Main symptoms
- •Marked skin dryness (xerosis)
- •Intense itching — cardinal sign
- •Red, oozing or crusty plaques
- •Sites: elbow/knee folds, face, neck, hands
- •Lichenification (thickened scratched areas)
- •Flare-up evolution
- •Atopic background (asthma, rhinitis, allergies)
- •Sleep disturbance (night itching)
Risk factors
- ⚠️ Family atopic history (×3)
- ⚠️ Filaggrin gene mutation
- ⚠️ Urban life, excessive hygiene
- ⚠️ Pollution, passive smoking
- ⚠️ Food allergens (infants)
- ⚠️ Dust mites, pollen, animal dander
- ⚠️ Stress
- ⚠️ Dry climate
Management and treatments
**Daily baseline**: emollients 1-2x/day (Dexeryl, Lipikar, Atoderm) — for life. **Flares**: topical steroids by zone (low potency on face, higher on body) for 5-14 days. **Tacrolimus** topical (Protopic) face/eyelids. **Oral antihistamines** for night itching. **Antibiotics** for superinfection. **Severe**: UVB phototherapy, ciclosporin, methotrexate. **Dupilumab** (Dupixent) very effective, available in Morocco, costly.
Prevention
Daily emollient moisturising, short lukewarm showers, lipid-rich/syndet cleansers, allergen avoidance, short nails, cotton clothing (avoid wool), stress management, breastfeeding > 4 months (protective).
Frequently asked questions
Does it disappear at adolescence?+
60-70% improve at adolescence. 30% persist into adulthood.
Are topical steroids dangerous?+
Not when properly used: appropriate potency, short duration, emollient maintenance. Steroid phobia is unjustified (HAS).
Link with food allergies?+
In eczematous infants, 30-40% have food allergies (egg, milk, peanut). Test if severe eczema.
Does stress worsen it?+
Yes — increases itch perception and triggers flares. Relaxation + CBT helpful.