Chronic dermatological conditions like eczema, psoriasis, and bullous diseases are significant health issues that affect a substantial number of people worldwide, including in Sri Lanka. These conditions not only impact patients physically but also carry psychological and social burdens due to their often-visible nature. Effective management requires a deep understanding of their clinical features, treatment options, and the challenges that can interfere with successful treatment adherence. Eczema is a chronic, inflammatory skin condition characterized by dry, itchy, and red patches of skin. It is most commonly seen in children but can persist or develop in adulthood. Eczema often flares due to environmental triggers, allergens, or stress, and its chronicity can severely impact the quality of life, particularly due to sleep disturbances caused by intense itching. Infections are also common due to scratching, and patients are prone to bacterial or viral superinfections like impetigo or eczema herpeticum. The mainstay of treatment for flare-ups is corticosteroid creams, which reduce inflammation. Regular use of emollients helps maintain skin hydration and serves as a preventive measure against flare-ups. In more severe cases, calcineurin inhibitors (e.g., tacrolimus) are prescribed to reduce immune system activity. For severe cases, systemic immunosuppressants like cyclosporine or newer biologics (e.g., dupilumab) are used. Treatment adherence is often hindered by the need for consistent moisturization and steroid application. Financial barriers to accessing high-quality moisturizers and biologics, as well as fear of steroid overuse, contribute to poor compliance. Additionally, environmental triggers such as heat, humidity, and exposure to allergens can make disease control difficult in tropical climates like Sri Lanka's. Psoriasis is a chronic autoimmune condition characterized by the rapid turnover of skin cells, leading to the formation of red, scaly plaques, most commonly on the elbows, knees, and scalp. The severity ranges from localized plaques to extensive body involvement, and patients often suffer from joint pain if they develop psoriatic arthritis. Psoriasis can lead to severe physical discomfort and psychological distress due to its visibility and the stigma associated with skin conditions. These include corticosteroids, vitamin D analogs (calcipotriol), and coal tar preparations, which help reduce skin cell production and inflammation. Light therapy using UVB radiation is often used in moderate cases to slow skin cell turnover. In more severe cases, systemic immunosuppressants like methotrexate, cyclosporine, and biologic agents targeting specific immune pathways (e.g., TNF-alpha inhibitors, IL-17 inhibitors) are used. The chronic nature of psoriasis necessitates long-term treatment, which can be expensive, particularly when biologic therapies are required. In Sri Lanka, access to these therapies is limited, and high costs prevent many patients from adhering to prescribed regimens. Additionally, the lack of awareness about the autoimmune nature of psoriasis can lead to the belief that topical treatments alone will suffice, causing frustration when symptoms persist. Bullous diseases, such as pemphigus vulgaris and bullous pemphigoid, are rare but serious chronic autoimmune blistering conditions. These diseases are characterized by the formation of large, fluid-filled blisters on the skin and mucous membranes, which can lead to significant discomfort, pain, and risk of secondary infections. If untreated, they can be life-threatening, particularly in elderly patients. High-dose systemic corticosteroids are the first-line treatment to reduce inflammation and immune activity. Agents such as azathioprine, mycophenolate mofetil, and rituximab (a monoclonal antibody) are used to control the autoimmune response. Managing blisters and preventing infections is crucial, and wound care is a significant component of treatment. In cases of secondary bacterial infections, antibiotics are necessary. Bullous diseases require lifelong immunosuppressive therapy, which carries significant side effects, including increased infection risk. Long-term use of corticosteroids can lead to complications such as osteoporosis, diabetes, and hypertension, which further complicates treatment. In Sri Lanka, the availability of advanced immunosuppressive therapies may be limited, and patients may not have easy access to specialists with expertise in these rare diseases. Patients with chronic dermatological conditions often struggle with maintaining long-term treatment due to a lack of understanding of the disease’s chronic nature. In Sri Lanka, where acute illness-focused care is more prevalent, the importance of long-term treatment for chronic conditions is often underappreciated, leading to treatment discontinuation when symptoms improve temporarily. Many patients in Sri Lanka face financial difficulties in accessing expensive treatments like biologics or even high-quality topical treatments and moisturizers. The public healthcare system, while providing basic care, may not have all the advanced medications needed for severe cases, and private care may be unaffordable for the majority. Chronic skin diseases often result in emotional distress, anxiety, and depression due to their visible nature and the social stigma attached to them. Psychological support is rarely integrated into dermatological care in Sri Lanka, leaving patients to deal with the mental health burden on their own, which can negatively impact treatment adherence. The tropical climate of Sri Lanka, with its high humidity and temperature, can exacerbate skin conditions, particularly eczema and psoriasis. Patients may find it difficult to adhere to topical treatments in such conditions, and there is often limited advice on how to adapt skincare routines to environmental challenges. Access to specialized dermatological care is limited in rural areas of Sri Lanka, where patients often rely on general practitioners who may not have the expertise to manage complex skin conditions. Additionally, there can be communication barriers between patients and healthcare providers, leading to misunderstanding or incomplete information regarding the necessity of consistent treatment. Chronic dermatological conditions such as eczema, psoriasis, and bullous diseases present significant challenges in terms of management and patient quality of life. In Sri Lanka, these challenges are compounded by socioeconomic factors, limited access to advanced treatments, and cultural perceptions of skin disease. Effective management requires not only clinical treatment but also patient education, psychological support, and healthcare system improvements to overcome the barriers to long-term compliance..
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