Atopic dermatitis on the face [and neck] – what the symptoms and signs look like, treatment principles

At the heart of the development of pathology is a gene mutation. “Atopy” is an atypical reaction to external factors combined with impaired immune system function and dysfunction of the skin barrier.

Atopic dermatitis on the face is most common in children at an early age, causing irritation of the skin on the cheeks, accompanied by redness, dryness, unevenness, and severe itching. A variant of the manifestation of atopy in children is a rash of small weeping vesicles. Skin rashes in children provoke scratching, as a result of which the damaged areas of the skin bleed, get wet, and crusts form on them. Atopic dermatitis on the face in adults is less common and manifests itself in the form of light pink rashes, most often affecting the eye area. In addition to physical discomfort (inflammation, dryness, tightness, peeling, itching, sometimes even leading to insomnia), adults also experience psychological discomfort, since the manifestations of atopy on the face are clearly visible to others.

Why does atopy occur on the face?

In addition to genetic predisposition, the causes of atopy on the face can be hormonal disruptions, unfavorable ecology, malnutrition, irritability, anxiety and stress, sleep and wakefulness disturbances.

In children, about a third of cases of atopic dermatitis are provoked by allergies. The course of the disease may be associated with hypersensitivity to allergens, which for infants and young children are mainly milk, eggs, wheat; less often – fish and nuts. In adolescents, food irritants often become fish, nuts, apples, raw carrots.

Adults, among other things, react to volatile allergens: animal hair, plant pollen, dust mites. In addition, in adults, psychosomatics can play a significant role in the appearance of atopic dermatitis (as a result of low self-esteem, increased anxiety, conflicts in the family or in the team, professional burnout, etc.).

Forms and stages of atopic dermatitis

There are three age-related forms of atopic dermatitis:

• infantile, or exudative – manifests itself at the age of 2-3 months to 2 years, often aggravated in the spring and autumn (red-bluish spots, nodules, vesicles, erosion);
• nursery, or erythematous-squamous – typical for children from 2 years to puberty (dry skin covered with grooves and small-lamellar scales, small flat and follicular nodules);
• adult, or pruriginous – manifests itself in puberty and adulthood (small dense nodules and vesicles that do not open and do not form erosions).

Atopic dermatitis is a relapsing disease that has both acute phases and periods of remission. At light form of the disease, exacerbations are observed 1-2 times a year in limited areas of the skin, moderate the course is characterized by widespread skin lesions with moderate itching and exacerbations 3-4 times a year. At heavy form, there is a diffuse (large-scale) skin lesion with constant severe itching and frequent relapses, with exacerbations of 5 or more times a year.

There are the following stages of the development of the disease:

• initial stage (redness and swelling of the cheeks, slight peeling, scales);
• The stage of exacerbation, or the stage of pronounced changes: – acute phase (itching, blisters, redness, multiple scratching and erosion, weeping areas, seizures and cracks on the lips); – chronic phase (dry skin, thickened plaques, underlined skin pattern – grooves);
• remission stage: – incomplete remission / subacute phase (redness, peeling, scratching, including against the background of skin tightening); – complete remission (symptoms gradually fade until complete disappearance);
• Complete clinical recovery (no symptoms for 3-7 years).

Principles of treatment of atopic dermatitis on the face

Treatment of atopic dermatitis is always individual and is prescribed by a specialist dermatologist after a comprehensive diagnosis. To improve the condition of the skin, eliminate symptoms and, ultimately, achieve a sustainable remission or complete cure, a systematic approach is used:

• Diet (prefer boiled, stewed and baked dishes; drink plain water in sufficient quantities; do not overeat; maintain a balance of proteins, fats, carbohydrates).
• Exclusion of allergens, that is, control of the patient’s environment (regularly clean and ventilate the premises; minimize interaction with animals; exclude from the diet those products to which an allergic reaction has been proven and an exacerbation of the skin process occurs.
• Systemic pharmacotherapy in accordance with the doctor’s prescription.
• Skin care (including cosmetics for moisturizing and softening the skin, bath oils).
• Rehabilitation, lifestyle correction (healthy sleep, exercise, etc.)

Fundamentals of daily care for atopic skin

Damaged skin requires careful daily care. In particular, it is recommended:

• Wash your face no more than twice a day, do not steam your face with hot water, do not rub your face with a towel, but gently blot.
• Use mild cleansers.
• Moisturize and nourish the skin with special creams, lotions and ointments.
• Use humidifiers to maintain the optimal humidity in the room of 30-40%.
• Protect your face from direct sunlight.
• Use special protective cosmetics from exposure to the sun or low temperatures.
• Adult women are advised to carefully select decorative cosmetics, and men – to be careful when shaving. Avoid getting alcohol-containing perfumes on the affected skin.

La Roche-Posay cosmetics for atopic skin

Skin prone to atopy has a broken skin barrier, against the background of lipid deficiency and accelerated loss of moisture, dryness and hypersensitivity of the skin develop, and, as a result, the skin requires careful daily care.

La Roche-Posay products from the Lipikar(2) range were developed in collaboration with dermatologists specifically for the care of dry, sensitive and atopic skin:

LIPIKAR BAUME AP+M(3)

Triple action balm for face and body

A universal product that can be used by both adults and children from infancy. Lipid-replenishing balm provides an immediate moisturizing and soothing effect on dry skin, helping to reduce itching and irritation. Helps keep skin hydrated for up to 48 hours(4). The balm regulates the skin microbiome, contributes to the restoration of the protective function of atopic-prone skin, and significantly contributes to the prolongation of the remission period.

LIPIKAR SIN AP+(5)

Cleansing cream-gel for the face and body of babies, children and adults

A universal product without perfumes, can be used by both adults and children, including infants from the first days of life (6). Does not contain soap and parabens. Instantly softens the skin and reduces the feeling of tightness immediately after washing.

LIPIKAR AP+ OIL Emollient bath and shower oil

The tool has been tested under the supervision of dermatologists and pediatricians, can be used by both adults and children from infancy. Suitable for dry, very dry and atopic skin. The unique patented ingredient Aqua Posae Filiformis(7), which is a lysate of Vitreoscilla Filiformis(8), grown in La Roche-Posay thermal water rich in Selenium, helps to restore the skin microbiome and strengthen its protective barrier. Formulated with niacinamide to soothe and comfort skin, while Shea Butter provides intense lipid replenishment to help reduce dryness and tightness.

THERMAL WATER LA ROCHE-POSAY

Mineral-rich thermal water, when sprayed on the face, instantly moisturizes and softens the skin, relieves discomfort, soothes the skin and. It has a high content of selenium, a powerful natural antioxidant that protects human skin from the negative effects of free radicals. Helps slow down the aging process of cells, protects against the effects of UV radiation (9).

1 Schultz-Larsen F. Atopic dermatitis: a genetic epidemiological study in a population-based study of twins. Journal of the American Academy of Dermatology 1993; 28: 719–23, B. Taylor, J. Wadsworth, M. Wadsworth. Changes in the prevalence of childhood eczema since the 1938-45 war. Lancet. 1984; 2: 1255–1257.

2 Lipikar

3 Lipikar balm Ape+M

4 Instrumental test, 26 participants

5 Lipikar Syndet Ape+

6 For babies born after 37 weeks of gestation

7 Aqua Pose Filiformis

8 Vitreoscilla Filiformis

9 UV radiation