Eczema

Eczema, or atopic dermatitis, is chronic inflammation of the skin and usually appears before 5 years of age. The skin is generally itchy, red, scaly, and is sometimes so raw that it oozes and then crusts over. 

Some describe eczema as an outside-in disease - where the primary problem is a defect in the skin barrier. Others describe eczema as an inside-out disease - where the primary problem is a defective immune system. Surprisingly, current literature doesn't support the widely believed theory that eczema is from allergies. [1, 2, 3]

By the time I see a child with eczema, the parents are usually feeling trapped. They are using topical steroids to manage the most inflamed areas of skin for their child, but truly want another solution - one that doesn't require a daily pharmaceutical. Bravo. They are searching for REAL health for their child - they want to pe beneath the surface of their child's symptoms (inflamed skin) and find the underlying reasons why their child's immune system is imbalanced. Music to my ears!

When I evaluate a child, I'm always listening to the child's story and paying attention to symptoms that he has had along the way. Often what I hear are signs of digestive imbalance - the same child with eczema has or had colic, reflux (GERD), constipation, and/or recurrent diaper rashes. And I'll often hear other signs of immune system imbalance - recurrent ear infections, seasonal allergies, asthma, and/or chronic nasal congestion.

Sometimes eczema is the only symptom.
But on further investigation, you often find labs showing immune and/or digestive imbalance. 
Did you know that over 70 percent of your immune system is in your digestive system? It's called GALT - gut associated lymphoid tissue.

So I usually test every child I see with eczema to get a snapshot of their immune and digestive health. 

LAB TESTING: A helpful test to evaluate a patient's digestive health is a comprehensive digestive stool analysis. I use a lab called Genova Diagnostics to do this test and you can find a practitioner in your area to order this test for your child. This test evaluates digestion, absorption, bacterial balance and tests for yeasts as well as parasites. It's helpful as a beginning "snapshot" and follow-up snapshot of digestive imbalance (or balance). It's fun to see how this test improves and a child's symptoms resolve.  

 

Helpful tests to evaluate a patient's immune health include blood testing to check for food protein intolerances (especially to dairy and gluten). When testing for problems with foods, do both true food allergy (IgE-mediated) and food sensitivity (IgG-mediated) testing. Be sure to use a lab that tests for all four subclasses of IgG. I use Alletess Medical Laboratory, and you can find a practitioner in your area to order this test for your child. Pay particular attention to cow's milk and gluten blood testing. Helpful tests include IgE for cow's milk, and testing for the sub-fractions of milk with IgG and IgA testing.  Sub-fractions of milk include: casein and whey. When looking for gluten intolerance, best to be very thorough. Test for IgG to gluten, IgG and IgA anti-gliadin antibodies, IgA antibodies to tissue transglutaminase, anti-endomysial IgA, total IgA, and HLA typing for celiac disease (a genetic mutation test).  Some of these tests can be run through standard labs, while others are run through specialty labs such as Alletess Medical Laboratory. Depending on the clinical situation, I may test a child's stool for gluten and cow's milk intolerance in addition to the blood testing mentioned above.  Since the immune system reactions to foods are centered within the intestinal tract, an earlier way to detect gluten and milk sensitive inpiduals can be through specialized stool testing done through EnteroLab. Another helpful test is urine peptide testing for dairy and gluten through Great Plains Laboratory. This test helps evaluate if your child can completely digest dairy and gluten proteins. Undigested protein in the digestive tract can be problematic. 

Of course this is just a snapshot of the diagnostic testing - for example, another helpful immune system test includes checking a vitamin D level, since vitamin D is vital for a normal functioning immune system. After all the testing is done, I review the results with the parents. 

TREATMENT: Our first goal is to find the right diet for the child. Overtime, we eliminate food allergies and intolerances (sensitivities) from the child's diet. This takes a heavy burden off of the child's immune system. Often the child's eczema will improve and sometimes totally resolve. 

But as I always say (and sometimes it's hard to hear) - Diet is a HUGE something, but it's not everything. There are four legs to a table, and diet is just one leg. We also need to focus on digestive health, detoxification (neutralizing toxins) and drainage (getting toxins out of your body), and stress management!

With over 70 percent of your immune system in your digestive system - we can't lose focus that we need to help the child's digestive system heal. Sometimes that through eliminating food allergies and intolerances, other times by reducing sugar and starches in the diet. A great way to support digestive health is through probiotics - living bacteria. Along with probiotics, two other supplements that help support the immune system are cod liver oil and vitamin D. 

I remember when my oldest daughter was an infant with eczema, I was rushing around all stressed out trying to get her to her first photo shoot and would you believe I saw her eczema flare-up immediately! That's when I realized stress affects everything, even eczema! Stress management is another topic all together - but in general stress is reduced with REAL food, exercise, adequate sleep (which can be difficult for those with itchy eczema), and a zen-like mindset (a life-long goal).   

Sometimes the final touch that helps the eczema resolve are homeopathic remedies that help the body detoxify and drain toxins. Think of your house overflowing with dirt, you sweep up the dirt and put it into the trash can (detoxification) and then someone takes the trash can out to the curb (drainage). With eczema, I often think of the body as overflowing with toxins (dirt) and with a little spring cleaning, the eczema resolves. 

It's not always so easy - of course! But more often than not, the eczema resolves. And that is what keeps me going - there's nothing more gratifying then ping beneath the symptoms (inflamed skin) and solving the system imbalances (digestive and immune) and watch the child heal from the inside out!

Sources:

1. Sandilands, A. et al. Filaggrin's fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. 2007;127(6):1282.
2. Chan, LS. Atopic dermatitis in 2008. Curr Dir Autoimmun. 2008;10:76.
3. McGrath, J. et al. The filaggrin story: novel insights into skin-barrier function and disease. Trends Mol Med. 2008;14(1):20.