Babies with burning cheeks, children who can't bend their knees and are desperately scratching the folds of their arms... 20% of children under 7 years old and 15% of infants from 3 months old (figures from the French Society of Dermatology) suffer from Atopic Dermatitis, the scientific name for eczema. What are the solutions to relieve them?
What is eczema or atopic dermatitis?
According to its “official definition”, atopic dermatitis – or atopic eczema – is a chronic inflammatory disease of the skin due to an abnormality of the immune response and a deficiency of the skin barrier .
What triggers eczema?
Like many chronic skin diseases, eczema is of multifactorial origin. There is both a genetic factor (between 50 and 70% of affected children have a parent who is also affected and if both parents are affected, the risk reaches 80%), an immune factor (increased sensitization to certain pathogens and allergens) and an environmental factor (including pollution ).
The explanation? Healthy skin constitutes a defensive barrier against external agents. But skin affected by atopic dermatitis lacks ceramides in its horny layer , and like a leaky wall, it lets attackers (pathogens and allergens) pass through and its defenders (its hydration) escape.
What to do against eczema?
At the first symptoms, it is essential to consult a dermatologist who will prescribe a treatment (corticosteroids applied locally during flare-ups) but will also be able to see if there is an atopic "terrain". Atopic dermatitis is in fact considered the cutaneous aspect of Atopy which also includes allergic asthma, rhinitis and conjunctivitis.
What are the symptoms of eczema?
Atopic dermatitis is marked by permanent skin dryness, with regular outbreaks of what is commonly called eczema, most often punctuated by teething and nasopharyngeal infections in infants. Red patches and inflammatory lesions (erythema, vesicles) appear, accompanied by severe itching. By scratching, there can be superinfections. The appearance of scabs announces the remission phase.
In infants, these patches are located on the cheeks, arms, thighs and abdomen.
Then, in children and adolescents, they migrate to the folds (back of the knees, crook of the arms), hands and feet, around the mouth and even the eyelids. The attacks can again be linked to an infection or vaccination, but also to stress (exam, family crisis, etc.). In many, atopy calms down (like asthma) after 6 years, but the skin remains dry. 4% remain atopic in adulthood.
Atopy is more or less severe, there is a scale used by dermatologists to evaluate it, called SCORAD (or Scoring atopic dermatitis).
The effects of eczema
Along with acne, atopic dermatitis is one of the skin diseases that most impacts social life. The constant itching can cause severe psychological distress. In young children, the itching, which persists at night, can ruin sleep and life, and consequently that of an entire family. School-age children sometimes feel excluded because of the way others look at them. Some even try to hide their legs or arms under clothing, or no longer want to go to school. Finally, the itching sensations are so painful that they can cause irritability and bad moods. The deterioration of self-image is also accentuated in young girls suffering from eyelid eczema who cannot wear makeup.
The care products to use and the right actions to follow
The treatment prescribed by the dermatologist or pediatrician is based on dermocorticoids in the event of an outbreak, to be used locally for 3 days on average.
But dermatologists have found that attacks can be spaced out considerably by applying the right care and the right actions.
A gentle toilet
This should be done with a cleansing oil or dermatological bar. Classic soap and shower gel are much too aggressive and stripping. Avoid hot and long baths, which increase the permeability of the skin. Instead, take a lukewarm 5-minute shower. When you get out of the shower or after washing your hands, dab your skin with the softest towel possible and do not rub. Your skin is already fragile enough!
Daily hydration
The best treatment for atopic skin remains the daily application of a specific emollient. Their long-term use not only has a beneficial effect on skin dryness, but studies have shown that it allows flare-ups to be spaced out and therefore the need for dermocorticoids to be reduced. These emollients must have a high concentration of nourishing vegetable oils and butters, soothing active ingredients, and even antibacterial ingredients in their formula to prevent the proliferation of Staphylococcus Aureus.
The problem: it's tedious, because the formulas, even if they have greatly improved in naturalness and texture, remain quite thick and we often run after the children to manage to spread them. But it's a habit to take from a very young age and that must be made fun with a song, a story or a game, because these children will have to learn to coat themselves alone and practice this gesture all their lives. There are also Therapeutic Education programs within hospital departments to learn how to take care of themselves.
Good habits
- To teach the little ones: during flare-ups, do not scratch with your nails, which are aggressive and potentially carry germs, but with the palm or the back of your hand.
- For clothing, we prefer loose cuts to limit friction on the skin, and cotton or silk rather than wool.
- Thermal cures: prescribed by a doctor and reimbursed by health insurance, 3-week thermal cures have proven their effectiveness on pathologies such as atopy. In addition to general hydrothermal treatments (baths, showers, massages) and daily local treatments, it is a place of therapeutic education and exchange through games and workshops for the youngest. It allows young children to relieve their symptoms and acquire more autonomy. Around ten French thermal spas are indicated for dermatology
What to Avoid in Case of Atopic Dermatitis
Since atopic skin is fragile and porous, it is essential to be extra vigilant about the cosmetics used and their composition. Be careful because many blogs and other articles denigrate certain cosmetics, particularly conventional ones, and sometimes promote products that are just as bad for this skin.
Prohibited ingredients
- Perfumed cosmetic products : whether synthetic or natural perfume, we avoid them for hypersensitive skin, because there are as many allergens (if not more) in a natural perfume as in a synthetic one.
- Potentially irritating or allergenic preservatives : MIT, MCIT should be avoided, as they are irritating, as is benzoic acid, which is authorized in organic products.
- Sulfates, the foaming agents in most classic shower gels, are too harsh for these skins. They disrupt the microbiota and the hydrolipidic film.
- Soap : AVOID! Except for cold saponified soap, fragrance-free, with a high oil content of the best quality, i.e. a soap purchased from a small soap maker and paid more than €10. Forget industrial soap, which is extremely stripping and has a pH that is far too high, including Marseille soap !
- Lanolin: derived from sheep fat, it is highly allergenic. However, it is more than rare to find it in a specific emollient for atopic skin.
- Endocrine disruptors : obviously, as for everyone, but again, they are difficult to detect and many brands eliminate them. We therefore favor, it is obvious, products with a Clean charter but above all products stamped "tested under dermatological control" and even "under pediatric control".
A healthy environment
We use a hypoallergenic detergent for laundry but also for sheets for atopic people, to avoid all surfactants and perfumes. Also be careful not to use fabric softener because it is the last rinse water that contains it.
We avoid all household products and furniture containing volatile organic compounds (VOCs): construction materials, decoration, insulation, paints, thinners, glues and varnishes, but also cleaning agents, air fresheners, stain removers, insecticides and descaling agents.
Microbiota, a way forward for atopy
Advances in knowledge of what was once called skin flora have shown that the diversity and balance between the microorganisms that make up the microbiota prevent colonization by aggressive species and participate in the defenses of the skin's immune system. However, we now know, thanks to a study published in the journal Nature, that atopic dermatitis is closely linked to a strong imbalance in this microbiota and to the overdevelopment of Staphylococcus aureus in it. It attaches to the skin and creates a shield that contributes to amplifying eczema flare-ups, dryness and itching. While corticosteroids remain the standard treatment, we are discovering the benefit of creating emollients enriched with active ingredients (pre and post biotics) that help rebalance the microbiota, reduce the inflammatory factor and prevent Staphylococcus aureus from settling in. It is to counteract the latter that certain brands have developed pre and post biotic complexes.
The food routine
Breastfeeding until 6 months, especially if there is a history of atopic dermatitis in the family, helps reduce the risk of food allergies in the baby. It is better to introduce certain foods late, and only one by one, such as eggs and fish (after 12 months), as well as all oilseeds (after 3 years).
If atopic dermatitis is not linked to a particular food, some can make it worse, especially those that have a pro-inflammatory action or promote acidity in the body . Thus, acidic sweat can promote attacks. It is therefore necessary to favor a basic diet (fruits, vegetables, legumes and whole grains). Plants, rich in antioxidants, help fight inflammation. Obviously, you must eat a balanced diet, avoid sugary and processed foods , saturated fats (cooked butter and margarine, cold cuts, fried foods, chips, etc.), junk food. Some atopic people also suffer from irritable bowel syndrome, which tends to acidify the body. In this case, it is better to dissociate the intake of starchy foods and fruits and vegetables, and see if the symptoms reduce when you eliminate gluten and cow's milk products. But also, because atopy is linked to a dysbiosis of the microbiota, and because the intestinal microbiota and the skin microbiota are closely linked, eat foods rich in pre and probiotics and in particular all fermented foods (yogurts, kefir, kombucha, etc.). We can also supplement this diet rich in fermented foods with food supplements rich in probiotics.
