Atopic dermatitis and alopecia areata, new treatment perspectives

What do atopic dermatitis and alopecia areata have in common? They have a similar underlying mechanism, they are considered by many to be only an aesthetic problem when in fact they make the lives of those who suffer from them very difficult. Now they also share one new treatmentrecently approved and reimbursed by the Italian Medicines Agency (Aifa), effective for the more severe forms of both diseases, which carry a high price in terms of not only physical but also emotional suffering. Those who suffer from it often suffer discrimination at work or are even fired. On the economic front, the bill is heavy also because significant sums must be used, entirely borne by the patients, for treatments necessary to keep a disease at bay that cannot be cured.

Not an aesthetic problem

In terms of affections and social life, high rates of anxiety, depression and sleep disorders often end up compromising relationships and leading to self-isolation. When my first child was born, I couldn’t feed him or hold him because of the lesions on my arms and the itching that didn’t let me sleep – says Mario Picozza, president of the National Atopic Dermatitis Association (Andea) and FederAsmallergie -. Those who suffer from atopic dermatitis do not have an aesthetic problem, but one chronic pathology that often takes away sleep, compromises intimate and social life, opens up to discrimination if the lesions are visible. As for thealopecia areata, it does not concern at all only the hair: in severe forms, all body hair can be lost, including eyelashes — specifies Claudia Cassia, president of the Italian Association of Alopecia Patients and Friends (Aipaf) —. There are children who become victims of bullying because of their appearance, also because it is feared that they are suffering from a contagious disease. The adultsalso in this case, they can lose their jobs, being removed from public places, women abandoned at the altar. A new treatment recognized for severe and serious forms is also important in view of the recognition of alopecia areata as a chronic disease and, therefore, for a new management and management of patients.

The remedies

Aifa’s approval concerns a drug in tablets (baricitinib) belonging to the class of inhibitors of Janus kinases or JAK inhibitors, enzymes involved in immune and inflammatory processes. a medicine already in use for years for rheumatoid arthritis and now the green light is given to it refundability regard adults suffering from moderate to severe atopic dermatitis or severe alopecia areata, for which the first treatment ever reimbursed by the NHS. The therapies available for atopic dermatitis today are, finally, many, effective and well tolerated – explains Antonio Costanzo, director of Dermatology at the Humanitas Clinical Institute in Milan -. What is important to have one clear diagnosis in order to arrive at the most suitable therapeutic strategy chosen by the dermatologist based on age, severity of symptoms and possible presence of associated diseases. In less serious cases Corticosteroid-based anti-inflammatory creams can be used
while in those more serious we opt for systemic therapy, by mouth or injection, with traditional immunosuppressive drugs or with the most recent biological drugs.

Several options

The last one medicinal who obtained the AIFA reimbursement, reserved for those who do not benefit from other treatments already available, has the advantage of acting very quickly, calming itching and also improving skin lesions
. A different discussion must be made though alopecia areatawhich is often temporary and which in mild forms you may see hair regrowth without any treatment, generally within a year. However, the more extensive it is, the more difficult it is to respond to therapies. Even if they exist different options available to the specialist (corticosteroids, anthralin, topical immunotherapy), which must be followed for approximately 6-10 months before seeing a result, definitive recovery is never achieved. This disease can recur over time – underlines Bianca Maria Piraccini, director of the Dermatology and Venereology Unit of the University of Bologna -. The current treatments have as their objective block the attack of the immune system and stimulate hair regrowth, a strategy that works especially for people with milder forms (i.e. approximately less than 50% hair loss). But with the arrival of JAK inhibitors we can do better even in severe forms of alopecia areata: baricitinib is the first of this “family” of medicines and studies indicate that, as the months pass, patients see hair, eyelashes and hair reappear.

Wigs refunded today only in Emilia Romagna

L’alopecia areata a chronic autoimmune disease that causes hair loss, which falls out acutely, forming one or more round patches that can enlarge and merge until all the hair (alopecia totalis) and body hair (alopecia universalis) fall out. It can occur at any age and although the causes are not yet completely clear, it is believed to have a multifactorial origin, which means that a variety of genetic and environmental factors contribute to the appearance of the disease. For years, doctors and patients have been asking for the recognition of alopecia areata as an autoimmune, chronic and relapsing disease – says Bianca Maria Piraccini -. A crucial step to give dignity to one disease which, at the moment, does not exist for the National Health Service. And in order to have an exemption code, so that sick people are not forced to pay out of pocket for aids such as wigs, That at the moment they come to Italy refunded only in Emilia Romagna.

Not just skin, there is often asthma too

There Atopic dermatitis in Italy it affects approximately 1 in 10 adults and 1 in 4 children, with a peak incidence between 10 and 20 years of age. a Chronic relapsing inflammatory disease with different causes. Those who suffer from it often have a genetic predisposition to hypersensitivity to environmental allergens (around 30% of those who suffer from it, sooner or later also have asthma and allergic rhino-conjunctivitis). To decide the strategy to adopt, the intensity of the itching, the extension and localization of the lesions, the clinical course and the impact of the disease on the patient are evaluated – explains Antonio Costanzo -. L’final goal to make the lesions on the skin and the itching disappear, achieving long-term stabilization and reducing the severity and duration of flare-ups. To achieve it you need to use emollients daily and avoid coming into contact with irritating or allergenic substances such as too “strong” soaps, wool, plants and grasses that can annoy.