Atopic eczema diagnoses have steadily increased in Sweden over the past few decades, even though the rate has now slowed. Eczema gets worse during the winter, in dusty conditions and when the air is dry. The exact cause of the disease remains unclear, but heredity and our Western lifestyle increase the risk of being affected. Children with eczema mostly have a higher socioeconomic background, even though the differences are not as clear now as they were a few years ago.
“It has previously been said that most children grow out of their eczema and about 60 per cent are indeed symptom-free as teenagers. But many of them will relapse later in life and in that case often with hand eczema,” says Laura von Kobyletzki, a researcher at Lund University, Occupational and Environmental Dermatology, Skåne University Hospital, Malmö.
Biological and social factors
Depending on age, eczema affects different areas of the body. In young children it is found on the cheeks, around the mouth, on the stomach and back, and in the creases of joints. Among young people it is mostly found on their head and throat, whereas for adults hand eczema is more common. Atopic eczema is a barrier disease that damages the skin’s natural protection and makes it weaker and susceptible to bacteria and microbes. It is also one of the diseases that affects quality of life to a great extent due to itching, pain, sleep disorders and stigmatisation. For women, the prognosis is often worse because of a combination of biological and psychological differences and social factors.
Women may have worse rashes in connection with menstruation, pregnancy or menopause and also feel that their quality of life is impacted more.
Laura von Kobyletzki says that research has identified a connection between severe eczema and reduced stress tolerance and impaired cognitive ability. Children with severe eczema have lower grades in school which, among other things, may be due to a lack of sleep that leads to concentration difficulties, as well as absence from school due to acute flare-ups or healthcare interactions. In adults the disease may affect self-esteem and the ability to form close relationships. Research has shown that individuals with atopic eczema are less likely to get married or cohabit, compared to those without the disease.
“Severe atopic eczema affects all areas of life and in some cases can lead to sick leave and stays in hospital. It is a psychological strain to live with itchiness and it can lead to limitations in both the choice of career and leisure activities. Physically demanding jobs in which the skin is subjected to stress, as well as mentally exhausting work, may have a negative effect on the disease.”
Atopic eczema increases the risk of developing other atopic conditions
People with atopic eczema have an increased risk of developing other atopic conditions such as hay fever, asthma and food allergies. This is commonly called the “atopic march” and shows how allergic conditions often start with eczema and then develop into other diseases. There is also a comorbidity aspect, particularly in the case of severe atopic eczema, relating to depression and anxiety, and inflammatory diseases such as cardiovascular disease, intestinal diseases and rheumatoid arthritis, which may be attributable to common risk factors or the chronic inflammation associated with the disease. Treating atopic eczema is therefore important in order to reduce the development of comorbidity.
Up to one-third of all those with atopic eczema have a genetic mutation (the filaggrin mutation), which dries the skin and makes it crack more easily. The protein filaggrin plays an important role in maintaining the skin’s structure and moisture balance, and protects against harmful substances that may trigger an inflammation. The mutation is an important factor in atopic eczema and is linked to how early the eczema is contracted and its severity.
“Early treatment is crucial for mitigating eczema or even slowing the development of other diseases. Furred animals generally have a protective effect.”
Using new biological drugs, patients can be offered targeted treatment based on each person’s specific medical needs. The active substance in these drugs has a biological origin and is aimed at the immune system. Immunomodulators are drugs that, for example, inhibit specific parts of the inflammation process by blocking the effect of the signal molecules that the immune cells use to communicate with each other. In atopic eczema these molecules become overactive, which leads to chronic inflammation. Recently, JAK inhibitors – small synthetic molecules – have been introduced which, like biological drugs, act more precisely by blocking inflammation.
New study examines the costs
“Many patients think that they must live with their eczema. However, there is now good treatment available, and care must be demanded until there is a satisfactory outcome. Even though eczema is a chronic disease, you can live a good life, but knowledge is required about the treatment ladder in order to extend the intervals between relapses. I have seen patients who, with the right treatment, have got a whole new life, so there is hope!”
Laura von Kobyletzki is now starting a new study in which she will examine the costs that the individual patient has to pay for medicine, emollient creams, extra clothes and bed linen, as well as the indirect costs such as sick leave and healthcare interactions.
“You may need to be off work to go to the doctor or because you have been unable to sleep at night. Or perhaps you need to take time off to go for light therapy or to take care of your child’s eczema. We know that atopic eczema entails major costs for the healthcare system, but no one has previously looked at the costs that the patient has to cover,” she concludes.
