Neurodermatitis: «Don't scratch!» doesn't help
A rainy afternoon, the family is sitting comfortably in front of the TV - and one of the children scratches his arms. «Don't scratch!» say the parents, annoyed. Wrongly, as experts emphasise. «Admonishments don't help one bit,» says Dagmar Simon. «Then the child scratches all the more.»
Dagmar Simon is a senior physician at the University Clinic for Dermatology in Bern and says what people with atopic dermatitis suffer from the most: «Itching, itching, itching!» She mentions the word three times. Often unbearable itching is the main symptom of atopic dermatitis, the technical term. «Atopic» comes from «atopy» and refers to the tendency to allergic reactions. However, many other factors play a role in atopic dermatitis, not just allergic ones.
In Switzerland, around 20 per cent of children are affected. Among adults, the figure is around four to five per cent, according to a brochure published by the allergy centre aha! Atopic dermatitis can reduce quality of life, impair school performance and lead to difficulties in the social environment: When it itches, you sleep badly and find it difficult to concentrate on homework; with a rash on your face, it takes effort to approach others.
The genetic predisposition
The sofa scene at the beginning of this text shows that the whole family is affected when a child has atopic dermatitis. Itchy, reddened, swollen, cracked and possibly inflamed skin cannot be ignored. And without treatment, it only gets worse. Sufferers who come to Professor Simon's eczema consultation with large open patches usually ask her two questions: Where does it come from? What can we do about it?
In atopic dermatitis, the skin's barrier function is defective: it loses moisture more easily and dries out. As a result, it can become red and cracked, ooze and become inflamed - often in the hollows of the knees and bends of the arms, on the face, neck and hands. In most cases, this is not due to a poor diet, and the emotional state is not the only decisive factor, even if these factors can influence the appearance of the skin. «Neurodermatitis sufferers are not unstable, they are completely normal,» Simon clarifies. Those affected also do not have a nervous disorder, as was previously wrongly assumed and the disease was called «neurodermatitis» (derived from the Greek word for «nerve»). Rather, there is a genetic predisposition: Biochemical studies suggest that the skin lipids and structural proteins in people with atopic dermatitis are composed differently than in healthy skin. As a result, their skin protects them less well against environmental influences and becomes inflamed more easily.
A study shows that children who grow up on a farm are less likely to suffer from atopic dermatitis.
However, various studies suggest that hygienic conditions can also have an influence. For example, the KiGGS study on child health in Germany in 2014 found that atopic dermatitis is more common in children and adolescents with a high social status than in children of the same age with a low social status. A study for Switzerland and other central European countries in 2013 showed similar findings: children who grow up on a farm are less likely to have allergies or asthma - and less likely to suffer from atopic dermatitis. Many city children grow up almost sterile, without contact with animals, but with wet wipes always to hand. «It's better to let them play in the dirt!» advises Dagmar Simon and: «The best thing would be a cow in the nursery.» The immune system needs to be trained early on so that it can build up tolerance and not develop allergies.
Five tips for the skin
What helps with neurodermatitis:
1. cleanse properly: Do not shower too hot and apply cream to the whole body afterwards. This also applies to swimming pool visits. Use soap-free shower gels, also for washing your hands. Avoid fragrances. If you use fabric softener, it is better to add a splash of vinegar to the final rinse so that no fragrances remain in the laundry.
2. dress well: Avoid irritation of the skin by wearing soft, breathable materials such as combed cotton, viscose, lyocell and not scratchy wool. Airy cuts are better than tight-fitting clothing. Wear underwear with the seams facing outwards. There are special pyjamas made of silk, and antimicrobial clothing can reduce germs on the skin.
3. relieve itching: Always have a moisturising lotion in the fridge and apply to very itchy areas. What also helps, for example in school lessons: pinch instead of scratching; occupy your hands with something else, for example a spinner.
4. inform yourself: The foundation «aha! Allergy Centre Switzerland» foundation offers information brochures on topics such as atopic eczema or cortisone for free download, www.aha.ch > Shop > Skin. Under «Living with allergies» you will find dates for children's camps, youth camps and neurodermatitis training courses for children and parents throughout Switzerland. Worth reading: the textbook «Neurodermatitis - A guide for doctors and patients» by Dagmar Simon (Uni-Med 2018, 96 pages, approx. 50 Fr.).
5. be considerate of your skin: this also applies when choosing a career. If you have sensitive skin, it is better not to work in professions where you have to wash your hands frequently or handle skin-irritating substances, such as hairdressers, bakers, florists, carers, metalworkers or dental technicians. Otherwise hand eczema can worsen or appear again.
Most fall ill in the first five years of life
In 85 per cent of cases, atopic dermatitis becomes apparent in the first five years of life. However, the symptoms can also first appear during the school years - or sometime later. If the disease is mild, it is possible for the symptoms to subside by the time the child reaches school age. The children then retain sensitive, dry skin, but no longer have eczema. This applies to around half of children with the disease. The others later suffer from permanent or recurring skin changes that are so typical of atopic dermatitis.
«The disease progresses in phases,» explains Dagmar Simon. In a team with doctors, psychologists and carers, she regularly runs atopic dermatitis training courses. There, the participating children and their parents are given a step-by-step plan. «Patients should learn to be their own doctor. They can't visit a practice every time they have an attack.» It is important to the dermatologist that the measures taken are not ultimately more burdensome than the disease itself. Her tip: «It's best to take a pragmatic approach and not let the disease take over.»
Lotions, creams and oil baths
So what can you do? Good basic skin care is the be-all and end-all. In the first stage of the recommended treatment plan, moisturising is sufficient: after a (not too hot) shower, apply lotions, creams or ointments to dry skin and give the child a moisturising oil bath. Even products from the supermarket are suitable for this, says Dagmar Simon, «but they must be free from fragrances and preservatives.» It's good if even the youngest children apply their own moisturiser, as this gives them a feel for whether their skin is rough or smooth and supple. «They should get involved, help out and not see their parents as the bad guys with the ointment tube.»
The second stage of the treatment plan begins when skin reddens, flakes and starts to itch. Ointments and creams containing cortisone or so-called immunomodulators (active ingredients: pimecrolimus, tacrolimus) are usually recommended here to prevent the itching from getting so bad in the first place. These products are applied directly to the red patches and have an anti-inflammatory effect on the cells that cause inflammation in the skin.
Good basic care is the be-all and end-all of treatment. Even the youngest children need to learn this.
Simon calls cortisone preparations «the first choice against inflammation» because they quickly relieve itching. However, she also knows from her consultations that many parents are afraid of cortisone. If the cortisone is too strong and used for too long, the skin becomes thinner or forms streaks, becomes more vulnerable and heals more poorly. «Cortisone must be used in the correct dose and with breaks, then no side effects are to be expected,» reassures the dermatologist.
In the third stage, during an acute flare-up with very severe itching, the specialists usually prescribe stronger doses of cortisone ointments (class 3) and/or the immunomodulator tacrolimus. In particularly severe cases, anti-inflammatory systemic therapy with tablets or injections is usually required. UV light therapies, as used for adults, are not an option for children in order to avoid the risk of skin cancer. «In the next few years, a lot will happen in the treatment of atopic dermatitis,» says Dagmar Simon. A new antibody has recently been approved for the treatment of affected adolescents from the age of twelve and adults (Dupilumab, trade name: Dupixent), but it still needs to be tested for children. It is worth regularly visiting a dermatologist's practice to keep up to date.
Take a time-out
Sometimes simply taking time out can help. This doesn't have to be a long holiday in a high mountain clinic or at the North Sea, as can be prescribed for very bad skin. A week at a children's camp is also good. Nadia Ramseier organises camps in Graubünden and the Bernese Oberland for children and young people aged 8 and over who have conditions such as neurodermatitis, intolerances, allergies or asthma. She works at the «aha! Allergy Centre Switzerland», is a qualified practice assistant and a qualified nutritionist. Around a third of children with moderate or severe atopic dermatitis also suffer from a food allergy. «Our aim is for the children to be able to enjoy a carefree week's holiday without having to ask themselves: "Can I eat this croissant or not?» Dietary cooks prepare the meals and time is set aside three times a day for moisturising. The young holiday guests have their creams and ointments in their luggage and simply continue with their usual skin care programme.
programme. This is very valuable for those affected, says Ramseier. «They realise: «I'm not alone with this, there are other children who have such troublesome skin.» That can motivate them at home.» Because the creaming continues there.
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