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
· 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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