Experts talks

What causes and treatment for eczema ? All you need to know about atopic dermatitis

Discover five good reflexes to have with atopic skin!
Practical advice to space out eczema flare-ups: hygiene, diet, environment, itching & irritation, sport

Dr Magali Bourrel-Bouttaz, Dermatologist - France.

An atopic eczema flare-up is never a random occurrence. You are always able to overcome it, but it's also important to recognise the situations in everyday life that encourage the flare-ups. Dr Bourrel-Bouttaz uses a simple comparison to make her point: 'If there's a fire in your house, you spray water on it. If it starts again two weeks later, you spray water again. And you keep doing this until you understand what is starting the fire!' Thanks to her explanations below, discover triggers, understand why there are flare-ups, reduce the number of risk factors and space crisis out as widely as possible.

Dr Magali Bourrel-Bouttaz, Dermatologist - France.

No intensive cleaning, no scrubbing, no irritation, no soaking in the water and no perspiration… Atopic skin performs poorly, its barrier role is more permeable than normal skin and lets environmental allergens in. Anything that can impair the skin's barrier role can trigger an eczema flare-up: strong cleaning, soaking, long baths…

For skin and hair, use a soap-free moisturizing cleanser or a deeply hydrating cleansing oil that respects the skin's physiological pH of 5.5. Water must be no warmer than 34°C.
Dry skin gently, patting it instead of rubbing it, with a clean and soft cotton towel.
Clean perspiration away as quickly as possible. Its irritating pH level aggravates 100% of atopic skin.
Systematically apply an emollient (moisturising cream) morning and evening all over the face and body. Be generous in the amount of cream you use and turn each moment into one of tenderness and play with your child.

Have a five-minute shower or bath, every day in the summer and twice a week in the winter, with a soap-free and perfume-free cleanser.
Apply an emollient adapted to the season, like a balm in the winter and a cream in the summer, even days when your child doesn't wash, all over her body and not just on the eczema patches.

Don't take several showers a day, use water that is too hot, or soap.
Do not use commercial wipes.
Don't wait until itching starts to moisturise.

While diet is not a cause of atopic dermatitis (commonly called atopic eczema), paediatricians nonetheless recommend a few basic principles.

Be vigilant when introducing solid foods to your infant, currently recommended for starting at between four and six months.
It's better to follow a diet that fights inflammation thanks to selected fats: raw butter, uncooked fresh cream, first cold press olive oil for cooking, first cold press canola oil for seasoning.
Limit sugar intake, which makes perspiration more acidic: morning cereal, snack cookies and treats, candy, soft drinks…

Eat a balanced and seasonal diet.
Take pre- and probiotics if your child is on antibiotics or suffering from gastroenteritis.

Don't give water with a high mineral content, or soft drinks on a daily basis.
Don't eat too much industrially prepared food.

3/ Environment: inside and outside

As the direct interface between his body and the exterior world, your child's skin is very sensitive to his environment. And because its barrier function isn't very effective, his atopic skin is more permeable, it lets in all the air's particles and reacts strongly to all kinds of stresses.

Clothing

'It is important to realise that clothing rubbing on skin is one of eczema's main triggers,' Dr Bourrel-Bouttaz underlines.

Don't dress your child too warmly, as perspiration aggravates eczema and itching.
Choose soft clothing in natural fibres (cotton). Don't buy wool; it's too irritating.
You might even try white clothing without industrial dye, to be on the safe side.
Be careful about elastics, labels that sometimes rub, and clothing that is too tight.
If needed, put your baby's undershirt on inside out so that the seams don't rub her.
Wash all new clothes before using them.

Laundry

Use liquid detergents and rinse well. Don't overload the machine.
Fabric softener is an additional product, but it does make clothing less irritating on skin. Test for yourself whether to use it or not, and what works best for your child.
Using a clothes dryer also makes clothing softer.

Climate throughout the Seasons

Cold is your child's biggest enemy! Be sure to moisturise your child's skin well throughout the winter. According to Dr Magali Bourrel-Boutaz¹, '90% of atopic skins do better in the sun.' But remember, too, that direct sun exposure for children under three years old is not advised. For older children, enjoy the sun in the morning and in the later afternoon, with a 50+ SPF sunscreen.

Use a water mister on your child's face to limit contact with pollen.
Vacuum your house frequently.

Don't dry laundry outside during the pollen season.
Don't decorate his room with curtains or carpeting.

4/ Itching & irritation : the impact of stress

A child with atopic skin isn't necessarily more sensitive than one without. Stress hormones spread through the skin in the same way with everyone, atopic skin or not. However, not providing treatment for your child, or constantly telling her that she is nervous, will decrease her resistance and make her more susceptible to stress,' explains Dr Bourrel-Bouttaz.

Facing chronic discomfort, an atopic baby cries more often than normal, including at night, to express her irritation. The constant trial and sleep difficulties can also be a source of anxiety for your child, and she will need you to reassure her and make her feel safe and secure. It's also likely that you too will be distraught and tired, thanks to a situation whose consequences are felt by the whole family!

The right attitude to adopt

Hang in there, despite the stress… You're working hard to keep your child calm and make family life as normal as possible. And you're right! Your immense efforts help your child in the best way possible to get through this rough period. Even better, you're teaching him how to confidently face other kinds of adversity later in life. Keep at it! You have supporters all around you to help out.

Create a gently reassuring environment. Stress and immunity are linked, and the former has been shown to favour the development of eczema in some studies². 'That does not necessarily make is a psychosomatic disease. But a vicious circle can develop between stress and immunity,' cautions Dr Bourrel-Bouttaz³. Massages, ideal for applying the daily moisturising treatments, and skin-to-skin contact are two ways of calming your child and developing ties in a peaceful way. There's no such thing as too much!

Have an educational attitude to downplay difficulties.
Talk about other aspects of your child's life: school, friends…

Don't put eczema at the centre of your child's life.

For children with atopic skin, sports are particularly beneficial for developing social relationships and stimulating growth. As well, sports take children's mind off their troubles, and reduce stress. While playing, your child forgets his skin problems and the itching.

Three essential pieces of advice

Perspiration must be quickly removed with a shower followed by a moisturising cream. Your child must not use products other than his own, as his skin won't tolerate them.
Lots of sportswear is made out of potentially irritating synthetic and technical fabric. Wash it before using it and after each time it's worn. Apply an emollient cream before your child puts the clothes on to act as a barrier and prevent irritation.
Children with atopic skin can indeed go swimming. Eczema isn't contagious! Use goggles and a bathing cap in silicone. Apply a moisturising cream before jumping in the pool to protect from water that is too warm and chlorine's irritating effects.