How to recognize eczema?
The Eczema is a pruritic dermatosis characterized by a non-infectious inflammation of the skin which is accompanied by redness, fine vesicles, dander and itching. It can begin very early in life, and is observed even in infants. Sufferers experience periods commonly known as “eczema flare-ups” during which symptoms worsen. These outbreaks, of variable duration, are interspersed with periods of remission. Eczema is often associated with asthma or various allergic reactions.
The mechanism of eczema is not yet well understood, it would affect both the immune system and skin cells that act as a barrier for allergens. Eczema is a disorder of a genetic nature, but environmental factors such as the presence of chemical irritants or stress would influence its appearance.
Among all skin diseases, eczema is the most common: this disease motivates up to 30% of consultations in dermatology. In industrialized countries, it would reach 15% to 30% of children and 2% to 10% of adults. According to recent estimates, eczema cases have doubled and perhaps even tripled in the last 30 years.
To explain this growing incidence of eczema, various hypotheses have been advanced. For example, it is suspected that changes in infant dietary habits resulting from breastfeeding abandonment and early exposure to food allergens would play a role in the onset of this early disease. Indeed, it seems that the exclusive breastfeeding of the infant during the first 3 months partially protects against atopicdermatitis. On the other hand, there is no link between early introduction of solid foods and the development of eczema in young children.
Main types of eczema
There are several types of eczema, although the term “eczema” is usually used to refer to different variants of the disease.
Atopic eczema or atopic dermatitis
It is the most common form of chronic eczema. Atopy is the tendency to react by allergic reactionsmediated by antibodies called IgE in contact with allergens normally harmless to the rest of the population (dust, pollen, animal hair, etc.). Atopic people often present, simultaneously or alternately, various allergic reactions, such as hay fever , urticaria, asthma or food allergies. These allergies often have a hereditary component since they are observed in many cases in families where at least 1 member suffers.
Atopic dermatitis affects 10 to 20% of children and 2 to 3% of adults in Europe. The disease starts most often in the infant and persists most often during childhood up to 5-6 years, but it sometimes persists in adulthood in about 15% of patients.
Here is what is known about the causes of atopic dermatitis which is a multifactorial disease involving genetic and environmental factors:
Atopic dermatitis is a disease with a genetic factor since 50 to 70% of parents of atopic children have a sign of atopy (eczema in childhood for example) and 70% of identical twins both have atopic eczema. This genetic factor is polygenic because it affects at least 2 types of genes:
- Superficial cutaneous barrier genes: the skin has a very thin and very resistant superficial barrier, yet patients with atopic dermatitis carry genetic mutations, notably on the gene coding for filaggrin, a structural protein of the epidermis playing a role in the structure of the skin barrier and maintaining an optimal level of skin hydration. As the skin plays less of a role as a barrier, antigens and chemical irritants can therefore penetrate more easily.
- genes of the cutaneous immune system: thus atopics react more to their environment, and trigger skin inflammatory reactions in the presence of antigens, notably involving Langherans cells (antigen presenting cells), lymphocytes (white blood cells producing antibody)…
Atopic dermatitis is a disease in which environmental factors are involved including:
- The digestive flora: we have been discovering for some years how the microbiota or composition of the digestive bacterial flora plays a role in many diseases and in the individual response to treatments. Atopic dermatitis is no exception to this rule since it has been discovered that the microbiota is a complex ecosystem involved in the maturation of the immune system. Anomalies of early diversification of the gut microbiota have been observed in atopic risk children and neonates at risk of atopy.
- Cutaneous flora: The cutaneous microbiome of the newborn is gradually formed after birth from the mother’s microbiome and the environment. As for the intestinal microbiota, there are differences between the cutaneous microbiome of atopic children and that of non-atopic children, especially during attacks of atopic dermatitis, during which there is a proliferation of strains of staphylococci (staphylococcus aureus in 90% of case and Staphylococcus epidermidis), related to skin immunity deficiency through a deficit in “natural antibiotics” of the skin: beta defensins.
Thus, local treatments for atopic dermatitis tend to favor natural bacterial diversity on the surface of the skin to limit the role of Staphylococcus aureus. Thus, it is necessary to avoid antiseptics in atopic dermatitis and the local steroids feared by the mothers tend to favor bacterial diversity, to the detriment of Staphylococcus aureus.
The increase in the frequency of atopic dermatitis has been regular for several decades in developing countries, suggesting that environmental factors play a major role in the pathophysiology of the disease, including the reduction of exposure. Infectious agents in early childhood: recent studies confirm that the “western urban” type of lifestyle poses an increased risk of atopic diseases compared to the “rural” type of lifestyle (exposure to bacteria and parasites early childhood), especially in populations predisposed genetically and in the same geographical areas. This also evokes other factors more present in the “western urban” way of life (role of the abandonment of the breastfeeding? milk allergy? greater concentration of pollutants and allergens in the environment?). but this remains to be proven scientifically. Finally, it should be noted that there is more children’s eczema in the countries of Northern Europe than in the countries of Southern Europe: it is therefore questionable whether there are factors that may lead to eczema in children
the Northern countries (is the meticulous hygiene of young children in the North responsible for the increase of the child’s eczema in these countries? are the children of the North more subject to allergens only in the South – can the colder climate explain the greater frequency of eczema in children in northern countries? …)
All of this data has made it possible to develop the “biodiversity theory” that protects atopic dermatitis, which combines environmental biodiversity and biodiversity of the various cutaneous and digestive microbiomes.
How is atopic dermatitis manifested?
- In infants lesions begin on the cheeks or forehead and scalp, then they extend on the extension of the arms and legs and the trunk .It is dry and rough redness or oozing and crusting , which always itch (the infant tends to carry their hands, which can cause scratches.
- After 2 years, atopic dermatitis lesions will predominate in the bending folds of the elbows and knees or wrists.
- In adolescents and adults, the lesions are located mainly on the face and the neck (the Anglo-Saxons speak of “head and neck dermatitis”) and the members. They are often thickened (we speak of lichenification of the skin).
Complications of atopic dermatitis
– Superinfection with staphylococcus aureus or “impetiginisation”, responsible for purulent discharge, sometimes with yellow bubbles and crusts like honey.
– Superinfection with the herpes virus (especially HSV-1). It is rare (5% of children with atopic deratitis) but formidable, it results in a sudden worsening of the disease and the appearance of small multiple vesicular lesions evoking those of chickenpox, giving wounds. We are talking about Kaposi-Juliusberg syndrome.
The management of the atopic dermatitis of the child thus resorts to the limitation of the favoring factors and in particular the elements accentuating the cutaneous drought by applying moisturizing creams, avoiding the too hot baths and prolonged and by using soft soaps (of type bath oil or surgras for example). Hydrotherapy is one of the therapeutic weapons to fight against atopic eczema but it is generally used only in conjunction with conventional corticosterone creams during outbreaks in particular.
Allergic contact dermatitis is characterized by eczema lesions appearing on average 3 days after contact of the skin with certain substances called allergens (this delay can be increased to 10 days if it is the first contact of the skin with the skin. allergen). This is an allergic reaction to the substance. This allergic reaction does not necessarily occur during the first contact and can occur after several months or years of tolerance to the allergen (one becomes allergic to a substance that was tolerated, for example, nickel jewelry or coins).
Depending on the type of eczema, the symptoms may last 1 or 2 weeks, or continue for several years.
When scraped, the plates ooze and become more irritated. Sometimes these areas can become infected. It is possible in particular to contract;
- impetiginisation , which is a bacterial superinfection, especially with Staphylococcus aureus, of the eczema, characterized by the appearance of meliceric crusts (like crystallized honey),
- A cellulite. This complication is characterized by the sudden appearance of swelling on the skin of a limb, which becomes sensitive, red and hot.
In these cases, it is important to consult quickly.
The symptoms of eczema
- Itchy red itchy patches, dry skin crusts and dander , at specific places in the body (depending on the type of eczema).
- The appearance of small vesicles.
- Over time, the skin can become thicker, drier, lose its hairiness and change pigmentation.
People at risk for eczema
- People with close relatives or allergies (allergic asthma, allergic rhinitis, food allergies, and certain urticaria) are at higher risk of atopic eczema.
- People who live in a dry climate or in an urban area are at higher risk of developing atopic eczema.
- There is also a hereditary tendency for seborrheic eczema.
Although eczema is a disease with a strong genetic component, many factors that are highly variable from one individual to another can make eczema worse. Here are the main ones.
- Irritations caused by contact with the skin (wool and synthetic fibers, soaps and detergents, perfumes, cosmetics, sand, cigarette smoke, etc.).
- Allergens from food, plants, animals or air.
- Moist heat.
- Wet and dry the skin frequently.
- Emotional factors, such as anxiety, relationship conflicts and stress. The experts recognize the great importance of emotional and psychological factors in the exacerbation of a multitude of skin diseases, including eczema 1.
- Skin infections, especially those with fungi, such as athlete’s foot.
Prevention of eczema
|Can we prevent?|
|For the moment, there is no recognized measure to prevent the appearance of eczema; there is no medical consensus in this regard.
Nevertheless, the medical community is exploring various avenues for the prevention of atopic eczema. They could especially interest parents with allergies, who want to reduce the risk that their child suffers too. To know them, consult our page Allergies.
|Measures to alleviate eczema attacks|
|Avoid food allergens. Food allergens may contribute to outbreaks of atopic eczema. To find out, the only way is to discover by allergy tests foods that can cause or aggravate seizures, and avoid them while making sure to replace them with other non-allergenic foods with nutritional value similar. You can consult a nutritionist about it. The following foods are generally recognized as potentially allergenic (non-exhaustive list):
– nuts and seeds (Brazil, Grenoble, pecans, pistachios, almonds, etc.);
– milk (from cow, goat and mare);
– the egg white;
– fish, crustaceans and molluscs;
– soybeans.Reduce stress. Any technique that reduces stress can be recommended since it seems to stimulate allergic reactions. Doctors consider that stress does not cause eczema, but may worsen the symptoms or cause relapses. Would the reduction of stress go through the modification of certain leisure activities? In this regard, a study in Japan published in 2001 showed a direct link between stress generated by video games and atopic eczema attacks. In addition, according to this same study, the frequent use of the cell phone would increase allergic reactions. See the topic Stress and anxiety for different ways to reduce stress.Limit exposure to allergens. Reduce the presence of dust mites and dust by avoiding carpets and drapes, putting Gore-Tex covers on mattresses, possibly spraying anti-mite products and using a high-performance vacuum at least 3 times a week.Tips for skin care
Skin Care Note: The various treatments and preventive measures recommended by dermatologists to control eczema sometimes require daily care and require patience, especially in the case of young children. Current research shows that these measures can significantly improve the condition of affected children and prevent long-term medication.
Medical treatments for eczema
Currently, there is no cure for eczema. As a result, conventional procedures are essentially limited to reducing inflammation and easing the discomfort that eczema causes. Discover the irritants or allergen that cause flares of eczema, and then avoids them reduces the symptoms.
Corticosteroids. Corticosteroids (cortisone) creams or ointments are applied to affected areas, reducing itching and inflammation. Creams with less steroid content can be used as a maintenance treatment once or twice a week. Creams and ointments that have a strong steroidal effect are used to relieve major irritations, but over a short period, because in the long run, they lose their effectiveness and can thin the skin. Oral corticosteroids are sometimes prescribed in cases of severe eczema, but only for a short time because of their side effects, such as the loss of bone minerals.
Antihistamines. Antihistamines may be used occasionally to reduce itching. In particular, they can help young children sleep by preventing them from scratching during eruptive seizures that occur at night.
Tacrolimus and pimecrolimus. These 2 topical immunomodulatory drugs without steroids are recent. They have the effect of decreasing the activity of the immune system (including inflammation) and are an alternative to corticosteroids, with few side effects. However, their long-term safety has not been established and there are some fears that they increase the risk of skin cancer. Their use is not recommended for children under 2 years old.
Cyclosporine. Used in very severe eczema only, cyclosporine is a fungal agent with immunomodulatory properties. Administered orally, it would be more effective than topically, but also more dangerous. Because of its side effects on the liver and blood pressure, it can only be used for short periods.
Note. The antibiotics may be necessary when a bacterial infection (including an impetigo ) or fungal attacks an eczema plate.
Phototherapy or photochemotherapy (exposure to ultraviolet light combined with taking a drug that photosensitizes the skin) may be prescribed, obviously except in the case of hypersensitivity of dermatitis to the sun. Devices emitting UVB or UVA radiation are then used. However, patients should be aware that they are at increased risk of cancer and premature aging of the skin. In addition, simple exposure to the sun has beneficial effects for some people.
All medical and complementary experts recognize the importance of emotional and psychological factors in eczema. One of the most recognized psychological approaches is cognitive-behavioral therapy. It is simply a question of modifying what appears to play a not insignificant role in the duration of the eruptive crises: the simple fact of scratching itself. This impulsive but controllable habit damages the skin and makes it more vulnerable.
Of course, we know that if potential allergens and irritating factors for the skin are stress that can easily be detected, psychic stress (emotional, nervous, etc.) is much more intangible. Yet its impact on body balance is real.
It should be noted that the effectiveness of educational programs for parents has been demonstrated. Through meetings and training, these programs allow parents to better combine the different medical, nutritional and psychological aspects of treating their child’s eczema.
– Use of compression stockings or varicose vein surgery in the case of varicose eczema.