The skin is the largest organ in the body, and also one of the most visible, so that the diseases that affect it are exposed to our own and other people’s eyes. In the case of atopic dermatitis and psoriasis, this visibility often causes the severity of their impact to be socially trivialized. “They are associated with something purely aesthetic, when the truth is that they are chronic inflammatory pathologies that, when not well controlled, affect numerous areas and can have a profound physical and emotional impact on the lives of those who suffer from them,” explains the doctor. Ricardo Ruiz-Villaverde, head of the Dermatology Service at the San Cecilio Hospital in Granada.
Both are immune-mediated diseases, that is, they occur as a result of an abnormal reaction of the immune system. Although there is no cure for them, current dermatology is making great strides in the therapeutic options for these two diseases, although early detection and good communication between patients and health professionals are still key to ensuring that their signs and symptoms are treated. symptoms are reduced to a minimum.
Dr. Ricardo Suárez Fernández, head of the Dermatology Service at the Gregorio Marañón Hospital in Madrid, explains that, until not many years ago, atopic dermatitis in its mild forms, which usually occurs predominantly in childhood, used to present a good prognosis. However, in recent times there has been an important change in the management of its severe forms.
Africa Luca de Tena, 43 years old, has not needed to reach adulthood to suffer the consequences of severe atopic dermatitis: “I have had it since birth.” As a patient and as spokesperson for the Association of People Affected by Atopic Dermatitis, she highlights: “The fact that it is such a widespread disease in its mildest version – everyone has a nephew with eczema – works against us. She makes it hard for people to believe how exhausting it can be to live with that constant itch every day of the year. Or that you avoid any mirror so as not to see yourself.”
The most characteristic symptom, in fact, is itching: the vast majority of patients with moderate-severe atopic dermatitis suffer from intense daily itching and, due to scratching, significant skin lesions can occur. “It can be truly disabling and, in addition, it can cause enormous psychological damage,” explains Dr. Suárez, who recalls that, for him, “it was really shocking to see the suffering of these people, their inability to look in a mirror or their effort to cover injuries with scarves or turtleneck sweaters.”
Atopic dermatitis
How many suffer from it and how does it affect them?
- Affects 171 million of people in the world
- A 15%-20% of children and a 1%-3% of adults in the world they suffer from it
- 60% of those affected start the disease in his first year of life
- In Spain, 30,000 adults have severe atopic dermatitis
- Its characteristic symptom is chronic itchy skin
- 86% of patients suffer intense itching daily
How it affects quality of life
- Sleep disturbances
- Irritability
- Emotional distress
- Shame
- Feelings of rejection
Where is it mainly located
- Cheeks
- Arms
- Legs
- around the joints
- dolls
Source: Spanish Association of Dermatology and Venereology (AEDV), WHO, Association Affected by Atopic Dermatitis (AADA)
Until years ago, there was a lot of ignorance about this disease, which had a strong impact on the quality of life of those who suffered from it. Some patients, exhausted and without hope, ended up abandoning the health system. This was the case of Luca de Tena: “A few years ago, with 90% of my body covered in eczema and unable to sit or lie down, they convinced me to go back to the doctor. And that was when they told me that there were options.”
Advances in treatments have also affected the quality of life of patients. “There has been progress in the pathogenic study of the disease, its pathophysiological bases have been discovered and molecules have begun to appear to combat this disease,” explains Dr. Suárez. “The change in the management of moderate-severe disease has allowed those frustrating consultations to now be experienced with emotion by patients and by ourselves.” From her experience, África Luca de Tena works to disseminate and make the disease visible: “There is no cure, but it is important to have high therapeutic objectives that reduce itching, skin inflammation and the number of outbreaks.”
The stigma of psoriasis
Another immune-mediated dermatological disease is psoriasis. Like atopic dermatitis, it is also chronic and also has a great impact on quality of life. Dr. Ruiz-Villaverde, from the San Camilo Hospital in Granada, explains that, although its most characteristic manifestation is the appearance of thick, red and scaly skin lesions, “it is important to keep in mind that it is an inflammatory disease that does not affect not only the skin and nails, but can involve other organs, such as the joints, and can lead to the appearance of other associated diseases, such as diabetes or hypertension.”
Psoriasis
How many suffer from it and how does it affect them?
- Affects 125 million of people in the world
- In Spain there are more than a million of people with psoriasis
- 30% of patients also have psoriasic arthritis
- It manifests itself with the appearance of reddened skin lesions covered with whitish scales
- Its most common symptoms are itching, burning, bleeding and pain
How it affects quality of life
- Shame
- Social isolation
- Mood changes
- Difficulties in relationships, work and school
Where is it mainly located
- genital area
- Knees
- Scalp
- Nails
- Elbows
Source: WHO, Psoriasis Action, International Federation of Psoriasis Associations
The case of Montse Ginés, president of Acción Psoriasis, is an example of the different faces of this disease: “I started with joint pain and they diagnosed me with arthritis, for which they gave me anti-inflammatories and corticosteroids that did not work very well for me. Years later, the skin lesions appeared and that was when they told me that I had psoriatic arthritis and that it was a disease that would be with me forever.”
Life with psoriasis, points out Dr. Ruiz-Villaverde, “is very stigmatizing and can cause many people to suffer reactive anxiety processes, especially in the most serious cases or in which the lesions are more extensive and in visible areas. In addition, it is difficult for them to go to the beach or the pool for fear of rejection, since many people mistakenly think that it is a contagious disease.”
Added to this is the itching, pain and all the signs and symptoms that prevent a normal life. In the words of Montse Ginés: “It is not just an aesthetic problem, although there are still those who see it as if it were a second-class disease; In fact, many patients also have that perception, as if they had to put up with it.”
In this sense, the NEXT Psoriasis survey, carried out by Acción Psoriasis among 1,265 patients from all over Spain, reveals that four out of ten patients believe that the disease affects them in their daily lives not only on a physical level, but also emotionally and social. This report also warns that up to 13% of patients with moderate-severe psoriasis do not currently receive healthcare.
As in atopic dermatitis, advances in psoriasis have also made it possible to improve the quality of life of patients and, in many cases, aim for the lesions to become less prominent or even disappear. “It is about making a joint work plan with the patient from the first moment: explaining to them that there are many therapeutic alternatives and starting a joint path aimed at making them feel as good as possible,” explains Dr. Ruiz-Villaverde.
As final advice, both Montse Ginés and África Luca de Tena highlight the work of patient associations: “They are places where you find other people who live with your same pathology. They are your equals, you see that they can overcome it and you feel accompanied. In addition, they inform you and help you take responsibility for your health.”
#Psoriasis #atopic #dermatitis #fear #mirror