Misconceptions about eczema.

False, eczema affects both children and adults, although it is true that the former are most affected. Indeed, it is estimated that about 2 to 3% of adults suffer from eczema in Europe compared to 10 to 20% of children. Adults prone to eczema often had flare-ups during their childhood, although this is not always the case. Eczema often fades over time but can persist in some cases.

This is false. Indeed, redness, itching, skin dryness, and skin thickening are the main symptoms associated with eczema, but they are not exclusive to it. They can be caused by other skin diseases, such as psoriasis, the seborrheic dermatitis, fungal infections or scabies. These conditions are, in fact, often mistaken for eczema.

False, the face is not the only area that can be affected by eczema. Red patches can also appear on the hands, arms, elbows, legs, buttocks... It is simply more often noticed that a person is prone to eczema flare-ups when it manifests on the eyelids, cheeks or forehead, areas that are difficult to conceal.

This statement is true. Indeed, eczema can have a significant impact on the quality of sleep for those who suffer from it, and approximately 80% of adults with atopic dermatitis complain of sleep disturbances.

The intense itching, feelings of discomfort, and pain associated with eczema skin lesions can disrupt sleep, making it difficult to fall asleep and leading to frequent awakenings during the night. These sleep disturbances often cause individuals with eczema to experience fatigue, irritability, and a decrease in concentration during the day.

For more peaceful nights, dermatologists advise individuals suffering from eczema to take a quick, not too hot shower in the evening, and to thoroughly moisturise and soothe their skin with an emollient immediately afterwards. They also recommend wearing cotton gloves to prevent scratching during sleep, as well as loose-fitting pyjamas.

Eczema is a stigmatising disease that can be challenging to live with for those affected, who may tend to isolate themselves. It often happens that their acquaintances or people they meet mistakenly believe that it is a contagious disease. Eczema cannot be transmitted horizontally, that is, from an affected person to a non-affected person.

However, it is important to know that eczema can be genetically passed on to children, in which case we refer to it as atopic dermatitis (vertical transmission). Individuals suffering from atopic eczema often have an anomaly in the gene coding for filaggrin and other proteins essential to the stratum corneum, resulting in a fragile skin barrier that easily allows allergens to penetrate. This anomaly can be passed on to their offspring.

This statement is both true and false. Indeed, some people affected by eczema notice an improvement in their skin condition with the arrival of warmer weather, while others see their lesions worsen. This is referred to as photosensitive eczema. This is a photo-allergy, meaning a cross-reaction between a product containing an allergenic molecule and the UV rays of the sun. It's quite rare, but it does happen.

It is often thought that sun exposure is beneficial for eczema due to its stimulation of vitamin D synthesis. A recent study has shown that vitamin D increases the production of cathelicidins, molecules that act against Staphylococcus aureus, a bacterium that sometimes colonises eczematous skin. Staphylococci can cause secondary infections of the eczema, which can sometimes have significant consequences. Vitamin D has a protective effect against this. Furthermore, it promotes the production of proteins necessary for the functioning of the skin barrier, which limits dryness and the entry of pathogens.

Note : Even though the sun can provide benefits, it's important to remember that it is also harmful to the skin. To prevent the risks of melanomas, solar spots and premature ageing, it's crucial to apply a broad-spectrum sun care product, protecting against UVA and UVB rays, before each exposure. Individuals affected by eczema should opt for a cream with a rich texture, which can nourish their skin in addition to protecting it.

True and False, it depends on the essential oils. Most are not recommended for sensitive skin due to the allergens they contain, which includes eczema-prone skin. However, some can help to alleviate the itching caused by eczema, notably tea tree essential oil (INCI: Melaleuca Alternifolia Leaf Oil), Roman chamomile essential oil (INCI: Anthemis Nobilis Flower Oil), and true lavender essential oil (INCI: Lavendula Angustifolia Oil).

This is indeed a common misconception. Eczema is not at all related to a lack of hygiene. On the contrary, eczema can be exacerbated by excessive care that could strip away the hydrolipidic film present on the surface of the epidermis, thereby further weakening the skin.

It is true that eczema flare-ups can be triggered by stress. Indeed, stress increases skin inflammation by causing the degranulation of mast cells, immune cells involved in allergic reactions. This is mediated by neuropeptides released by cutaneous nerve fibres: CRH (Corticotropin Releasing Hormone), neurotensin, substance P and other tachykinins. The release of these hormones triggers a cascade of reactions leading to the release of mediators responsible for the itchiness of eczema and the vasodilation of vessels.

This is false, provided that the correct measures are taken. If you are experiencing an eczema flare-up and you wish to do some sport, it is advised not to wear overly tight clothing that promotes sweating and to take a quick shower afterwards, followed by the application of an emollient. Sweat, which is acidic and contains salts, is one of the factors that can worsen eczema.

This is false, unfortunately. It is estimated that just over 50% of children suffering from eczema see their symptoms completely disappear in adulthood, while these persist in the other half. It should also be noted that eczema never goes away on its own and always requires appropriate medical care.

This is false, eczema is not merely a physical condition, it can also lead to anxiety. While some people manage their eczema relatively well, others suffer greatly from it, which can undermine their self-confidence and impact various aspects of their life: family, love, career. This is why appropriate medical care is so important, to ensure that eczema has the smallest possible impact on patients' quality of life. Psychological support may also be relevant for those who feel the need for it.

This statement is both true and false. Indeed, cortisone creams, often recommended for eczema, should not be used indiscriminately and are classified as medicines in France. However, a common mistake is to wait too long after the onset of an eczema flare-up to use them. Dermatologists advise not to wait and to apply a cortisone cream to the eczematous lesions as soon as the eczema flare-up occurs to defuse it.

It's true, several studies have shown that there is a link between pollution and the worsening of eczema. It has been specifically proven that exposure to fine diesel particles can increase itching in children suffering from eczema. Moreover, air pollution can also trigger an increase in the production of free radicals in the body, species that cause cellular damage and exacerbate skin inflammation.

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

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