Can eczema worsen?

Eczema is a skin inflammation that manifests itself through the formation of red patches on the skin, associated with an intense sensation of itching . There is not one, but several types of eczema. One of the most common is atopic eczema or atopic dermatitis. This skin condition develops in individuals with a genetic predisposition towards atopy, that is, the tendency to develop an allergic reaction to common environmental elements. The skin barrier of individuals prone to atopic eczema does not perform its role well, allowing both water to easily evaporate from the epidermis and allergens to penetrate it. Eczema can also be acquired and manifest without genetic predisposition. This is then referred to as contact eczema or allergic eczema.

Regardless of the form of eczema, skin lesions follow four major stages. Initially, they are red and warm, sometimes swollen, and accompanied by itching. A few hours later, small vesicles filled with clear fluid appear on the red lesions and the itching persists. Scratching then breaks these vesicles which begin to ooze. They then become crusts and heal. However, the healing process is more difficult in some cases than others and it can happen that the eczema worsens.

Eczema is a minor health concern in most cases. However, complications can occur. Fortunately, these are rare and can be avoided with certain actions. Among the possible complication scenarios is generalised eczema (erythroderma). Eczema is said to be generalised when the patches spread. They can sometimes cover up to 90% of the body. In addition to the usual redness and itching, oedemas are added. This form of eczema constitutes a dermatological emergency and sometimes requires hospitalisation.

It can also happen that lesions fromeczema break open and become infected. Certain viruses, like herpes, certain bacteria, such as staphylococcus aureus, or even certain fungi, like the candida albicans, can colonise the wound and lead to complications. Depending on the micro-organism causing the infection, it can cause pain and exacerbate itching/redness. It is imperative to consult a dermatologist in case of infection, so that they can identify the source and prescribe an appropriate treatment (antifungals if it's fungi, antivirals if they are viruses and antibiotics in case of bacterial colonisation).

The complications of eczema can be avoided by adopting certain daily habits.

• Avoid scratching areas affected by eczema.

  It is important to note that scratching can cause lesions, which serve as "entry points" for bacteria and viruses. Some people, for example, wear cotton gloves at night to prevent scratching during their sleep. Keeping nails short is also a good idea to avoid accidental injury. In addition to this, the application of certain ingredients (thermal water, essential oils, cold...) can help to soothe the itch.

• Regularly apply an emollient.

  To limit the evaporation of water from the skin and the penetration of pathogens or allergens, it is recommended to apply a emollient care at least once a day, and systematically after showering as water has a drying effect. However, scented moisturisers should be avoided, as they can exacerbate eczema problems.

• At the slightest doubt, consult a dermatologist.

  If you notice a change in the appearance of your lesions or a generalisation of your eczema, do not hesitate to consult a healthcare professional. They will be able to determine if your eczema is indeed worsening and, if so, prescribe a treatment. The earlier the intervention, the less significant the complications.

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

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