OVERVIEW
Intro ... Atopic dermatitis (AD) ....
DISEASE PROCESS: SYMPTOMS, DIAGNOSIS, TREATMENT
- Symptoms
According to the Cleveland Clinic, symptoms of atopic dermatitis is incessant pruritus (itching), xerosis (dry skin), fissures, and lichenification (thickened skin). There are three age-related stages: infantile, childhood (2-12 years old), and adult (puberty and beyond).
The adult stage is less predictable than infantile or childhood with patients experiences anywhere from a few outbreaks to a chronic, relapsing occurrences. Dermatitis of the hands is common and can be disabling. Lichenification and facial dermatitis are also common.
- Diagnosis
Pruritus and xerosis must be present when diagnosing atopic dermatitis. Other elements considered are family history, flexural lichenification in adults, and chronic relapsing dermatitis. Useful tests include "a serum IgE level, serum protein electrophoresis, fungal scraping for potassium hydroxide preparation and culture, and skin biopsy."
- Treatment
The primary treatments for AD are skin hydration using emollients and topical corticosteroids to suppress inflammation. "Topical calcineurin inhibitors" are often used in conjuction with the primary treatments. Severe disease may require sytemic corticosteroids, or for "severe, recalcitrant cases, phototherapy or systemic immunosuppressive medications may be necessary." For patients who do not respond to or worsen while using topical steroids should be assessed for allergic contact dermatitis. Antihistimines can be used to ease pruritus.
Alternative therapies include probiotics, vitamins, stress management, coconut oil, oatmeal baths. A promising new treatment for serious disease is the biologic, dupilumab.
- Outcomes
AD is a chronic condition with 40-60% of children with the condition continuing to suffer into adulthood.
JAPAN
A Japanese woman named Tommy chronicles her experience with AD and the various treatments she has tried, particularly discussing withdrawal symptoms she has experienced when stopping topical steroids. Tommy had mild eczema as a child, which cleared up without medication, only to return when she was 22 years old. She comments on the depression and embarrassment she experienced as she tried treatments and suffered withdrawal symptoms. Her conditions has relapsed numerous times and with it came psychological and physical limitations that interfered with her life and work, ultimately being diagnosed with "several clinical depression" when she was 27 years old.
- patient journey
- emotional/psychological effects
- Problems, concerns, fears? Where do they turn for support? Online and/or offline sources?
- Who do these patients interact with along each phase (HCPs)
- Include direct quotes from patients
UNITED STATES
Health Union, LLC survey atopic dermatitis patients to learn what it is like living with the condition. Most patients (93%) indicated they have identified their personal triggers, and 75% of them said that stress or anxiety was a common trigger. A full 98% of respondents said they employ many tactics to improve symptoms, including the use of moisturizers and soaps, avoiding scratching or rubbing, changing detergents, and avoiding perfumes. One respondent is quoted as saying, "atopic dermatitis is a time-consuming hassle of a disorder. It is insidious in how it affects every aspect of your life – and how you modify everything to minimize your symptoms." The survey also asks respondents to describe the consition as an animal, and most animals chosen were ferocious, irritating, or annoying. They included tiger, alligator, bear, lion, porcupine, mosquito, and alligator.
The website AtopicDermatitis states that adults with AD experience mood disorders such as anxiety or depression. These disorders, in turn, can be triggers for the condition, creating a vicious cycle. Children and adults, alike, suffer social stigmas because of AD, and many need psychological treatments, such as therapy, stress management, or relaxation training.
Atopic dermatitis patient Elizabeth Acuna discusses her experience with the condition. She notes the main limitation as low self confidence and self consciousness. She hated the summertime because she didn't want to wear shorts or bathing suits that exposed her skin, 90% of which was affected. In another interview, she discusses how effective the dupilumab treatment has been in managing her condition and the improvements in her daily life.
Gilbert Saenz, a dermatology physician assistant who suffers from moderate atopic dermatitis, talks about the embarrassment of constantly answering questions about the appearance of his skin. He also says the discomfort from the condition often makes it difficult to sleep or participate in sports or other daily activities. The unpreditability of when a flare up may occur interferes with everyday life. He further states that patients often feel guilt, as if they are doing something wrong that is causing the condition.