Social prejudice


You can only acquire new ideas if you are able to destroy the old ones.


 

Access to treatment is not just about doctor availability and treatment costs. 

 

The first obstacle patients have to contend with is prejudice. The aim of this page is to give patients the means to destroy that prejudice.

 

 

________________________________________

1. There’s no point in trying to treat it, it just keeps coming back again

2. It has to run its course

3. Help me get rid of this thing!

4. Something must have caused it

 

5. Atopic dermatitis is not a disease

6. It is allergic

7. It is all in the mind

8. Corticophobia

 

________________________________________

1/There’s no point in trying to treat it, it just keeps coming back again

Asthma is also a disease where patients experience periods of flare-up and remission, but no-one would dream of saying not to treat it because it might come back again!

This prejudicial attitude conceals two really major ideas that need to be brought out into the open:

• “There’s no point in trying to treat it” implies lack of understanding of the dangers of not treating it

• “It keeps coming back again” implies the expectation that the disease will one day go away for good

 

 

What are the dangers of not treating it?

• Impacting everyday life – work, sports, personal and sexual relationships

• Promoting the onset of allergies, whether of the respiratory tract (asthma) or the skin (contact eczema)

• Damaging self-esteem, with the accompanying risk of depression and suicide, particularly in teenagers;

 

Atopic dermatitis is a chronic disease that comes and goes. Recommendations for avoiding recurrences are as follows:

• Apply cortisone twice weekly as a preventive measure to all at-risk areas (1)

• Opt for global management: treat the intestinal flora, correct the diet, use dietary supplements, talk about it, reassure the patient

[1] Hanifin J. Gupta AK. Rajagopolan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic patients. Br. J. Dermatol 2002. 147. 528-37.

 

________________________________________

2/It has to come out

Eczema patches react to stress, diet and effort, by weeping and becoming visible on the skin. This is enough to fuel the idea that there is something bad inside that needs to get out. The something being waste matter, something bad, something toxic. Letting it out amounts to a kind of purification. This idea is far from unusual amongst our patients, making them not want to treat the disease no matter what, particularly as some doctors give the idea credence, which only serves to fuel patient corticophobia.

 

So what is the truth of the matter?

Anyone who has tried a detox, a particularly fashionable type of phytotherapy at the moment, has almost certainly experienced a little episode of acne! ‘Toxins’ are indeed evacuated via two channels:

• The sebaceous glands

• The sweat glands

As cortisone does not prevent them from performing their normal functions in any way, the toxins can still come out even when patients are being treated with dermocorticoids.

 

________________________________________

3/Help me get rid of this thing!

Chronic diseases comprise:

• Diseases where patient participation is not essential, e.g. high blood pressure, where all the patient has to do is swallow a pill

• Diseases where patient participation is essential, such as diabetes.

Atopic dermatitis belongs to the second group. But achieving adherence to this type of patient participation is far from easy. Why? (1)

• We no longer use our common sense to treat little problems with our bodies. Everything is referred to healthcare specialists. If there’s a problem, it’s up to them to find the solution. People no longer feel responsible for their own health.

• Weight of habits and there is an illusion that technology has an answer for everything. “We can get a man to the moon and you want me to believe that you can’t cure my eczema?”

The solution lies in having an educational approach.

 

[1] Réflexions sur la non-observance. S.G.Consoli. Annals of dermatology and venereology. January 2012. Volume 139. Supp1.528-532.

 

________________________________________

4/Something must have caused it

 

The idea of a causality link – i.e. a link between a single cause and a single effect – first appeared in the life sciences in the 19th century. Even if the idea seems very simplistic these days, it still holds sway in general thinking.

 

Tuberculosis is caused by Koch’s bacillus; diabetes is caused by the pancreas no longer secreting insulin; a heart attack is caused by a blockage in a coronary artery...it’s a way of presenting things that is easy to visualise and model, and consequently easier to understand.

 

What is implicit in this way of thinking is that removing the cause cures the disease. This is not how it works with atopic dermatitis. There is no cause, as it is the mark of our modern way of life on our genetic capital. It is called epigenetics. Over 100 genes are already affected, and the list is by no means exhaustive. [1]

 

[1] Saman Sabounchi, Jenna Bollyky, Kain Nadeau, Review of Environmental Impact of the epigenetic regulation of atopic diseases. Curr Aller Asthma Rep June 2015) 15-33

 

________________________________________

 

5/Atopic dermatitis? It’s not a disease!

This sentence expresses a sentiment of denial shared by doctors as much as by society in general.

 

Being bitten by a mosquito, stung by a nettle or scratched by a label – these are all good reasons to scratch, yet none of them are medical reasons. Scratching is a symptom that is governed by social codes rather than health issues.

 

Scratching does not trigger empathy in others – on the contrary, the reaction is “Stop scratching!” 

 

The general public sees a correlation between complexity of treatment and severity of illness: chemotherapy means cancer, but a little tube of cortisone cream does not give others the least idea of the ordeal a patient may be going through…

 

And yet their quality of life is the same: shattered!

 

So what are we waiting for to change how we view eczema? [1]

 

[1] Changer son regard sur l’eczéma. Bourrel Bouttaz M. Editions Ovadia

________________________________________

 

6/It’s allergic

Most patients think that atopic dermatitis is the result of an allergy. Why?

 

Anything that’s itchy and red is given the label allergy… because people don’t know any better. The word inflammation is understood as meaning a problem with the joints but not a problem with the skin. Tools like the drawings below can be very useful in such cases.

 

• Atopic dermatitis functions like a flame-thrower on anything that gets through the skin

 

• An allergy functions like sniper and is specific to the antigen-antibody reaction

 

It is of major benefit to separate the two concepts:

Atopic dermatitis is a non-specific reaction and if allergy test results are negative, the key is to find the factors triggering the flare-ups.

Allergies do not cause atopic dermatitis, babies do not have allergies, and only 30% of patients with atopic dermatitis will also develop allergies. The less atopic skin is treated, the more an atopic patient is likely to develop an allergy – double whammy!

 

________________________________________

 

7/It’s all in the mind!

This type of comment often indicates a flat refusal on the part of family or healthcare providers, such is their feeling of helplessness.

 

The fact that stress can trigger flare-ups is not the slightest proof of it’s being a psychosomatic illness. 

 

But there is no doubt that it affects a child’s relationship with their mother and family life in general, quickly “doing everyone’s head in”, and that it impacts a child’s ability to develop safely and securely, making them more sensitive and thus artificially giving credence to the idea that “it’s all in the head”.

 

Treating atopic dermatitis in children also means managing the anxiety engendered by this disease. [1]

 

[1] Stress parental des mères d’enfants d’âge préscolaire atteints d’eczéma atopique, mémoire présenté par M.H. Poulin, Université de Québec, January 2005

________________________________________

 

8/Fear of cortisone

Self-care is not always easy, even when you are in discomfort or pain.

Patients will only adhere to the treatment if the following three conditions are all present:

• They trust the treatment system

• They trust the treatment

• They have confidence in themselves and they are motivated

The act of starting treatment instantly focuses the attention on all the prejudices, fears and incomprehension surrounding this disease. Fear of cortisone is not just fear of the effects of the product – it is also a concentration of all the other things, often because the patient has no other way of expressing it.

 

So: are you corticophobic? Take the Topicop test [1].

0 = completely disagree

1 = mostly disagree

2 = mostly agree

3 = completely agree

The nearer your score is to 36, the more corticophobic you are, and vice versa.

The (scientifically proven) correct answers are the ones that give you a score of 0.

 

 

 

 

Corticophobia score: TOPICOP

 

Eczema and corticosteroid cream questionnaire

Your doctor has prescribed, either for you or your child, a treatment that involves applying a skin cream containing corticosteroids. This questionnaire will help us to see how you feel about following this course of treatment. Please answer the questions by ticking the box that best describes what you think.

 

Tick one box per question

 

In the questionnaire, we use the initials CC to refer to Corticosteroid Creams, also known as dermocorticoids or cortisone creams.

 

BELIEFS: 6 items

1. CCs get into the blood

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

2. CCs promote infection

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

3. CCs make you fat

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

4. CCs damage the skin

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

5. CCs can affect my future health

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

6. CCs promote asthma

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

 

BEHAVIOUR: 6 items

7. I don’t know the side effects but I’m scared of CCs

o Completely disagree

o Mostly disagree

o Mostly agree

o Completely agree

8. I’m scared of using too large a dose of the cream

o Never

o Sometimes

o Often

o Always

9. I’m scared to use it on areas where the skin is thinner, like the eyelids

o Very rarely, never

o Sometimes

o Often

o Always

10. I put off using it as long as possible

o Never

o Sometimes

o Often

o Always

11. I use it as briefly as possible

o Never

o Sometimes

o Often

o Always

12. I need reassurance that it’s safe to use CCs

o Never

o Sometimes

o Often

o Always


social prejudice in atopic dermatitis