At night, "drilling the heart itch", how can it be so difficult to sleep well? The disease is high in winter, and the elderly are included in the "new classification"

Winters are cold and dry, and skin itching problems are frequent, especially atopic dermatitis (AD), which is the most abrasive. As a refractory systemic immune disease, atopic dermatitis is one of the heaviest non-fatal skin diseases, which can occur in men and women of all ages, but it is worth noting that in recent years, the prevalence of the elderly is gradually increasing, and in the "Guidelines for the Diagnosis and Treatment of Atopic Dermatitis in China (2020 Edition)", senile atopic dermatitis in people over 60 years old is gradually valued as a new classification. Worryingly, the elderly often treat it as ordinary itchy eczema and other idleness...

The incidence of old age continues to rise

Itchy, itchy, itchy! With the arrival of winter, many elderly people have persistent skin itching, and the situation is even worse at night, so that the elderly who have slept for a short time have almost lost the opportunity to sleep well.

"Itchy heart, itchy at night can't sleep." Mr. Li, who is nearly seventy years old, is very tough, and even has few colds and fevers on weekdays, but not long ago, he suffered from persistent, repetitive, itchy and intolerable "eczema", "just think of applying some ointment and taking some medicine, who knows it doesn't work at all, it is getting more and more serious." ”

With the sudden drop in temperature, there are many elderly people in the dermatology department of the hospital, many of whom have been treated in the "wrong direction" like Mr. Li. "The doctor said that I actually had atopic dermatitis, but I had never heard of it before, and I always treated it as eczema, and the result became worse and worse." Mr. Li looked helpless.

Professor Li Wei of the Department of Dermatology of Huashan Hospital affiliated to Fudan University said that in his expert outpatient clinic, nearly a quarter of the elderly patients with atopic dermatitis, the elderly suffer from atopic dermatitis, often associated with cardiovascular disease, metabolic diseases, mental disorders, seasonal rhinitis, conjunctivitis, asthma, chronic obstructive pulmonary disease, etc., which also increases the difficulty of standardized diagnosis and treatment of atopic dermatitis.

"Because older people often have a background of systemic disease and the incidence of tumors is also high, special attention needs to be taken to exclude other pruritus diseases with similar clinical manifestations when diagnosing geriatric atopic dermatitis." Such as bullous pemphigoid, cutaneous T-cell lymphoma, scabies, purpura dermatitis, pruritus, urticaria and drug eruptions. Li Wei said.

Mostly related to aging, allergies and so on

Clinically, patients with atopic dermatitis over 60 years of age are classified as elderly atopic dermatitis, of which the incidence is higher in men than in women. The reason why atopic dermatitis is high in the elderly population is due to the change in the skin structure and function of the elderly with age, and the phenomenon of decreased sebum secretion ability, skin barrier dysfunction and sweat reduction appears on the basis of allergic constitution, thereby inducing or aggravating atopic dermatitis. In addition, genetic and living environment changes are also important reasons.

Professor Li Wei analyzed: "Compared with infant, childhood, adolescent and adult patients, the main symptoms of senile atopic dermatitis are itching and generalized dermatitis, accompanied by dry skin, skin lesions are distributed throughout the body, extensor of limbs is more common, rash forms are diverse, there can be erythematous patches, desquamation and lichenid changes, and there can also be nodular itchy rash. If the disease worsens, a severe and generalized rash can form and even erythroderma. ”

Patients with atopic dermatitis have long been subjected to psychological and physical torture, not only life is affected, but even some patients suffer from anxiety disorders and depression, and anxiety and insomnia add more pain to the elderly. According to the "Investigation Report on the Survival Status of Patients with Atopic Dermatitis in China", 50%-63% of patients with atopic dermatitis are plagued by itching for up to 12 hours a day, and even some people sleep for less than 4 hours. In addition, "a significant number" of patients feel helpless (31%), anxious (40%), and irritable (31%), and some patients with severe atopic dermatitis have had suicidal thoughts and committed suicidal behaviors.

Keep in mind the four key points of protection

In life, although many elderly patients suffer from atopic dermatitis, but the disease is not enough to understand, not enough attention, and even many wrong treatment, some people are worried about the side effects and safety of drugs, resist medication, some people choose home remedies, thereby delaying or even aggravating the condition.

"Atopic dermatitis can have a more serious impact on elderly patients, and it is even more necessary to treat it in a timely manner." Professor Li Wei said that the elderly are more likely to have symptoms of dryness and itching, and the body's compensatory ability is reduced, because poor sleep and poor rest caused by dermatitis and itching can easily lead to the occurrence of other diseases. If the skin itching does not stop, repeated is not good, be sure to go to the dermatology department of the regular hospital in time to receive standardized treatment, Mo Yin is afraid of medical delays.

Professor Li Wei said that existing treatments, such as oral glucocorticoids and immunosuppressants, because they are not precisely targeted at the pathogenesis of atopic dermatitis, resulting in limited efficacy, potential safety risks, previous treatment of moderate and severe atopic dermatitis immunosuppressants, due to the indiscriminate suppression of the immune system, may produce many toxic side effects, such as liver and kidney function damage, bone marrow suppression, increased blood pressure, gingival hyperplasia and so on. Elderly patients who do not undergo long-term standardized treatment can easily lead to disease recurrence and affect the quality of life of patients, including sleep, social and mental health.

"From a mechanistic point of view, the new biologics can specifically block the key pathogenic factors IL-4 and IL-13 without interfering with other immune cells and molecules, which is a precision-targeted therapy that rapidly, significantly, and continuously improves the degree of lesions and pruritus symptoms." At the same time, its safety has also been confirmed by a number of clinical studies and real-world studies, which is a safe, effective and long-term systemic treatment method, and is now included in medical insurance, which can help elderly patients establish long-term treatment willingness and confidence. Professor Li Wei said.

Professor Li Wei reminded that if the elderly suffer from atopic dermatitis, they should pay attention to protection in life to avoid recurrence or aggravation of the disease, including four major aspects:

First, elderly patients with atopic dermatitis should reduce the frequency of using hot baths, apply warm water showers, and avoid high temperature damage to the skin; second, use less shower gel or soap so as not to cause the skin to be more dry and rough; third, in terms of dress, we should try to choose pure cotton and other natural fabrics and loose clothing to reduce skin irritation; finally, we must pay attention to rest, avoid excessive physical and mental fatigue, thereby affecting the body's immunity.

Author: Tang Wenjia

Editor: Tang Wenjia

Editor-in-Charge: Fan Liping

Image source: Respondent

*Wenhui exclusive manuscript, please indicate the source when reprinting.