Assoc. Kazandzhieva graduated in medicine in 1985 and began working as an assistant in the Department of Dermatology and Venereology at VMI-Pleven. In 1992, he acquired a speci alty in dermatology and venereology. Since 1994, he has been at the Clinic for Skin and Venereal Diseases of Medical University - Sofia.
Specializes in skin diseases at the University Skin Clinics in Vienna and Zurich. In 2008, she was elected as a docent at the Department of Dermatology and Venereology, MU-Sofia. He is a member of the board of the European Academy of Dermatology and Venereology, the management of the Bulgarian Dermatology Society, an expert in the European program for the prevention of occupational skin allergies.
The cases of atopic dermatitis have become extremely frequent. For the last 20 years, every fifth child suffers from the skin disease. Such are the findings of the specialist dermatologists in the campaign "Free in their skin" for atopic dermatitis. Prof. Dr. Zhana Kazandzhieva shared more about the topic.
Prof. Kazandzhieva, what is the reason for the increased number of patients with atopic dermatitis in recent years?
- Undoubtedly, the reason is the changed way of life - industrialization, global pollution, stress. There is an interesting study done in two large cities in China and one in the US. The authors studied the skin microflora in order to get an idea of what changes in atopic dermatitis. At the end of the study, they were in for a surprise - it turned out that the microorganisms on the surface of the skin were so different that only by the changes in the microbiome could it be known which child lived in which city.
In fact, what is atopic dermatitis and what are the etiological factors for its manifestation?
- Atopic dermatitis is a type of eczema. Part of the big three eczemas – contact, seborrheic and atopic. Let's clarify that the terms dermatitis and eczema are equivalent. It is equally correct to say atopic dermatitis and/or atopic eczema. The etiology of atopic dermatitis is still not fully understood. What do we know so far? We know that unlike other types of eczema, there is a genetic predisposition, a broken skin barrier and an immunological imbalance.
How does the disease manifest itself - which parts of the body does it affect and can non-specialists mistake it for another type of dermatosis?
- Atopic dermatitis, unlike other types of eczema, has different manifestations in different age groups. In babies, the face is most often affected, in older children - the bends of the elbows and knees, and in adults, the changes may be limited to the back or limbs, but they can also cover the whole body. The various clinical manifestations on the skin are often difficult, and therefore it is good to make the diagnosis by an experienced dermatologist, who then prescribes not only the appropriate treatment, but also the specific dermatological cosmetics.
How is the diagnosis made?
- Various diagnostic methods are used. Most often, dermatologists comply with the classification of Hanifin and Rayka. This classification dates back 40 years, but still most accurately describes the clinical criteria. There are also multiple methods for calculating the severity of atopic dermatitis - EASI, SCORAD. The doctor's experience is most important - atopic dermatitis does not only need treatment, but also numerous lifestyle advice.
What are atopic dermatitis attacks and what are the factors that aggravate the condition?
- I don't think "seizures" is an accurate term. Atopic dermatitis is a chronic-relapsing disease, and when it worsens, we talk about a relapse.
There are many factors that aggravate the disease - stress, excessive sweating, wearing woolen clothes, improperly used cosmetics, pollution in the professional environment.
Is there a cardinal treatment for atopic dermatitis and is it available for Bulgarians?
- If we assume that "cardinal treatment" is synonymous with "definitive treatment", then there is no such thing. In the case of severe forms, we hope for the so-called biotherapeutics that significantly improve eczema changes and hence the patient's quality of life. Some of the medicines, called biologics and small molecules, have already been approved by the European Medicines Agency. Unfortunately, they are not yet available in Bulgaria for patients with severe forms of atopic dermatitis
Is there a daily care that can relieve a child's atopic dermatitis?
- Of course, such care is mandatory, regardless of whether the child is in remission or with an exacerbation of the disease. In general, emollients are prescribed, which restore the water-lipid balance of the skin. From there - the choice of detergent, clothes, food, toys… Recommendations for these things are individual, depending on the severity of atopic dermatitis and the individual characteristics of the patient.