True/false about eczema

Written in partnership with Dr. Clarence De BELILOVSKY, dermatologist; member of the Mustela experts circle.

• Eczema-prone skin is a frequent disease among children and newborns.
True. Eczema-prone skin affects one in five children on average worldwide (1). It is the most widely spread skin disease among children. Moreover, this number keeps increasing. It is said that in industrialised countries, the percentage of people affected with eczema-prone skin has tripled in 30 years (2). Don’t worry then: if your baby is concerned, it’s not exceptional and they are not the only one. 
 
• My child has eczema-prone skin so has a bigger risk of developing staphylococcus aureus or impetigo.
False. It’s a fear more than a reality. Indeed, when you look at the oozing patches, we do wonder if there is a superinfection. What is true is that the presence of staphylococcus under the skin – for all skin types – is normal. These bacteria are part of our skin’s natural flora. They are more concentrated in the case of inflammations which is why skin samples indicate higher levels at this particular moment. Fortunately, their presence doesn’t necessarily trigger an infection. It can happen, but if atopic flare-ups are properly treated, it is rare. Impetigo is not found more often on eczema-prone skin. 
 
• Eczema-prone skin is an allergic disease.
True. This means that it is due to an overreaction of the immune system in the presence of allergens such as mites. It is not due to a lack of hygiene and is not contagious.
 
• Eczema-prone skin is hereditary.
True in most cases. To be more precise, about 70% of the children affected by eczema-prone skin have in their family a person who also had a sensitivity to atopy. To be more precise, the probability for a child developing it increases from 40% to 50% when one of the parents is atopic, and from 50% to 80% when both are (3). And what happens if there is no family history? Eczema-prone skin manifestations are linked to several genes. You may have it and it may be hereditary, but anybody may potentially be concerned. 
 
• Eczema-prone skin is contagious.
False. It is many things: allergic, genetic, hereditary (sometimes), but not contagious. Even in cases of flare-ups and inflammations.

 • Eczema-prone skin is for life.

True and false. Not necessarily. In any case, not with the same intensity. If eczema-prone skin can appear very early - from the first months after birth -, it can diminish around five or six years old and is quite rare among adults. It can even disappear entirely. It all depends on your child’s sensitivity. However, thanks to the application of baby/child specific emollient skincare products and the adoption of some simple steps at home or during your child’s activities, you can extend the periods of respite (see Treating atopic dermatitis: can it improve or disappear?)
 
• Eczema-prone skin can cause other allergies

False. Your child can have other allergies but only because they have a sensitivity to atopy. Eczema is one manifestation. Other allergies that this sensitivity can cause are asthma, hay fever, conjunctivitis or food intolerance. In all these cases, it is the same mechanics: the immune system, very sensitive, overreacts in the presence of allergens, such as dust, pollen or mites (see The influence of the seasons). Your child can have several allergies but the immune system is to blame, not eczema-prone skin. 
 
• There are some practices that favour periods of respite and reduce itching and atopic reactions.
True, and they are many. Starting with baby/child specific emollient skincare products and followed by daily precautions such as using cotton clothes, ventilating your home, avoiding your child sweating, and so on. Simple steps mostly that can extend the periods of respite and offer your baby a better quality of life even if such steps can’t entirely prevent flare-ups. 
 
• Skin sensitivity, eczema-prone skin, etc. Is there no point in bathing my child too often? 
True. An excessive hygiene routine can favour some allergies. Why? When your child’s body is less exposed to microbes, its immune system overreacts when confronted with them. Is that also true for atopic babies who must avoid contact with allergens? Yes, because the immune system needs to be stimulated by infections from early childhood. This contributes to its balance. Taking care of dust or mites to prevent eczema-prone skin is very good but eliminating them altogether is not the solution. There are therefore more children affected by eczema-prone skin in industrialized countries where hygiene routines can be excessive.
 
1Sources : Watson 2011, Isaac 1998.
2Source : http://www.fondation-dermatite-atopique.org/fr/leczema-atopique/definition-de-leczema-atopique
3Sources : Böhme 2003, Taïb 2008.