Dr. Ana Citoiu, Campus Medical Pallady: In order to control these conditions, patients must not leave the early signs of the disease unobserved
In Romania, both psoriasis and atopic dermatitis affect a significant number of people, being two chronic inflammatory skin conditions, which affect not only the physical health, but also the quality of the life of the patients. Although both are dermatological disorders, they differ significantly in terms of causes, clinical manifestations, immune mechanisms and necessary treatments. Regarding atopic dermatitis, a study conducted by the Romanian Society of Dermatology in 2024 highlighted a prevalence of 9.41% at national level, which means that almost one in ten Romanians suffer from this condition. In children, the prevalence is higher, reaching 20%, as shown in the study.
We discussed with a specialist dermatologist to better understand the differences between them and to find out how we can handle these conditions. Mrs. Ana Citoiu – a specialist dermatovenerology specialist welcomes her patients with a characteristic smile and special attention for each one. Through her cabinet on the medical campus Regina Maria Pallady pass hundreds of patients. The profession puts it in the face of many realities, but when it comes to autoimmune skin diseases, such as psoriasis and atopic dermatitis, it knows that there is no single treatment or a rapid solution. Everything is built on the basis of a complete understanding of the patient’s condition and lifestyle.
The immunological differences and the onset of the disease. What are the differences between atopic dermatitis and psoriasis?
“It is an art to understand that these conditions are not just about the skin,” says Dr. Citoiu, starting the discussion about psoriasis and atopic dermatitis, two autoimmune diseases that, although they have different origins, often intersect in the lives of those who face them. Psoriasis, with its erythematous and squamous plates, and atopic dermatitis, with its red lesions and intense itch, are conditions that, although physical, can deeply and mentally affect the affected person.
From an immunological point of view, psoriasis is an autoimmune disease predominantly mediated by T helper 1 (TH1) and TH17 cells, which leads to excessive proliferation of skin cells, called keratinocytes. This condition can start at any age, but it is most commonly encountered between 15 and 35. Atopic dermatitis, on the other hand, is associated with a dysfunction of the skin barrier and an immune reaction of type Th2 (allergic), especially in the early stages of the disease, frequently debuting in childhood.
Different clinical manifestations. Both diseases are based on genetic and environmental factors
The clinical appearance of the two conditions is also distinct. In psoriasis, the lesions appear in the form of erythemato-samous plates, well delimited, with thick scales, the sidels, which are frequently located on elbows, knees, scalp and lumbar area. Pruritus (itching) can be present, but it is not a dominant symptom. In contrast, atopic dermatitis is characterized by erythematous lesions, often with vesicles or crusts, intense itching and a common location on the face, neck, popliteal pits – the space behind the knee and the antecubital pits – the space at the wrist, in front, where the arm is bent. In this condition, itching is a central symptom and is often debilitating.
“Behind each lesion, there is a story,” adds the doctor, letting us understand that not only local or systemic treatments are essential, but also how the patient relates to his disease. “It is a delicate combination of patient genetics and environmental factors – from nutrition, stress, sleep and even the environment. When it comes to psoriasis and atopic dermatitis, every detail matters.”
Both psoriasis and atopic dermatitis have a significant genetic component, which explains why the family history is a major risk factor for both conditions. In psoriasis, the best known association is with the HLA-CW6 gene, especially involved in early onset forms. In atopic dermatitis, mutations in the gene Filagrine (FLG) affect the skin barrier and are among the most important in the development of the disease.
The role of lifestyle in the management of the disease. What impact do nutrition, stress or sleep disorders have on these diseases?
The lifestyle plays an important role in the management and evolution of both psoriasis and atopic dermatitis. It explains how this can influence the evolution and intensity of these conditions. “We know that diet plays an important role. Diets high in sugar and saturated fat can aggravate inflammation, while anti -inflammatory foods, such as fish, vegetables and olive oil, can help reduce symptoms.”
But, of course, diet is not everything, stress and sleep disorders are frequent triggers. “A very important factor is stress. Stress activates the HPA axis (hypothalamo-hypephozo-suprarenal), increasing cortisol production and changing the immune response. It is a vicious circle: the disease aggravates stress, and stress aggravates the disease. Therefore, stress management techniques and quality sleep are absolutely necessary.”
The doctor also tells about the importance of a good skin hygiene, but also about how external factors can contribute to the trigger of a psycho-emotional episode. “There are many patients who reach me with extended psoriasis plates after a major stress episode or infection. Climate change can also play a significant role in aggravating atopic dermatitis, especially during cold season or when humidity varies.”
How is the atopic dermatitis and psoriasis are diagnosed and treated? Biological therapies, an alternative that fascinates patients
The diagnosis of psoriasis and atopic dermatitis is based primarily on clinical examination, but can be supported by additional tests in atypical or complicated cases. In the case of psoriasis, the Auspitz (punctiform bleeding at the removal of scales) and the Koebner phenomenon (the belonging of the lesions at the place of a skin trauma) are specific characteristics. In atopic dermatitis, the diagnosis is based on criteria established in the specialized literature (Hanifin and Rajka), and the allergic tests are useful for identifying allergens.
The treatment for both conditions depends on the severity and clinical type of the disease. In the case of psoriasis, topical treatments (dermatocorticoids, vitamin D analogues) and phototherapy for moderate forms are used. For severe cases, systemic treatments and biological therapies are recommended. Atopic dermatitis is treated with dermatocorticosteroids, calcineurine inhibitors and local antibiotics.
However, Dr. Citoiu stops on a subject that is increasingly fascinated: biological therapies. “These treatments are truly revolutionary. They specifically target the molecules involved in chronic inflammation, without affecting the entire immune system, as is the case with classic immunosuppressants. These therapies can completely transform the quality of life with severe forms of psoriasis or atopic dermatitis,” explains Doctor.
However, behind this innovation, Dr. Citoiu draws attention to an essential aspect: the education of the patient. “In order to truly control these conditions, patients need to understand the disease. There are no wonderful treatments, but there is a path – a road that includes a correct lifestyle, treatments prescribed by the doctor and, last but not least, a quiet and patient mind.”
Finally, a simple but deep question, heard quite often in the doctor’s office: “How can we, as patients, accept and face these debilitating conditions, after all, easier?” The answer comes by itself: “By understanding, by taking care of our body, and by confidence in doctors. It is essential to recognize the early signs of the disease and not to leave them unobserved. I am glad when the patients come to me before the disease to control their control.”
Psoriasis and atopic dermatitis are dermatological conditions that require a complex and personalized approach, focused on adequate treatments, managing triggers and patient education. With a correct diagnosis, effective treatments and careful lifestyle management, patients can lead a healthier and more comfortable life, minimizing the impact of these chronic diseases on their daily lives. Even in the face of chronic skin conditions, there is always a way to live a better, more balanced and, above all, more aware of one’s health.
