Summer is here, bringing with it the sun and swimsuit season! Get out your umbrellas, hats and sun creams, because yes, we love our tan, but we also love our skin. However, taking care of your skin is not a matter of season, and remains essential all year round, winter and summer alike, especially when your skin is suffering from dermatological pathologies.
As you can imagine, today we're talking about your skin, but above all about atopic dermatitis!
Atopic dermatitis, more commonly known as eczema, is a multifactorial (1) chronic inflammatory skin disease that has a significant impact on the physical and psychological well-being and quality of life of sufferers.
The Global Burden of Disease has estimated that almost 223 million of persons were affected by this disease worldwide in 2022 (2). According to the GADA (Global Atopic Dermatitis Atlas), a large proportion of the population is impacted, of which 20% of children and 10% of adults (3).
So, in our humble capacity, we felt it was important to give you some insight into atopic dermatitis. Because a better understanding means learning to live with it more effectively.
What is atopic dermatitis?
As introduced above, atopic dermatitis, or atopic eczema, is a non-contagious allergic skin disease (4). It affects the body and mind on a daily basis, but also evolves in the form of occasional acute episodes of varying duration. These episodes (also known as eczema flare-ups) are marked by the appearance of symptoms such as itching and lesions that can have a major impact on the daily lives of those affected. Allergic in origin, atopic dermatitis is often linked to other allergic conditions, such as allergic rhinitis (better known as hay fever), allergic conjunctivitis or asthma.
Atopic dermatitis is therefore a dermatological condition whose symptoms affect daily life, and should not be confused with contact dermatitis, whose symptoms can be virtually identical. Here is a diagram explaining the differences between these two conditions (4-5).
What about symptoms?
People suffering from atopic dermatitis generally experience several physical symptoms that affect their well-being and quality of life.
These include dry or very dry and sensitive skin, localised red and scaly patches, intense and persistent itching, and skin lesions that cause significant pain and discomfort (6).
Atopic dermatitis can also have a significant psychological impact, causing sleep disorders, irritability and even depression.
Causes and factors
The causes of atopic dermatitis are complex and multifactorial. These include numerous factors and triggers, both endogenous and environmental (allergens, pollution, irritants, climatic conditions, etc.), which play a key role in this pathology.
Endogenous factors include genetic mutations leading to skin barrier dysfunction, skin microbiome abnormalities, immune system dysregulation and hormonal changes.
The complex interaction of these factors makes the skin particularly fragile and reactive. Indeed, this dysfunction of the epidermal barrier and the dysbiosis of the cutaneous microbiome lead to skin breakdown, creating dehydration and permeable, even spongy skin, giving access to allergens and aggressors, stimulating the immune system, which is already in alarm. This activation of alarm signals by allergens/aggressors leads to an inflammatory response, triggering a new outbreak of atopic dermatitis. (10)
In addition to the factors listed above, some of them cannot be controlled, but it is possible to limit others, such as stress, which is considered to trigger or exacerbate the symptoms of atopic dermatitis. Various clinical studies have shown that people with sensitive to very sensitive skin have a higher cutaneous reactivity to emotions than those with slightly sensitive or non-sensitive skin, as well as a poorer quality of life (7-8).
The body's response to stress can therefore have a negative impact on skin barrier function and influence the immune response (9). Le stress chronique peut également entrainer une vulnérabilité accrue aux infections et donc une aggravation des lésions cutanées.
Treatment of atopic dermatitis
At present, the treatment strategies employed are mainly symptomatic and consist in modulating the skin microbiome, targeting the innate and adaptive immune system, itching or inhibiting the inflammatory response (2).
The choice of anti-inflammatory treatment is largely based on the severity of the disease. Mild atopic dermatitis can generally be controlled with topical treatments, such as moisturizing creams that help repair the epidermal barrier. In this specific case, the choice of cream formula will be 'person-dependent' and will therefore need to consider criteria such as skin type, body area, dryness and inflammation, as well as individual patient preferences.
On the other hand, more advanced disease may require much more invasive treatment (11), accompanied by undesirable side effects:
Phototherapy: the use of ultraviolet light to treat atopic dermatitis not controlled by topical treatments. This is a therapy whose cumulative long-term adverse effects need to be taken into account, in particular photodamage, skin carcinogenesis and melanoma induction (12).
Systemic treatments: drug treatments only used on moderate to severe forms, with an action to control and block the biological mechanisms of inflammation responsible for the signs and symptoms of atopic dermatitis. Again, these treatments need to be closely monitored, as they contain certain contraindications (particularly for pregnant women).
These treatments, many of which are based on dermocorticoids or antihistamines, are effective in the short term, but what about their long-term effectiveness?
Living with atopic dermatitis
Deleterious consequences for quality of life
Living with atopic dermatitis can significantly impacts quality of life. Chronic itching, visible skin lesions and unpredictable flare-ups can affect sufferers' quality of life.
The persistent symptoms of atopic dermatitis can lead to high levels of stress and anxiety. Indeed, according to several studies (8,11), two-thirds of people with severe atopic dermatitis (67%) admit to suffering from intense periods of anxiety. Worse still, almost half (41%) report episodes of depression.
Visible lesions and physical discomfort can lead sufferers to avoid social interaction and public activities, thereby affecting self-image and self-confidence.
Moreover, this decline in self-esteem is often correlated with stigmatisation, particularly during childhood. According to the same studies (8,11), 7 out of 10 people with severe atopic dermatitis suffered from teasing at school.
But who better to talk about the impact of atopic dermatitis on quality of life than someone who has been affected themselves?
We went to meet Tom, an 18-year-old student, who agreed to talk about the impact of atopic dermatitis on his childhood and adolescence.
"I'd say that my eczema is one of the little battles I'm waging and will continue to wage against my skin. For as long as I can remember, at the slightest stress and particularly at certain times of the year (February-March), eczema flares up on my forearms and neck. I feel really lucky to only have them there! To be quite honest, I've tried various treatments prescribed by different dermatologists, from daily pills to countless day and night creams, but nothing works.
It's complicated, if not impossible for me to manage my stress, so I've got used to living with it! Now everything is better, I don't have as many symptoms as before. On the other hand, some things persist. For example, I can't wear necklaces in the summer when it's hot because the blotches reappear. So, I'm learning to deal with it this way, but I don't have any real long-term solution.”
What strategies are needed to adapt itself to atopic dermatitis?
As Tom points out, there are no long-term treatments for atopic dermatitis, but it can be effectively managed through a combination of preventative coping strategies. The aim is to help reduce symptoms and improve quality of life of sufferers.
According to the Jacques Cartier Clinic in Quebec City, moisturising the skin is essential.
This involves applying fragrance-free and irritant-free creams and soaps as well as showering at an appropriate temperature for no longer than 10 minutes. Avoiding triggers is also essential, especially common allergens and irritants.
Stress management techniques
Stress management is essential for people with atopic dermatitis, as it can exacerbate symptoms or trigger attacks. Some methods are effective in reducing the impact of stress on atopic dermatitis, such as relaxation techniques, yoga and sleep regulation
In fact, 50% of sufferers say that itching disrupts their sleep 5 to 7 nights a week (8,11), when it's vital to ensure a good quality of sleep for stress management and skin health.
What's more, emotional support cannot be overlooked in such a widespread condition. Some organisations are even going so far as to set up support groups for people with atopic dermatitis. These provide a place to share experiences and advice, reducing feelings of isolation.
Among these organisations is the Pierre Fabre Eczema Foundation, dedicated to the fight against eczema, which has been working since 2004 to provide patients and families with information about the disease and its management.
It is also possible and common to consult a professional: talking to a psychologist or psychiatrist can be helpful in learning how to manage the stress and emotions associated with atopic dermatitis.
Finally, cognitive-behavioural therapy is a psychotherapy that focuses on both cognition (thought patterns) and behaviour, with the aim of identifying and changing negative thoughts and behaviours that contribute to stress.
These are useful for working on the anxious state that can cause or be caused by eczema flare-ups, but also for modifying the behaviours associated with the symptoms, such as scratching and sleep disturbance.
Indeed, almost 9 out of 10 patients suffer from daily itching and almost 2 out of 3 adult patients itch for more than 12 hours a day.
The role of nutrition
In this context of multifactorial pathology, it is legitimate to ask how nutraceuticals and nutrition can play a role in preventing and alleviating the symptoms associated with dermatological pathologies such as atopic dermatitis. Nutrition, by food supplements, is increasingly becoming the strategy of choice in the prevention of various health issues. With holistic beauty and In & Out being a growth market, nutraceuticals are positioning themselves as a promising sector, making it possible to target key factors in dermatological pathologies such as inflammation, oxidative stress, preservation of the skin barrier and the microbiome.
According to the literature, fish oil supplements, rich in fatty acids such as omega-3, may be beneficial in improving the skin condition of people with atopic dermatitis or psoriasis (13). They help to reduce inflammatory lesions in the skin and relieve symptoms of dryness and skin irritation by improving hydration and cell oxygenation.
But that's not all: marine peptides have also demonstrated very interesting effects on stress, but also on skin hydration and accelerated healing. By modulating the expression of genes linked to the stress response and preventing the deregulation of proteins induced by stress, marine peptides can prevent the negative effects of stress on our skin (14-15).
Collagen peptides and glycosaminoglycans have also demonstrated beneficial effects on the skin. In particular, they stimulate the synthesis of hyaluronic acid (16), a key molecule in tissue hydration (17-18), which helps to keep the skin deeply moisturised, making it an important ally in the fight against dryness and tightness in skin with an atopic tendency.
Other ingredients are also described for their properties on sensitive and/or atopy-prone skin, such as:
Curcumin, the active ingredient in turmeric, with anti-inflammatory and antioxidant properties (19).
Ceramides and vitamin D, which regulate the skin barrier, controlling its immune functions (19).
Probiotics can modulate the immune system and reduce skin inflammation. They can also help balance the intestinal microbiota, which is linked to skin health.
Quercetin, a flavonoid found in foods such as onions and apples. Quercetin has been shown to have antihistaminic and anti-inflammatory properties, which are particularly useful in cases of allergic asthma, allergic rhinitis and atopic dermatitis (20).
This is a non-exhaustive list, which highlights the crucial role of nutraceuticals in preventing and relieving symptoms in people with sensitive and/or atopy-prone skin.
References :
(1) Williams, 2000 ; Hanifin et Rajka, 1980 ; Lloyd-Lavery et al., 2019
(2) GBD (Global Burden of Disease) 2022.
(3) Global report on atopic dermatitis 2022 – Global Atopic Dermatitis Atlas
(4) Dermatite atopique – symptômes, causes, traitements et prévention – Vidal
(5) Dermatite de contact – Troubles cutanés – Manuels MSD
(6) Ständer S. Atopic Dermatitis. N Engl J Med. 2021;384(12):113643
(7) Misery, L.; Sibaud, V.; Merial-Kieny, C.; Taieb, C. Sensitive skin in the American population: Prevalence, clinical data, and role of the dermatologist. Int. J. Dermatol. 2011, 50, 961–967.
(8) Misery, L.; Myon, E.; Martin, N.; Consoli, S.; Boussetta, S.; Nocera, T.; Taieb, C. Sensitive skin: Psychological effects and seasonal changes. J. Eur. Acad. Dermatol. Venereol. 2007, 21, 620–628.
(9) (Silverberg JI, Lei D, Yousaf M, Janmohamed SR, Vakharia PP, Chopra R, et al. Association of itch triggers with atopic dermatitis severity and course in adults. Ann Allergy Asthma Immunol. 2020;125(5):552-9.e2)
(10) Dermatite atopique - Inserm
(11) Simpson et al., 2017
(12) Rodenbeck et al., 2016
(13) Januszewski et al., 2023 - Nutritional Supplements for Skin Health—A Review of What Should Be Chosen and Why
(14) Dinel, A.L., Lucas, C., Le Faouder, J., Bouvret, E., Pallet, V., Layé, S., Joffre, C. Supplementation with Low Molecular Weight Peptides from Fish Protein Hydrolysate Reduces Acute Mild Stress-Induced Corticosterone Secretion and Modulates Stress Responsive Gene Expression in Mice. J. Funct. Foods. 2021;76:104292.
(15) Le Faouder, J., Arnaud, B., Lavigne, R., Lucas, C., Com, E., Bouvret, E., Dinel, A.L., Pineau, C. Fish Hydrolysate Supplementation Prevents Stress-Induced Dysregulation of Hippocampal Proteins Relative to Mitochondrial Metabolism and the Neuronal Network in Mice. Foods. 2022 May 28;11(11):1591.
(16) Wauquier, F., Boutin-Wittrant, L., Bouvret, E., Le Faouder, J., Roux, V., Macian, N., Pickering, G., Wittrant, Y. Benefits of Circulating Human Metabolites from Fish Cartilage Hydrolysate on Primary Human Dermal Fibroblasts, an Ex Vivo Clinical Investigation for Skin Health Applications. Nutrients. 2022 Nov 25;14(23):5027.
(17) Verdier-Sévrain S, Bonté F. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol. 2007 Jun;6(2): 75-82.
(18) Bukhari, SNA, Roswandi, NL, Waqas, M, Habib, H, Hussain, F, Khan S, Sohail M, Ramli NA, Thu HE, Hussain Z. Hyaluronic acid, a promising skin rejuvenating biomedicine: A review of recent updates and pre-clinical and clinical investigations on cosmetic and nutricosmetic effects. Int J Biol Macromol. 2018 Dec;120(Pt B):1682-1695.
(19) Jagetia et Agarwal, 2007 – Spicing of the immune system by curcumin
(20) Jafarinia et al.,2020 - Quercetin with the potential effect on allergic diseases
Commentaires