The Eczema Dilemma

Eczema

Words: Dr Rajgopal NIDAMBOOR 

Dermatitis is a broad expression. It covers different disorders, with one main presentation — a red, tickly rash. The term, eczema, is sometimes used for dermatitis. While some types of dermatitis affect only specific parts of the body, there are others that can present themselves anywhere. Some forms of dermatitis have a known cause; others may not.

Whatever the implication, dermatitis is always the skin’s mode of response to severe dryness, scratching, or a substance that is causing irritation, including an allergen. Generally, the causative allergic substance comes in direct contact with the skin; sometimes, the substance may also be ingested, or swallowed. Eventually, incessant scratching and rubbing may lead to thickening and hardening of the skin — a characteristic manifestation of the disorder.

Contact dermatitis is acute, or chronic, skin inflammation. It is often triggered by substances that come in contact with the skin. Individuals affected by the disorder may have unusual redness of the skin and/or itching. However, symptoms and clinical findings related to contact dermatitis differ substantially depending upon the cause of the problem. Origins of the disorder include allergic reactions, or responses, to a substance, including its direct toxic effects — viz., chemical irritants, medications, certain plants and/or their derivatives. Needless to say, itching is a classical symptom of the disorder.

The commonest of skin [reaction] patterns, dermatitis has dermal and epidermal components. Signs related to the dermis component include swelling, heat, itching, sensitivity and redness. There is also proliferation of the epidermis.

This often leads to the classical signs of dermatitis — thickening of skin along with scale formation. And, when the swelling in the dermis expands to the epidermis, the cells also ‘bloat.’ The resultant effect is the formation of vesicles [small sacs containing liquid]. Next — when the vesicles burst, as you may have seen in some cases, you notice the typical, acute ‘weeping’ pattern on the skin.

There are two ‘major’ forms of dermatitis, viz., contact dermatitis, which has been explored in the preceding paragraph, and contact allergic dermatitis, caused due to allergy. Contact dermatitis, a common public health problem, affects the hands in particular. While wear and tear is the most well-known cause of hand dermatitis, some simple irritants — e.g., external agents — account for the greatest proportion of the skin disease, especially in its allergic form.

Most outbreaks of dermatitis, as in the industrial set up, a common problem, are due to exposure and/or introduction of irritants into the work process, or changes in the environment — they are not caused due to allergy. While the skin is designed to withstand enormous wear and tear, everyday exposure to irritants would lead to cracks.

The cracks become infected when the epidermis and dermis are no longer protected by healthy skin like before.

Symptoms 

No matter the cause or type, contact dermatitis results in itching and a rash. While the itching is usually severe, the rash may vary from mild, short-lived redness to severe swelling and large blisters. Most frequently, the rash contains tiny blisters. It also often develops in areas ‘touched’ by the substance. Ordinarily, the rash appears earlier in thin, sensitive areas of skin. It spreads in areas of thicker skin, or on areas that had less contact with the substance, later. This gives us the feeling that the rash has extended. Touching the rash, or blister fluid, cannot spread contact dermatitis to other people, or other parts of the body, that did not make contact with the ‘culpable’ substance.

Diagnosis 

It is a matter of routine for your physician/therapist to ask about your personal and family allergy history, or history of exposure to irritating chemicals at work, or home, or your ‘association’ with poisonous plants. In addition to this, they may inquire about specific products you’d routinely apply to your skin, or hair — cosmetics, shampoos, hair dyes, skin lotions, nail polish, medicated, or antibiotic skin creams. After a review, along with physical examination, your physician/therapist may confirm the diagnosis.

In cases of dermatitis with the allergic connotation, you may be referred to a skin specialist, or dermatologist. The idea is to call for a more detailed study using patch testing. Patch testing is a type of allergy analysis in which small amounts of specific allergens are applied to the skin. Readings are performed on the underlying skin to elicit signs of the allergic reaction.

On the downside, patch testing, though useful, is complex. Besides, it goes without saying that people may be sensitive to several substances; so much so, a mere sensitivity to a substance may not necessarily reflect the cause. Your dermatologist would be better able to decide what substances to analyse, based on what a person might have been exposed to.

Common Causes Of Dermatitis 

  • Hair-remover, nail polish, deodorant, moisturiser, aftershave lotion, perfume, sunscreen cream etc.,
  • Medicated skin creams. Antibiotics, anti-histamines [diphenhydramine, promethazine], anaesthetics [benzocaine], antiseptics [thimerosal], stabilisers etc.,
  • Metal compounds. Nickel, especially in jewellery
  • Poison ivy, poison oak, poison sumac, ragweed, primrose, thistle etc.,
  • Industry chemicals. Tanning agents used in shoes, rubber accelerators and other substances used in gloves, leather goods, undergarments, and clothing.

Atopic Dermatitis

Atopic dermatitis [AD] is the most common type of eczema. It affects millions of children and adults alike across the globe. A chronic condition, AD can ‘come and go’ for years, or stay throughout life; it can also co-exist with, or overlap, other forms of eczema.

It is generally suggested that, in AD, the immune system becomes chaotic and frenzied. This causes inflammation that harms the skin barrier, leaving it dry and susceptible to itching and rashes that may appear purple, brown, or greyish, in darker skin tones and red in lighter skin tones.

Research suggests that some people with atopic dermatitis may have a mutation of the gene accountable for creating filaggrin. Filaggrin is a protein that helps our bodies maintain a healthy, protective barrier on the topmost layer of the skin. When there is inadequate filaggrin to build a strong skin barrier, the moisture can outflow and bacteria, viruses and other microorganisms, can cross the ‘barricade.’ This is why many people with AD have extremely dry and infection-prone skin.

Atopic dermatitis archetypally begins in childhood, commonly in the first six months of a baby’s life. Although it is a common form of eczema, it is severe and long-lasting. When you, or your child, have AD, it may improve at times; but at other times, it may get worse. In some children, symptoms may ease as they grow, while in some it may flare into adulthood.

Atopic dermatitis can co-exist with two other allergic conditions — asthma and hay fever [allergic rhinitis]. As for individuals who may have asthma and/or hay fever, or family members predisposed to such allergies, they are often more likely to develop AD.

Prevention & Treatment 

The best way to prevent contact dermatitis is by the avoidance of exposure to irritating chemicals, plants, jewellery and other substances that ‘trigger’ the disorder. To help prevent diaper dermatitis, a common problem, for instance, you should change your baby’s diaper frequently, wipe the soiled area with warm water and a soft cloth, and apply zinc oxide ointment, or cream. It is also advisable for you to avoid the use of commercial cleansing agents on your child’s delicate skin; they may trigger skin reactions. In the workplace set up, it is advisable to provide workers with protective equipment, clothing and ‘barrier creams’ to prevent contact dermatitis on the job.

Ayurveda

The mainstay of treatment in Ayurveda for vicharchika [dermatitis/eczema] is shodhan which eliminates the vitiated doshas. Parallel to shodhan shaman oushadh is assistance to correct the dhatus and bring them to normalcy. Virechana is the prime procedure for pitta dosha. The virechana Ayurveda drug after entering amashaya dislodges the vitiated pitta dosha and pacifies all pitta vikara of the body, just like a house which consists of fire will not only become hot when fire is made hot by adding suitable fuel and it also, likewise, gets cool when it is cooled. Virechana as shodhana chikitsa and shamana therapy, in combination, when followed systematically, provides relief from symptoms in patients having vicharchika.

  • Dr Shahin Pathan, Vaidya Rohini Salve, and Dr Pushkar Rai, “Ayurvedic Management of Vicharchika WSR to Eczema: A Case Study.” World Journal of Advance Healthcare Research, Volume 3, Issue 2, 2019 [79-84].

Homeopathy

A group of researchers studied 118 children suffering from atopic eczema. 54 children were treated with homeopathic medicine and 64 children were treated with conventional dermatology drugs. Both groups were followed for a period of 12 months. Children in both groups had their eczema symptoms improve. Disease-related quality of life improved equally in both groups. However, improvement of eczema as observed by physicians was significantly greater in the homeopathic group [p<0.001]

  • Keil T et al, Institute for Social Medicine, Epidemiology, and Health Economics, Berlin, Germany, in Complement Ther Med. 2008: Feb; 16[1]: 15-21.

A group of researchers studied 17 patients with intractable atopic dermatitis in Japan.  The patients had previously failed conventional dermatological drug therapy. They were treated with individualised homeopathic medical therapy, in addition to conventional dermatological therapy. The study’s follow-up period was six to 31 months. The efficacy of homeopathic medicines was measured by objective assessments of the skin condition and the patients’ own assessments, using a 9-point scale. One patient cleared completely, seven patients partly cleared [80 per cent better], and nine patients partially cleared [50 per cent better]. More importantly, five of 17 patients [29 per cent] were able to stop the use of topical steroid ointments.

  • Itamura R and Hosoya R. Homeopathy; 2003: 92 [108-114].

Nutrition

Objective. The pathophysiology of atopic dermatitis [AD] involves a complex interplay between immune system dysfunction, genetics, and environmental factors. It is well-known that nutritional status is essential to a proper functioning immune system, leading to a highly debated question regarding the role of dietary factors in the pathogenesis of AD. Food allergies and elimination diets have been broadly studied in atopy; however, less consideration has been given to how vitamins, minerals, and other micronutrients influence the risk for AD and severity of symptoms. This systematic review discusses evidence on how various micronutrients, including vitamins [C, E, and D] and trace minerals [zinc, selenium, iron, copper, magnesium, and strontium] are associated with AD, and how supplementation influence disease severity.

Design. A systematic search was conducted to identify the role that oral micronutrients have on AD. The authors reviewed 49 studies herein.

Results. While there are weak associations between vitamins C, or E and AD, there is sufficient evidence to suggest that vitamin D supplementation provides benefit in AD patients. Deficiency of selenium and zinc may exacerbate AD. Current reports are not sufficient to confidently discern the role of other vitamins and trace minerals on AD.

Conclusions. Though oral micronutrients may play a role in AD, the current literature is limited, and there is a need for more comprehensive randomised controlled trials [RCTs] to truly decipher the role between oral micronutrients and AD.

  • Alexandra R Vaughn, Negar Foolad, Melody Maarouf, Khiem A Tran, and Vivian Y Shi. “Micronutrients in Atopic Dermatitis: A Systematic Review,” The Journal of Alternative and Complementary Medicine. Jun 2019 [567-577].
Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360. 

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