Doctors spoke about atopic dermatitis threatening Russians

The problem of atopic dermatitis in the country is greatly underestimated. According to expert estimates, at least 25-30% of children in Russia and from 2 to 10% of adults suffer from it. At the same time, every fifth person with such a diagnosis has a severe form of the disease, which creates serious problems in life. Previously, such people had nothing to offer, except for hormonal drugs and antihistamines, which cause temporary relief and often addiction. Today, two classes of modern therapy have appeared, but in the vast majority of cases, patients are offered to buy expensive drugs at their own expense. Atopic dermatitis is not included in the benefit register, which is why people cannot receive adequate treatment.

Atopic dermatitis (AD) is one of the most common dermatological diseases. According to official data from the Ministry of Health of the Russian Federation, 271.5 thousand people in Russia have such a diagnosis, while the army of patients is growing every year. The exact cause of the development of the disease is unknown to science, but in most cases a genetic predisposition is revealed.

As the chief freelance specialist in dermatovenereology and cosmetology of the Ministry of Health of the Russian Federation and the Moscow Department of Health, Professor Nikolai Potekaev, says, atopic dermatitis is associated with the failure of many systems in the body: associated with hay fever, bronchial asthma, and gastrointestinal disturbances. Then she received the name neurodermatitis, which indicates a connection with the nervous system. And the current name speaks of atopy – interaction with the immune system.

Meanwhile, even today in Russia, atopic dermatitis is not officially classified as a systemic disease, which leads doctors into bewilderment. As the professor notes, Elena Fedenko, Department of Allergy and Immunopathology of the Skin, Federal State Scientific Center Institute of Immunology, Federal Medical and Biological Agency of Russia, it is unnecessary to prove the obvious: “AtD is a severe chronic systemic disease. There are 9 systems in the body, and all of them are interconnected, and the connection is provided by the immune system, the tenth, which controls all processes, representing a combination of organs, tissues and cells. When the processes are disturbed, a systemic autoimmune disease with multiple organ pathology occurs. For a long time, allergic diseases were not recognized as multi-organ diseases, but today this is beyond doubt. In AD, we fix a severe course in approximately 15% of patients, and moderate in another 36%. That is, half of the patients get sick with debilitating symptoms.”

In most cases, everything starts in early childhood, from birth, and is often the first step in the “atopic march”, that is, a series of atopic diseases. Doctors emphasize that in at least 90% of cases a person with AD has comorbidities. Most often it is allergic rhinitis, food allergies, bronchial asthma. So, for example, about 60% of patients with AD are prone to asthma, and up to 40% develop it, and allergic rhinitis develops in 80% of patients. And the more severe the disease, the higher the risk of developing such conditions. An international study conducted among 2000 adolescents with severe AD in different countries showed that 98% of them have comorbidities; such patients often develop cardiovascular diseases, angina pectoris, heart attacks, bronchitis, sinusitis, tonsillitis.

In a severe course of the disease, rashes are widespread (throughout the body), with prolonged exacerbations, rare and short remissions (the frequency of exacerbations is 5 times a year or more, the duration of remission is 1–1.5 months). Patients complain of severe itching that interferes with their sleep, reduces their performance, and sometimes causes depression, anxiety, low self-esteem, and even the desire to commit suicide. In addition, rashes in atopic dermatitis are often complicated by bacterial, viral and fungal infections of the skin.

Among other concomitant pathologies, diseases of the cardiovascular, digestive and respiratory systems are often detected in patients with AD. It happens that AD is accompanied by other autoimmune diseases: rheumatoid arthritis, lupus erythematosus, Crohn’s disease, ulcerative colitis, alopecia areata (baldness), vitiligo. Thus, the risk of Crohn’s disease in patients with AD is 34% higher compared to the general population, and rheumatoid arthritis is 72% higher.

“All this once again indicates that this is not just a skin disease, but a systemic disease, which is based on disorders of the immune system,” emphasizes Fedenko.

Many studies have already shown that patients with AD have greatly elevated levels of inflammatory mediators in unaffected skin and peripheral blood. The same picture happens with psoriasis, lupus erythematosus, rheumatoid arthritis. At the same time, compared with all the listed diseases, inflammatory processes in the blood in patients with AD are much more pronounced! However, if psoriasis, rheumatoid arthritis and systemic lupus erythematosus are included in the list of systemic diseases approved in the country for which patients are provided with drugs at the expense of the budget, AD is not included there, which significantly limits patients’ access to innovative therapy. “The treatment that we still use is not only ineffective, but also harmful. Recently, a child from Krasnoyarsk was brought to us with a severe form of AD, who was put on immunosuppressants, which are prescribed for organ transplantation. During treatment, he developed purulent granulomas, heart disorders, a herpes virus infection, and he almost died. This is not just anointed with cream and introduced hormones – first the patient gets an improvement, and then an even more severe course, ”continues Elena Fedenko.

Professor Natalya Ilyina, chief physician of the Institute of Immunology of the Federal Medical and Biological Agency of Russia, says that many high-tech, effective and safe drugs have appeared today. These are biological drugs from the group of monoclonal antibodies (the so-called targeted therapy), as well as from the group of Janus kinase inhibitors. All of them are included in the clinical guidelines for AD, and physicians are required to prescribe them. The only problem is that they are given free of charge either in a hospital or, if on an outpatient basis, then to beneficiaries, that is, mainly to patients with disabilities. “After the treatment, after 6 months, the patient’s skin becomes clear, and his disability is removed, which means that he is also removed from the free provision. Children from the regions receive therapy in federal centers, return home, and then come back the same way. Parents cannot buy these medicines at their own expense,” says Ilyina. In a number of regions, out of tens of thousands of sick children, no more than a dozen receive modern drugs. According to Professor Potekaev, only about 17% of the most severe patients are provided with innovative therapy. And the patients themselves are little informed about the possibilities of receiving innovative therapy. The head of the patient organization, Stanislav Mishin, cited the data of their survey: 90% of patients do not have access to innovative treatment; 80% have concomitant diseases, 74% have a reduced quality of life, and only 7% received a referral for a medical and social examination. In addition, 40% are unaware of their rights to receive modern treatment. Modern therapy was prescribed only to every tenth, and only 4% were provided with it.

Several institutes in Russia have found out interesting facts. The economic burden of only a severe form of AD among the adult population in the territory of the Russian Federation for 1 year is more than 13 billion rubles. (this is almost 3% of the healthcare budget of the Russian Federation in 2019). According to the head of laboratory No. 81 “Public Health Management” of the Institute of Management Problems named after. V.A. Trapeznikova RAS Dmitry Meshkov, on average, parents in the regions spend 8–12 thousand rubles on a child with AD (this includes medicines, comfortable clothes, and resorts), while the average household income is 40–60 thousand rubles. Parents of these children are often forced to change or quit their jobs to care for them.

Doctors say that in the modern world, atopic dermatitis is a chronic disease that, although not completely cured, can be controlled, even if it is severe. And they ask to include it in the category of severe systemic skin diseases and the federal register of preferential drug provision.