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  • Kayla Springer

Eczema Basics

Eczema is an umbrella term often used to describe the relapsing-remitting cycle of dry, itchy, rashy skin.



Highlights

  • Eczema commonly starts with dry, itchy skin. The scratching is what turns it into the angry, red rash we’re so familiar with.

  • It’s most commonly found in the skin flexures – the elbow patches, knees, neck

  • It can affect all age groups, but it is most commonly diagnosed before 5 years of age and affects 10% - 20% of kids. About half will outgrow it before adulthood.

  • Diagnosis is primarily clinical and based on symptoms.

  • Atopic Dermatitis is the most common form and is part of the “atopic triad,” along with asthma and allergies.

  • Approximately 70 percent of patients have a positive family history of atopic diseases.

  • Most common triggers: food, stress, irritants, and environment

  • Incidence of eczema is increasing 2- to 3x in industrialized nations since the 1970s.

  • Western treatment approaches: First-line treatment is with emollients and topical corticosteroids. Other options that may be used in patients unresponsive to first-line therapy include topical calcineurin inhibitors, phototherapy, or immunosuppressive agents.




Phases




Most Common Types

Atopic Dermatitis (most common)

  • Allergic disease and part of the “atopic triad” and is often found with asthma and allergies.

  • Approximately 70 percent of patients have a positive family history of atopic diseases.

  • It’s most commonly found in the skin flexures – the elbow patches, knees, neck etc


Contact Dermatitis

  • Allergic: delayed rxn to some allergen (poison ivy)

  • Irritant: occurs when chemicals or physical agents damage the surface of the skin faster than the skin can repair the damage







Xerotic Dermatitis

  • Worse in winter and cold, dry water

  • Limbs and trunk most often affected







Seborrheic Dermatitis

  • Closely related to dandruff

  • Causes a dry or greasy peeling of the scape, eyebrows, face and torso

  • Recommendations suggest using topical steroids no longer than 3 months at a time, and no longer than 5 weeks for high potency steroids. Unfortunately, this often goes unchecked and patients often end up using topical steroids much longer.



Causes and Risk Factors


Genetic Disruptions in skin barrier – fillagrin

Some studies have demonstrated that the development of atopic dermatitis shows genetic linkage to chromosome 1q21, which causes mutations in the filaggrin gene, This gene encodes a protein necessary for terminal differentiation of epidermis, can result in impairments in the barrier function of the epidermis result in increased exposure and sensitization to cutaneous antigens.


Genetics and Family history:

Approximately 70 percent of patients have a positive family history of atopic diseases. Eczema is one of these atopic diseases, the others being asthma and allergies.


Birth and childhood

Early childhood experiences can cause epigenetic and subsequent developmental changes. Whether you were born vaginally or via c-section, as well as if you were breast fed or bottle fed, can have drastic effects on the microbiome. Food introduction schedule and types also play an important part in the development. Where you grew up, including environment allergen exposure such as pollens and pets also play a part. Vaccinations and toxin exposure can increase the toxic body burden and cause the body to have more trouble detoxing.


Gut health and Microbiome status

The state of our skin almost directly correlates to the state of our gut health. Food sensitivities, poor diet, yeast and toxins, and an imbalanced microbiome can cause irritation of the local immune system in the gut, leading to leaky gut and subsequent inflammation in tissues such as the skin.


Immune system balance

Those with eczema and atopic conditions are often what is called “TH2 dominant”. This means that a certain branch of the immune system is overactivated, leading to increased incidence of allergies, cancer, and certain autoimmune diseases.


Toxic load

When our body’s are overburdened with more toxins than they are able to excrete, they can come out in the skin. This can cause a direct irritation, as well as systemic inflammation leading to more immune system activation and allergic tendencies in general.



Treatment


Each person is unique, and each person will have different requirements and imbalances. A number of treatment options are available and may work in different combinations for different people.These will likely need to be adapted and customized for each person and changed throughout the process according to cycles and symptoms.


Some of the modalities I use:

  • Diet and nutrition therapies

  • Herbal medicine

  • Acupuncture and Chinese medicine

  • Supplements, and orthomolecular medicine

  • UNDAs and biotherapeutic drainage

  • Light and phototherapy

  • Hydrotherapy

  • IV therapy

  • Pharmaceuticals (if required)

  • Moisturizer withdrawal

Click here to check out more about the modalities I use



Topical Steroid Withdrawal


Some people who use topical steroids may develop a condition called topical steroid withdrawal (TSW). TSW is a severe, inflammatory skin condition that looks like eczema, but has distinct patterns and cycles. It can take anywhere from 1-5 years for this condition to burn itself out, for our skin to detox from the steroids, and our body to rebalance itself.


For some, what they think is worsening eczema may actually be topical steroid withdrawal.




Learn more about the Course

Learn more about Topical Steroid Withdrawal






Works Cited

1. Weidinger S, Novak N. Atopic dermatitis. Lancet2016; 387:1109. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section

2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatoly 2014; 71:116.

3.Sidbury R, Davis DM, Cohen DE, et al. Guidelines of care for the management of atopic dermatitis: section

4. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327. Eichenfield LF, Tom WL, Chamlin SL, et al.

5. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014; 70:338.

6. Spuls PI, Gerbens LAA, Simpson E, et al. Patient-Oriented Eczema Measure (POEM), a core instrument to measure symptoms in clinical trials: a Harmonising Outcome Measures for Eczema (HOME) statement. Br J Dermatol 2017; 176:979.

7. Tollefson MM, Bruckner AL, Section On Dermatology. Atopic dermatitis: skin-directed management. Pediatrics 2014; 134:e1735.

8. Ersser SJ, Cowdell F, Latter S, et al. Psychological and educational interventions for atopic eczema in children.

9. Cochrane Database Syst Rev 2014; :CD004054. Staab D, Diepgen TL, Fartasch M, et al.

10. Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ

2006; 332:933.

11. Langan SM, Williams HC. What causes worsening of eczema? A systematic review. Br J Dermatol 2006; 155:504.

12. Langan SM, Bourke JF, Silcocks P, Williams HC. An exploratory prospective observational study of environmental factors exacerbating atopic eczema in children. Br J Dermatol 2006; 154:979.

13. Ellis C, Luger T, Abeck D, et al. International Consensus Conference on Atopic Dermatitis II (ICCAD II): clinical update and current treatment strategies. Br J Dermatol 2003; 148 Suppl 63:3.

14. Darsow U, Laifaoui J, Kerschenlohr K, et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a

European multicenter study. Allergy 2004; 59:1318.

15. Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol 2014; 31:21.

26. Garritsen FM, ter Haar NM, Spuls PI. House dust mite reduction in the management of atopic dermatitis. A critically appraised topic. Br J Dermatol 2013; 168:688.

27. Nankervis H, Pynn EV, Boyle RJ, et al. House dust mite reduction and avoidance measures for treating eczema.

28. Cochrane Database Syst Rev 2015; 1:CD008426.

29.Kjaer HF, Eller E, Høst A, et al. The prevalence of allergic diseases in an unselected group of 6-year-old children. The DARC birth cohort study. Pediatr Allergy Immunol 2008; 19:737.

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