Most often, the disease starts in childhood, but it can also occur in adults. In France, around 4% of people over 15 are affected by atopic dermatitis, also called atopic eczema. From adults affected (around two million people), 6% suffer from severe form of the disease that affects their daily life. For reasons still unknown, two out of three are women.
Red patches and itching
The atopic dermatitis evolves in spurts, often favored by stress or contact with irritating factors (heat, wool, etc.). On the skin, red, peeled patches form. They are very itchy. In adults, two areas are more particularly affected: head and neck, as well as the bends of the elbows and knees.
In children, the situation is not quite the same. In toddlers (under two years old), plaques develop especially on plump areas of the body: the forehead, cheeks or stomach. Later in childhood, it is mainly the folds of the elbows and knees that are affected.
Atopic dermatitis in adults: what causes?
Atopic dermatitis develops on a predisposed genetic background. It is linked to an intrinsic fragility of the skin. Often too dry, it no longer performs its function of barrier or “oilcloth” according to the pictorial expression of Dr Charlotte Fite, head of the dermatology department at the Paris-Saint Joseph hospital.
It is not an allergy
Normally, water and foreign objects slide off the skin. In atopic dermatitis, the skin of patients lets in substances from the environment, which causes inflammation. This reaction is not an allergy, but it is favored by a immune system disturbance.
The whole family is concerned
People with this atopic terrain can pass on this genetic predisposition to their children.
“In children suffering from atopic dermatitis, we find seven times out of ten a relative in the first degree (father, mother, brother, sister, Editor’s note) suffering from a disease of the atopy spectrum: eczema and / or conjunctivitis seasonal and / or allergic rhinitis and / or hives and / or asthma, ”explains Dr Fite.
Parents can, to some extent, prevent the onset of atopic eczema in their babies andn moisturizing your skin daily. “Moisturizers, called emollient, applied from the first weeks of life seem to reduce, or delay, the occurrence of atopic dermatitis in babies. They deposit a thin layer of fat which will protect the skin, ”explains the dermatologist.
The recommendation is the same adulthood. The first step in combating the disease is to moisturize your skin with specific creams, every day, and on the whole of his body. “You have to ‘cream’ your skin very regularly, on a daily basis, like you brush your teeth every day,” insists Dr. Fite. Likewise, it is also advisable to avoid anything that can irritate and weaken the skin barrier, such as prolonged baths or wearing itchy clothes.
Topical corticosteroids, effective treatments for atopic eczema
From a therapeutic standpoint, several treatments may be offered depending on the extent of the disease and the profile of the patient. Treat atopic dermatitis requires a certain perseverance because the disease does not always heal. On the other hand, the treatments, provided they are properly followed, allow effective control of flare-ups. Patients thus benefit from long periods of calm and can lead normal lives.
When the plaques appear on the body, the doctor will prescribe a topical corticosteroid cream (cortisone-based) to be applied once a day, until the skin has returned to a normal appearance, that is to say that it is again smooth, without redness or itching.
Occasionally, three to four weeks of application are necessary before obtaining this result. There are four levels of action (light, moderate, strong, very strong). The dermatologist prescribes the one that best suits his patient. Applied long enough and in sufficient quantity, these products relieve itching, strengthen the skin barrier and help control the disease in the vast majority of cases.
In video: How to properly use topical corticosteroids?
What about the side effects of cortisone?
These topical corticosteroids sometimes have a bad reputation with patients who fear the side effects of cortisone. However, the products applied to the skin are many less dosed than drugs taken by mouth. “In a 30 gram tube of betamethasone, the most commonly used topical corticosteroid, there is 1.5 grams of effective cortisone. This small gram will correspond to twenty or thirty applications. At this dose, the side effects are exceptional, ”notes Dr Fite.
The only precaution to be taken is to avoid applying a very powerful cream for a long time to areas where the skin is very thin (face, thigh, chest, etc.). Other solutions can be proposed.
Alternatives to topical corticosteroids exist
If these topical corticosteroids are not enough to provide relief, the doctor will suggest trying the topical tacrolimus, marketed under the name Protopic or Takrozem (its generic). This product does not contain cortisone. It comes in the form of an ointment, to be applied daily to eczema patches. It can be used as an alternative to topical corticosteroids to treat fragile areas such as the face.
A cut above: systemic treatments
If this fails, we move on to so-called “systemic” treatments which act (each in different ways) on the immune system: ciclosporin, the methotrexate and the dupilumab. One or the other of these products is chosen according to the profile of the patient.
- Cyclosporin is usually taken in tablets morning and evening.
- Methotrexate is available as tablets or by injection, once a week.
- For dupilumab, a more recent and very effective molecule, the patient can self-inject the product once every two weeks, after having learned the procedure from a nurse.
“These treatments have good efficacy, which is encouraging for patients,” assures Dr. Fite.
Alongside these therapies, simple hygiene advice helps protect your skin as much as possible. For the toilet, a short, lukewarm shower is better than a prolonged bath. “Soap-free” dermatological bars are less irritating to the skin. “Syndet galenic form soaps contain more fatty substances which leave a protective film on the skin”, specifies the dermatologist.
Covid-19: adapted barrier gestures
Finally, in the context of the Covid-19 epidemic, it is preferable to use hydroalcoholic gel rather than having to wash your hands with soap and water. “It might sound counterintuitive, but water tends to dehydrate the skin,” says Dr. Fite. It is better to use thick gels. These are the ones that contain the least alcohol, and therefore the least irritating to the hands.