Understand my skin
A red patch that itches – sounds like eczema! Many of us talk about eczema without really knowing what it is. Eczema is one small word that describes a number of different types that have neither the same causes nor require the same precautions.
Indeed, any kind of eczema has this symptom. For dermatologists, the three types of eczema are actually what are called "dermatitis": atopic dermatitis (commonly called atopic eczema), irritative contact dermatitis (irritative contact eczema) and allergic contact dermatitis (allergic contact eczema). While all three eczemas closely resemble each other when they flare up, they are distinct pathologies. Here’s our guide to understanding them.
Atopic dermatitis affects babies and children above all. In industrialised countries, the number of cases has tripled in the past 30 years: 10 to 30% of children are concerned, depending on the country. For most of them, atopic eczema disappears around seven or eight years of age.
To know more about childhood eczema, discover our article here: "Childhood eczema"
But the disease can also continue throughout adolescence. It’s estimated that 10 to 20% of teenagers around the world suffer from atopic dermatitis.
To know more about teenage eczema, discover our article here: "Teenage eczema"
Among adults, 10% are affected in industrialised countries. Among the 10% of adults living with atopic eczema, some have had it since childhood. Others have experienced periods of remission before seeing the problem return, sometimes years later. And for some, they experience it for the first time as an adult.
To know more about adult eczema, discover our article here: "Adult eczema"
Atopic eczema is a chronic and cyclical disease of very dry skin. Neither serious nor contagious, yet able to seriously impact quality of life, it has three phases that can spread out over weeks or months.
Rough, red patches appear on the face and body, as well as irritation and itchiness. Small blisters filled with liquid are sprinkled throughout each patch. Itchy feelings are often intense, leading to uncontrollable scratching. Patches then ooze and bleed and they can sometimes become infected. They end up drying out and disappearing thanks to a treatment prescribed by the doctor, most often topical steroids.
Skin returns to its ‘normal’ state, meaning very dry, tight and always feeling uncomfortable. Skin may also flake in some spots and show white lines and roughness.
A few weeks or months later, a new flare-up occurs, without it necessarily being linked to a clear cause. The cycle starts over again.
During flare-ups, the itching can sometimes have a huge impact on quality of life: irritability, sleep problems, tiredness, worry about how others see you, sometimes even psychological and relationship difficulties…
Atopic dermatitis can have two causes: there can be a genetic predisposition as well as epigenetic factors tied to the environment and lifestyle.
It runs in the family
This skin disease is often inherited. At its origin is skin that is permeable, very dry and porous. Since it is lacking lipids, it doesn’t act as a barrier to the environment. More permeable, it lets in allergens and irritants present in the environment, absorbing everything like a sponge.
Triggers and aggravating factors
A number of factors can trigger eczema to flare up on atopic-prone skin: the cold, wind, heat, perspiration, pollution, pollen, unadapted cosmetics, detergent, medication… Each person is sensitive to different things, all of which can be aggravated by diet. The digestive system and intestinal microbiome play a decisive role. Finally, stress and emotions can also trigger eczema. Each flare-up is the result of a runaway immune system that overreacts more and more as time goes on.
It’s important to treat atopic eczema as early as possible, whether for a child or an adult. Dermatologists have effective treatments to improve patients’ daily comfort. Short-term priority is focused on soothing itching, whereas in the long term the objective is to space out flare-ups.
Emollient care to moisturise skin and provide lipids
This is the simple and basic way to prevent flare-ups. If your skin is atopic, it’s important to apply an emollient specially formulated for your skin, all over your body, twice a day. The daily application soothes itching. Over the long term, it moisturises skin and furnishes the lipids it’s lacking, to restore its barrier function and space out relapses. Be sure to also use a gentle cleanser that doesn’t irritate skin, such as a shower oil. Finally, it’s always a good idea to be careful with any other cosmetic products that you use, as they may make your skin react.
Local, medical creams by prescription
When your skin has flare-ups, you still need to continue applying your moisturising cream all over, in addition to a cortisone-based cream that you apply to red and itchy patches, as soon as the first symptoms appear. With each new application, the patches get better, and their size diminishes – as well as the amount of topical steroid that you apply. By gradually reducing the amount you use, you avoid a rebound effect when you stop the treatment. Generally speaking, secondary effects brought on by the use of topical corticosteroids during atopic dermatitis are very rare, as long as you properly follow the doctor’s prescription.
Good habits
- Take short showers using warm or even cold water, every other day during a flare-up. Avoid baths.
- After a workout, wash away all perspiration in the shower.
- Wash your hands in cold or warm water, never hot, using the same product as you use in the shower.
- Choose a laundry detergent that your skin tolerates and soft textiles that don’t irritate it.
- Air out your residence every day, unless it’s pollen season.
- Do relaxing activities that you enjoy to help lower stress and improve your mood. Contact specialised patient and service associations to find help and keep a positive attitude, the best way to keep your eczema under control!
- There is also contact dermatitis, which can be one of two types: irritative contact dermatitis or, more rare, allergic contact dermatitis.
Discover our article: "Solutions that make living with atopic eczema easier"
Irritative contact dermatitis represents 80% of all contact eczema (irritative and allergic). It’s difficult to know how many people have irritative contact dermatitis since many never consult a physician. Even if it most often goes under detected, it’s estimated that between 2 and 10%1 of the population is affected, shared equally between women and men. Irritative contact dermatitis is responsible for 95%2 of professional skin diseases. Some people have both atopic and contact eczema.
With irritative contact dermatitis, the skin reacts after coming into contact with a specific irritative agent: a cosmetic product, chemical product, metal, medication, natural substance… In this case, we say irritative contact dermatitis because the reaction can be linked-to touching or rubbing the irritant for a certain amount of time. It is not an allergy and is not contagious.
Very often, this time of eczema affects the face and hands. Classic symptoms vary widely, depending on what each person is sensitive to. They can range from dry skin to redness, swelling, small bumps, red patches, blisters filled with liquid, stinging, burning and itching that can be intense… When the problem becomes chronic, the skin may also become thicker, flake and develop small splits and cracks. And when the affected area is visible, you also draw other people’s attention – which can create embarrassment or even a complex.
The body’s particular reaction to an irritant is linked to a faulty skin barrier. The reaction occurs a few hours after the exposure and is restricted to the precise area where the contact occurred.
Here are a few examples of irritants that can trigger irritative contact eczema. Be aware that the reaction will be even greater if there are also aggravating physical factors, such as friction, rubbing, the cold or heat…
- Chemical products: detergents, disinfectants, antiseptic products, acids, bases, organic solvents, cutting fluids
- Crop protection products
- Some plants
- Metal salts
One of the most well-known types of irritative contact dermatitis is "housewife dermatitis", caused by exposure to cleaning products and detergents. It occurs both in a domestic and professional context, in caretaking and health roles. Some jobs also present a higher risk of irritative contact dermatitis:
- Caretaking professionals: chemical products, detergents, disinfectants…
- Building professionals
- Healthcare professionals: frequent hand washing, chemical products, disinfectants, antiseptic products…
- Car manufacturing
- Agriculture and gardening professionals: crop protection products
Clean the area with a gentle cleansing product, as soon as possible. Consult your physician if you have a strong reaction.
Good habits
Allergic contact dermatitis is much rarer than irritative contact dermatitis. It amounts to about 20% of contact eczema cases.
Symptoms are very similar to irritative contact dermatitis: redness, swelling, bumps, red patches, burning sensations, intense itching, as well as skin that thickens and micro-cracks and splits that develop. These appear after repeated exposure to the same allergen.
In other words, it is possible to not have a reaction during many years of exposure to a specific allergen, then all of a sudden have a bout of eczema. The period during which no particular warning signs appear is when sensitisation occurs, which precedes any attack.
The reaction happens in the area where the contact occurred, generally 24 to 96 hours later. Symptoms can also arise much later and spread to a wider area than just where there was exposure, sometimes even on other parts of the body. Quality of life can be highly impacted due to the itching and discomfort, as well as how other people look at you if the reaction is on a visible part of the body.
Dermatologists often say that irritative eczema is the entry point to allergic eczema since the two forms are very similar. They are fundamentally related to each other. Through repeated exposure to an allergen, irritative eczema becomes allergic eczema. The body becomes sensitised, provoking an immune reaction, even at very low levels of the allergen.
Where eczema is located can help you identify its cause:
- Scalp: shampoo, hair dye products, hairstyling products…
- Face: cosmetics, toiletry products, topical treatments, sunscreen, perfume…
- Eyelids: make-up, eye drops, nail polish (since we touch our eyes over 100 times each day, without even realising it)…
- Lips: lipstick or lip balm, toothpaste, musical instrument…
- Ears, neck: jewellery, nail polish, perfume…
- Body: underwear, toiletry products
- Legs and feet: plasters, shoe glue, socks…
- Hands: The list of everything we touch during the day is too long!
Again, some jobs are at a greater risk of developing allergic contact dermatitis:
- Hairdresser and beauty salon professionals: chemical products, hair dye, nail polish and, perfume…
- Building professionals: concrete, cement, glue, paint, varnish…
- Healthcare professionals: frequently washing hands, chemical products, medication, latex gloves, plaster glue, prostheses…
- Bakers: flour, spices, aromas…
- Car manufacturers: paint, lubricants, rubber, industrial oils, solvents…
- Agriculture and gardening: pesticides, fertilisers, crop protection products…
If you think you have allergic contact dermatitis, consult your doctor who can prescribe an adapted topical treatment (often a corticosteroid). At a later stage, you can also see an allergist or dermatologist specialised in allergies and do an allergy assessment. The objective, obviously, is to identify what you reacted to so that you can avoid contact with it in the future.
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