National Eczema Association’s view on stress causing eczema

A nice piece from Dr Peter Lio at the National Eczema Association (USA):

I’d like to conclude with some thoughts about stress, the mind, and the psyche. There was a study in 2003 that showed very clearly that not only did stressful events worsen folks’ atopic dermatitis but they actually slowed down the barrier function healing of their skin. Another study of non-eczema patients found that their skin barrier function started to break down when presented with psychosocial stress or sleep deprivation.

A study that came out last year involved patients viewing a humorous film and sampling their B cells (the immune cells that make the immunoglobulin allergy proteins) before viewing and after. After the humorous film, the allergy proteins were decreased significantly. It’s interesting, this idea that your mood and your state of mind could change something so quickly. In my experience, it does seem to bear out that more optimistic patients do seem to have better outcomes and are able to get their eczema under control more easily. And this has struck me again and again as important.

Taking care of your skin and taking care of yourself from a mind/body holistic perspective, not to sound too flaky, really does seem to help. I think it helps your skin and it helps the rest of your body and mind, and that cannot be overemphasized.

On the other hand, we know that having eczema does not mean you’re doing something wrong. I want to make sure that message is clear. It doesn’t mean you screwed up, it doesn’t mean you’re a bad parent for your child with eczema, it doesn’t mean that you’re not “holistic” or “balanced.” You shouldn’t blame yourself for it. We know this is a real disease and it is not just in anybody’s mind.

Source: http://www.nationaleczema.org/articles/everyday-skin-care-maintaining-skin-integrity-and-avoiding-inflammation

The inherited skin barrier defect

Our daughter’s paediatrician mentioned that both myself and my daughters’ father have something called the filaggrin gene mutation. He came to that conclusion from seeing the skin we had: our palms are excessively lined (“hyperlinear palms”) and our skin is somewhat dryish and scaly on the back of our hands, feet, forearms and lower half of our legs (very mild form of “ichthyosis vulgaris”).

Filaggrin is a very important protein that acts as our skin’s natural moisturiser and barrier. 

Dr Amy Stanway, Department of Dermatology, Waikato District Health Board (2004) writes on the New Zealand Dermatological Society Incorporated website (DermNet) that:

There is emerging evidence that inflammation in atopic dermatitis results primarily from inherited abnormalities in the skin – the skin “barrier defect”. This barrier failure causes increased permeability of the skin and reduces its antimicrobial function.

An inherited abnormality in filaggrin expression is now considered a primary cause of disordered barrier function. Filaggrins are filament-associated proteins which bind to keratin fibres in the epidermal cells. The gene for filaggrin resides on Chromosome 1 (1q21.3). This gene was first identified as the gene involved in ichthyosis vulgaris.

It is postulated that the loss of filaggrin results in:

• Corneocyte deformation (flattening of surface skin cells), which disrupts the organisation of the extracellular lipid (fat) – the lamellar bilayers.

• A reduction in natural moisturising factors, which include metabolites of pro-filaggrin.

• An increase in skin pH which encourages serine protease activity – these are enzymes which digest lipid-processing enzymes and the proteins that hold epidermal cells together. Serine proteases also generate active cytokines like IL-1a and Il-1beta and promote skin inflammation.

A great diagram showing all this is provided on ThePaleoMum.com’s post on “Overcoming Medical Dogma – Eczema”:

What does this mean?

Our daughters will have inherited this faulty gene and would genetically have dry skin, prone to skin reactions and inflammation. So, it is even more important (even without the eczema) to protect this poor skin barrier by hydrating it and keeping it intact as much as possible, and keep on top of it! Eczema may also be a more chronic issue for our daughter i.e. eczema will be more persistent for her than for other children who do not have the gene mutation. The American medical research  is nicely summarised on the End Eczema blog’s post “Filaggrin mutation means more persistent eczema”.

Does this gene affect you / your child too?

For more reading, see the list below:

A New View on the Roots of Itchy Skin by Ingfei Chen  (published in The New York Times, 24 April 2008)

The allergy gene: how a mutation in a skin protein revealed a link between eczema and asthma by W. H. Irwin McLean (published online, 14 January 2011)

Atopic Eczema and the Filaggrin Story by Sara J. Brown, MBChB, BSc, MRCP,* and Alan D. Irvine, MD, FRCPI (2008)

Selective Ablation of Ctip2/Bcl11b in Epidermal Keratinocytes Triggers Atopic Dermatitis-Like Skin Inflammatory Responses in Adult Mice by

Ichthyosis vulgaris

New Zealand Dermatological Society Incorporated (DermNet)

British Association of Dermatologists – Ichthyosis

Foundation for Ichthyosis & Related Skin Types (USA)

Ichthyosis vulgaris: the filaggrin mutation disease by  Thyssen JP, Godoy-Gijon E, Elias PM. (published online 6 May 2013).

The Eczema Diet by Karen Fischer

I recently purchased this book after seeing it on the shelf at Commonsense Organics Wakefield Street. I flicked through a few pages and HAD to buy it!

It has been a very informative read. It talks about the specific nutrients that eczema-prone people lack / need more of to nourish the skin & stop the itch/flares, about the food items that contain amines (or is histamine producing!), and about the alkalinity and acidity of foods (excess acid -> more itch). It all makes sense and is a very straightforward read backed by science & research.

I’d recommend getting hold of this at your local library or store! We haven’t yet done the whole “diet” yet though, but I have already learnt in the past about what does cause histamines & itch for my daughter by close observation – this book just helps even more and I reference the book a lot when prepping food for my daughter.

Check out Bamboo Bubby’s  detailed review on The Eczema Diet for more info on the book.

The commercial description on the book is also copied & pasted below:

The Eczema Diet by Karen Fischer
Eczema-safe food to stop the itch and prevent eczema for life.

‘… a beautifully presented and practical book that will be a valuable and powerful tool for improving the general health and the skin of millions of eczema sufferers around the world.’
Dr Gary M. Leong, Mater Children’s Hospital, Queensland

For the first time, the findings of hundreds of international researchers and skin specialists have been pieced together to solve the eczema puzzle. The result is the first diet designed to correct the underlying causes of eczema so you can gradually go back to a normal diet and remain eczema-free.

Whether you have a mild patch of dermatitis or you’re enduring chronic eczema from head to toe, The Eczema Diet shows you how to create beautiful skin for life. Tried and tested for more than a decade, the comprehensive program covers all eczema conditions and features separate programs catering for all age groups, including babies.

You’ll also find:

– a fast-track detox for adults
– skin care + non-diet information
– effective dandruff + cradle cap remedies
– emergency itch-busters
– how to prevent salicylate sensitivity
– menus for the entire family, including lunch boxes + party food
– delicious recipes

Vicious Circle of Atopic Eczema

Atopic eczema all starts with the itch, which then gets driven by toxins produced by Staph. aureus once there is broken skin and continuous scratching and re-breaking of skin.

1. Itchy, dry skin
2. Scratching breaks the skin surface.
3. Lesions begin to weep.
4. Staphylococcus aureus (Staph. aureus) infect skin and colonise weeping lesions.
5. Toxins that are released by the Staph. aureus stimulate the body’s natural immune response.
6. The person’s mast cells release histamine. Mast cells are the tissue cells of our immune system – refer to Britannica Encyclopedia or Wikipedia. Immune system proteins called antibodies, which are bound to mast cells, bind to foreign substances/antigens (in this case, the Staph. aureus toxins) to remove them, but in the process the mast cells are stimulated to release their histamines.
7. Histamine causes inflammation and itch.

And then we have itchy, dry skin again….and the circle continues until we stop it by ensuring there is no more breaking of skin…

Source: a photo we took of the educational material that was shown to us during one of our consults by the Eczema Nurse of the Paediatric Community Nursing Team, Child Health Service, Wellington Hospital, Capital & Coast District Health Board.