Atopic eczema in a baby: how to recognise it?

Atopiceczema is a common skin condition that can have a significant impact on the quality of life of those affected. This disease is characterised by the presence of lesions and red patches that cause intense itching. Eczema can develop from early childhood and persist into adulthood in about 10 to 15% of cases. Studies have shown that there is a high prevalence of family history of eczema in children affected by this disease. Approximately 50 to 70% of children suffering from it have a first-degree parent who has also been affected.

Atopic dermatitis develops in individuals with genetic predispositions to allergies, a genetic condition referred to as 'atopic'. These individuals exhibit a dysfunction in their skin barrier, which is characterised by a deficiency in sebum, lipids, and other molecules essential for the integrity of the skin's horny layer. This alteration of the skin barrier makes the skin more vulnerable to environmental irritants and allergens, which can trigger inflammatory reactions.

Furthermore, the immune system of individuals suffering from atopic eczema secretes large amounts ofImmunoglobulin E (IgE), antibodies, in response to environmental antigens. This exaggerated immune response is the cause of the redness, skin dryness, and irritation experienced by those with atopic eczema.

Atopic eczema can appear from the first few months of life in an infant. It's important to remember that this skin condition is not contagious and parents do not need to take any specific measures to protect themselves. Atopic eczema is linked to the infant's skin's lack of ability to defend itself against its environment, which causes inflammation. Atopic eczema in a baby triggers various symptoms, including:

• A skin dryness across the entire body, despite maintaining daily hydration. The deficiency of the infant's skin barrier leads to significant water losses. This phenomenon is called xerosis.

• The emergence of swollen, red, scaly patches located at various parts of the body. The location of these patches evolves depending on the child's age. They are typically found on the face (forehead, chin, cheeks) and limbs (legs, arms) in infants. The lesions then tend to relocate to the folds of the skin (neck, ear, elbow, buttock, wrist, ankle) after the age of two. These patches gradually become covered with vesicles that begin to ooze and eventually leave crusts.

• Itching that causes the baby to scratch.

Infant eczema is characterised by a cycle of flare-ups interspersed with periods of remission. Generally, the outbreaks are separated by moments of calm, eventually disappearing in the coming years. However, atopic dermatitis can sometimes persist into adulthood.

Seeing your child in distress is a significant source of stress for parents. Fortunately, it is possible to alleviate infants suffering from atopic eczema. One of the actions not to be underestimated is to consult a doctor who can offer you suitable treatments. Depending on the severity of the eczema, they may advise using a lotion, cream or emollient ointment, sometimes in conjunction with a low-strength topical corticosteroid .

The emollient should subsequently be applied daily to maintain skin hydration and strengthen the skin barrier. By providing lipids to the stratum corneum, this treatment helps to prevent future flare-ups. The topical corticosteroid is applied as soon as a flare-up begins to emerge. Indeed, it is often preferable to apply it as soon as redness begins to appear in order to contain the flare-up.

Furthermore, to soothe and prevent eczema in infants, hot baths should be avoided. High temperatures tend to dissolve the hydrolipidic film present on the skin, which further weakens the child's skin barrier. After the bath, gently dry their skin using light patting and opt for soft and fluffy towels. Other habits can be adopted to limit flare-ups, such as banning carpets and heavy curtains, textiles that can trap dust, regular vacuuming, etc.

• GOLDENBERG G. & al. Eczema. The Mount Sinai Journal of Medicine (2011).

• BORRADORI L. & al. Dermatologie et infections sexuellement transmissibles. Elsevier Masson (2017).