14 September marks World Atopic Eczema Day – a day dedicated to raising awareness of a disease which places a heavy multidimensional burden on patients and caregivers alike. The theme for this year’s global campaign is #InsideAtopicEczema, and it looks at the five major burdens of the disease: extreme physical pain and itch, burden on families and caregivers, burden on finances, burden on mental health, and burden of daily management.
What is atopic eczema?
Atopic eczema is a condition that is suffered by many worldwide. It is also known as Atopic Dermatitis (AD) and is one of the more common forms of eczema that can be particularly difficult to resolve. Atopic eczema is a chronic, inflammatory skin disease with unpredictable flare-ups, which result in part from an overactive immune system leading to problems with the skin’s barrier.
The inflamed skin and intense itching associated with moderate-to-severe atopic eczema can occur all over the body. Commonly affected areas include the knees, elbows, face, neck, feet, hands and wrists. The disease is highly variable and ranges from mild to severe requiring incremental management approaches.
“Despite common misconceptions that atopic eczema is ‘just’ a skin condition, living with this disease goes far beyond the skin and it impacts many aspects of a patient’s health, life and relationships. In fact, a recent population-based study in the United States has shown that the impact of moderate-to-severe atopic eczema on the overall health of adult patients is comparable to other serious chronic disorders such as heart disease. The patient burden of itch is complex and linked to other symptoms including pain, sleep, and emotional disturbance” says pharmacologist and Sanofi Medical Advisor, Dr. Dwayne Koot.
“Atopic eczema requires an in-depth understanding and consideration of appropriate treatment strategies, as some people with moderate-to-severe atopic eczema continue to experience debilitating symptoms despite consistent application of moisturisers and the use of prescription topical therapies. Atopic eczema is a condition which can take control of a person’s life, causing serious, on-going sleep disturbances, symptoms of anxiety and depression and feelings of isolation and helplessness. Many people feel that their atopic eczema negatively impacts many aspects of their life and influences important life decisions – socially and professionally” says Koot.
Burden of atopic eczema
Among skin conditions, atopic eczema is a leading cause of global burden of disease. The five major burdens of the disease are outlined below.
Extreme itch and physical pain: Itch is a misunderstood and underestimated burden of atopic eczema. Many patients describe the itch as all-consuming and worse than pain. This itch is often accompanied by pain caused by scabbing and open wounds from uncontrollable scratching inevitably leading to skin infections.
Burden on family and caregivers: Parents of atopic eczema patients need to spend hours every day caring for their child’s skin. Time is lost on repeated doctor’s visits, and spouses of patients need to provide continuous support and empathetic understanding of the disease presentation.
Burden on finances: Atopic eczema patients and caregivers need to cover the cost of doctors, specialists, expensive prescribed or over-the-counter medications, wet wraps and topical treatments. Patients can also experience a loss of wages if they are unable to work as a result of their condition. Further sleep disturbances contribute towards a lack of productivity and poor focus.
Burden on mental health: There is a high level of depression and frustration for patients with atopic eczema compared to other skin diseases. Patients are expected to perform at a regular level (at work, school, and life) because they are experiencing ‘just eczema’.
Burden of daily management: Topical treatments to help manage atopic eczema are burdensome as they need to be applied every day, which may take a lot of time. Patients need to be careful of food choices to avoid flare-ups, as well as of which soaps, fabrics and sanitisers to use.
How does one manage atopic eczema?
Gentle skincare and the frequent application of liberal amounts of moisturisers are very important, especially in the management of milder cases of atopic eczema. In cases of more severe eczema, dermatologists may prescribe topical therapies, which have rapid, localised anti-inflammatory effects. This calms the flare-ups and helps break the itch-scratch cycle. Utilising topical creams and ointments of appropriate potency as maintenance therapy to prevent flares is a further strategy to discuss with a healthcare professional. Escalation to a trial of phototherapy or a systemic medicine is typically indicated where topical treatments are not effective.
“Biologic therapy is the most recent systemic option for adults with moderate-to-severe atopic eczema who are not controlled with topical steroids or who cannot use them. Biologics are innovative targeted medicines that specifically block the drivers of the inflammation,”says Koot.
“Uncontrolled moderate-to-severe atopic eczema can be incredibly difficult for patients and their families, seriously impacting daily life. However, diligently following the general rules of gentle skin care, avoiding environmental triggers, moisturising often and seeking medical advice can help patients achieve greater control and live a better quality of life. Our understanding of the disease has increased tremendously over the last decade. Obtaining sustained control is the goal that can rectify many associated psychosocial issues,” says Koot.
“It is our hope that through our partnership with The Allergy Foundation of South Africa and continued educational efforts, we can raise greater awareness of the burden of atopic eczema and the impact on daily quality of life as well as encourage appropriate steps to be taken towards getting the disease controlled at an individual patient level,” says Koot.