The skin, the largest and most visible organ of the human body, but one of the most unprotected

The skin is very accessible to abuse, as it is very close at hand it is easy for us to attack it, we spread what anyone recommends, we misuse creams, we favor infections, we use grass, soaps not suitable for the skin, high exposures to negative agents and remedies are the order of the day, however it is the largest organ of the human body and we must take care of it as such.

The skin also presents various diseases, which are more present than one imagines or probably lives their consequences in silence. For example, acne is suffered by 9 out of 10 adolescents, atopic dermatitis, 1 in 5 children, and in the case of psoriasis, in Mexico it is estimated that it affects between 2 and 3% of the population between 20 and 55 years old .

When we see a change in the skin, the immediate specialist is the dermatologist, the most qualified person to treat these conditions that also have multiple consequences and are even associated with other diseases.

Given this wide spectrum of needs for the skin, around 150 specialists gathered at the 5th Latin American Scientific Forum on Dermatology, which takes place from October 11 to 13 in Playa del Carmen, Quintana Roo. It is an academic agenda that shares novelties in dermatology, clinical practice, therapeutic novelties and research in development.

For example, “today skin treatments seek to complement the topical route with biological, a segment that is integrated for the care of these diseases,” explains Ricardo Swain Charpenel, general director of LEO Pharma Mexico. Diseases such as psoriasis, atopic dermatitis and eczema, will soon be facing changes in their medical approach, with products made with biological engineering that have given very good results in various diseases such as lupus, or rheumatoid arthritis and that are now integrated for care and skin care.

atopic dermatitis

One of the issues that most draws the attention of specialists is Atopic Dermatitis, which, due to its incidence, is present in the day-to-day life of clinics. “We see it in 1 in 5 children, especially in developing countries, which, being the most frequent inflammatory immune-mediated disease, require much more research work, because so far there is nothing to cure it,” explains Dr. Yuri Igor López Carrera, president of the Poblana Academy of Dermatology.

López Carrera explains that this occurs because there are many pathways of inflammation, many associated genes and many alterations that give the same phenotype, that is, everything looks very similar in the patient, but they have a different expression.

The way in which it develops is also changing, that is, it can present itself from very early stages of life, which is the most frequent (50 to 60% of patients are diagnosed before the age of 2 and 80% before 5 years), also up to 5% of patients develop the disease in adulthood.

Atopic dermatitis has characteristics that allow its diagnosis and progress, lesions in the extensor areas, in folds, behind the knees, neck, under the ears, even erythroderma, which is a generalized reddening of the skin or very specific areas. Something that also identifies the disease is that these patients do not produce the normal fat of the skin, the ceramide is not in an adequate form, which causes a greater loss of water and with it a lack of moisturization. That dry skin allows the entry of different allergens or issues from the external environment and will cause inflammation. “These are the most important changes, and they cause a patient to get worse and worse.”

The specialist highlights the relevance of living in cities to present this type of disease, where its prevalence has increased “in rural children, in general, we do not see these diseases because the immune environment gives you the ability to recognize foreign agents and fight them. In contrast, in the cities we avoid contact with these agents, but we have pollution and other phenomena that promote the disease”.

Today the treatments are aimed at reducing inflammation mainly. Although we still do not have medications to improve the immune situation, solutions are currently being sought in this regard that act on specific inflammation pathways and that allow improvement in all the patient’s symptoms without major side effects. Other treatments that have existed for a long time also continue to be investigated, for example Methylprednisolone, which is strictly for dermatological use, indicated for inflammatory processes and has been used as an option with few side effects.

Beyond the atopic consequences, the psychological ones

Something very relevant for the medical community is to talk about the psychological consequences for patients, in this sense, López Carrera states that these patients generally suffer from stress, depression and even suicidal ideation, which in general can occur in chronic diseases and this does not is the exception. “In addition to this atopic march, which is to start with dermatitis, food allergies and even asthma, there is also the psychiatric and psychological march of the patient, this was described in a study in 2008 and showed that the stress of being criticized and judged directly impacts . The patient begins to hide, wear clothing that covers, avoid social events, or open places, all this later leads to depressive symptoms and other conditions.

Even in 2020 it was shown that the interleukins involved in the disease (4 and 13) have an alteration of inflammation at the brain level and that they begin to directly affect the thalamus in terms of learning and memory, which makes patients hyperactive and isolated of the community.

Another factor that stresses is that today it is still an expensive disease because it includes creams, soaps, clothing care, treatments, this is an expense that can cause problems even at the family level, hence the importance of treating it at an early stage. “In a Mexican study, mild illness costs between 2,000 and 3,000 pesos a month, moderate it goes up to about 8,000 pesos, and severe the amount varies a lot.”

For Dr. Leonel Fierro-Arias, a highly specialized doctor in the dermatology service of the General Hospital of Mexico, atopic dermatitis and skin diseases in general are diseases with which one has to learn to live, as happens with diabetes, hypertension or others.

Atopic dermatitis is characterized by this dry and sensitive skin that can go into a crisis of inflammation. To avoid these conditions, the doctor assures that we must be attentive to the triggers of change, for example, in these sensitive skins, hydration is essential, “we have to pamper the skin so that it does not go into crisis, avoid inappropriate chemicals, lotions, perfumes , friction, severe carving, dry cleaners, fabrics that favor the process and stress, which is also an important trigger”.

nelly.toche@eleconomista.mx

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