Atopic dermatitis causes a lot of problems not only to patients and their families: sometimes even doctors find it difficult to make a proper diagnosis and implement effective treatment. We talk to prof. dr hab. n. med. Joanna Narbutt, experienced dermatologist, national consultant in the field of dermatology and venereology.
Professor, is it possible to determine how many or less children in Poland have AD and what age are they?
There are a lot of them - according to publications and epidemiological studies, it is estimated that atopic dermatitis may affect even a dozen or so percent of the entire child population. At the same time, the criteria for the diagnosis of this disease do not allow it to be diagnosed before the child's third month of life. A large proportion of clinical cases develop in early childhood, up to the age of 1, and 80% - up to the age of 5.
During the conference inaugurating the "Understanding atopic dermatitis" campaign, you mentioned that atopic dermatitis is often diagnosed "exaggerated" in children who do not have it at all. Why?
The diagnosis of this disease is made on the basis of clinical criteria, referred to as the Hanifin and Rajka criteria. There are over a dozen of these criteria, the most important are, among others, itching of the skin, its dryness, characteristic changes located in certain places on the skin, the chronic and recurrent nature of the disease, its family history, or additionally the so-called white dermographism, when the skin turns white after scratching. not red. In order to be able to diagnose AD, at least three of the four main criteria and at least three minor criteria must be met. Meanwhile, in infants, there are many disease entities that cause similar symptoms.
The most common of these is seborrheic dermatitis, which is common in newborns and infants, while others include baby acne, irritation, herpetic dermatitis, contact dermatitis, and diaper rash. The symptoms of each of them may wrongly suggest that we are dealing with atopic dermatitis. An additional difficulty is that these diseases can also coexist with AD, and then the correct diagnosis requires a lot of experience from the doctor.
Must not onlytake into account the presence of diagnostic criteria consistent with the criteria of Hanifin and Rajka, but also collect and analyze data from family history, often additional tests are also necessary. This is why doctors sometimes misdiagnose AD in children who do not have AD. Such an overly hasty diagnosis of atopic dermatitis causes the child to have an atopic patch for a long time.
AD is a genetically determined disease that may have periods of clinical remission, but if you have it, you have it for the rest of your life
Is such a misdiagnosis a threat to a child?
Yes, first of all, that atopic dermatitis is wrongly but very strongly associated with food allergy. So sometimes a misdiagnosis of AD unnecessarily condemns such a toddler to a restrictive elimination diet, especially dairy-free. Additionally, parents usually start looking for information about atopic dermatitis as soon as they know the diagnosis.
They read a lot, usually on the Internet, learn that it is a chronic disease, that irritating and potentially allergenic factors need to be eliminated from the child's environment - and sometimes they panic. They remove carpets and curtains from the house, throw away the dog or cat, over-care for the baby's skin, unnecessarily smearing it with lots of emollients.
Unnecessarily? Does this mean that the use of emollients without clear medical indications may have some negative consequences?
It all depends on the quantity and quality of the preparations. It is not known yet. However, there are some works, but no clear ones, which say that if we care for the skin of a child who is genetically burdened with atopy with emollients from the first day of life, then the risk of developing atopic dermatitis can be reduced. On the other hand, many scientists and doctors warn against the use of emollients, especially those with a complex composition, containing e.g. fragrances, because, at least in theory, a child's skin may be allergic to them.
I assume that you can use emollients even in children who are not atopic, but they must be properly selected and have the simplest possible composition. However, the most important thing is not to overdo the care of such children. After all, their skin is very delicate and if we put something on it every few hours and wash it twice a day, disturbing the lipid coat and using cosmetics that change the pH of the skin, theoretically, allergy may occur.
It is very easy to come across discussions about atopic dermatitis on forums for mothers on the Internetskin. Moms compare their children's skin condition and try to diagnose themselves. Is a parent able to recognize that a child has AD by comparing its symptoms with those of another child of a similar age?
No, I am very warning against such diagnoses. The number of articles in the press and on the Internet about AD has certainly increased awareness of this disease entity. And unfortunately, people who are not doctors do not have experience, often try to make such a diagnosis by force. Meanwhile, atopic dermatitis is a disease with a very diverse clinical picture. Even two children of the same age may have different symptoms: the skin of one will be vivid red, all over it, severely itchy, the skin of the other will be moderately dry, and the disease will be evidenced only by slight inflammatory changes in the elbows and under the knees.
In this disease, the child is unequal to the child. Of course, fortunately, these severe forms are much smaller and they most often result from improper treatment, improper care and the fact that someone has missed something - if there are inflammatory changes, we must use anti-inflammatory drugs, e.g. topical steroids or local calcineurin inhibitors. Unfortunately, some parents are very afraid of these drugs and try to avoid them as much as possible - which in turn means that the disease sometimes affects the entire skin.
To which specialist should a parent who suspects AD in a child go? Pediatricians, dermatologists, allergists?
In my opinion, it would be right if a dermatologist was the doctor determining the diagnosis when atopic dermatitis was suspected, because doctors of this specialization have the best knowledge of differentiating similar disease entities, of which there are really a lot of them. Then, after the diagnosis is made, in milder cases, the attending physician may be a family doctor or a pediatrician, because then certain standards of treatment are applied.
If we suspect or diagnose an additional allergy, e.g. food allergy, asthma or allergic rhinitis, then a specialist allergist should be a doctor supporting the diagnosis and possibly treatment. As you can see, AD is a disease that requires multi-specialist care. Sometimes a psychologist also has to join all these specialists - this is the case with children who are unable to function normally due to severe itching and a very bad skin appearance.
The care of a psychologist is also often needed by their parents.
And how often is AD currently diagnosed in adults? Is recognizability of this diseasein this case also increased?
It used to be said that AD grows out of AD, but now we know that this disease accompanies patients throughout their lives. It is self-silencing - now a bit later than it used to be, because most often during puberty - which means that the skin of most sick children no longer shows inflammatory changes, and such changes often never appear again.
We have been observing for some time that approximately 20-30 percent of sick children, this disease stays in the adult stage and accompanies them for the rest of their lives, recurring from time to time. However, we have the impression that the number of cases of atopic inflammation in people aged 50-60 is increasing, which was once really rare. However, there is no epidemiological data on this subject.
Is the modern lifestyle we lead - stress, rush, pollution, addictions - favoring AD in adults who have never shown symptoms of atopy before?
This is a very difficult question and there is no clear answer to it. Perhaps it is influenced by the lifestyle, maybe the medications taken, environmental pollution, sometimes they are patients after some neoplastic diseases, after immunosuppressive treatment. Reading various studies, I know that at this stage no one can answer them unequivocally.
Expert
Prof. dr hab. Joanna Narbutt, MD, PhD A dermatologist-venereology specialist, he is a national consultant in the field of dermatology and venereology, as well as the head of the Department of Pediatric Dermatology and Oncology at the Medical University of Lodz. Her main clinical and scientific interests are psoriasis, atopic dermatitis, photoprotection, urticaria, cancer and allergies. Her numerous publications devoted to these issues can be found in national and international medical journals. Prof. dr hab. n. med. Joanna Narbutt is a member of the Polish Dermatological Society, European Society for Dermatological Research, European Academy of Dermatology and Venereology. He is also a member of the Qualifying Team for Biological Treatment of Psoriasis established by the National He alth Fund. Prof. Narbutt is also a laureate of many prestigious national and international scholarships, including American Academy of Dermatology, European Society for Dermatological Research; L'OREAL Scholarship for Women and Science.
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