Eczema Clinical Protocol

Eczema is an inflammatory skin condition that is most prevalent in children due to an allergic response hyperactive IgE activity from the Langerhan cells and other dermal dendritic cells in the epidermal layer.  The condition is commonly localised to the neck, hands, feet and flexures such as the elbows and the backs of the legs.   During the acute stages of eczema dermal blood vessels undergo vasodilation making them more permeable causing plasma to leak into a localised area resulting in oedema. The oedema manifests itself as small blisters on soft skin that rupture producing exudate and crusting. On hard skin such as the hands and feet the blisters conjoin and bubble known as ‘polypholyx’. During the chronic stage inflammation reduces and the area that has been aggravated through itching and rubbing is painful and forms a thick horny layer known as lecification. 

 Symptoms

·         Tiny blisters conjoining to form larger blisters called ‘pompholyx’ on the soles of the feet or hands

·         Skin will be red and swollen accompanied by itchiness and warmth to touch 

·         Lecification due to the skin being aggravated though itching and rubbing

·         exudate and crusting 

Pathophysiology

This may be a combination of genetic and environmental factors.

If both parents have atopic conditions such as asthma or hayfever

the child is 70% more likely to have an atopic condition in the

infant years that occur as flare ups during adult life when under

stress. Clusters of interleukins IL-3,IL-4,IL5 and IL-13(TH2

cytokines)on chromosome 5q have been associated with atopic

lesions .

T-Helper 2 (TH2) cell up-regulation results in a down-regulation

of T-Helper 1 (TH1) cells. TH2 dominance increases the synthesis of inflammatory cell mediators; Immunoglobulin E (IgE) and T-lymphocytes which activates Langerhan cells and other immune supportive dermal cells in the epidermal layer. This can cause innocuous endogenous molecules (ie: pollen and dust) to react as antigens. 

Digestion seems to be major factor related to flare ups. Low levels of HCl production combined with leaky gut and dysbiosis trigger allergic reactions to food such as milk, peanuts and gluten proteins. In addition poor fat metabolism may relate to a thin epidermal layer in atopic eczema causing lesions and scaling of the skin.

Medical Management

Medicines such as oral or topical corticosteroids are used to reduce inflammation and antihistamines to reduce itching.  If the eczema becomes affected by bacteria antibiotics are also prescribed. 

Clinical Considerations

·         Food allergy testing may be useful to help eliminate certain allergens from the diet.

·         Stools Analysis to check fat metabolism and for the presence of bacteria

·         Drugs such as Ibuprofen may cause a leaky gut

·         Low stomach acid may affect the breakdown of proteins and cause bacterial overgrowth.

·         Poor liver function causing toxic overload has been related to poor skin conditions

Nutritional Support

·         Quercetin is a flavonoid that has been shown to exhibit broad immune modulating   effects[1],[2].

·         Omega 3 fish oils during pregnancy may reduce the risk of food allergy and eczema in children. There may be additional anti-inflammatory effects of EPA and DHA in early immune development through bioactive lipids and T-cell suppression^[3],[4],^[5].

·         Omega 6 can improve a range of skin problems in eczema especially when GLA is combined with Omega 3^[6]. PUFAs in general tend to be deficient in those with itchy, dry skin[7]

·         MSM sulphur acts as an anti-inflammatory and cleanses the system

·         Zinc is supportive to the skins integrity to reduce inflammation and encourage wound healing[8]

·         Vitamin D acts as an immunomodulator of dendritic (Langerhan) cell activity[9]  

·        Digestive Enzymes and HCl  to support the digestion of proteins to reduce allergen response.

·         Probiotics for the colonization of the neo nate GI tract by healthy intestinal microbial flora to support the balance of TH1/Th2 immunity[10].

Dietary Changes

·         Gluten, dairy and egg proteins may act as antigens causing an allergic response

·         Exogenous toxins such as household cleaning products, shampoos and creams may cause a toxic overload on the liver

·         A rich diet in antioxidants may reduce toxic overload and support an anti-inflammatory process

·         Oily fish, nuts and seeds 3-4 times a week may help support the skin barrier integrity

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[1]Welton AF, Tobias LD, Fiedler-Nagy C, et al. (1986) Effect of flavonoids on arachidonic acid

metabolism. Prog Clin Biol Res;213:231-42

[2]  Anti-inflammatory and anti-allergic properties of flavonoids. Prog Clin Biol Res 1986;213:471-

80 [review])

[3] C. Furuhjelm, K. Warstedt, J. Larsson, M. Fredriksson, M. Fageras Bottcher, K. Falth-Magnusson, K. Duchen. Fish oil supplementation in pregnancy and lactation may decrease the risk of infant allergy, Acta Paediatrica

[4] Horrobin DF. Essential fatty acids in clinical dermatology. J Am Acad Dermatol 1989;20:1045–53.

[5] Henz, Jablonska, van de Kerkhof, Stingl, Blaszczyk, Vandervalk, Veenhuizen, Muggli and Raederstorff (1999), Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. British Journal of Dermatology, 140: 685–688. [Abstract] http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2133.1999.02771.x/full

[6] Miller CC, Tang W, Ziboh VA and Fletche MP (1991) Dietary Supplementation with Ethyl Ester Concentrates of Fish Oil (n-3) and Borage Oil (n-6) Polyunsaturated Fatty Acids Induces Epidermal Generation of Local Putative Anti-Inflammatory Metabolites Journal of Investigative Dermatology  96: 98–103[Abstract] http://www.nature.com

[7] Hallahan G and Garland MR (2004) Essential fatty acids and their role in the treatment of impulsivity disorders’ Prostoglandins, Leukotrienes and Essential Fatty Acids 4:211-216

[8] Schwartz, J. R., Marsh, R. G. and Draelos, Z. D. (2005), Zinc and Skin Health: Overview of Physiology and Pharmacology. Dermatologic Surgery, 31: 837–847. doi: 10.1111/j.1524-4725.2005.31729

[9] Piemonti  L, Monti P, Sironi M, Fraticelli P, Leone BE, Cin ED, Allavena P and Di Carlo V Vitamin D₃ Affects Differentiation, Maturation, and Function of Human Monocyte-Derived Dendritic Cells, The Journal of Immunology, 2000, 164: 4443-4451

[10]  Plummer N, Wood.C  The Neonate Immune System and Risk of allergy. A Delicate Balancing Act, Positively Influence by Probiotics and Fatty Acids.

B vitamins for a healthier mind

B vitamins are water soluble and found in a wide range of foods such as beans, pulses and wholegrains. They work in a multifunctional way by supporting many of our body’s systems such as the release of energy from food, our hormones and brain chemistry.

Have you remembered to take your B vitamins today

A recent study by Oxford and Oslo University found that using high dosages of vitamin B12, folic acid and B6 reduced homocysteine levels. Elevated levels of homocysteine have been associated with damage to blood vessels resulting in cognitive impairment .  By reducing elevated levels of homocysteine over a period of two years with B vitamin supplementation brain shrinkage reduced by 30%. 

Feeling the blues

B vitamins are essential for the manufacturer of our happy hormones dopamine and serotonin. Deficiencies in these vitamins may be shown by signs of depression, anxiety and cognitive decline. During the winter serotonin levels tend to be low due to the lack of sunlight and therefore it is important that we support serotonin production through supportive nutrients. 

Creative minds

Can you remember your dreams?  B6 has been associated with dream recall and vivid dreams and therefore may aid to a creative mind. 

Get your thinking cap on

The whole B complex is involved in neurotransmitter and nerve response.  A healthy B vitamin status supports the brain chemistry and response to help you get through your day to day activity. Making sure you have a rich diet in B vitamins is associated with better concentration and memory

How to deal with Seasonal Affective Disorder (SAD)

·     How common would you say Seasonal Affective Disorder is in the UK, and is it increasing? If so, why is that?

SAD has a higher prevalence during winter months in countries further away from the equator , such as the UK which sits in the higher latitudes of the northern hemisphere. A theory is that shorter days equate to less sunlight causing lesser degree of the neurotransmitter serotonin as it is converted to melatonin to encourage sleep.  An estimated 2 million diagnosed with SAD in the UK. 75% of these being women.  

The first classification of SAD as a medical condition was in the 1980s by the National Institute of Mental Health (NIMH). However, it is likely that there has been a steady trend in SAD occurrence since the industrial revolution.  Two centuries ago 75% of workers were outside in natural sunlight with manual labour jobs whereas in the modern world the inverse is true.  The new headway of modern technology has given a dawn to social and work opportunities to perform tasks outside of a persons natural body clock therefore putting it out of keel and therefore increasing the incidence of SAD and related conditions

·     Is there a difference between having the winter blues, and actually being diagnosed with SAD?

Yes there is a difference between the two. Between September and March many people can associate with the ‘winter blues’- feeling of dislike to waking to dark mornings, having shorter days, eating more and getting up in the morning is becoming more of an uphill struggle. However, when experiencing SAD these feelings are heightened and additional symptoms can be experienced from the list below:   

Depression

Lethargy

Carbohydrate cravings

Anxiety

Lack of concentration

Apathy

Suicidal thoughts

Increased appetite

Irritability

Loss of libido

Low immunity status

lack of need for social interaction

digestive discomfort

·     Is there anything we can do to prepare for the onset of winter to avoid suffering when the winter hits – looking at both diet and lifestyle?

Before the winter get your vitamin D status checked by the doctor as a low vitamin D status has been associated with poor immunity and anxiety and depression through the winter season.

Ensuring a healthy diet is inplace may have its benefits as a biological increase of melatonin during the winter months may increase ghrelin. Ghrelin when concentrated in blood plasma levels may over stimulate the appetite and encourage social avoidance.  Therefore, maintaining a blood sugar balance in a tight equilibrium from a diet rich in protein and low in refined carbohydrates may sustain energy levels, support mood and help with satiety. An example of nutrient dense foods to include could be oily fish, nuts, seeds avocado and spirulina to provide essential fatty acids to support brain tissue integrity and hormonal levels, and amino acid l-tryptohphan , a precursor to serotonin.    As well as having a good level of fats and proteins soluble and insoluble fibres and probiotics will be important to support the removal of toxins through the digestive tract. Peristalsis during the winter may become less frequent due to low serotonin levels, therefore supporting and building up a healthy gut biota is preferable for the first line of defence in immunity, energy levels and healthy neurotransmitter response through gut B vitamin synthesis.   

·     What can we do during the winter months to try and overcome SAD, especially when people when feel less inclined to be outside?

Vitamin D is synthesized by humans in the skin from 7-Dehydrocholesterol upon exposure to ultraviolet-B radiation from sunlight. Low blood status of vitamin D levels in winter is linked with poor immunity, depression and anxiety.  Taking a winter holiday close to the equator for the sun to boost serotonin and vitamin D levels may help improve mood and energy.

When in the UK exercise inside first to encourage endorphins and then take the last half of your fitness regime outside.  By going outside you will be naturally boosting serotonin through daylight to support a healthy mood
.

·     What supplements would you recommend during these months to help?

Vitamin D Serum calcidiol levels do not plateau until after 3-4 months of supplementation, so short term supplementation may not correct low levels sufficiently. Long term supplementation is required at high intake and safety data suggests this can be at levels of at least 1000iu per day.

Omega-3  and 6 fatty acids  to help support cognitive function, nervous system and hormonal integrity.

B  vitamins are required for the release of energy from food, for the healthy function of the nervous system and for the production of hormones. 
   

Probiotics to encourage a healthy gut flora to support the elimination and nutrient absorption process that may have been affected by low levels of serotonin.

5-HTP can be naturally found in griffonia simplifica seed. 5-HTP is a precursor to the neurotransmitter serotonin and therefore it may help regulate mood and memory.