Itchy, burning, dry skin with red, rough patches. With the simple description of the symptoms, it is already clear that those who suffer from atopic dermatitis (AD) do not have an easy life, especially if the disease manifests itself moderately to severely. And if it is a child, it is not difficult to understand that it can be a disease with a strong impact, especially if it is not treated properly. Fortunately, there are ways to relieve symptoms and ensure that AD does not take over the lives of those who suffer from it. For this, it is very important that the little ones understand the problem and get involved in the treatment, explains dermatologist Pedro Mendes Bastos, from CUF Descobertas Hospital, Lisbon.
Although it can occur at any age, atopic dermatitis -also known as atopic eczema- is especially common in infants, children and adolescents, appearing in most cases during the first year of life. According to the expert, it is estimated that this chronic inflammatory skin disease “can affect 20% of the pediatric population in developed countries” and “usually improves with age, and can persist into adulthood in a third of cases ”. ”.
Is it DA?
The main symptoms of AD include dry skin (xerosis, in medical parlance), pruritus or itching, and eczema, which is the name given to the rough, scaly, reddish patches that can appear recurring over months or years. . According to the doctor, “it is easy for parents to suspect AD if these symptoms and signs are chronic and evolve with phases of aggravation and phases of calm”, which should motivate a medical consultation.
Regarding the location of the lesions on the body, he says that “in childhood and puberty, patches of eczema usually appear in the folds of the skin, behind the knees or on the neck.” In the case of adults, “the pattern can vary, involving the skin in a generalized way, or specific areas such as the hands, face or eyelids.”
But what exactly causes AD? “The answer is not simple”, says Pedro Mendes Bastos, according to whom this chronic disease “is more common today than in the past, especially in urban areas as well as in colder climates”, opining that “the combination of atopic genes [predisposição hereditária para certas reações imunológicas exageradas] with certain environmental characteristics determines the appearance of this disease”. Even so, the clinician is quick to clarify that “AD is not an allergy, although it often occurs in children who have respiratory allergies, such as some forms of asthma or allergic rhinitis.”
There are two mechanisms that give rise to the appearance of changes in the skin: on the one hand, we find “abnormalities of the skin barrier and inflammation caused by the cells of the immune system, mainly white blood cells”. In other words, as stated by the dermatologist, “the skin of an AD patient does not function as an effective barrier, as it does not have the same ability to hydrate and defend itself against the constant aggressions of everyday life, such as bathing, rubbing clothes or temperature variations”. On the other hand, “the excessive reactivity of the cells of the immune system in the skin perpetuates inflammation and barrier problems, generating a vicious circle of xerosis, itching, redness, peeling and cracks, which constitute these areas of eczema”, he clarifies. the.
Don’t let DA control it
First of all, it is important to note that there is no single solution that can be prescribed for all people. Above all because, as the doctor underlines, “there is a spectrum of severity of AD”, and most cases are considered mild, so “they can be adequately controlled with topical care”, that is, application to the skin. However, “some people will experience moderate to severe forms of AD, and other types of treatment, such as phototherapy, are often necessary. [tratamento com radiação ultravioleta] or oral or injectable drugs.
Pedro Mendes Bastos reinforces that “the treatment of AD must be very individualized and according to the particularities of each patient and the type of injury prevailing at each moment”. Among the therapeutic solutions available, the need to maintain continuous care stands out – regardless of whether or not there is aggravation of symptoms – which involves the “appropriate use of creams and hygiene products to reinforce the skin barrier and calm skin reactivity “. Also, in times of crisis or for more severe cases of AD, “treatment may include topical or systemic drugs, that is, oral or injectable,” he says.
Is it possible to lead a “normal” life?
Yes it is. In fact, as the dermatologist underlines, “that should be the goal, to achieve control of AD that allows us to lead a life as normal as possible”, that is, going to the pool or playing sports, among other activities. Even so, the specialist makes it clear that “it will not always be like this, because having AD implies going through good times, but also through moments of crisis.” In his words, “living with AD is a learning process and a construction that is done, establishing a relationship of trust with the doctor”.
This relationship is really crucial, since “even for moderate and severe forms of AD there are now effective and safe dermatological treatments, with the approval of pediatric drug agencies”, so he believes that the main message for these children and his parents “must thirst for hope”.
“Time and experience” are factors that the clinician considers essential for parents to learn to manage their children’s AD. And this with the help of the pediatrician or family doctor, since “most children with AD will happily present mild forms”, which can, in most cases, be diagnosed and treated by these health professionals.
“In the event that it is not possible to control it with the treatments prescribed by the doctor, it may be necessary to consult a specialist,” he explains, adding that “moderate-severe AD cases are those that should be followed up by a dermatologist, since more complex treatments may be necessary for the adequate control of the disease”.
Explain AD to the little ones
Despite the involvement of parents, children should not be left out, even so that they can contribute to the success of treatment. Asked what is the best way to explain this disease to the little ones, the dermatologist shares that “the easiest thing is to say that the skin of children with AD is like a house without doors or windows”, so “you have to take special care to protect this house to keep it protected and thus make the skin more comfortable and less itchy”. For the specialist, “actively involving children in treatment is essential to achieve control of AD”, which, in his opinion, is easy, since “children are intelligent and perfectly understand how to care for their skin if it that is to say, he explained them in a simple and didactic way”.
Precisely with the aim of simplifying the task of talking about AD to the youngest, Sanofi launched the All About Atopic Dermatitis project, which in addition to providing various information about the disease, also includes videos and books written in a pleasant and accessible language. , aimed at children with AD.
In the company of Diana, an 8-year-old girl who has been living with severe AD since she was 6 months old, other children will be able to understand what the disease consists of, feel that they are not alone and even realize that it is possible to overcome all the problems and stigmas. . According to Pedro Mendes Bastos, who has collaborated as a scientific critic of films and books, “fighting misinformation and facilitating the lives of children with severe AD are the objectives and advantages of this type of material.”
The psychological impact of AD
Explaining AD using materials appropriate for the pediatric age makes sense, especially in cases of moderate-severe AD, since in these situations, in addition to the physical impact, an important psychological impact can also be observed.
This is because “intense itching is a cardinal symptom, and it can be so intense that it disturbs sleep, with potentially serious consequences in the affective and cognitive spheres.” And this is observed in both children and adults, as highlighted by the clinician, according to whom, “itching and eczema on the skin can be quite shocking and cause discomfort that culminates in lack of attention at school and even behaviors of anxiety”. “Cases of moderate-severe AD must be evaluated as a whole, and the most effective intervention to avoid the psychological impact is, in the first instance, the treatment of this dermatological disease”, he reinforces, recalling that “the affective and family contexts deserve a Proper evaluation, of course, and its correct evaluation is also an important part of managing moderate to severe AD.”
Source: Observadora
