There are always better ways to get psoriasis and neurodermatitis under control – but the use of innovative therapies requires enlightened doctors and patients.
People with psoriasis or neurodermatitis not only suffer from unpleasant itching, but also have a significantly reduced quality of life. This can even lead to incapacity to work. Chronic inflammatory skin diseases such as psoriasis and neurodermatitis (atopic dermatitis/atopic eczema) are still not completely curable, but research is constantly making progress and enabling the development of modern therapies. In the “Presse” industry talk, organized jointly with AbbVie, therapy innovations in dermatology were highlighted. Discussion leader Eva Komarek, General Editor for Trend Topics at the Styria Media Group, welcomed the following panel of experts: Sylvia Perl-Convalexius, resident dermatologist and chairwoman of the Vienna Medical Association, Christian Posch, head of the dermatology department at the Hietzing and Ottakring clinics, and Ahmad Jalili, director the Dermatology & Skin Care Clinic Buochs in Switzerland.
Christian Posch, head of the dermatology department at the Hietzing and Ottakring clinics, Eva Komarek (Styria Media Group), Sylvia Perl-Convalexius, specialist in skin and sexually transmitted diseases, Ahmad Jalili, director of the Dermatology & Skin Care Clinic in Buochs in Switzerland. Günther Peroutka
There are different treatment methods for both neurodermatitis and psoriasis depending on the severity. The severity is defined by the number and extent of the inflamed skin areas and the burden caused by the disease. In mild forms, both chronic diseases can be treated with emollients, i.e. moisturizing creams, ointments and lotions. “They must be free of allergenic substances, i.e. without fragrances and preservatives,” said statutory health insurance doctor Perl-Convalexius. “For a mild form of neurodermatitis with dry skin, basic therapy may be sufficient. If eczema occurs more frequently, anti-inflammatory ointments or creams as well as light therapy can be used.”
When it comes to psoriasis, around 80 percent of patients have a mild form. “For mild psoriasis, topical therapies, such as cortisone or vitamin D3 preparations, are used,” said Jalili, an expert in the field of psoriasis. “20 percent of patients suffer from a moderate to severe form of psoriasis. The disease is particularly stressful when it occurs in visible areas, such as the hands or face. Then you are really stigmatized,” explained the specialist from central Switzerland. “At this stage, ‘external’ therapies are usually no longer sufficient. You have to treat patients with ‘anti-inflammatory’ treatment because the chronic, permanent inflammation also means that patients have additional risks that go beyond the skin problems.” Psoriasis is a multisystem disease. This ranges from joint problems to high blood pressure, diabetes, obesity, cardiovascular diseases or depression. Modern, targeted systemic therapies, such as interleukin inhibitors, can specifically prevent inflammatory messenger substances and thus inhibit inflammation in the body. “Due to the targeted use, there are hardly any side effects,” observed Jalili.
Overall, psoriasis has been very well researched. “In the case of psoriasis, the foundations for understanding the disease were laid more than 20 years ago,” said Posch. “This allows the development of many new therapy options.” Research into neurodermatitis is much younger, but is rapidly catching up, so that systemic therapies are used not only in psoriasis, but also in neurodermatitis. “We are seeing similar positive developments in the treatment of neurodermatitis as those that took off with psoriasis ten years ago,” says Posch. There has been a real revolution in the treatment of moderate to severe neurodermatitis with modern systemic therapies. “These include biologics in injection form or Janus kinase inhibitors in tablet form,” said Perl-Convalexius. “Many patients welcome oral therapies. It can also be observed that the itching can be stopped earlier than with previous therapies.”
Early deployment
Posch emphasized that the specific use makes the therapies more effective and the risks of side effects can be better managed. In principle, the following applies to every therapy: If side effects occur, it is important to consult a dermatologist. “At first glance, modern systemic therapies are more expensive than conventional therapies. In a cost-benefit calculation, this would be put into perspective because of the effective treatment,” the dermatologist is certain. “At the end of the day, data is the best argument. If the data is missing, there are no arguments.” For mild and moderate neurodermatitis or psoriasis, for example, there is almost no data basis at all. Austria is still in its infancy when it comes to so-called health services research – i.e. which intervention has which effects. There is a solid data basis in Germany. On the other hand, Austria has a major advantage over Germany and Switzerland when it comes to using new therapy options: “In this country, in addition to approval, the state of science is also crucial for the use of a new therapy and the use of modern therapies is therefore possible if their effect is confirmed said Posch. Jalili described this as exemplary. “It is important to start the optimal therapy early. The better the treatment, the faster the performance and quality of life of those affected improve. Chronic diseases such as psoriasis and neurodermatitis are extremely psychologically stressful. Without treatment, the life expectancy of people with severe psoriasis is on average five to ten years shorter. New therapies increase the hope of patients who have been suffering from chronic illnesses for a long time.”
Diversity of therapy necessary
“At the moment we cannot cure, but with modern therapies we are much more flexible,” said Jalili. “With innovations, higher standards of treatment can be achieved.” This is shown, for example, by the EASI score (Eczema Area and Severity Index), which is used to clinically assess the extent and severity of neurodermatitis and achieves better values through modern therapies. A wide range of treatments is also required because not every patient responds equally well to therapy. “Some patients do not respond or respond inadequately. Then you have to switch to another therapy,” said Perl-Convalexius.
In order to get closer to the major goal of freedom from symptoms or healing, further research is required. Clinical studies play a major role in further researching modern preparations. “We learn more with every use of therapy innovations,” said Posch. In principle, there should be no difference between clinic and private practice when using modern therapies. “Patients are not deprived of innovative therapies when they see a resident doctor. However, many doctors of the older generation have fears about new therapies,” said Perl-Convalexius. “With regular training, it shouldn’t be a problem to always be up to date.” It is also important that patients actively deal with the disease. This requires a good consultation with the doctor. “The better a patient understands a therapy, the more likely they are to accept a prescribed treatment,” Jalili said.
“Unfortunately, hostility to science is very pronounced in Austria. More openness to the new findings would be desirable,” says Perl-Convalexius. For Primar Posch, the patient journey is important: patients must be guided correctly so that each patient receives the best possible care. “The clear path is not yet optimally prescribed. There is a need for better collaboration between clinics and the private sector.”
Causes and characteristics
Neurodermatitis
Frequency: Around two to five percent of adults in Austria live with neurodermatitis.
Characteristics: Typical for this disease is very unpleasant itching and dryness of the skin, which turns into eczema, i.e. an inflammatory change in the skin.
Causes: A misdirected immune system and a disruption of the skin barrier and microbiome. A genetic predisposition can be inherited, but it does not necessarily mean the onset of the disease. The causes should not be confused with the trigger factors that can trigger or worsen flare-ups, such as environmental influences, skin contact with allergens, wool, animal hair, etc. Avoiding external influences helps against flare-ups, but does not combat neurodermatitis causally.
psoriasis
Frequency: Around two percent of Austrians live with psoriasis.
Characteristics: Typical are inflamed, red, sharply defined and flaky areas of skin, so-called plaques, which can appear on the body and scalp. Typical places are on the elbows and knees. However, changes to the nails and joints (psoriatic arthritis) can also occur.
Causes: The body’s own defense system plays the main role in psoriasis. It is controlled by various messenger substances. In psoriasis, the immune system becomes excessively active and too many inflammatory messenger substances are released, resulting in an uncontrolled inflammatory process. In this way, the symptoms typical of psoriasis start with scaling, redness of the skin, pain or itching.
Information
The industry discussion is a collaboration with “Die Presse” and took place with financial support from AbbVie.
2023-09-22 08:18:31
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