Indians with atopic dermatitis or ‘itchy rash’ need newer treatment options

The dictionary defines an itch as ‘an uncomfortable sensation on the skin that causes a desire to scratch.’

Rajesh, 14, a 9th standard student woke up one morning with an itch on his hand and the back of his neck which did not subside despite repeated scratching. At first, he ignored it and then bought a soothing cream from the neighbourhood chemist. This helped for a while but then the sensation returned. His scratching got even worse at night and led to the development of a red rash in those areas. Slowly he began losing sleep and his studies suffered. His skin became dry and flaky in some places. He also noticed some raised patches which oozed out some fluid. His parents got worried but none of their home remedies helped. Rajesh started feeling depressed and stopped meeting his friends. His parents then assumed that it was a skin allergy and gave him an antiallergic medication which also did not help. Finally, a desperate visit to a skin specialist (dermatologist) resulted in the diagnosis of Atopic dermatitis (AD).

Not ‘just’ a skin allergy

AD is a common, chronic (long-term) and non-contagious inflammatory skin condition. It makes your skin feel itchy and can occur at any age though it often develops during early childhood. [1> In some patients, AD becomes extremely severe for a certain period (called a flare-up) and then clears up for a while. It affects up to 230 million people worldwide. [2> In India, AD majorly affects 2.7% of children between 6-7 years and 3.6% of those between 13-14 years. [3> A combination of familial, genetic, environmental (e.g. air temperature, humidity, urban setting, etc.) and inflammatory factors are responsible for AD.

Patients with AD can have several symptoms such as dry or irritable skin, itchy skin in areas like the hands, back of the neck or the upper portion of their feet or patches of thickened/cracked skin. The itchiness caused by AD often causes patients to keep scratching the itch and this sensation becomes more severe at night. Patients with AD also commonly suffer from other conditions like food allergies, asthma or hay fever. Flare-ups are commonly observed during the winter months. [4> If left untreated, patients can suffer from secondary bacterial and viral infections, visual abnormalities and scarring.

Impact on the patient’s quality of life

AD profoundly affects the quality of life of the patients. Those with childhood AD suffer from sleep disturbances, poor performance in school and social/mental/behavioural issues which also negatively affect their parents/caregivers. Such children can also experience bullying and avoidance resulting in low self-esteem and feelings of rejection. AD leads to high levels of anxiety/depression and suicidal thoughts in patients. Such individuals also feel self-conscious or ashamed when others are exposed to their condition.

No single and effective cure

Though there is no single cure for AD, early diagnosis and timely treatment can help the patients to live a better quality of life. Flare-ups can be managed if diagnosed in time and a healthy, gentle skin routine can improve the overall well-being of the patient. A dermatologist can prescribe creams that help moisturize the skin, treat inflammation or any infection. Some oral drugs can also help control inflammation while a newer injectable option treats severe AD. Depending on the age of the patient and severity of AD, light therapy (which uses controlled amounts of sunlight or ultraviolet light) can be used to treat AD. Counselling can be used to help the patient overcome social barriers and relaxation or behaviour modification and biofeedback can aid those who scratch habitually. Other lifestyle changes include wearing non-irritant clothing (preferably cotton), bathing in lukewarm water and using hypoallergic, fragrance-free, non-soap cleansers.

The stigma and social isolation experienced by AD patients is severe and since early diagnosis is the key, reaching out to the dermatologist at the earliest is essential to find the right treatment option. Since specific treatment options are limited, the availability of newer and effective therapies for AD can be a boon to these patients.

[1> Rajagopalan M, Chitkara AJ, Dalwai S, De A, Gulati R, Mukherjee S, Mutalik S, Sharma N, Shenoi S, Vaidya P, Tilak A, Adhav C. Burden of Disease, Unmet Needs in the Diagnosis and Management of Atopic Dermatitis: An Indian Expert Consensus. Clin Cosmet Investig Dermatol. 2021 Nov 22;14:1755-1765.

[2> Tsai TF, Rajagopalan M, Chu CY, Encarnacion L, Gerber RA, Santos-Estrella P, Llamado LJQ, Tallman AM. Burden of atopic dermatitis in Asia. J Dermatol. 2019 Oct;46(10):825-834.

[3> Rajagopalan M, Chitkara AJ, Dalwai S, De A, Gulati R, Mukherjee S, Mutalik S, Sharma N, Shenoi S, Vaidya P, Tilak A, Adhav C. Burden of Disease, Unmet Needs in the Diagnosis and Management of Atopic Dermatitis: An Indian Expert Consensus. Clin Cosmet Investig Dermatol. 2021 Nov 22;14:1755-1765.

[4> Rajagopalan M, De A, Godse K, Krupa Shankar DS, Zawar V, Sharma N, Mukherjee S, Sarda A, Dhar S. Guidelines on Management of Atopic Dermatitis in India: An Evidence-Based Review and an Expert Consensus. Indian J Dermatol. 2019 May-Jun;64(3):166-181.

The author is the president of the Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) and Professor of Dermatology, Delhi. Views expressed are personal.

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