What is Eczema?
Also known as dermatitis, it corresponds to an inflammatory reaction of the epidermis. This inflammation leads to an alteration of the skin barrier, which then becomes more permeable to irritants and allergens. The skin loses its natural hydration, making it dry, irritable, and prone to intense itching. There are several types of eczema, the most common of which is atopic eczema.
Atopic eczema is a chronic disease that evolves in flares. It often occurs in a family atopic context, associating asthma, allergic rhinitis, and allergic conjunctivitis. Other forms include contact eczema, triggered by contact with an allergenic or irritating substance, and seborrheic eczema, linked to an overproduction of sebum.
Causes and Risk Factors
The causes of eczema are multifactorial, combining genetic, environmental, and immune factors. Atopic eczema, for example, often stems from a genetic predisposition that affects the structure of the skin barrier. Mutations in the gene encoding filaggrin, a protein essential for the integrity of the stratum corneum, are frequently observed in affected individuals.
Several factors can trigger or worsen eczema flares:
- Allergens (pollen, dust mites, animal dander, certain foods).
- Irritants (harsh soaps, perfumes, chemicals, wool clothing).
- Climate (dry air, temperature changes).
- Stress and emotional factors.
- Excessive sweating.
- Skin infections, especially bacterial or fungal.
Symptoms and Signs
Eczema symptoms vary by age and type of eczema, but share common characteristics. The most constant sign is pruritus, which is intense itching that can severely impair quality of life and sleep.
Symptoms in Infants and Children
- In infants, eczema often appears on the face (cheeks, forehead) and scalp, then spreads to skin folds (elbows, knees). Lesions are red, oozing, and may form scabs.
- In older children, eczema primarily affects the folds of the elbows, knees, wrists, and ankles. The skin becomes dry, thickened (lichenification), and scales may appear.
Symptoms in Adults
Adults present with red, dry, thickened, often very itchy patches, located on the neck, elbow and knee creases, hands, and feet. Chronic scratching exacerbates lesions and can lead to secondary infections.
Diagnosis of Eczema
The diagnosis of eczema is primarily based on a clinical examination of the skin and the patient’s medical history. A doctor identifies the characteristic lesions and assesses the severity of the itching. They generally make the diagnosis without requiring additional tests in the majority of atopic cases. However, further investigations may be useful to better characterize the eczema.
In cases of suspected contact eczema, the doctor may suggest patch tests. These tests involve applying small quantities of potentially allergenic substances to the skin on the back, then observing the reaction after 48 to 72 hours. They help identify the responsible allergen and thus allow it to be avoided.
Treatments and Management
Eczema treatment aims to reduce inflammation, relieve itching, restore the skin barrier, and prevent flares. Management often involves a combination of medication and daily hygiene and care measures.
Medication Treatments
- Topical corticosteroids: These are the cornerstone of treatment for eczema flares. Applied topically, they quickly reduce inflammation. The doctor adjusts the potency and duration of treatment to the severity of the eczema.
- Topical calcineurin inhibitors: These medications (tacrolimus, pimecrolimus) are an alternative to corticosteroids, particularly suitable for delicate areas like the face. They work by modulating the local immune response.
- Antihistamines: They help reduce itching, especially at night, thereby improving sleep.
- Systemic treatments: In severe forms of eczema, systemic treatments (oral or injectable, such as immunosuppressants or biologics) are sometimes necessary. They act on the general immune response.
Emollient Care and Hydration
Daily and generous application of emollient (moisturizing) creams is fundamental to restoring the skin barrier and keeping the skin supple. They help prevent dryness and space out eczema flares. Use fragrance-free and preservative-free products.
Recent Scientific Advances
Eczema research is constantly evolving, bringing new perspectives for its management. Recent advances focus particularly on biotherapy and a deep understanding of the immune mechanisms involved. In the first half of 2025, research efforts continue to focus on targeted treatments and personalized approaches for people with severe eczema.
Biologics, like dupilumab, have revolutionized the treatment of moderate to severe atopic eczema. These medications work by blocking specific interleukins (IL-4 and IL-13) that play a key role in eczema inflammation. Research is now moving towards other immune targets, with new molecules in promising clinical trials.
Furthermore, the study of the skin microbiome, this complex ecosystem of microorganisms living on the skin’s surface, offers new avenues. Microbiome imbalances seem to play a role in exacerbating eczema. Scientists are exploring approaches aimed at modulating this microbiome to restore healthier skin and better control eczema.
Prevention: Is it Possible to Reduce the Risk?
Although it is difficult to completely prevent the disease, especially atopic eczema linked to genetic factors, several measures contribute to reducing the frequency and intensity of flares. Identifying and avoiding triggers is an important step in preventing eczema.
- Constant hydration: Apply emollients daily to strengthen the skin barrier.
- Gentle hygiene: Prefer short, lukewarm (not hot) showers and use mild, soap-free cleansers. Gently pat skin dry instead of rubbing.
- Appropriate clothing: Wear loose clothing made of natural fibers (cotton) and avoid wool or synthetic materials that irritate the skin.
- Environmental management: Maintain a cool, humid atmosphere in your home. Ventilate regularly and, if necessary, use a humidifier.
- Avoid irritants: Identify and minimize exposure to known allergens and irritants (household products, perfumes, dust).
- Stress management: Relaxation techniques help reduce stress, a common aggravating factor of eczema.
Living with Eczema
It is a chronic condition. Learning to live with eczema involves adopting adapted care routines and knowing how to manage flares. A good understanding of one’s condition and close collaboration with one’s doctor or dermatologist are essential. Quality of life is often impacted by the presence of eczema, particularly due to itching and sleep disturbances.
Psychological support helps greatly. Support groups or patient associations offer a space to share experiences and practical advice. Patient therapeutic education is also a pillar of care. It provides the necessary tools to understand the disease, manage treatments, and prevent eczema relapses.
Frequently Asked Questions (FAQ)
Is eczema contagious?
No, it is absolutely not contagious. You cannot catch or transmit the disease through contact with an affected person. It is an internal inflammatory condition of the skin.
Can eczema be completely cured?
In many cases, especially in children, atopic eczema can improve or disappear in adulthood. However, for others, it is a chronic condition with periods of improvement and flares. Management aims to control the symptoms of eczema and prevent recurrence.
How can I quickly relieve an eczema flare-up?
During a flare-up, apply corticosteroid creams prescribed by your doctor to inflamed areas. Also use cold compresses to soothe itching. Avoid hot showers and replace irritating clothes with soft fabrics like cotton.
What role does diet play?
Diet plays a variable role. In some children, food allergies (cow’s milk, eggs, peanuts) can trigger or worsen eczema. However, in adults, this link is less common. It is essential to obtain a medical diagnosis before radically changing one’s diet to treat eczema.
What are the possible complications?
Complications primarily include skin infections (bacterial, viral, or fungal) due to scratching or alteration of the skin barrier. Severe eczema also affects sleep, self-esteem, and can lead to psychological disorders such as anxiety or depression.
Additional resources
- To extend your knowledge and decipher other markers, more articles are available here.
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