Hoy se celebra el día nacional de la enfermedad crónica de la piel más frecuente en la infancia, la dermatitis atópica. Entre un 10 y un 20% de los niños en países industrializados la padece, pero no solo es cosa de niños, si no que cada vez es más frecuente la continuación e incluso aparición en adolescentes y adultos.
Os podría hablar largo y tendido de esta patología cutánea porque entre otras cosas, yo misma la padezco, pero hoy voy a limitarme a aclararos qué es, y como mantenerla a raya.
La dermatitis atópica (DA) es una enfermedad inflamatoria, pruriginosa, de evolución crónica ligada a los linfocitos T de la piel que suele cursar a modo de brotes. De carácter hereditario, esta dolencia suele asociarse a una piel seca que se irrita con facilidad. Es frecuente que quien la padece o algún familiar directo padezca asma, rinitis o alergias alimentarias, al conjunto de todo ello más la DA, se le denomina atopía.
El picor, la piel seca y las placas (eczema) son los síntomas que nos indican la presencia de DA aunque dichos síntomas pueden variar de un paciente a otro, cosa que complica su diagnostico y diferenciación de otras patologías.
Lo más característico de esta dermatitis es que cursa alternando periodos de brotes y remisiones. Los brotes son fáciles de diagnosticar ya que comienzan con un enrojecimiento de la piel (eritema), que da lugar a vesículas, exudación, costras, cicatrización y finalmente piel seca. Es durante el brote cuando el picor es más intenso y el riesgo de lesiones por rascado e infección es mayor.
Es fundamental llevar a cabo una serie de medidas higiénico-dietéticas no solo durante los brotes, sino también durante los episodios de calma para intentar que los brotes sean menos intensos y más distanciados en el tiempo. La utilización de productos inadecuados en el baño y en la hidratación del paciente atópico pueden desencadenar o agravar los brotes, de ahí que se recomiende usar productos adecuados para evitar la persistencia de la DA.
El baño ha de ser corto, nunca más de 10 minutos, siempre con agua que no supere los 34 grados, a ser posible sin esponjas ni manoplas y con un gel sin detergente (syndet) que no dañe la piel y que la hidrate p. ej. Lipikar Syndet de la Roche-Posay o el gel de Leti AT4 son dos de mis favoritos.
Tras el baño el secado debe hacerse sin frotar, a modo de golpecitos ya que si friccionamos o frotamos en exceso podemos aumentar la irritación de la epidermis.
Una vez retirado el exceso de agua debemos usar un emoliente que forme una capa protectora en la superficie del estrato corneo reteniendo agua y aportando lípidos que restauran la barrera cutánea e impidiendo la penetración de alérgenos y sustancias irritantes, además este emoliente reestablece el equilibrio de la flora cutánea y controla el picor ayudando a espaciar los brotes p. Ej. Lipikar Baume AP para el brote y Lipikar leche para el mantenimiento o Leti AT4 leche corporal son algunos de los emolientes con los que yo he obtenido mejores resultados.
Cualquier producto que sea especifico para la piel atópica no debe contener conservantes, perfumes, ácido salícilico,… han de aplicase una ó dos veces al día, siempre después del baño y antes de salir al exterior especialmente en invierno. Hay que usar prendas sueltas de algodón que evitan el picor y dejan que la piel respire, materiales como la lana o la licra además de aumentar el picor pueden aumentar la sudoración de la piel y con ello la necesidad de rascar.
Los corticoides tópicos y los inhibidores de la calcineurina (tacrolimus, pimecrolimus) son muy útiles en el control del eczema y han demostrado ser muy seguros, no obstante siempre han de usarse durante los periodos de brote y bajo prescripción y supervisión médica.
Prometo que os volveré a hablar más detenidamente de la DA porque al igual que sucede con cualquier otra patología crónica, sé q puede ser difícil de llevar y controlar y cualquier información siempre es bien recibida no obstante os doy mi secreto para controlarla: hidratación, hidratación y más hidratación.
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