.
Consequences also on patients’ pockets
So far the problems related to diagnoses. But there is also a lot to do with regard to therapies. “The most modern ones intervene in a targeted way on the production and activity of some cytokines such as interleukin 4 and / or 13 or drugs that block the activity of enzymes called Janus chinasi – says Peris -. Thanks to these drugs it is currently possible to keep the disease under control with considerable effectiveness and good tolerance “.
The problem, as revealed by the survey, is that a very small proportion of patients would have access to these molecules. With a triple damage: less appropriate care, higher costs and less adherence to treatment. Another of the difficulties encountered by those suffering from atopic dermatitis is in fact its lack of inclusion in the Essential Levels of Assistance. And, consequently, its absence from the National Chronicity Plan. Translated: there are no exemptions for those who suffer from it, neither during the diagnostic process nor for the purchase of topical drugs.
Problems not only for the skin
The importance of a correct diagnosis is also fundamental to avoid the appearance of some disorders associated with the disease: on all those of sleep, which in the various studies were recorded in a proportion of patients between 33 and 87 percent. And which, according to Italian specialists, represent one of the main risk factors for the development of further problems that are more frequent (compared to the general population) among those suffering from atopic dermatitis: from anxiety to depression, from hypertension to diseases coronary.
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