Atopic dermatitis: beware of incoming thoughts!

France – Atopic dermatitis is the subject of many misconceptions on the part of patients or parents of children suffering from these skin diseases. This has a direct impact on establishing and successfully completing an effective treatment. Many treating physicians notice the gap between their medical knowledge and the insights their patient receives. But sometimes it can also be interesting for specialists to question their own concept of the disease.

Medscape French Edition rate Dr. Isabelle Dreyfussclinical pharmacist, in the reference center for complex and rare dermatological diseases and syndromes of genetic origin at the Department of Dermatology at the Hospital de Larry (Toulouse), who researched this topical topic on the occasion of 17The tenth French Allergy Congress (CFA).

Medscape French Edition: Are preconceptions and beliefs of the patient an obstacle to the proper implementation of treatments in atopic dermatitis?

Dr. Isabelle Dreyfuss There are indeed many misconceptions and misconceptions that interfere with the proper implementation of treatments, especially for mild and moderate forms in children. I would even say that there are few chronic diseases that accompany children with many prejudices. The origin of disease is the subject of a very popular idea. Many parents consider their children’s skin diseases to be related to food allergies. It happens that they changed the milk two or three times before the consultation. For medicine, atopic dermatitis is a chronic disease of polygenic origin that develops on a genetic ground with provocation or exacerbation of situations: the use of soaps, detergents or perfumes, deficits of innate and adaptive immunity. This complex disease is rarely associated with allergies. But because parents are convinced of the nutritional origins of eczema, they find it difficult to stick to treatments that rely on local care, such as applying topical anti-inflammatory corticosteroids on the lesions and an emollient cream to avoid drying out. In addition, the development by relapse is for them evidence of the inefficiency of treatments and fuels reluctance to topical corticosteroids.

This complex disease is rarely associated with allergies.

Medscape: How do you explain persistent corticophobia?

Dr. Dreyfuss There are several factors that contribute to the development of corticophobia: there are irrational fears, false messages conveyed by the media, the Internet or those around them, but there is also ignorance of the side effects of treatment. There is often confusion with orally administered corticosteroids. Some parents fear the potential side effects of topical corticosteroids, such as those that may occur with oral corticosteroids, such as facial swelling, affecting the adrenal glands or developmental disturbances. Ironically, they often don’t hesitate to follow their one-week prescription of prednisolone for bronchitis. You should know that with topical corticosteroids, the effect of the systemic passage is minimal. For the latter, one year of continuous whole-body therapy is equivalent to one week of oral corticosteroid therapy. I also think that the reluctance can be explained by the uncertainty about the duration of treatment and the amount of cream to be applied. It is important for the attending physician to clarify this.

Medscape: How can doctors themselves fuel corticophobia?

Dr. Dreyfuss : Surveys show that medical studies logically underestimate corticophobia. But it may be necessary for clinicians to question their way of presenting things, and in particular to realize that they sometimes use restrictive or negative terms that add to their patients’ phobias. An example of an expression to avoid? “If absolutely necessary, apply very small amounts to very inflammatory lesions.” Of course, I voluntarily focused on the line but it is well understood that each of the expressions ‘small amount’, ‘urgent necessity’, ‘severe inflammatory lesions’ can feed suspicion. Even a “small amount” disturbs the anxious patient.

Medscape: Do patients tend to turn to “do-it-yourself” treatments?

Dr. Dreyfuss : completely. The search for alternative treatments stems from corticophobia. For example, we note the use of magnets or firebirds, the main danger of which is the delay in effective treatment. More or less allergenic essential oils or somewhat whimsical homemade recipes, such as rubbing half a lemon on pests or keeping a green clay poultice overnight, can aggravate the situation. There is a risk of contact dermatitis. You should know that patients with atopic dermatitis hypersensitivity very easily. This is the downside of home remedies: They can be very harmful. As for vegetable oils – almond or olive, they are often mistakenly used instead of moisturizers. However, although it has an occlusive effect like an emollient, it does not treat dry skin.

Medscape: How should clinicians deal with false beliefs?

Dr. Dreyfuss The golden rule is to have the patient speak without harsh judgment or reaction. He should be able on his own to mention the dangers of the “treatment” he put in place. In other words, the patient will end up saying that it is not working. Even in the city, nothing prevents you from taking an educational position. A doctor can use a stand that holds figurative pictures to show his patient what’s going on in the skin. He should clearly explain his prescription and indicate the amount and location of the cream to be applied to give the patient full ability to repeat the procedure at home. It may be reassuring to remember that topical corticosteroids work and provide relief very quickly.

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