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The concept of atopy

Atopic dermatitis is not an allergy

The word "atopy" is derived from the Greek "a" meaning "without" and "topos" meaning "place".
"Without a place" is a perfect way to describe this disease, which is difficult to understand.

Atopy is a genetic predisposition to allergies, known as the atopic family history. Almost 80% of children with eczema have a family history.

Atopic dermatitis is a chronic inflammatory skin disease
Atopic patients (50 million people affected in Europe, up to 20% of children worldwide) have defective skin permeability and a hyperreactive and unbalanced immune system. The skin is dry, sensitive and hyperreactive.

Filaggrin, a protein of the skin which ensures adhesion between cells in the outermost layer of the skin, is deficient. In addition, the skin lacks the lipids which are naturally found on its surface and which protect it from potential allergens.

Under these circumstances, irritants found in the environment and which are usually well tolerated, such as pollen, dust and certain hygiene products, can penetrate the skin and cause a flare-up of eczema.

The disease usually occurs after (and sometimes before) the age of three months and can last between a few months and several years, depending on the child. Without proper treatment, the vicious cycle of itching settles in: the skin barrier deteriorates even further, allowing more allergens and irritants to penetrate the skin and to cause further itching.

However, few cases persist into adulthood: half the children with atopic eczema before the age of one are cured by the age of five, although the skin is still very dry in the following years.


Picture the human skin as the wall of a house:

There are two main phases in atopic dermatitis and atopic eczema: breakout and remission.
The breakoutresults in inflammation, itching, oozing, scabs, etc.
Remission, which occurs between two breakouts, is characterized by severe dryness.

People with the following symptoms should consult a dermatologist:

  • Itchy rash - difficult to detect in infants, but sleeping disorders are an indication.
  • A rough and thickened skin.
  • Oozing eczema patches.
  • Scabs form on the patches.

The location of the lesions provides another clue.
It varies during childhood:

  • Infants often have eczema on the face, especially on the cheeks and chin.
  • During childhood, it tends to occur on the knees, wrists, elbows and neck.

Breakouts usually start with red and itchy patches.

The skin gets dry, thickens and becomes rough. Eventually, it oozes and scabs appear. Scratching worsens the disease, sometimes even leading to infections.

Once the diagnosis has been established, the lesions must be treated and the skin condition quickly normalized without overprotecting the patient. The main priority in treating the disease is to restore the protective functions of the skin, which is a natural barrier preventing the penetration of external agents, rather than hunting down dust mites and pollen - an almost impossible and tiresome task for parents! Recent studies also show that removing every single aggravating factor can actually increase the risk of children developing eczema. Hence, the best reaction is to focus on treating the disease by using soft toiletries, emollients and topical corticosteroids.

Aggravating factors

Daily life with ointment

First, be careful not to confuse the factors leading to flare-ups with the underlying cause of atopic dermatitis: a structurally deficient skin barrier.

The factors triggering breakouts are numerous and cannot be prevented
They can be related to the environment, food or even emotions - although we cannot explain it, emotions can play a significant role in the frequency or severity of eczema attacks. Teething and ENT disorders may also trigger eczema breakouts in infants.
Furthermore, reactions to aggravating factors vary from one individual to another.

The most common aggravating factors are as follows:

  • Dust, dust mites and pollens, which are naturally present in the air
  • Soaps, laundry detergents and home cleaning products
  • Tobacco and pollution
  • Heat (+ sweat) and very dry air
  • Irritating clothing: wool, synthetic fabrics, etc.
  • Pets
  • Emotional stress
  • Teething
  • Changes in temperature
  • Food allergens
  • Swimming in the sea or pool

However, it is better to control inflammation upon the first signs of eczema rather than trying to eliminate environmental factors.

"With each breakout, we wonder if our little girl's life is plagued by how we raise her, what she eats, what she wears, or anything else. We find this disease very confusing; it is not easy to understand."
Isabelle, mother of Octavia, 3 years old

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