By Dr. Martine Avenel-Audran
The skin of patients with atopic dermatitis is drier than normal skin, and as a consequence, the skin barrier is weakened and more permeable to allergens. It is therefore recommended to use cosmetics "for sensitive skin" that do not contain the most high-risk allergens, particularly fragrances.
Using fragrances and fragranced products is not recommended for atopic patients, especially infants and children, and this includes the "eaux de parfum" now marketed for babies.
In adults, perfume can be used occasionally, but it is preferable to apply it to clothes rather than directly onto the skin.
The face should be cleansed using a syndet (soap-free cleansing product) or a rinse-off milk or lotion. Next, after drying skin gently by dabbing, it is recommended to apply a non-fragranced day cream.
Deciding whether to opt for a thick or fluid texture depends on the severity of skin dryness, and more importantly, the comfort provided. The same principle applies to choosing an emollient cream for the body.
For more information about the different textures : leaflet_peau_et_galenique_eczema_atopique.pdf
There are no specific guidelines for washing hair. It is preferable to opt for a non-fragranced shampoo, however, it is important to be aware that certain "gentle" foaming agents are often used, such as cocamidopropyl-betaine, which pose a high allergy risk in atopic patients.
Hair color treatments and color removal products
These products also present an allergy risk but it is no greater in atopic patients than non-atopic patients.
These products always contain fragrances. Furthermore, they sometimes contain protein hydrolysates (mainly from wheat) that are likely to provoke severe allergies.
Hairspray has the disadvantage of being both fragranced and in spray form, and is therefore likely to come into contact with the skin or respiratory tracts.
Other hair setting and volumizing products
Setting gels, creams or other oils are a good alternative because they do not come into contact with the skin.
However, many atopic patients can use these products without any problem.
Nonetheless, if the scalp becomes itchy, it is important to investigate the potential cause.
Various dermo-cosmetics manufacturers offer a range of make-up for sensitive skin.
A hydrating, tinted cream is often enough to even out the complexion when eczema is not present. In the case of face eczema, after applying treatment (topical corticosteroids or tacrolimus), a thicker foundation or even a compact can be used to conceal lesions.
For eyelids, it is advisable to wait until the eczema has healed before using eyeshadow or mascara, and to always use a range specifically for "sensitive skin".
Make-up can be removed with micellar lotion or a non-fragranced make-up removing lotion, however, even if the label states that it is "no-rinse", the product should be rinsed off with water.
Using a thermal water spray can be a pleasant way to finish off make-up removal.
Nail polishes that are fragrance- and formol-free should preferably be used. Semi-permanent nail polishes and the glue for false nails are made from acrylic resins that can be sensitizing.
It is advisable to have false nails applied by a professional as the risk of contact with the fresh, highly sensitizing resin is less likely than with home-use kits.
The odors from perspiration are caused by dead skin cells and bacteria which colonize certain areas such as the underarms, the genital regions and the soles of the feet.
Using a deodorant every day is not essential: most of the time, proper daily cleansing of these areas in the shower with soap is enough.
In cases of excessive perspiration, using a deodorant (which conceals odors) or an anti-perspirant (which reduces the quantity of sweat) may be advisable.
To limit the risk of irritation, it is preferable to opt for an alcohol- and fragrance-free stick or roll-on bottle.
Epilation causes skin inflammation around the hair follicle, which can risk aggravating eczema. Therefore, it is not advisable to epilate areas where eczema is present.
On the other hand, patients can epilate the areas which are free from eczema.
It is advisable to avoid:
- using hair-removal creams (often fragranced to camouflage the smell of sulfur associated with the presence of thioglycolate)
- regular shaving with a razor, as the blades contain nickel which is a potential allergen
- depilatory waxes, whether hot or cold, because they contain derivatives of colophane which is also a potential allergen
It is preferable to use tweezers on the facial areas or an electric epilator on the legs.
Hair can also be removed permanently in a few sessions. The efficacy of this treatment depends on the darkness of the hair color. It can be performed by a specialized dermatologist using depilatory lasers or intense pulsed light.
It can be expensive, and the price varies depending on the establishment.
These products artificially stain the uppermost layer of the skin and are naturally eliminated when the skin regenerates.
Given that the majority of self-tanners contain fragrances, they should only be used occasionally.