Atopic dermatitis is a complex and chronic disease whose treatment requires medical professionalism and societal support for management. General guidelines for treatment and care offer relief to everyone, both adults and children. Fortunately, in recent years, novel treatment methods and disease relievers have emerged, such as new precision medicines and AEGIS-treated silk fibroin garments, which protect the skin from external irritants.
Atopic dermatitis, also known as atopic eczema, is considered one of the most common inflammatory skin diseases. It is an intensely itchy skin rash affecting approximately 20% of children and adolescents and 10% of adults worldwide. The incidence varies across different geographical regions and countries. In developed countries, the incidence has reached a plateau, while elsewhere, the incidence and prevalence are on the rise. According to data from the National Institute for Health Development, the number of atopic dermatitis diagnoses in Estonia has increased by 10.4% over the last three years, reaching 22,140 cases.
The symptoms of atopic dermatitis are diverse, and the severity can range from episodic rashes to persistent, extensive skin inflammation. Therefore, a mild form of the disease may go undiagnosed if a doctor is not consulted. Fortunately, in most children, the course of atopic dermatitis is mild, and for many, the disease resolves with age.
The course of this disease is individual for everyone, and this must certainly be taken into account in a long-term treatment plan: how each patient experiences their disease and what impact it has on their mental health. The disease is also extremely variable.
By providing adequate skincare and treatment, it is possible to ensure a better quality of life for patients and their families. Supportive family members and an understanding attitude in kindergartens, schools, workplaces, and society contribute to better and more lasting treatment outcomes, as atopic dermatitis is a very environmentally sensitive health problem in every sense.
Causes and Treatment
Studies have shown that atopic dermatitis often involves hereditary changes in the skin, which make
it more vulnerable to irritations, and an overactive immune system, which causes inflammation. Furthermore, environmental conditions such as pollution, dust, and allergens play a significant role in the development of the disease.
The basic treatment for atopic dermatitis is skincare with emollients, supplemented by so-called second-line corticosteroid creams, which help control inflammation and itching.
Irrational use of corticosteroid creams means both overuse and undertreatment. There are specific rules for their use that the doctor must explain to the patient. A universal rule is that one fingertip unit, or 2.5 cm of treatment cream, covers an area approximately the size of two palms. In cases of improper use of corticosteroids, infections may occur, the skin may thin, and dilated capillaries (telangiectasias) and stretch marks (striae) may develop. Underuse creates a predisposition for chronic inflammation.
Regular use of emollients allows for extending the intervals between hormone cream applications and has a steroid-sparing effect.
Many parents are concerned about the side effects of corticosteroids, and this must certainly be addressed so that both young and adult patients receive effective treatment. The best must be made of every treatment.
Calcineurin inhibitors are also used for the treatment of atopic dermatitis, which are a hormone-free or hormone-sparing alternative. In general treatment, phototherapy can also be performed, and in more severe cases, oral or injectable therapy.
Skincare and regular moisturizing are time-consuming activities that fall entirely on the shoulders of patients and their families, including financially.
Innovations in Skincare and Treatment
Scientific research on the treatment of atopic dermatitis is constantly evolving.
Functional AEGIS-treated silk fibroin garments, novel in Estonia but in use in Europe since 2009, protect the skin from external irritants and are especially comfortable for young children. Smooth clothing and avoiding irritating fabrics and fibers are essential for preventing skin irritation. Atopic dermatitis treatment guidelines provide recommendations for textiles that come into contact with the skin (clothing, bedding), and comfortable, lightweight AEGIS-coated garments are also discussed. This is a functional garment made from patented silk fibroin fabric with antibacterial treatment, which is biocompatible with the skin. DermaSilk is knitted pure silk fibroin with an AEGIS coating. The material has antibacterial properties and acts like a second skin, also ensuring good thermoregulation. Such functional textile garments also significantly improve the sleep quality of those suffering from atopic dermatitis, helping to break the itch-scratch cycle.
Unlike corticosteroid creams, garments have no side effects or usage restrictions. Although they do not replace medical treatment, with proper care and garment selection, it is possible to achieve a corticosteroid-sparing effect, meaning fewer hormone creams are needed. By combining DermaSilk with other treatment methods, it can offer effective assistance.
The latest treatment direction involves precision medicines; currently, these can be administered either as injections or tablets. There is also a demand for new topical medications, and research in this area is ongoing.
Dr. Maie Jürisson, Dermatologist at North Estonia Medical Centre and Tallinn Children’s Hospital:
“In Estonia, as in other developed countries, the treatment approach is based on guidelines developed and adopted by expert groups consisting of medical scientists and doctors. These guidelines compile the results of scientific research and the practical experiences of many doctors. The Health Insurance Fund finances evidence-based treatment methods and medicines recommended in the guidelines. In recent years, several novel medicines have started to be funded, and we hope this trend continues.
Corticosteroids and calcineurin inhibitors can be purchased from pharmacies with a subsidized prescription. The Health Insurance Fund also finances phototherapy and biological medicines for atopic dermatitis, which target specific inflammatory mechanisms and provide effective treatment for particularly severe cases of atopic dermatitis. The compensation of medicines has helped alleviate the burden on families, considering that new medicines are expensive: the cost of treatment per month ranges from 500 to 1000 euros. However, effective treatment is crucial for ensuring quality of life, especially for families where children suffer from severe atopic dermatitis.”
Impact on Daily Life
Atopic dermatitis significantly affects the daily lives of children and adolescents, extending beyond physical symptoms such as itching and skin irritation. Constant itching, a deteriorated health condition due to insomnia, and daily skin care represent a significant burden for the patient. Fatigue resulting from sleepless nights and persistent skin itching can strongly affect daily energy levels and concentration. Furthermore, itching and skin irritation can promote irritability and nervousness, often leading to mental and emotional fatigue.
Young people with atopic dermatitis often face social stigmatization and appearance-related problems. During disease flare-ups, they may feel shame and low self-esteem due to the appearance of their skin. This can even lead to avoiding certain activities, such as sports or physical education classes, where skin-irritating clothing and sweating can further worsen itching and inflammation. Social isolation and discomfort when choosing certain clothes or footwear are daily challenges that make it more difficult for young people to socialize and participate in social life.
Compared to their peers, children with atopic dermatitis rate their quality of life lower, even if the disease
has not flared up. Chronic itching, poor sleep, and continuous care lead to mental and physical exhaustion, which is a serious obstacle to children’s development and well-being. All these factors affect not only the child’s quality of life but also their self-esteem and daily coping.
For parents facing atopic dermatitis, the following recommendations apply: consistent treatment and skincare are of key importance; it is necessary to establish a daily skincare routine; one must be aware of triggers for flare-ups; and it should be remembered that allergies may not always provide a clear answer as to what causes skin inflammation to worsen.
In society, kindergartens, and schools, the understanding that people are different should advance. We should foster an understanding attitude in children’s institutions so that children with atopic dermatitis can calmly care for their skin without being shamed or ridiculed. Children with chronic skin conditions need more support and understanding from their peers.
Associated Diseases
In quite many schoolchildren, atopic dermatitis is accompanied by pollen allergy, which manifests as so-called hay fever. If the allergen is also house dust mites, allergic rhinitis may also occur. In cases of atopic dermatitis, the risk of developing asthma is also increased. Children with atopic dermatitis more frequently suffer from common colds.
In infants and young children, food allergies may accompany the disease: the more severe the course of atopic dermatitis, the greater the likelihood of food allergy. In older children and adults, chronic stress and depression, as well as obesity, occur alongside atopic dermatitis. Children with atopic dermatitis more frequently suffer from common colds. The disease can also strongly affect children’s psychological well-being.
