What Your Dermatologist Will NEVER Tell You About Eczema (that you need to hear immediately)
The skin condition in which the skin is very dry, itchy, and flaky is called eczema, or atopic dermatitis. The barrier of the skin is compromised. Most babies who experience eczema or atopic dermatitis do also later in adulthood, and there is a connection to allergy (called the allergic triad) in which individuals who are afflicted with eczema may also have asthma and rhinitis (a runny nose that is triggered by allergy).
Eczema is not a deadly condition. Researchers don’t spend much money to discover something more about it, because many people who do not have severe eczema do not understand that it really is impactful to your physical, mental, and emotional wellbeing, and that living with endless suffering, as in any other condition, is not really adequately quality for life.
Patients usually spend sleepless nights with scratching, waking up with bloody sheets, have showers that are painful and sore, itching with stress and sometimes itching for no reason at all, and not knowing the causes from one day and the next. The peeling skin from cortisone, and sometimes the need for cortisone shots, antihistamines, immune-suppressants to stop the immune response are all just a small percentage of the real problems that these people are facing with. All these people want to do is just stop scratching.
What your dermatologist won’t tell you?
Dermatologists have an excellent knowledge on our skin since they are trained in that organ. However, sometimes when we look at one organ exclusively, we are more apt to see symptoms only rather than cause. Eczema is a tough condition to discover, because where the pathology lies is often deeper than the skin’s surface. There are ways to reduce the inflammation associated with eczema, and there are known triggers which can aggravate an immune response.
Every patient with eczema has its own different triggers. There are however a series of patterns which really seem true.
Everything that may help eczema seeks for time and patience. Many patients who are itchy and sore just want relief. You’ll just have to ask yourself whether you want a momentarily relief or you want to get to the bottom of the problem?
Triggers like food allergies that often go undiagnosed for those with eczema since the methods of testing are unfortunately not covered, or very rarely discussed within our medical system. OHIP does not cover either IgE blood testing for foods or IgG delayed-type hypersensitivity blood testing for foods, and as a result, it is expensive for patients to pay out-of-pocket for every potential trigger, which can be many. IgE skin scratch tests offer mostly false negatives for those with skin issues and it does not react when it is supposed to, but it mostly does when it should not.
So what are the triggers for eczema?
The breakdown in eczema is in the innate immune system. This is the part of the immune system that is responsible for telling the body what is foreign and what is not in the skin, lungs, and gastrointestinal tract from the moment we emerge from our mother’s womb. It makes sense, because when we are babies, these are the major ways we can succumb to infection. Unfortunately, if one part of this system is affected by something seen as “foreign”, then we know the other parts of the system are struggling.
Researches demonstrate that the gastrointestinal tract is where this breakdown occurs, and it can often occur before birth. Mothers who are given good bacteria or probiotics, and specific strains of probiotics that balance a very reactive innate immune system, do prevent and reduce the incidence of eczema in children of mothers with eczema or a genetic connection to eczema. Bacterial balance in the gastrointestinal tract is a very important part of eczema management.
Eczema breakouts occur reliably with certain foods. These food groupings have allergy potential, and some types of eczema are more prone to allergy (IgE-associated atopic dermatitis) versus those that are not IgE-associated. IgE is an immunoglobulin or protein produced by our body in the response to allergy.
What has been linked with eczema is food like: dairy proteins, wheat and wheat gluten, tomatoes, citrus and citrus juices, nuts, certain fruits (apples from specific trees that have links to oral allergies, peaches and cherries from the prunus family) potatoes, and refined and synthetic sugars. Many people react differently to these foods, so evidence is mostly inconclusive. That does not however mean that we should discount all of the research completely! It means that it will take more work to determine what the cause is. Food allergies are the leading culprit in eczema.
Hormone systems can be also added, as stress and stress hormones have the ability to increase inflammation. Stress hormones and the hormone connection can also be an important contributor in eczema.
Chronic inflammation is an ongoing issue in eczema. Corticosteroids help with the local inflammation, but they do not support systemic inflammation. Important things like good quality omega-3 oil can really support inflammation pathways and act like cortisone and cortisol, but they can also help to support the production of a good skin barrier. The skin barrier and its inability to stay intact and produce adequate oils as a protectant is an issue in eczema.
My immune-suppressants are doing the job, so why should I care about getting to the root cause?
Immuno-suppressants like Tacrolimus as in Protopic and Elidel are wonderful to get flare ups under control, and at many points restore quality of life. The side-effects can be intense, and these interventions have links to carcinogenesis. However, to prevent further risk from their use it is important to find the root cause.
What can you expect your life to look like with eczema when you find out your triggers?
Patience is definitely a virtue. You may continue to need to rely on cortisone or other immune-suppressants but you may be able to reduce the amount that you depend on them. You may need to handle your stress differently than your friends. You may not be able to eat whatever you want, but everything will be OK.
You will still need to apply good quality moisturizers, like, for example, Pure + Simple, La Roche Posay, Eucerin, Cetaphil, Keri that will help you with dryness and keep your skin barrier intact, but perhaps less as your skin barrier might be a little more resilient than it normally would be. You can expect to have an improved quality of life, which is ultimately what all of us wish to have. So, there’s still something good after all! Be patient and keep going! Everything will be fine!