Eczema is a group of chronic inflammatory skin disorders that causes redness, swelling, itching, dryness, thickening, cracking, and even oozing and bleeding.

Millions of people suffer from eczema, affecting 15-20% of children and 1-3% of adults worldwide.

One in 10 individuals will develop eczema during their lifetime, with prevalence peaking in early childhood.

31.6 million people (10.1%) in the U.S. have some form of eczema. 

The ‘atopic eczema epidemic’ has developed in industrialized countries within the last four decades.

Experts warn policymakers that allergic disease might replace infectious disease as a significant cause of ill health in cities undergoing rapid demographic changes in developing countries.

Millions of people suffer from eczema worldwide; atopic eczema (A.E.) has a lifetime prevalence of between 15 and 20% in industrialized countries but a deficient majority in rural nations. 

The most common type of eczema is atopic dermatitis. 

“Atopic” means a genetic disposition of the body to develop a hypersensitive allergic reaction upon contact with an allergen.

Atopic is also described as an inherited tendency to develop dermatitis, asthma, and hay fever. 

Dermatitis refers to the inflammation of skin presenting with the symptoms of redness & itchy.

Up to 60 percent of people with atopic dermatitis develop asthma or hay fever (allergic rhinitis) later in life, and up to 30 percent have food allergies. Atopic dermatitis is often the beginning of a series of allergic disorders, referred to as the “atopic march.” Development of these disorders typically follows a pattern, beginning with atopic dermatitis, followed by food allergies, then hay fever, and finally asthma. However, not all individuals with atopic dermatitis will progress through the atopic march, and not all individuals with one allergic disease will develop others.

SIGNS & SYMPTOMS: 

The symptoms of eczema usually start in early childhood; The causes of eczema are likely to be multifactorial, involving genetic, socioeconomic, and environmental factors.

The rashes can occur on any part of the body, although the pattern differs at different ages. In affected infants, the rashes commonly occur on the face, scalp, hands, and feet. 

In children, the rashes are typically found in the bend of elbows and knees and on the front of the neck. In adolescents and adults, the rashes usually occur on the wrists, ankles, and eyelids in addition to the bend of the elbows and knees. 

Depending on the particular type of eczema someone has, symptoms and signs can include:

• Inflamed skin: Dryness, Itchiness, swelling, scaling of the skin. 
• Itch & Scratch: The more you scratch it, the worse it generally gets. If itching becomes very bad, it’s tempting to scratch the skin, but this makes irritation worse (known as the “itch-scratch cycle”). Scratching the itchy skin can lead to oozing and crusting of the rashes and thickening and hardening (lichenification) of the skin. The itchiness can be so severe as to disrupt sleep and impair a person’s quality of life.
• Blisters or crusty areas of skin that can crack open, ooze, and become scaly.
• Peeling, flaking skin due to severe dryness. 
• Cuts and cracks in the skin due to severe dryness, which can sometimes lead to bacterial infections.
• Changes in skin color and texture, such as skin becoming rougher, darker, and thicker.
• Sensitiveness to products like shampoo, lotion, household cleaners, soap, gasoline, aftershave lotions, and cleansers
• Burning due to irritation or exposed, raw skin
• Secondary problems include anxiety, depression, trouble sleeping, embarrassment, and difficulty concentrating.
• Atopic eczema, caused by allergies, can sometimes occur with other symptoms like fever, fatigue, asthma, or respiratory issues.

TYPES OF ECZEMA: 

• Atopic dermatitis: is the most prevalent form of eczema. It usually starts in childhood and usually gets milder or goes away by adulthood. Atopic dermatitis is part of what doctors call the atopic triad. “Triad” means three. The other two diseases in the triad are asthma and hay fever. Many people with atopic dermatitis have all three conditions.
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• Contact dermatitis happens when you touch a substance that irritates your skin or causes an allergic reaction. The most common causes are detergents, bleach, latex, skincare products, makeup, soaps, perfumes, paint, etc.
• Neurodermatitis: thick, scaly patches form on your arms, legs, back of your neck, scalp, bottoms of your feet, backs of your hands, or genitals
• Dyshidrotic eczema: causes small blisters to form on your hands and feet. It’s more common in women than men & can be caused by: Stress, allergies, damp hands and feet, exposure to substances like nickel, cobalt, or chromium salt.
• Nummular eczema: This type of eczema causes round, coin-shaped spots to form on your skin. The word “nummular” means coin in Latin.
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• Seborrheic dermatitis:  mainly affects your scalp. It causes scaly patches, red skin, and stubborn dandruff. Seborrheic dermatitis can also affect oily areas of the body, such as the face, sides of the nose, eyebrows, ears, eyelids, and chest.
• Stasis dermatitis: happens when fluid leaks out of weakened veins into your skin. This fluid causes swelling, redness, itching, and pain.

It is possible to have more than one type of eczema on your body at the same time.

PATHOPHYSIOLOGY:

Although the pathophysiology of A.D. is not entirely understood, numerous studies demonstrated that skin barrier dysfunction, neuroinflammation, altered lipid composition, microbial imbalance, and immune dysregulation contribute to the pathobiology of A.D.

Skin Renewal disruption: 

By virtue of its unique anatomical position, the skin is the epithelial surface at the frontline of host defense. Skin is an essential barrier that efficiently protects and minimizes damage from environmental (e.g., microorganisms, physical trauma, ultraviolet radiation) and endogenous (e.g., cancers, inflammation) factors under homeostatic conditions. 

This formidable barrier function resides mainly in the epidermis, a dynamic, highly-stratified epithelium. Because it’s a protective layer, the epithelium is constantly renewing itself, shedding old damaged cells and growing new, healthy ones in their place. This process helps keep the skin barrier strong and resilient in healthy people without eczema but becomes disrupted in those with eczema due to inflammation.

When someone has eczema, the process of shedding and renewing corneal skin cells becomes disrupted.

Gut Health:

Patients with A.D. have significantly lower numbers of intestinal commensal Bifidobacterium and higher numbers of Staphylococcus than healthy control subjects. Overgrowth of pathogenic bacteria, such as Escherichia coli and Clostridium difficile, is postulated as being associated with a decrease in beneficial bacteria, reduced induction of regulatory T (Treg) cells, loss of immune tolerance, and increased intestinal permeability.

Genetics:

Several studies suggest an increased risk of developing A.E. in individuals with loss‐of‐function mutations in the filaggrin gene, which is present in up to 10% of western European populations. Filaggrin is one of several structural proteins of the epidermis, which contribute to maintaining an effective skin barrier. Disturbances in skin barrier function facilitate greater penetration of allergens through the skin.

Researchers have identified that mutations in KIF3A, FLG, and CARD11 genes are commonly associated with the development of eczema.

New research supported by the National Institutes of Health describes how two comparatively common modifications in a gene called KIF3A are responsible for an impaired skin barrier that allows increased water loss from the skin, promoting the development of atopic dermatitis known as eczema. 

 For example, mutations in FLG are found to be associated with Atopic dermatitis development. The protein filaggrin (FLG) is present in the skin and nasal epithelium and helps maintain the skin barrier while performing other functional roles.

Many studies have related common loss-of-function filaggrin (FLG) gene defects to eczema’s incidence and severity and asthma’s severity during childhood.

However, genetic mutations alone might not be enough to cause clinical manifestations of A.D. It is merely the interaction of a dysfunctional epidermal barrier in genetically predisposed individuals with harmful environmental agents that lead to the development of the disease.

CONVENTIONAL TREATMENT:

There is currently no “cure” for eczema, only ways to help manage eczema symptoms.

The management of mild A.E. includes topical application of corticosteroids and emollients, and refractory moderate or severe A.E. is managed with systemic therapies, including Antihistamines (like hydroxyzineoral) and steroids immunomodulators (tacrolimus and pimecrolimus) or immunosuppressive drugs such as azathioprine, cyclosporine, mycophenolate, and methotrexate. 

Current conventional medical treatment for moderate and severe A.E. is not satisfactory, as long-term oral corticosteroid use can lead to adverse reactions such as suppression of the hypothalamic-pituitary-adrenal axis, osteoporosis, aseptic necrosis of the hip, hypertension, ocular changes, and altered immune function. Side effects of immunosuppressive medications, particularly the risk of hepatosplenic T-cell lymphomas associated with azathioprine, have raised the alert. Therefore, many people with A.E. may choose to use natural & herbal medicine to treat A.E.

Although topical and systemic antibiotics have been used to eradicate bacteria from A.D. skin, long-term use has limitations due to the induction of resistant microorganisms and the negative impact on host commensal bacteria.

Eczema causes significant distress in terms of discomfort and effect on appearance. In the case of children, the impact on the child and family is mainly due to sleep disturbance and itching. Research suggests that the impact of eczema on quality of life is second only to that of cerebral palsy, with more significant implications reported for A.E. than for asthma or diabetes. 

NATURAL & HOLISTIC TREATMENT:

Recent studies demonstrated that appropriate probiotics are beneficial in preventing and treating A.D. through modulating host immune responses.

There has been a documented increase in the proportion of the general population who use Complementary and Alternative Medicine (CAM) for a variety of ailments in many countries, such as Korea (68.9%), France (49%), Germany (46%), United States (34%), Belgium (31%), U.K. (26%), and Sweden (25%).

According to the Global Burden of Disease study, A.E. is the most debilitating skin disease globally, ahead of psoriasis, alopecia, and cellulitis, making it the most critical dermatological condition to combat concerning the quality of life of the world’s population. 

A recent Australian prospective cohort study over 40 years showed that childhood eczema was strongly associated with adult atopic the incidence and persistence of adult atopic asthma, suggesting that early treatment may reduce morbidity later in life.

Conventional treatment plans typically use steroids to manage symptoms; however, side effects must be considered, such as suppressing overall immunity making you more susceptible to infection and illness.

Steroid creams are indicated as a temporary solution, and they do not address the underlying cause of eczema.

On the other hand, natural therapies can work to correct the underlying imbalance that caused the body to react in the first place, offering relief without the unwanted side effects of steroid treatments.

Thus, a vast number of patients seek alternative treatments. In one study, 51 percent of patients with eczema reported using one or more forms of alternative medicine, with homeopathy, health foods, and herbal remedies being the most common.

This ties in with the WHO definition of Health. WHO states: Health is a state of complete physical, mental & emotional well-being and not merely the absence of disease.

This means to treat a person inflicted with chronic disease, we as physicians should focus on treating him as a whole and not only on a physical level.

Integrated or Holistic medicine therapies treat a person as a whole – Physically, Mentally, emotionally, socially, and environmentally. 

With more than 14yrs of clinical practice, I have learned that in order to truly & completely heal a person dealing with chronic eczema; we need to get into the details about the root cause, provide natural remedies, aim for natural topical applications, thorough guidance about lifestyle, probiotics, supplements and so much more; therefore I have created Eczema Wellness Program which integrates all the holistic methods of healing this chronic health issue.

Last but super important, I like to work as a team with my patients, so I’m their doctor, mentor & friend in their healing journey. 

References:

1: https://medlineplus.gov/genetics/condition/atopic-dermatitis/

2: https://www.eurekalert.org/news-releases/688391

3: https://www.karger.com/Article/FullText/370220

4: https://www.karger.com/Article/FullText/370220