Eczema is an inflammatory skin disease. It is characterised by red, itchy inflammatory lesions. Scratching is a natural response, but it can exacerbate eczema lesions. Here, we focus on ways to alleviate this dermatosis.
Atopic eczema, a common dermatosis.
The atopic eczema (or atopic dermatitis) is a chronic inflammatory skin disease that progresses in flare-ups. This dermatosis usually develops in early childhood and persists into adulthood in over 50% of cases.
Eczema affects 2 million adults in France, which is nearly 4% of the population. It is the second most common skin disease, just after acne.
Atopic eczema occurs in individuals with a specific genetic predisposition that favours allergies, referred to as an atopic predisposition. The term 'atopy' refers to a person's tendency to develop an allergic reaction to normal environmental elements (animal hair, dust, pollen...), which do not cause problems for the rest of the population. This atopy is caused by a dysfunction of the skin barrier due to a lack of sebum, lipid and cell adhesion molecule production, which then can no longer fulfil its protective role.
When a person suffers fromeczema, their skin is constantly very dry. During flare-ups, itchy red patches appear. The itching causes a thickening of the skin (lichenification) and scratch marks (excoriations).Appropriate management of eczema can reduce the frequency and intensity of flare-ups.
The correct practices to adopt for atopic skin.
When suffering from atopic skin, two things are necessary.
Restore the skin barrier.
Atopic skin is characterised by a disruption of the hydrolipidic barrier, which no longer fulfils its protective role: the skin allows water to evaporate in large quantities, which dries it out. Moreover, it allows allergens and irritants to penetrate, thus triggering an inflammatory response. Therefore, strengthening the skin barrier is necessary to alleviate eczema.
For this, the application of a emollient balm several times a day (at least twice), particularly between bouts of atopic eczema, is essential in order to restore the skin barrier by compensating for the lack of lipids. This helps to prevent the evaporation of water and the entry of allergens that cause the inflammatory reaction. The emollient balm nourishes, softens and soothes the skin. It provides a feeling of hydration and comfort. These benefits help to limit the frequency and intensity of flare-ups.
Although the application of an emollient balm can restore the skin barrier, it alone is not sufficient to soothe eczema: it needs to be combined with topical corticosteroids . Indeed, the emollient balm helps to strengthen the hydrolipidic barrier, but during eczema flare-ups, topical corticosteroids, through their anti-inflammatory action, help to alleviate redness and itching by reducing the inflammatory response.
Please note : the use of dermocorticoids should be done under the supervision of a doctor. To avoid adverse effects, dermocorticoids are often used in treatment courses.
Dermatologist Dr. B. LEVY GAREL explains that there is an unjustified fear of corticosteroids, known as corticophobia: "The treatment of eczema relies on the use of topical corticosteroids. However, many patients are afraid to use them. It's important to know that untreated eczema can lead to a risk of secondary infection. Thus, the benefit/risk balance is in favour of treatment with topical corticosteroids.Of course, if your eczema requires the application of topical corticosteroids every day, it means that this treatment is not sufficient. In this case, you should consult a dermatologist. The reasoned application of topical corticosteroids, following the treatment prescribed by your doctor, aims to treat eczema without causing adverse effects through the absorption of corticosteroids into the bloodstream."
What to do when the skin itches?
As mentioned earlier, eczema lesions are always accompanied by a feeling of intense itching (pruritus). However, scratching and scraping the skin exacerbate eczema lesions and intensify the urge to scratch. Moreover, itching sensations disrupt sleep and cause irritability, thereby affecting the quality of life. To combat these, there are several anti-itchingsolutions available.
Benefit from the advantages of the cold.
Cold has the ability to reduce feelings of itchiness. You can apply a cold pack, wrapped in a cotton cloth to prevent direct contact with the skin, to the affected areas. The technique of using cool pebbles is also very practical and effective. Massage your skin with a small cool pebble to soothe feelings of itchiness.
Important : Never apply an ice cube directly to your skin, as it may cause a burn.
Use thermal water.
Originating from underground sources, thermal waters are naturally enriched with minerals and trace elements, allowing for therapeutic use. They possess healing, restorative, and soothing properties. Therefore, the use of thermal water can help alleviate itching. Spray the thermal water onto your skin for an extended period to benefit from its soothing properties. For optimal effectiveness, keep your thermal water in the refrigerator.
Please note : If someone in your circle suffers from eczema, it is pointless to tell them to stop scratching. Indeed, scratching is an automatic and natural need, and constitutes a normal response to itching. Therefore, if you want to help your loved ones, it would be more beneficial to recommend the anti-scratching solutions previously suggested.
If you are suffering fromcontact eczema, it is crucial to remove the object that caused this reaction as quickly as possible. These actions are also suitable for alleviating the itching while the eczema subsides.
ORCHARD D. & al. Eczema management in school-aged children. Australian Family Physician (2017).
WEINDINGER S. & al. Atopic dermatitis. Lancet (2020).