The itching and dry cracked skin of eczema patients has been identified as a significant promoter of the atopic march – a progression in infants who develop eczema and are more likely to develop food allergies, hay fever and asthma as they grow older. Moisturizers - especially early in a child's life - may help prevent eczema, food allergies and other allergic diseases. "When food particles are introduced through the skin rather than the digestive system, they are much more likely to cause allergies," says Donald Leung, MD, Ph.D., head of Pediatric Allergy & Clinical Immunology at National Jewish Health. "Cracks in the skin of those with eczema often set off a chain of allergic diseases that develop over several years."
Ava Segur - a 17 year old who experienced the atopic march first hand – says it started with eczema when she was just six weeks old. They were trying to get her skin inflammation under control, when they were suddenly confronted with another problem. "She had hives all over her arms and neck," says her mother Stephanie. "So we took her to the hospital and found out she is allergic to peanuts, pine nuts and shellfish."
A few years later, Ava developed exercise-induced asthma and has participated in numerous clinical trials seeking better treatments for eczema and a better understanding of the atopic march. "If we can find a solution that will work to stop this before it starts, it will be very rewarding to know that I was able to be a part of that," Ava says. "Restoring the skin barrier as soon as eczema develops is the best way to stop the atopic march in its tracks and prevent allergic diseases from developing," Leung added.
Soak And Seal
Research has shown that patients with eczema lack important proteins and lipids in the outer layers of their skin. The skin forms an important barrier, keeping moisture in and external allergens or microbes out. As a result of eczema patients' defective skin barrier, water escapes from the skin, drying it out and leading to cracking and itching. Cracked, itchy skin is a hallmark of eczema. Scratching the dry, itchy skin of eczema patients can further damage the skin barrier and activate the immune system. Increasing evidence indicates that food particles entering the body through cracks in the skin can trigger an allergic response that leads to a food allergy.
Once that allergic response has been triggered, the immune system is primed to develop not only eczema and food allergies, but also hay fever and asthma. To do this, experts recommend what they call "soak and seal," which involves thoroughly moisturizing the skin in a warm bath, then trapping the moisture in with a moisturizing ointment. It's a method Kriston Kline says helped her 19-month-old son's skin begin to heal within a week. "It provided him with immediate relief, and each time we do a soak-and-seal treatment, his skin looks so much better," says Kline. "Not only is this making him more comfortable now, but if it can help protect him from allergies and asthma, that is a huge benefit for his future."
Careful care of a baby's skin right from birth could prevent eczema and other allergic diseases. A baby's skin is particularly susceptible to drying out when it first emerges from the warm, watery environment of the womb into the dry air of the outside world. A few small studies have suggested that regular treatment with skin moisturizers can help reduce an infant's chances of developing eczema and the other diseases in the atopic march. Leung is currently working to confirm those studies and identify the ideal moisturizer components to prevent eczema and the other diseases of the atopic march.
Atopic Dermatitis Yardstick Provides Practical Guidance
Patients with atopic dermatitis (ADF) - also known as eczema - often face an uphill battle for treatment. Symptoms include severe itching, scaly rashes, extreme dry skin and inflammation. Those who suffer from AD spend sleepless, itchy nights fearing they have nowhere to turn and their symptoms may never resolve. This creates therapeutic challenges for clinicians treating AD
New treatments including new drugs are now available and can offer relief. According to a new yardstick published in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), treatment for AD has changed a lot in the last few years. “The Atopic Dermatitis Yardstick was written by AD experts who are allergists and dermatologists because we want physicians who see patients with AD on a regular basis to know there are effective treatment options available,” says allergist Mark Boguniewicz, MD, ACAAI Fellow and lead author of the yardstick. “In the yardstick, we cover the challenges and barriers to treatment success. We offer definitions of disease severity, review treatment failures, address treatment in a step-wise fashion and cover the emerging science and implications for new therapies.” The yardstick has practical recommendations for physicians about which medications are appropriate at which stage of diagnosis.
Itching is the hallmark of AD, and the cycle of itching and scratching makes the condition worse because it causes damage to the skin and often creates secondary infections, which can be serious. AD patients are at increased risk, not only for skin infections, but, according to a recent study, also for multi-organ and systemic infections. Patients with AD can be presented with a range of disease severity, from mild intermittent disease to severe difficult-to-control disease. “All patients must keep their skin highly moisturized, regardless of the activity or severity of their disease,” added allergist Luz Fonacier, MD, ACAAI board member and co-author of the yardstick. “We emphasize throughout the yardstick that even when patients step up to stronger medications, they should still continue basic treatment of bathing with warm water followed immediately with heavy moisturization, i.e. soak and seal.”
The last few years have seen the introduction of targeted therapies, also known as “precision medicine.” Two new medications have recently been approved for AD. The first, crisaborole, is an ointment that reduces itching, redness and swelling of the skin. It is the first anti-inflammatory medication to be approved for the treatment of mild to moderate AD in more than 15 years. It is approved for patients two years of age or older. Dupilumab, the second new medication, is a biologic therapy given by injection for patients 18 years or older with moderate to severe AD who haven’t responded to or can’t use topical medications.
There are effective medications available that help relieve AD symptoms and now can also target some of the underlying mechanisms of the disease. “People with AD have been frustrated by the limitations of existing treatments,” Fonacier said. “We’re very excited by the new medications which were developed based on better understanding of atopic dermatitis. We expect additional therapies to be approved soon. Allergists have the right training and expertise to diagnose AD, and to offer relief with the right treatments. We’re glad we can add these treatments to our arsenal of weapons to combat the symptoms of AD.”
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