Understand my skin

Eczema in winter - How to treat atopic dermatitis in winter?

Atopic dermatitis can be triggered by genetic factors (e.g. atopic predisposition, other allergies), but also by lifestyle (e.g. food, aero-allergens, infectious agents, clothing, emotional stress) or external factors by altering the skin barrier with specific dermatological signs.

What are the symptoms?

The most common form is infantile dermatitis (under 2 years of age), the onset of which occurs around the age of 3 months with a rash on the cheeks. It consists of erythema (redness), excoriations, papulo-vesicles or exudate (oozing areas), then evolving into scabs accompanied by intense itching that affects the patient through discomfort and sleep disturbances.

Another form of this disease is juvenile dermatitis (children over 2 years of age) that may appear in the beginning or as a continuation of the previous form. In this case, lesions are less acute, especially in areas of flexion (e.g. elbows, back of the knee, neck folds, hands and wrists) and evolving in the form of plaques with a tendency to lichenification, erythema or itching. In this case, dry skin (cutaneous xerosis) is persistent and requires the application of specific creams.

In adolescents and adults, atopic dermatitis cases represent a small percentage (less than 10%). It is generally characterised by residual symptoms (on hands, eyelids) and intense dryness of the skin.

Extreme temperatures and low humidity during winter are a major triggering factor in the occurrence of atopic dermatitis, through rapid skin dryness, followed by skin barrier damage that can spread and ultimately become infected. In this case, topical antibiotics and treatment are needed, causing drug susceptibility and temporary discomfort.

As a consequence, it is very important to know that under a certain temperature and humidity, the application of emollients must be constant, without interruption, and especially urgent treatment should be applied in case of obvious lesions. Short showers are also recommended, the water should not be hot and special washing gels should be used.

When leaving the house, it is important to limit the impact of cold on the skin by wearing gloves, scarves, natural fibre clothing, and applying emollient creams to the face.

How do we treat atopic dermatitis exacerbated by exposure to cold?

The treatment is determined by the dermatologist depending on the stage, clinical appearance and symptoms. A treatment regimen is initiated consisting of topical corticosteroids or calcineurin inhibitors, systemic antihistamines to relieve itching, as well as local emollients. Good collaboration between patient and doctor is required and the duration of the treatment is determined based on evolution. Being prone to irritation, the patient’s sensory stability is important for the development of the disease, and it is important to control the vicious circle of itching-scratching.

What is the prognosis and when should treatment be stopped?

Generally, evolution is favourable under treatment and in time, spikes triggered by internal and external factors will be increasingly rare. As a result, the main objective is to maintain the integrity of the skin barrier at an optimal level, through a constant and well-implemented care routine.

For atopic dermatitis that is severe, generalised, and resistant to treatment, modern medicine has new-generation systemic therapies to reduce symptoms.

From my own experience in treating this condition, I can confirm that being well informed and respecting medical prescriptions can provide a long-term favourable response for patients, with increasingly fewer exacerbations, so those affected have a better quality of life.

Conclusions – Practical advice

General measures – Detecting and excluding trigger factors, diet, air humidity, inadequate hygiene and clothing, avoiding extreme temperatures;
Specific treatment – immediate, adapted to lesions – and over the long term;
Maintenance treatment – continuous application of emollients;
It is not recommended to use natural therapies, remedies or miraculous products that can aggravate the lesions and complicate the response to subsequent treatments.