Very often, eczema occurs in “atopic” people, whose allergic terrain is conducive to the development of skin manifestations (urticaria), respiratory (rhinitis or allergic asthma) … We then speak ofatopic eczema, or atopic dermatitis. It is a chronic inflammatory disease of the skin, not contagious, which progresses in flare-ups and can affect all parts of the body. If it mainly affects babies and children, it can persist or develop into adulthood. In France, it concerns approximately 2.5 million patients including 20% of children under 7 years old, according toFrench Eczema Association.
THE’atopic eczema results in a skin dryness, from redness and of severe itching. Small blisters can also appear in the folds, hands and mouth: when they rupture, they ooze and form conspicuous scabs. When improperly treated, eczema can be the cause ofanxiety, of sleeping troubles, ofsocial isolationor even depression. It is therefore essential to take care of it by combining a basic treatment and a more specific treatment to treat the inflammation in the event of relapses.
It is important to distinguish between atopic eczema, contact eczema (or contact dermatitis), which occurs as a reaction to an irritating or allergenic product or material. The symptoms are the same and can be caused by many allergens (nickel, dyes, leather, glue, rubber, perfumes, topical medications, preservatives, etc.). In some cases, these allergens are related to the patient’s profession (hairdressers, construction workers, health professionals, horticulturalists, etc.). We then speak ofoccupational eczema.
In this case, the recommended treatment is total eviction of the faulty product. A reclassification can sometimes be considered, even a change of profession. Under certain conditions, Medicare can then cover the related expenses (training, accommodation and transport).
Atopic eczema: hydration as a basic treatment
A basic treatment, that is to say a treatment taken over the long term, in prevention, is essential to limit the inflammatory reactions when one is subject to outbreaks of eczema. It consists of moisturize your skin daily using local (topical) treatment with emollients and moisturizers to lubricate the still wet skin after the shower.
“Care and hygiene products must be gentle, soap-free and fragrance-free. Be careful in particular with irritating cosmetics, passive smoking, air conditioning and excessive temperatures (hot or cold) which can dry out the skin or make it sweat. , and generate inflammation“, specifies Dr Delphine Staumont, dermatologist, in a press kit produced by the French Eczema Association.
Use local corticosteroids in case of eczema flare
In the event of an eczema flare, treatment is based on the use of cortisone creams. For red and itchy lesions, priority is given to topical corticosteroids, including for the youngest (the cortisone concentration in creams varies according to location and age). “If necessary, topical therapeutic alternatives (Tacrolimus ointment) exist, especially for long-term use in certain areas (such as the face) “. This treatment should be continued until the lesions have completely disappeared.
In case of acute attack, the treatment is often spectacular and the problem can be resolved in a few days. If it is a chronic eczema, the treatment is longer, but its duration must remain limited: the corticosteroid-based creams must be gradually stopped under penalty of worsening the situation. The classic scheme is an application twice a day, then once a day, and every other day …
After local corticosteroid therapy, the relay can be provided by emollient creams to lubricate the skin. We recommend one to two applications per day in winter, when the eczema is more intense, every other day in spring and once a week in summer.
In video: How to properly use topical corticosteroids?
Phototherapy, immunosuppressants or anti-infectives in case of failure of local treatments
In the most severe cases, so-called “systemic” treatments can be prescribed in case of failure, or in addition to local treatments:
- Immunosuppressants. In adults, and sometimes in older children, cyclosporin may be prescribed. “The treatment is limited in time, most often to pass an inflammatory ‘cap’,” says Dr Staumont. Other immunosuppressants can also be used, such as methotrexate, or more rarely mycophenolatemofetil and azathioprine. The treatment modalities are detailed on a case-by-case basis by the prescribing physician.
- Anti-infectives. Occasionally, antibiotics may be prescribed in case of bacterial superinfection. In case of co-infection with the herpes virus, the doctor may also prescribe antivirals.
- Antihistamines, “especially in the event of allergic symptoms associated with eczema: rhinitis, conjunctivitis …”.
“Oral or injectable corticosteroids are still sometimes used, but to be avoided, because they can lead to a ‘rebound effect’ of the eczema attack!”, Warns Dr. Staumont.
- Finally, treatment with ultraviolet rays (phototherapy) is regularly used in eczema with good results. “Like sun exposure, these phototherapy sessions carried out for several weeks in a city office, under medical supervision, help reduce inflammation,” recalls the dermatologist.
Are thermal cures effective in fighting eczema?
The spa treatment can be acclaimed to improve the daily life of patients suffering from eczema. While several studies carried out by spa operators highlight notable benefits (reduction in itching and insomnia), it should be noted that these studies do not follow the same protocol as clinical trials attesting to the effectiveness of drugs.
The resorts highlight the quality of their waters, which are particularly rich in trace elements, but according to dermatologists, this is not the main reason for the improvement in symptoms. During these cures, patients participate in particular in “pomadage” workshops, Has group psychotherapy, or even at information meetings with doctors … It is undoubtedly this “educational” dimension which explains the benefits of thermal cures: curists learn to better understand their disease, to use the right products, to do the right things and gradually come to terms with their skin.
The thermal cure can therefore be considered in addition to traditional treatments, but it should not replace them!
A spa treatment can be reimbursed, at the rate of one treatment per year, if it is prescribed by a general practitioner or a dermatologist. A support form is required to be eligible for a reimbursement of 70% for treatment and 65% for medical supervision. Subject to a resource limit, part of the transport and accommodation costs may also be reimbursed.
Severe eczema: new treatments still being evaluated
In severe forms of eczema resistant to the treatments mentioned above, biotherapy in the form of a subcutaneous injection may be offered to the patient. Currently, the only molecule available is dupilumab. “In adults, it can only be prescribed in the event of failure, contraindication or poor tolerance of ciclosporin”, specifies Dr. Staumont.
Other biotherapies are in the testing phase such as lebrikizumab, tralokinumab, and nemolizumab.
JAK inhibitors, topical tofacitinib, crisaborole ointment … promising avenues
Other molecules are under advanced development in clinical trials:
- orally (JAK inhibitors blocking the inflammatory response in the cell, such as baricitinib, upadacitinib, abrocitinib or anti-H4R inhibiting another histamine receptor);
- Where by local route (topical tofacitinib).
“A crisaborole ointment (a phosphodiesterase 4 inhibitor, involved in the activation of immunity cells) is already available in the United States, but not in France, “says Dr. Staumont.
For the moment, these new treatments only concern adults suffering from moderate to severe eczema, resistant to conventional treatments. In the future, they may be available in adolescents, and then in the youngest child for more severe cases.
To limit the risk of flare-ups, soothe the symptoms and complete the treatments, here are some habits to take on a daily basis:
- Cut your nails short and put mittens on the little ones to limit lesions.
- Prefer showers to baths and use surgras soap or shower creams sold in pharmacies or drugstores. Favor a lukewarm temperature, and do not exceed 15 minutes per day. The skin should then be rinsed, dried and creamed. In addition, chlorinated water aggravates eczema, so avoid the swimming pool.
- Fabrics with an abrasive texture, such as wool and some man-made fibers, can irritate the skin. Instead, opt for soft, light, cotton clothes, which do not cause friction. A tip for babies: put their underwear inside out to avoid contact with the seams.
- Also pay special attention to laundry products you use : as for personal hygiene, it is better to avoid anything that contains perfume. And don’t forget to wash all the clothes you just bought before wearing them, as some contain irritating chemicals.
- Limit stress and divert your attention from lesions using relaxing activities such as yoga, meditation, baking, but also gentle sport. Art therapy can also be an interesting alternative: practice music, painting, reading, acting, embroidery, etc.