Atopic Dermatitis (atopic eczema)

If you are living with atopic dermatitis, you are being treated for it and yet you continue to experience daily discomfort, symptoms and even exacerbations, you are in clinical inertia. This means that your disease is not well managed. Fortunately, there are very simple solutions to get things under control.  Find out in this article!

What is atopic dermatitis?

The skin naturally produces a protective barrier against external aggressions. Atopic dermatitis is a disease that damages this barrier. This causes inflammation aggravated by environmental factors such as heat or pollen. This inflammatory skin disease is not contagious. It causes itching and develops in flare-ups (attacks lasting up to several months).

Atopic eczema is linked to certain genes, but not only. It is also facilitated by the presence of allergenic substances and environmental factors. This disease often appears in childhood, from the age of three months: it is called infant eczema. It may disappear or persist into adulthood. Eczema can be localised, for example you may only have it on your hands or feet. 

What causes this skin condition? 

The causes of atopic eczema can be diverse and unknown, but some factors have already been identified as triggers and aggravators: 

• Heredity: there is a genetic background favourable to the development of atopic eczema. Between 50 and 75% of children affected by eczema have parents who are also affected.
• Allergies (food, animals, pollution...).
• Anxiety, stress.
• A dysfunctional immune system.     

When in contact with a potentially allergenic substance, the body takes time to react and to develop the skin inflammation that is the symptom of eczema. Once penetrated, the allergenic substance binds with proteins in the skin and triggers an immune response. T-cells (cells of the immune system) will learn to recognise these substances and trigger an inflammatory reaction on each contact.

 What are the symptoms of atopic dermatitis?

Atopic eczema appears in flare-ups, periods of up to several months. It can clear up and come back for no particular reason. If you live with atopic eczema, you may have: 

• Redness ;
• Vesicles (small blisters);
• Scaling (peeling skin);
• Scabs on the face, scalp, in the joint areas of the limbs (elbows, knees...);
• Plaques, lesions (abnormalities of organic tissue);
• Itching. 

In adults, the lesions are concentrated on the head, neck and limbs (arms and legs). They may persist or fade, which is the chronic nature of atopic eczema. 

How does atopic eczema manifest itself? 

 Atopic eczema manifests itself as dry skin due to a deteriorating skin barrier, the appearance of red patches and itching (pruritus). 

In infants 

 In infants, atopic eczema develops mainly on the face, limbs and scalp, and eventually the trunk is also affected. The baby cries more and tries to rub against the sheets, and may also show signs of scratching. 

In children 

In children the symptoms are the same but may be in other places. Atopic eczema is mainly found in the folds: knees, hands, feet, ankles, and elbows. The disease can, in the most severe cases, lead to stunted growth. 

How is atopic dermatitis treated? 

Atopic dermatitis is a chronic disease, it will not disappear completely or permanently. However, it is possible to live well with it by treating the symptoms, particularly during the periods of flare-ups (but not only). The aim is to limit the impact of the disease on the quality of life. 

Dry skin is a key feature of atopic eczema. To properly moisturise your skin, an emollient (softening, tissue-relaxing) product is recommended outside of the flare-up periods: this is known as background treatment. The aim of the emollient is to restore a protective barrier that the skin lacks in the case of dermatitis. You can apply this cream all over your body, every day, after a shower. Its use in infants helps to reduce the development of atopic dermatitis. 

To treat flare-ups of atopic eczema, your doctor may prescribe anti-inflammatory creams, which are steroids (or dermocorticoids), to treat the lesions. Depending on your profile (age, location of the lesions, severity), the intensity of the treatment may change. It is applied once a day to the areas affected by the lesions.

You should know that the earlier you treat an outbreak, the better it will be controlled. This reduces the risk of superinfection and allows the skin barrier to recover more quickly. 

What about skin changes and complications?

 If the dermatitis is not well controlled and you scratch, there may be swelling, pain and the appearance of pus on the irritated areas. Superinfection is the most common complication. It occurs during the oozing phase when the blisters are scratched and pierced, healing is slowed down, so the skin becomes susceptible to infection. For example, a herpes virus infection can be serious and severe, so contact with people who are prone to herpes should be avoided.   

It should be noted that atopic eczema can seriously impact quality of life due to itching, embarrassment (physical and social), sleep disturbance, impact on daily activities and mood disturbance. 

Is your atopic dermatitis under control? 

79% of the patients questioned in an internal study* at Wefight live with uncontrolled atopic dermatitis, i.e. the patient has no treatment adapted to his or her disease, or no treatment at all!

The consequences affect the general well-being: persistent symptoms, itching, disturbed sleep, discomfort in daily activities...

There are several reasons why patients live with an uncontrolled disease. In the first case, patients have a treatment, but it does not suit them or is not adapted: this is called therapeutic inertia. 

 In a second case, there are also all those patients who do not even know they are living with atopic dermatitis, we say they are in diagnostic wandering. According to the same study, ¼ of patients living with atopic dermatitis were diagnosed two years or more after the first symptoms appeared. 

 As you can see, knowing how well the disease is controlled is crucial. If you know that it is still progressing, for example, the idea is not to wait until you have an exacerbation (worsening, dermatitis attack) to make an appointment with your doctor. If you are managed and followed up before you are in serious pain, it will reduce the risk of having serious flare-ups. The earlier the disease is managed, the better you will be treated!

How do you know if your disease is well controlled and if your treatment is appropriate? 

There are ways to find out. One of them is a tool available in my application: the ADCT (Atopic Dermatitis Control Tool) test. It is a tool that allows you to measure the control level of Atopic Dermatitis, therefore to evaluate if you are well treated or not. It is available in my app Vik Atopic Dermatitis (for iOS or Android). More than 4200 patients have taken this test on Vik DA so far. 

In a few questions, it allows you to assess: 

• The importance and frequency of itching ;
• The general severity of the symptoms;
• The level of discomfort with atopic dermatitis;
• The effects on sleep quality;
• Effects on daily activities;
• Effects on mood and emotions.

If you have a medium or high score on this test, you should see a general practitioner or a dermatologist. In other words, if you have symptoms that interfere with your daily life, it means that your treatment is inadequate, or that you don't have a treatment but would need one. If your disease is well controlled (low ADCT score), no problem: everything is fine! 

Please note that the ATCD test is part of a series of questionnaires available in my Vik Atopic Dermatitis app, which allow you to test your knowledge of the disease: to evaluate the level of control, the severity of the disease, the importance of the symptoms... These questionnaires can therefore help you to better know and understand your atopic dermatitis and thus reduce therapeutic wandering.

For more information on Vik Atopic Dermatits, download the app for free: Click here

*Wefight internal study: "AD patient journey and impact of ADCT test on decision making". Conducted on the Vik DA app from August 2021 to October 2021 on adult users (patients and relatives of patients) living with AD who took the ADCT test, i.e. 103 people.

External sources:

• « Eczéma ou dermatite atopique : causes, symptômes et évolution », Ameli.fr
• « Causes et prévention de la dermatite atopique (eczéma) », Vidal.fr
• « La dermatite atopique », 29/05/21, Pr. Delphine Staumont, Dermato-info.fr