Atopic dermatitis or eczema in children

Dr. Anne-Marie Calza

Pediatric dermatologist, Geneva

January 13, 2021

Atopic dermatitis is an inflammatory skin disease that is on the rise, affecting 15% of children. More of 2 /3 of patients start their disease in the first year of life. The natural course is often favourable. A minority of them will keep their eczema eczema as an adult or will develop other conditions (allergic rhinitis or conjunctivitis, asthma).

What do the lesions look like?

In eczema there are several types of lesions:

– Redness and oozing

– Dryness

– Blistering, crusting, scratching

– Thickening of the skin.

Are there any particular locations specific locations?

In the first year of life, eczema likes the chubby areas of the child. Then the condition moves to moves into the folds (hollows, elbows wrists, knees, ankles). When the eczema is located elsewhere, contact dermatitis must be evoked.

How does eczema develop?

Its course is punctuated by flare-ups which are triggered for various reasons.

In children
Infections, changes of habit, dental flare-ups, and rarely feeding.

In older children
Infections, seasons, stress, and contact eczema.

Why do people get atopic dermatitis?

Several reasons have been identified:

• Family background.

• Dry skin caused by the lack of a protein, filaggrin, in the epidermis. This skin does not play its role as an impermeable barrier and allows external elements to pass through.

• A particular functioning of the skin’s defence system of the skin’s defence system with an army army that gets angry at enemies that are not by triggering numerous inflammatory inflammatory reactions. On the other hand, this system has a learning faculty which explains the improvements.

• Superinfections (staphylococcus, herpes, chicken pox, molluscum, warts) are frequent due to the fact that the defence system is occupied by false enemies.

• Certain allergens (dust, animal hair or pollen) (dust, animal hair or pollen) aggravate the attacks but rarely responsible for everything.

Why is the child treated?

This chronic disease alters the quality of life of those who suffer from it by its irritability, difficulty in sleeping, concentration sleep, concentration, and aesthetic damage. aesthetic damage. Children who are treated recover faster.

Is it necessary to carry out additional tests?

No systematic examination but a possible targeted allergological assessment (rast, prick) or patch tests.

What can be done?

Accessible targets: Infection, inflammation, dryness, and scratching.

Infection: Infection is permanent. It can be It can be fought in different ways. – Reduce dryness and inflammation – Washing the skin – Textiles with a silver ion base or made from from certain silks – Antibiotics (cream, tablets)

Inflammation: two weapons are available. Corticoids: This large family of molecules classified by potency (from 1 to 4) is used in cream or ointment. Their use requires specific teaching to parents and the success of the treatment depends on the time spent on it. If used wisely, corticosteroid therapy can be used wisely, it can be used for years without growth arrest, immunosuppression, discoloration, or atrophy.

Anti-calcineurins (pimecrolimus, tacrolimus). They do not have a deleterious effect on the thickness of the skin. Their main indication is the face.

However, certain hazards should be noted:
• The herpes virus gives rise to more extensive infections with a deceptive clinical misleading.
• These molecules are young and some fear effects on the immune system.

Dryness: a very important target between bouts. Washing should be gentle and not too frequent. When the child gets out of the bath, the skin from the bath, the skin must be abundantly creamed with a neutral, fatty preparation (without urea, lactic acid, or perfume). The best cream is the one that the child likes and tolerates. It is important to involve the child in the treatment is important. One should be wary of the many “organic” oils and preparations. Most contain preservatives and many plants are allergenic.

Scratching: improved by oral anti-histamines in the evening and other little tricks: cool water compress, misting, cold pack, cool temperature.

Harder to reach targets

Environmental factors play a major role, but a role, but an environment that is too environment is not a good thing. On the other hand, a child should not be to animals, dust, mould or dirt. dust, mould or pollen. Avoid irritating textiles (wool, synthetics) etc. Favour light-coloured cotton clothes prefer hypoallergenic detergents, do not use fabric softeners. Set up a room without carpets, hangings, woodwork. Use anti-allergic bedding without feathers. Wash lint.

Cures: This is an opportunity for parents to see the care given to the child up close. These are nice holiday places. Improvements are noted with cures of a minimum duration of 3 weeks.

Homeopathy is difficult to evaluate. This empirical medicine is very popular in vogue in Europe. Its reasoning bases have never been subjected to the objective demonstration.

In summary
• Do not exceed the area to be treated prescribed by the doctor.
• Know how much you are using between each appointment.
• Only apply the product prescribed by the child’s doctor.
• Be sure of the diagnosis of eczema.

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