Atopic dermatitis (or eczema) is a common disease in children. It is found in some adults, especially women. It is characterized by dryness of the skin, redness and itching.
There atopic dermatitis, also called atopic eczema, is a of the most common childhood illnesses which can appear in the first months of life. It also concerns the adults. Among the symptoms, we find dryness and itching of the skin. How recognize atopic dermatitis? How to treat it? Info, photos, creams and treatments.
Definition: what is atopic dermatitis?
There atopic dermatitisalso called atopic eczema is a “chronic inflammatory skin disease that turns red and itchy in individuals who are predisposed to experiencing these manifestations in the form of eczema which may be associated with other diseases: asthma, allergic rhinitis, etc.” defines Professor Julien Seneschal, professor of Dermatology in the Adult and Child Dermatology department at Bordeaux University Hospital.
At what age are we at risk for atopic dermatitis?
► Atopic dermatitis most often begins around the age of 3 months, but can also be observed from the first days of life. In infants, “skin lesions mainly affect the face (cheeks) and the convexity zones (elbow, knee)” specifies the dermatologist. It sometimes happens that almost all of the skin on the body of certain babies is affected.
► When the child grows upatopic dermatitis is generally localized at the folds (elbows, wrists and backs of knees). The lesions also appear on hands, face and eyelids. As the child grows into adolescence, it is not uncommon for symptoms to improve with less frequent flare-ups; or even disappear in some. “We think that 10% of children are affected by atopic dermatitis” indicates Professor Julien Seneschal.
► A adolescenceit is possible to see eczema flare-ups reappear due to the psychological state caused by this period of life.
atopic dermatitis Photos
Can you have adult atopic dermatitis?
Atopic dermatitis most often disappears before the age of 5, but “10% of children with atopic dermatitis will keep or reactivate atopic dermatitis in adulthood, indicates the dermatologist. 4.5% of the adult population has atopic dermatitis, with a majority of women (60% of cases).” In adulthood, the lesions mainly affect the face and the creases of the elbows or knees.
What are the symptoms of atopic dermatitis?
Atopic dermatitis develops in the form of flare-ups interspersed with phases of remission and calm. An outbreak of atopic dermatitis very often begins with the appearance of:
- of skin redness: erythema
- of the itching which can be significant and disrupt patients’ sleep and quality of life,
- dryness of the skin, called xerosis.
- Then, small elevations appear giving a feeling of roughness to the skin.
- They develop in the form of vesicles, resembling small bubbles of liquid. These rupture and release a translucent liquid causing oozing.
- Crusts form on the ruptured vesicles.
What causes atopic dermatitis?
The causes are multiple. “Many factors can come into play to predispose someone to atopic dermatitis, including a genetic predisposition (have a parent or family member who has this disease or an associated disease) to have skin that is more fragile and more permeable to allergens. This genetic predisposition is associated with elements of the immune system which will become too activated. Environmental factors will participate in the emergence of the disease (contact with allergens, winter climate which promotes drying of the skin, living in an urban environment…)“, informs Professor Julien Seneschal.
► The people with a close relative suffering from atopic eczema or associated conditions such as asthma, allergic rhinitis or food allergies) are at greater risk of developing atopic dermatitis. This is linked to a genetic predisposition (the genes being present on the chromosomes). Furthermore, certain environmental factors such as a dry climate or living in cities are also risk factors for developing the disease.
Does the sun make atopic dermatitis worse?
Exposure to ultraviolet radiation from the sun has instead tendency to improve atopic dermatitisbut only under certain conditions:
- a short exposure, before 12 p.m. or after 4 p.m.,
- in swimsuit,
- and if there is wind.
On the other hand, the infrared rays from the sun that heat the skin can worsen eczema due to sweat production. Children and adults with atopic dermatitis must follow a few instructions:
- Apply a milk or emollient cream.
- Wear ventilated cotton or linen clothing to let the skin breathe.
- Take a shower after exposure under the sun.
- Protect yourself with a sunscreen factor 50, fragrance-free, preservative-free, nanoparticle-free, particularly if you have atopic-prone skin.
Asthma, urticaria or chronic rhinitis reinforce the need to carry out an allergy assessment
“The diagnosis of atopic dermatitis is mainly clinical: it is based on a clinical aspect of the lesions and taking into account family historyindicates Professor Julien Seneschal. Objective scores (assessment by the doctor such as SCORAD, EASI or IGA scores for example) or subjective (questionnaires given to patients) can be used to assess the severity of the disease and the impact on daily life.“. Additional examinations are not necessary to make a diagnosis. The allergological assessment is done when there is evidence that the disease may be aggravated by an environmental factor. The presence of asthma, urticaria or chronic rhinitis reinforces the need to carry out an allergy assessment.
The treatment of atopic dermatitis is based on “treatment of flare-ups and long-term maintenance treatment to avoid recurrenceinforms Professor Julien Seneschal. The treatment of atopic dermatitis, a chronic disease, requires close collaboration between patient and doctor..” Atopic dermatitis flare-ups are treated with anti-inflammatories. “First-line treatments are local dermocorticoids. Large doses of topical corticosteroids may be required at the start of treatment to calm the inflammation. Then we reduce the doses to arrive at average doses without side effects“, underlines our interlocutor. In general, treatment goes from daily to weekly or bi-weekly.
Avoid using corticosteroids on the face!
“For adults with lesions on the face, it may be prescribed a calcineurin inhibitor (topical tacrolipus) because the use of corticosteroids on the face should be avoided. Antihistamines are rarely useful and effective because they are not a treatment that addresses the mechanism causing the scratching“, he informs. “When topical corticosteroid treatments are not enough to calm the inflammation or when flare-ups are too frequent, general treatments (subcutaneous or oral) can be offered to patients: cyclosporin which has a marketing authorization for atopic dermatitis and methotrexate which does not have a marketing authorization for atopic dermatitis but a certain number of studies have shown a benefit for patients as well as a new molecule available since the beginning of 2019, Dupilumaba monoclonal antibody (biotherapy) by injection“, indicates the dermatologist. Note that many molecules are in the process of development, according to Professor Seneschal. In addition to medications, taking an atopic dermatitis requires good hydration: drink enough water daily and moisturize the skin every day.
Which cream for atopic dermatitis?
Daily application (morning and evening) of neutral moisturizing creams without perfume or preservatives (emollients) is an integral part of the treatment. It is recommended to apply your emollient treatment to damp skin after a shower. This facilitates application and above all facilitates the retention in the epidermis of water which may have penetrated during washing. Maintenance treatment consists of in the application of emollients which aim to restore the skin barrier. “The emollient creates a protective film on the skin and protects it from the environment” explains the dermatologist. This treatment must be daily.
► Use essential oils is not recommended in a person with atopic dermatitis due to the risk of allergy.
What are the complications of atopic dermatitis?
The most frequent complications of atopic dermatitis concern superinfections of the skin: in fact, lesions caused by atopic dermatitis can be colonized by staphylococcus aureus or the herpes virus.
- If they are infected with Staphylococcus aureus, the lesions become pustular and the crusts yellowish. Antibiotic treatment must be prescribed quickly.
- If they are infected with the herpes virus, there may be an appearance of a fever, a rapid change in the appearance of the lesions and a change in general condition. It is urgent to consult a doctor in order to implement antiviral treatment.
Growth retardation can be observed in severe atopic dermatitis. Growth retardation is restored when treatment of dermatitis allows the lesions to improve. Atopic dermatitis can cause sleeping troubles (waking up at night, irritability, crying, etc.). On the other hand, ophthalmological complications of atopic dermatitis, such as keratoconjunctivitis and cataract are rarely observed.
There primary prevention of atopic dermatitis is not possible Today. “Given the promising results of a first study with a small number of patients which suggested that the use of emollients from birth in infants at risk could prevent the onset of atopic dermatitis, two recent international studies have not unfortunately not confirmed these first results“, informs Professor Julien Seneschal. On the other hand, the Emollients provide secondary prevention of flare-ups. However, simple measures make it possible to avoid or not aggravate the inflammatory outbreaks of atopic dermatitis:
► Do not heat the room above 19 degrees, ventilate in winter and summer
► Respect the anti-mite measures
► Avoid smoking
► Prefer cotton clothing because they are less irritating
► Avoid wearing synthetic fabrics and wool
► Wash your hair with dermatological shampoos soft
► Use soap-free products
► Cut your nails carefully to avoid damage occurring when scratching
► Rinse well after bathing in the sea because salt irritates the skin
► Avoid swimming in a swimming pool during flare-ups because the chlorine is an irritant, apart from flare-ups, rinse well in a shower after swimming and apply a emollient on the body.
Thanks to Professor Julien Seneschal, professor of Dermatology in the Adult and Child Dermatology department at Bordeaux University Hospital.