Atopic eczema, allergy on the skin

A predisposition to allergy

Atopic eczema, neurodermatitis, atopic dermatitis, or infant eczema, so many names for the same skin disease. Atopic is a predisposition to allergy that manifests itself through different pathologies such as hay fever, allergic asthma or eczema. This skin disease is not serious but is very unpleasant during flare-ups. In the case of atopic disease, the immune system produces antibodies against seemingly harmless substances (allergens) such as foodstuffs, pollen, house dust, animal hair, wool, etc. The immune system is then able to produce antibodies against these substances.

Who’s involved?

Occurring very early in life, it can appear as early as the first few months in the predisposed baby. There is indeed a strong hereditary component : if both parents are affected, the risk for the child to develop atopic eczema is around 50%.

When the disease starts early, the prognosis is favourable, with eczema being rarer after the age of 3-4 years. About two-thirds of children are free of lesions by the age of 10. Only the most severe forms persist into adulthood.

In adulthood, itching predominates, responsible for the appearance of patches of skin thickened in places and streaked by the nails during scratching. It is in adults that lesions of all types can be found on dry and rough skin.

The face, the nape of the neck, the folds of flexion and the trunk are the elective site of lesions in adults.

Constantly increasing

It is an increasingly common skin disease in industrialized countries; about 10% of the population in industrialized countries has atopic dermatitis. In Europe, one child in ten is affected, but the figures vary widely from country to country. Therefore, it is difficult to know the exact prevalence of atopic dermatitis in Europe. It most often begins before the age of 1 year and affects 10 to 18% of infants. In 80% of cases, it improves by the age of 2 years. It persists in adulthood in 10 to 15% of cases.

What stage of atopic eczema are you at?

There are 4 stages in the evolution of this disease:

  • Phase 1 or erythematous phase : the skin is red, small blisters appear, accompanied by itching (pruriginous phase),
  • Phase 2 : The vesicles regroup,
  • Phase 3 : The blisters ooze,
  • Phase 4 : appearance of crusts, the fall of which leaves a red skin.

Location changing with age

Depending on age, dermatitis will not affect the same parts of the body:

  • in infants: cheeks, scalp, shoulders, chest and thumb,
  • from 2 years old: elbow bends, wrists, knees, ankles,
  • in teenagers: eczema is still located on certain flexor folds of the limbs, around the eyes, on the soles of the feet,
  • in adults: on the nape of the neck, ankles, feet and hands

Identifying dry skin from atopic skin

If your skin is tight and flaky – for example, if it “snows” when you take off your pantyhose – if you have “snakeskin” or even slightly grainy skin in places, you probably have dry skin. On the other hand, if dry skin is accompanied by severe itching and red lesions, you probably have atopic dermatitis.

Putting on makeup? Yes, but…

There’s no reason why you shouldn’t wear makeup when you have atopic skin. But it’s better to be careful with the products you choose. In general, avoid cheap make-up, rarely of good quality. Instead, favour hypoallergenic make-up ranges, specifically designed for the most sensitive and reactive skins, sold in pharmacies or on specialised sites.

How do you manage atopic eczema?

Environment :

The house, let alone the room, must be healthy:

  • reduce carpets, lint (wash them often)
  • avoid pets
  • do not overheat the rooms
  • Air and vacuum frequently.

Clothes:

  • Wash with a detergent that does not contain fabric softeners or phosphates. Rinse well.
  • Prefer cotton to wool and synthetics.

Feeding (for predisposed children) :

  • Favour breastfeeding as long as possible (protective effect).
  • do not start diversifying before 6 months and introduce only one food per week if possible
  • opt for hypoallergenic (HA) milks if the baby is bottle-fed.

Fight against skin dryness to prevent new crises:

  • For children, add oils to the bath to reconstitute the hydrolipidic film. Lipids help restore the skin’s barrier function and slow down dehydration. Good results are obtained with bath products based on urea or omega fatty acids.
  •  Avoid baths and showers that are too hot or too long.
  • Wash with soap-free products (gel or dermatological bar) because the PH is closer to that of the skin and this does not accentuate skin dryness.
  • Wash with your hands (cleaner than a washcloth).
  • Wash hair with mild or frequent use dermatological shampoos.
  • Gently cleanse the face.
  • Dry the skin by dabbing it dry, without rubbing.
  • Apply a dermatological moisturizing cream to the skin:
  • In case of atopic eczema, the hydrolipidic film secreted by the skin is not enough to protect it. The skin therefore needs a supply of fat.
  • For this reason, ointments, creams or lotions with a high fat and water content are the best choice, as they keep the skin moist.

Which products to choose in case of atopic eczema?

Several ranges of cosmetic care products, specifically formulated against atopic eczema (hypoallergenic, without fragrances or preservatives or based on thermal water…) are available in pharmacies or on certain specialized sites. They are often prescribed by dermatologists. The formulation (composition) and the galenic (texture) of the treatment are important for the success of the treatment.

Learn more: Atopic Eczema Training Courses for Parents

Aha (Swiss Allergy Centre) organises training courses for parents of children with neurodermatitis in some French-speaking cantons (GE, FR, VD). They will learn how to manage their child’s disease. The training is given by specialists who will provide them with useful information on the medical and psychological aspects of the disease. These training sessions are supervised by interdisciplinary teams (paediatricians, allergists, child psychiatrists, etc.).

For more information, please visit: www.ahaswiss.ch (Section: Training / courses for parents)

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This post is also available in: French