Solutions & treatments

What happens in atopic skin? (and how can you reduce eczema flare-ups?)

A more severe form of very dry skin, irritated skin with itching is considered atopic skin. This skin disease starts at a very young age and has all the characteristics of a genuine epidemic. It is even one of the main causes of visits to the dermatologist! In the past 30 years, the number of cases of atopic dermatitis has doubled or even tripled in western countries*.

Atopic skin is not well known or understood, yet it disrupts the lives of children and their parents. However, recent scientific discoveries have improved understanding of the illness and changed the way it is treated starting at birth.

Atopic dermatitis is an inflammatory skin disease that is characterised by extreme dryness and red patches often covered with small vesicles (small “blisters”) that cause intense itching.

Atopic dermatitis is a benign and non-contagious chronic disease with flare-ups of eczema.

These acute break-outs have a significant impact on quality of life and often cause insomnia. Over time, an atopic profile can manifest in other allergies such as asthma, allergic rhinitis or allergic conjunctivitis. The complications are bacterial or viral (herpes) secondary infections. Molluscum contagiosum, a viral condition, also appears more often on atopic profiles.

The skin is extremely dry and becomes more permeable, no longer playing its barrier role against external stresses and allergens. But not all dry skin becomes atopic.

Atopy develops on profiles with a genetic predisposition.

Studies have shown that if one parent has atopic skin, the probability of the child having the same skin condition is 30%**. If both parents are affected, the probability is 70%**.

In addition to the genetic factor, atopic skin is also related to :

an abnormal immune system

which over-reacts, creating inflammation. The epidermis becomes permeable to allergens (mites, animal hair, pollen) and certain bacteria (Staphylococcus aureus), which trigger inflammatory reactions.

Food allergies

cow’s milk, eggs, etc. are also involved digestively in triggering certain eczema flare-ups. Other factors such as chemical products applied to the skin, heat or perspiration are irritants that cause these flare-ups.

However, in the vast majority of cases, atopic children do not have food allergies. Food allergies manifest themselves as digestive signs and a “break” in height and weight curves.

*Dermatite atopique: épidémiologie en France, définitions, histoire naturelle, association aux autres manifestations atopiques, scores de gravité, qualité de vie (Atopic dermatitis: Epidemiology in France, Natural History, Association with Other Atopic Manifestations, Severity Scores, Quality of Life). E. Mahé. Ann. Dermatol. Venereol. 2005 ; 132

**Dermatite atopique. SA Büchner. Swiss Medical Forum No. 19, May 2001

Stage 1

Atopic dermatitis generally starts between the second and third months of life when highly-localised red patches appear on the cheeks, and hands, then spread to flexion creases on the knees and elbows. The illness evolves through flare-ups over one to two years.

The skin is permanently dry, which leads to itching, causing insomnia and a decrease in quality of life.

Stage 2

After several years, some children may develop other atopy signs, such as allergic rhinitis and/or allergic asthma. This is the last stage of the “atopic march”. It often involves scratching and high rates of staphylococcus aureus colonisation on the skin.

Therefore, in order to prevent it from appearing and worsening, the scientific community currently recommends early management from birth to treat atopic skin in newborns who do not yet show signs of the condition but who have a favourable genetic predisposition.

People affected are genetically prone to allergies (atopy-prone).
They may also have respiratory problems (asthma), problems in the ears, nose and throat (allergic rhinitis), eye problems (allergic conjunctivitis) or digestive problems (food allergy).
Babies and infants are the most likely to be affected, usually between three months and five years, with a peak of 80% of cases appearing before the age of one. But atopic skin can persist longer, up to adulthood.

Dr Michèle Sayag, Allergist.

An internet user’s question: How can atopic dermatitis be prevented and treated?

Prevention is used for “at-risk” children, namely children with at least one allergy-prone parent. In these cases, for example, we know that it is best to avoid contact with cats during the first few weeks. As regards treatment, outbreaks of eczema should be treated as early as possible with topical anti-inflammatory steroids. Changes in the skin barrier should be treated every day with an emollient.

Dr Michèle Sayag, Allergist.
Dr Michèle Sayag, Allergist.

An internet user’s question: Can the water I use to wash my child make his atopy worse?

Hard water makes dry skin worse and therefore affects the skin barrier which allows allergens from the environment to penetrate the skin and trigger outbreaks of eczema in atopic children.

Dr Michèle Sayag, Allergist.
Dr Michèle Sayag, Allergist.

An internet user’s question: I suffer from allergies (eczema, shingles). Will my daughter therefore be more prone to developing these skin problems?

Shingles is not an allergy but a viral infection. However, if you suffer from atopic allergic reactions, your daughter is more likely than average to suffer atopic dermatitis.

Dr Michèle Sayag, Allergist.

Once the progressive nature of atopic dermatitis was understood, a new approach to the disease was adopted with two key objectives that should encourage you to contact your dermatologist.

Complete diagnosis

What strategy should be adopted to manage a progressive disease?

We should short-circuit the progression and act as early as possible, in the stage of “pre-atopic” dryness in at-risk infants: those whose skin is very dry, whitish and rough, and those whose parents or siblings have had atopic skin.

How should this be done? By intervening as early as possible with the most targeted treatment available, because each atopic dermatitis flare-up promotes new relapses.

It is essential to treat each flare-up in a drastic way, which will limit the reappearance of lesions and reduce the length of the illness’s progression.

Medicated treatments for eczema flare-ups mainly rely on local corticoids (or topical steroids). They eliminate inflammatory lesions and provide rapid relief from itching. The lesions frequently recur when treatment is discontinued. The amount of local corticoids applied depends on the surface area requiring treatment and the subject’s age. The number of tubes used over a defined period is quantified by the doctor.

Avoid applying them to the face or to an infant’s nappy area.

Tacrolimus may be used as a second-line treatment if topical steroids have failed, but only on children over the age of one. Other treatments are only considered for adults and adolescents.
Food elimination diets are only justified after medically confirming a food allergy (using food allergy tests in a specialised environment).

Be sure to follow all of your dermatologist’s advice. Remember to take the following precautions:

Avoid allergens likely to cause an acute inflammatory reaction such as mites, pollen and animal hair and feathers, as well as exposure to tobacco, which is an irritant.
Avoid introducing solid foods too early for infants. Follow the advice of your paediatrician or general practitioner.
Opt for cotton clothing. Avoid wool and synthetic clothing that could irritate skin.
Be careful not to use too much detergent when doing laundry. Too much detergent may make skin fragile.
Remember to iron your clothes or tumble dry them. This will make them softer and more comfortable.
Make sure the temperature in your home is not too hot (19-20°C) and regularly humidify the air. Air rooms every day, both summer and winter.
Regularly humidify your bedroom or simply hang a wet towel in it overnight.
There are no restrictions on sports unless excessive perspiration aggravates itching.

Every day, take a five- to ten-minute shower with warm water (it should not be more than 35 degrees Celsius; dry skin does not like hot water).
Do not use bubble baths or bath salts, which always dry out and irritate the skin.
Wash your body with an ultra-high-tolerance cleansing product; ideally a liquid Syndet or a lipid-enriched and anti-dryness cleansing bar (to strengthen the skin barrier). Say goodbye to ordinary soaps because they irritate and dry out the epidermis.
Meticulously dry skin, carefully and lightly dabbing it with a cotton towel.

Once or twice a day, generously apply an ultra-high-tolerance emollient that promotes the reconstruction of the skin barrier, makes your skin supple and soft and reduces hyper-reactivity.
Once or twice a day when experiencing eczema flare-ups, use a moisturising and superfatting treatment that relieves itching and limits inflammatory reactions on your whole body except on eczema lesions.