Atopic dermatitis: hyper-reactive skin

Understanding Atopic Dermatitis

Atopic dermatitis is the most common skin disease (or dermatosis) in children in France. It needs to be diagnosed by a doctor.

Atopic dermatitis, a skin disease from childhood

Atopic dermatitis is a chronic skin disease that combines periods of flare-ups and periods of calm. It is also called atopic eczema . It most often occurs in children from the first trimester of life. Affected individuals have an atopic background , that is, they are predisposed to allergies. 

Most often, this atopic eczema disappears during adolescence but it can sometimes persist into adulthood.

Symptoms and locations of atopic eczema

Symptoms of atopic dermatitis

Atopic dermatitis causes:

• Very inflammatory lesions during flare-ups. These are red, raised patches. In infants, vesicles are sometimes noted, i.e. small blisters on the skin that contain a translucent liquid. These vesicles can rupture, ooze and form scabs. Some lesions even end up becoming chronic and have a drier appearance.
• Significant itching ( or intense “pruritus”) occurs at the lesions. There is a risk of infection when scratching.
• Xerosis is a dryness of the skin found mainly in older children and less frequently in infants. It can be localized or generalized.

Location of lesions

The location of the lesions changes depending on the age of the individual:

• Up to the age of 1 year, the lesions affect the convexities of the body: the cheeks, the forehead, the external faces of the arms and thighs. Sometimes, the damage can affect the entire body.
• From 1 to 3 years old, the hands, ankles, and the folds of the elbows and knees are particularly affected.
• From 3 to 4 years of age, lesions of the folds and face are associated.
• In adolescents and adults, lesions affect the triad of the neck, face and hands, but skin involvement can be generalized.

Causes of atopic dermatitis

These are genetic and hereditary factors that predispose to atopic dermatitis. In affected individuals, the hydrolipidic film of the skin is altered. This is a protective film that lines the epidermis and is composed of fatty substances and water. In addition, the intercorneocyte cement is also degraded: it normally ensures cohesion between the superficial cells of the skin.

The skin's protective mechanisms being altered, this results in:

• an increase in skin permeability: water from the epidermis evaporates more, which explains the dryness of the skin  ;
• easier penetration of allergens and irritants into the skin, which explains eczema and significant skin inflammation;
• skin infections that develop more easily: consultation is necessary at the slightest sign of infection!

Excessive hygiene can further damage the skin barrier, so it is very important to choose your hygiene products carefully. This is also the case for showers and baths that are too hot and prolonged.

As a general rule and unless otherwise advised by a doctor, diet is not considered to be an aggravating factor in atopic dermatitis. However, according to several studies, certain strains of probiotics taken orally could prevent the occurrence of atopic dermatitis in infants. These are good bacteria that make up the microbial flora of the digestive tract, genitals, and also the skin. Some emollient balms or creams, to be applied to the skin, are also formulated to strengthen the skin's microbial balance!

Fight against atopic dermatitis

Fighting atopic dermatitis first means preventing inflammatory flare-ups from occurring.

Changing your habits to avoid atopic dermatitis flare-ups

To space out the inflammatory flare-ups of atopic dermatitis as much as possible, changing your hygiene habits is an essential prerequisite:

• The temperature of the water in showers and baths should remain lukewarm and always below 37°C, with an ideal of 34°C.
• It is best not to stay in the water for too long: 5 minutes is enough for a shower, and 15 minutes is a maximum for a bath.
• Soap is too aggressive for the skin of a person with atopic eczema. Contrary to a widespread misconception, Marseille soap is particularly drying. It is preferable to use a syndet (dermatological cleansing product without detergent), a dermatological superfatted product , or even cleansing oils . Pharmacists and doctors will be able to advise you.
• Patting the skin dry with a terry towel rather than rubbing helps to respect the skin tissue.

Other habit changes that can improve symptoms and prevent flare-ups:

• Avoid using fabric softener and large amounts of detergent which remain in the fibers of the laundry.
• Prefer natural fibers for dressing like cotton.
• Sweating promotes itching: avoid overdressing children and respect the ambient temperature for the home (18°C to 20°C).
• Avoid hanging laundry outside during pollen season.
• Cut nails short to reduce scratching injuries.

Moisturize to limit flare-ups of atopic dermatitis

Properly moisturizing your skin means restoring its protective hydrolipidic film. Suitable products are available in pharmacies and help combat atopic dermatitis flare-ups and the associated itching. They also prevent flare-ups from resurfacing during periods of calm.  

To be applied daily on the advice of your doctor or pharmacist, emollient treatments in the form of milks, creams, balms or cerates restore the skin barrier. They allow:

• To combat dehydration of the epidermis by evaporation of water;
• To reduce the permeability of the skin to allergens and irritants;
• To capture water using humectants.

Applied after showering on slightly damp skin, emollient treatments are even more effective.

Treating Atopic Dermatitis Flare-Ups

On prescription only, creams containing a cortisone derivative can combat inflammation of eczema plaques during flare-ups of atopic dermatitis. One of the main obstacles to the correct management of this disease is called "corticophobia". This is the fear associated with the use of these corticosteroids. It is felt by many people, particularly parents of children with atopic dermatitis.

To reduce itching, symptomatic treatments (such as antihistamines) can be implemented in addition to emollient care.

Oral treatments are available for the most severe forms of atopic dermatitis.