Dr. Melinda Gooderham
Dermatologist & Medical Director, SKiN Centre for Dermatology
Living with atopic dermatitis is an ongoing challenge. Better patient engagement and integrated, timely care can lead to better outcomes.
Atopic dermatitis (AD) is a chronic inflammatory skin disease that is the most common form of eczema. Symptoms include intense, uncontrolled itching, dry scaly skin, and a rash on the face, hands, arms, legs, and even other parts of the body. People living with AD may experience many flare-ups per year, each lasting up to 15 days.
While the exact cause of AD is unknown, it’s believed to be a combination of immune, genetic, and environmental factors. About 17 percent of Canadians will suffer from AD at some point in their lives. “Most of the time, it develops in early childhood,” says Dr. Melinda Gooderham, a dermatologist and Medical Director at the SKiN Centre for Dermatology in Peterborough, ON. “Some will go into remission, while up to 30 percent will continue to have the disease throughout their lives.”
The chronic skin inflammation of AD goes well beyond the surface and can have a significant impact on patients’ physical and mental health.
The burden of living with AD goes beyond the surface
The chronic skin inflammation of AD goes well beyond the surface and can have a significant impact on patients’ physical and mental health. “AD may look like just a skin rash but it’s much more than that,” says Dr. Gooderham. The constant or recurrent itch causes people living with AD to lose sleep at night, which can affect their ability to concentrate at work or at school. “Because of this, AD has also been linked to mental health issues like anxiety and depression in both kids and adults, as well as attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD),” says Dr. Gooderham. “We’re not quite sure if it’s the itch and sleep loss directly or the systemic inflammation caused by the disease that leads to the mental health burden, but there’s a clear association.”
Social stigma is another burden of living with AD. With visible skin lesions, people with AD may feel embarrassed or self-conscious and may worry that others will perceive them as infectious or contagious. Additionally, “with the constant itch, there’s the need to scratch, which doesn’t look good in public places, so a lot of the time people with AD end up retreating, staying at home, and avoiding social events, which can then have a domino effect on other things like their relationships,” says Dr. Gooderham.
Disease management needs to go beyond treating the itch
While there’s no cure for AD, there are numerous treatment options, ranging from basic skincare in milder cases to prescription topical treatments, phototherapy, oral medications, and injections in moderate to severe cases. Each comes with advantages and disadvantages, as well as potential side effects. However, patients with moderate to severe AD may visit more than three doctors before finding the treatment protocol that’s right for them. In fact, many people living with AD drop out of the health care system due to lack of clarity over next steps after topical treatment. Additionally, because of the flaring nature of AD, patients often don’t see the value of chronic therapy. Unfortunately, this approach often doesn’t lead to optimal patient outcomes.
To be effective, patient care needs to go beyond treatment, to include services that not only help people manage the physical disease but also support their emotional and social well-being. “Rather than just trying to treat the patient’s skin, we’re trying to take a more holistic approach these days,” says Dr. Gooderham. “It’s not just getting medication for a skin disease, it’s also getting people to understand that the itch they have may be linked to the anxiety or depression they suffer from. Otherwise, people may see one health care practitioner about the rash and another about the anxiety without looking at the two as a whole. A patient-centred, engagement approach with the right health care team helps to avoid that fragmentation of care.”
Seek timely care from a health care practitioner
The sooner one seeks help for AD, the better the long-term outcomes. “I find that some patients put off seeking treatment because they’re afraid of the side effects. However, they need to consider the side effects of avoiding timely treatment,” says Dr. Gooderham. “Not treating AD has consequences, not only to the patient’s physical management of the disease but also to their emotional and mental health. The sooner you can deal with it, the less long-term impact there will be.”
AD is a chronic autoimmune disease and has an impact well beyond the skin. “The good news is that there are treatments available, and people shouldn’t be afraid of them,” says Dr. Gooderham.
This article was sponsored by an IMC Member Research-Based Pharmaceutical Company.