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Eczema

Category: Illness or disabilities

Type

Involuntary

Introduction and description

‘Dermatitis’ and eczema are simply different aspects of the same skin condition. Dermatitis/eczema is an area of inflamed skin, marked early by redness and itching, and as time goes on by minute papules and vesicles which eventually get bigger with weeping, oozing, and crusting. Later there maybe ‘scaling, and often pigmentation’.

Eczema is sometimes called ‘atopic dermatitis’. Strictly speaking the word ‘atopic’ means an allergic reaction. But this is actually incorrect. As we shall see, a broad range of cases of eczema are caused by bacteria and viruses, and yet another set by toxins such as heavy metals and chemicals. All these are pathogens toxic to the body, depending how toxic to the body the substance is, the reaction may be mild or severe.

The production of pus filled blisters is the mechanism by which the body rids itself of pathogens. In other words, in all cases of eczema, a pathogen is to blame, either attacking the body from within, or attacking the skin from without. Generally speaking one can find the pathogen by analysing the pus.

Eczema is thus a symptom of infection or attack by a pathogen and bearing this in mind the statistics related to dermatitis and eczema make rather sobering reading.

Dermatitis affected over 15 million US workers in 2010, nearly 10% of the then working population, and its prevalence varied by demographic characteristics and industry and occupation of employment.

Data from an occupational health supplement to the 2010 National Health Interview Survey (NHIS-OHS) were used to estimate the prevalence of dermatitis overall and by demographic characteristics and industry and occupation (I&O) of current/recent employment.
Data were available for 27,157 adults, including 17,524 current/recent workers. The overall prevalence rate of dermatitis among current/recent workers was 9.8% (range among I&O groups: 5.5-15.4%), representing approximately 15.2 million workers with dermatitis. The highest prevalence rates were among I&O groups related to health care. Overall, 5.6% of dermatitis cases among workers (9.2% among healthcare workers) were attributed to work by health professionals. PMID: 22674651

In other words, hospital and health workers look as though they are a serious source of infection.

In developing countries like Tanzania, the spectrum of skin diseases among elderly patients attending skin clinic shows eczema is the leading disease group. In one study of 142 patients, for example, with age ranges of 55-99 years, Eczema (43.7%), and unclassified eczemas (33.9%) predominated. [PMID: 26905256]

One could propose the somewhat controversial hypothesis that those without eczema in this day and age, are probably the ones with a deficient immune system.

Symptoms

Apart from the symptoms mentioned above, itching , pain, rash, inflamed skin and pus filled wounds, the other symptoms are as follows.

Sexual problems, depression, anxiety and suicidal ideation

It is inevitable that anyone with a feeling of low self worth because of their appearance is going to have sexual problems and anxiety etc

In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. PMID: 27819713

Emotional and conduct problems

This finding is also not entirely unexpected, as emotional problems – frustration, anger etc are all bound to occur. But the conduct and hyperactivity problems are not easily explained. Were they the result of the itching and pain that results, or the medication they were given, or the pathogen causing the eczema in the first place?

This study aimed to examine the association of eczema, asthma and hay fever with mental health in a general child population and to assess the influence of parental socioeconomic position on these associations…. We conducted a cross-sectional health survey of children aged 3, 6, 11 and 15 years in the City of Copenhagen, Denmark. …9215 (47.9%) children were included in the analyses. RESULTS: Linear regression analyses showed that children with current eczema symptoms had higher SDQ scores of emotional problems … conduct problems … and hyperactivity problems…. compared with children without current symptoms of the relevant disease. For most associations, parental socioeconomic position did not modify the effect. PMID: 27742629

ADHD/ADD

Atopic dermatitis (AD) is associated with chronic itch, allergic disease and sleep disturbance, all of which might increase the risk of attention deficit (hyperactivity) disorder (ADD/ADHD). Previous analyses have found a consistent association between AD and ADD/ADHD, although the underlying factors contributing to such an association remain underexplored. Additionally, the relationship has been underexplored in adults.

We analysed data on 354 416 children aged 2-17 years and 34 613 adults age 18+ years from 19 U.S. population-based surveys, including the National Health Interview Survey 1997-2013 and the National Survey of Children's Health 2003/4 and 2007/8. RESULTS: In multivariate models adjusting for age, sex, sociodemographics, allergic disease and healthcare utilization, AD was associated with ADD/ADHD in both children, and adults. PMID: 27105659

The paper came to the conclusion that sleep deprivation played a very large part in this, along with the headaches, asthma and anaemia. Some correlations seemed to indicate that food allergy was the root cause of all the problems.

Other comorbidities

Atopic dermatitis comorbidities extend well beyond the march to allergic conditions (food allergy, asthma, allergic rhinitis, allergic conjunctivitis, and eosinophilic esophagitis), suggesting both cutaneous and systemic immune activation. In reviewing atopic dermatitis comorbidities, Councilors of the International Eczema Council found a strong pattern of immune activation in peripheral blood and the propensity to both skin and systemic infections. Associations with cardiovascular, neuropsychiatric, and malignant diseases were increasingly reported PMID: 27771048

In other words, whatever pathogen or pathogens are causing the eczema, they are the cause of a great many more problems besides just eczema. Given the fact that the pus from the weeping wounds of an eczema sufferer usually contains the pathogens, it might be useful to use it as a very clear indicator of all the infections people do have. Probably a great deal more reliable than blood tests and a great deal less aggressive and painful than lymph node tests.

Causes

The production of pus filled blisters is the mechanism by which the body rids itself of pathogens, it expels them floating on a bed of ooze, so that we can wash them away on a regular basis using warm water [and just warm water], or soak them up in some dry sterile dressing that we can be disposed of safely.

In other words, in all cases of eczema, a pathogen is to blame, either attacking the body from within, or attacking the skin from without. Sometimes the eczema that results from an internal pathogen is not even given the name eczema, we call it ‘chicken pox’ for example, or Paget’s disease, not eczema even though one of the symptoms is clearly eczema.

So eczema is a symptom not a cause and thus we need to be searching for pathogens.

Stress

There is a known link between stress and all forms of skin disease:

There is a link between emotional stressors (acute or chronic), psychiatric diseases, and dermatoses (e.g., psoriasis, atopic dermatitis, urticaria, viral warts, herpes simplex, vitiligo, acnes, alopecia, prurigo, etc.) and different cytokines and mediators produced in the skin and involved in their pathogenesis. PMID: 24558766

But this is because the immune system is compromised by stress. In other words, the cause is not stress, the cause, as we have said, is one or more pathogens, but whenever the immune system is compromised, the pathogen can get a hold and start working again, whereas if the immune system is active, it can keep the pathogens at bay.

Viral infection and vaccines

Quite a number of viruses produce symptoms that are to all intents and purposes eczema. Viruses that produce skin eruptions and blisters are called vesiculating viruses [viruses causing blisters]. Thus the virus causing chickenpox produces eczema; the herpes family of viruses can produce eczema [and the name for the eczema they cause is Eczema herpeticum]; coxsackievirus A16, and the vaccinia virus cause eczema; the smallpox virus produces eczema. In other words any virus that produces ‘vesicules’ has the potential to cause Eczema – it is just that we tend not to call it that because we know the virus. For example

Eczema herpeticum is an extensive vesicular eruption caused by cutaneous dissemination of herpes simplex virus in patients who have underlying skin conditions or epidermal barrier disruption. Herpes simplex virus type 1 (HSV 1) is the most common etiology. This is the first report in Chile of a case of eczema herpeticum caused by HSV 2 PMID: 19802405

Eczema vaccinatum

Those already having eczema, impetigo, or dermatitis may well have an existing viral or bacterial infection. If they then get yet another infection or are vaccinated with a vesiculating virus, then the cumulative effects can be catastrophic. They can kill babies and in infants cause severe distress, in some cases they can be fatal in infants as well. In effect, very very severe forms of eczema result, in which “numerous umbilicated vesicles are superimposed on those already there’. There is fever and swelling [fever to kill the virus, swelling an attempt to help the immune system ‘troops’ to reach the site more quickly’]. Survivors can also have scarring from pockmarks.

Let us now imagine an infant who has been given a vaccination for measles or chicken pox, say. Measles and chicken pox are both latent viruses [capable of staying in the body indefinitely], so will reside in the infant’s system, held at bay by the immune system. We now give the baby a smallpox vaccination. The baby’s immune system now has two, maybe three viruses to fight, and in some children their immune system is simply not able to fight that many.

Eczema vaccinatum in an adult

The name given to the serious form of eczema that results is Eczema vaccinatum – eczema from vaccines. The most serious is the one from the smallpox vaccination. To all intents and purposes the baby/infant/adult is fighting smallpox. It is characterized by “serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by widespread infection of the skin”. Smallpox.

General guidelines have evolved which say that Smallpox vaccine should NEVER be given to patients with a history of eczema or possible susceptibility to skin diseases. But this totally misses the point. Ideally we should be saying that vaccination should never be given to anyone who shows signs of existing viral or bacterial infection they are having difficulty counteracting. Eczema is a symptom of a vicious battle between the immune system and one or more viruses and possibly bacteria, in which pus is used to expel the pathogens. The worse the eczema, the more virulent and numerous the pathogens are likely to be.

To quantify the population at risk of serious adverse reactions to replicating smallpox vaccine……. An estimated 48,121,280 to 50,028,045 individuals (15.2-15.8% of the U.S. population) are potentially contraindicated to replicating smallpox vaccine. This rises to 119,244,531 to 123,669,327 (37.4-38.8%) if household contacts are included…………… These figures are significant and larger than the only previously published study. PMID: 27739111

Furthermore, it may be sensible to prioritise vaccine use, giving children protection against the most deadly and nasty first, and then let the parents decide whether, when and if they want their child vaccinated against viruses with latency - measles, chicken pox etc.

Bacterial infection

One recurring theme in some forms of dermatitis, is the breakdown of the natural skin barrier – the ‘skin flora’ by some agent and its subsequent invasion by bacteria.

The bacteria

Next generation sequencing has confirmed the cross-sectional association between atopic eczema and Staphylococcus aureus colonisation. The two studies that used this approach have shown that disease flares are associated with a significant fall in skin microbiota diversity and an increase in the relative abundance of both S. aureus and epidermidis. PMID: 27667310

Staphylococcus epidermidis is a Gram-positive bacterium, and one of over 40 species belonging to the genus Staphylococcus. It is part of the normal human flora, typically the skin flora, and less commonly the mucosal flora. Although S. epidermidis is not usually pathogenic, patients with compromised immune systems are at risk of developing infection. If the papers on PubMed are representative, however, the most common bacteria to invade is Staphylococcus aureus:

We conducted a cross-sectional study of children and adults diagnosed with atopic dermatitis and S. aureus colonization. …..A total of 91 patients were included and 100 S. aureus isolates were analyzed. All strains were methicillin-susceptible S. aureus. ……Our data, in a southern Brazilian sample of AD patients, revealed a low prevalence of mupirocin and fusidic acid resistance of S. aureus atopic eczema colonizer strains. However, for neomycin and bacitracin, which are commonly used topical antimicrobial drugs in Brazil, high levels of resistance were identified. Further restrictions on the use of these antimicrobials seem necessary to keep resistance as low as possible. PMID: 27828633

Staphylococcus aureus, is part of the skin and gut microbiota of all of us including infants, and there are some papers that indicate only certain strains are to blame:

Although the frequency of early gut colonisation by S. aureus was not related to subsequent eczema development, the S. aureus strains that were found to colonize those infants who developed atopic eczema were less likely to carry the gene encoding the superantigen SElM (p=0.008) and the gene for elastin-binding protein (p=0.03), as compared to strains that were isolated from infants who had not developed atopic eczema by 18 months of age. …. PMID: 27761891

this is the subject of ongoing research.

The cause of the disruption of skin flora

One major cause of the disruption of skin flora is urine and faeces. Thus the elderly or ill who are incontinent, and babies and infants with wet nappies, are stripped by the urine in particular of their natural protection. Once stripped, infection sets in and the bacteria to benefit are those immune to urine, those expelled in urine and faeces, or those that live naturally near the area stripped:

Incontinence-associated dermatitis (IAD) is a common skin disorder seen in patients with incontinence. Typically IAD presents as inflammation of the skin surface characterised by redness, and in extreme cases, swelling and blister formation. If untreated this usually rapidly leads to excoriation and skin breakdown, which may subsequently become infected by the skin flora. PMID: 26972998

And

Urine alters the normal skin flora and increases permeability of the stratum corneum, and faecal enzymes on the skin contribute to skin damage. Faecal bacteria can then penetrate the skin, increasing the risk of secondary infection. PMID: 27734729

So in a sense the cause of eczema in some people – babies, infants and old people - is a dirty nappy.

Another stripper of the natural flora on the skin appears to be some combinations of hard water and the chlorine in swimming pools and drinking water:

Our study shows that exposure to hard water and infant swimming interact. to increase the prevalence of childhood eczema. A breaching of the epidermal barrier by detergents or salts in hard water and by chlorine-based oxidants in swimming pool water might explain these interactions. PMID: 22591883

It is not hard water of itself. Thus simple calcium carbonate in the water drunk or in the bath is not the cause:

We did not find an association between eczema and water hardness at home ….during the first four years of life. PMID: 26298601

but ANYTHING - soap, detergents, and other chemicals - that strip the skin of its natural defences will have the same effect.

Toxins - Heavy metals

PubMed contains hundreds and hundreds of papers detailing toxins that cause contact allergies. Nickel seems to be very high on the list because of its continued use [despite regulations] in jewellery. Perfumes are another source. For example:

OBJECTIVES: To assess prevalence measures of atopic dermatitis (AD), asthma, allergic rhinitis and hand and contact dermatitis in adolescents in Odense municipality, Denmark…. The study was carried out as a cross-sectional study among 1501 eighth grade school children (age 12-16 years) and included questionnaire, interview, clinical examination and patch testing. RESULTS: The lifetime prevalence of AD was 21.3% (girls 25.7% vs. boys 17.0%,) … The lifetime prevalence of hand eczema .. was 9.2%, … with a significant predominance in girls. A significant association was found both between AD and inhalant allergy, and between AD and hand eczema using lifetime prevalence measures. The point prevalence of contact allergy was 15.2% (girls 19.4% vs. boys 10.3%,), and present or past allergic contact dermatitis was found in 7.2% (girls 11.3% vs. boys 2.5%). Contact allergy was most common to nickel (8.6%) and fragrance mix (1.8%). PMID: 11260009

And

In April 2014, the European Chemicals Agency defined the concept of 'prolonged contact with skin' as used in the EU nickel restriction…. We performed a limited market survey in Stockholm, Sweden. Items with metallic parts that come into contact with the skin, except those explicitly mentioned in the legal text, were chosen. ….One hundred and forty-one items belonging to one of three categories - accessories, utensils for needlework, painting and writing (called utensils), and electronic devices - were tested in the study. Forty-four percent of all items were DMG test-positive (releasing nickel), and 9% gave a doubtful DMG test result….. The large proportion of nickel-releasing items in the present study shows clearly that broader parts of industry need to take action to prevent nickel allergy. The high proportion of DMG test-positive items indicates that there is still much work to be done to reduce the nickel exposure of the population. PMID: 27125984

And here is a most interesting source ….

Laptop computers may release nickel and cobalt when they come into contact with skin. …..Nickel and cobalt spot tests were used on the lid and wrist supports of 31 laptop computers representing five brands. The same surfaces were tested on all computers. ……Thirty-nine per cent of the laptop computers were nickel spot test-positive, and 6% were positive for cobalt. The nickel on the surface could be worn off by consecutive spot testing of the same surface. … Skin contact resulting from laptop use may contribute to an accumulated skin dose of nickel that can be problematic for sensitized individuals. PMID: 27133625

Toxins - Household products and cosmetics

One major source of problems is cosmetics and other supposed skin care products ranging from sunscreen lotions, to baby care shampoos to lipsticks, and eye shadow , which often have high levels of heavy metals or a toxin called Methylisothiazolinone - found in 'leave on' hand creams, foundation, sunscreen lotion, baby skin care lotion plus a number of related products. It is a preservative but causes dermatitis amongst other problems. There is also an alarming new trend to put nanoparticles in skin care products such as sunscreen lotion, hand creams and cosmetics. Skin diseases will be the least of a person's problems in this case, as nanoparticles can cause gene mutation.

Other household and ‘personal care’ products known to cause eczema include shampoos and body washes, anti-perspirants, deodorants, perfumes, and cleaning agents. An example [from literally thousands on PubMed]

Surfactants are cleansing agents used in products such as shampoos and soaps….. Forty-seven participants completed the study. Excluding doubtful reactions, positive reactions were most common to oleamidopropyl dimethylamine (34%) and dimethylaminopropylamine (34%), followed by isostearamidopropyl morpholine lactate (23%). Co-reactivity was high among oleamidopropyl dimethylamine, dimethylaminopropylamine, cocamidopropyl betaine, amidoamine, and isostearamidopropyl morpholine lactate. PMID: 27775977

It is noticeable that a number of products known to be toxic to the skin and especially sensitive skin like that of a baby or infant are being incorporated in baby products claiming to be ‘hypoallergenic’ and ‘safe and tested’, which is, shall we say, truly evil. Wash your baby in warm water. Wash your child in warm water. Soap is not needed nor are ‘body washes’.

Toxins - Nanoparticles, air pollution and air pollutants

Both toxic gases and nanoparticles in the environment cause irritation

Daily outpatient visits between 2007 and 2011 (1826 days) were collected from Huashan Hospital in Shanghai, China. We used an overdispersed generalized additive model to investigate the short-term association between environmental factors and outpatient visits for eczema. Daily outpatient visits for eczema were significantly associated with air pollution and meteorological factors. For example, a 10 μg/m³ increase of 7-day (lag 06) average concentrations of PM10 (particulate matter no greater than 10 microns), SO₂, NO₂ was associated with 0.81%, 2.22% and 2.31% increase in outpatient visits for eczema, respectively. PMID: 27834842

Toxins – insecticides and pesticides

It is well known that pesticides are widely used compounds. In fact, their use in agriculture, forestry, fishery and the food industry has granted a huge improvement in terms of productive efficiency. However, a great number of epidemiological surveys have demonstrated that these toxic compounds can interact and exert negative effects not only with their targets (pests, herbs and fungi), but also with the rest of the environment, including humans.
This is particularly relevant in the case of workers involved in the production, transportation, preparation and application of these toxicants.
Accordingly, a growing body of evidence has demonstrated the correlation between occupational exposure to pesticides and the development of a wide spectrum of pathologies, ranging from eczema to neurological diseases and cancer.
… Indeed, the use of personal protection equipment is necessary while handling these toxic compounds, but education of workers can be even more important: personal contamination with pesticides may occur even in apparently harmless situations. This review summarises the most recent findings describing the association between pesticide occupational exposure and the development of chronic diseases. PMID: 27748877

And

A diverse group of agro-chemicals are indiscriminately sprayed by the farmers for pest control to enhance crop yield. About 25 million agricultural workers in the developing world suffer from at least one episode of poisoning each year, mainly by anticholinesterase- like organophosphates (OPs)…… Pesticide sprayers showed a number of clinical symptoms like eczema, saliva secretion, fatigue, headache, sweating, abdominal pain, nausea, … [etc] These findings suggested that farmers who work with OPs are prone to neuro-psychological disorders and diabetes. PMID: 27688820

Fungus

Fungus in the environment as spores, appears to be more of a problem than fungal infection. For example:

During April 2011-April 2012, we conducted a cross-sectional study and collected 13,335 parents-reported questionnaires of 4-6-year-old children from 72 kindergartens in Shanghai, China. Logistic regression model was used to investigate associations….. .., the factors which were strongly associated ..with lifetime-ever eczema included …… dampness-related exposures in the early residence (mold spots/stains: 1.41; mold odor: 1.41) and in the current residence (water damage: 1.33; damp stains: 1.34; mold spots: 1.32; and windows pane condensation: 1.31). Parental smoking, pet-keeping, and incense-burning had NO significant associations with childhood eczema. PMID: 27812754

If we now go back to one of the causes above – incontinence and urine – which strips the skin of its protective layers, then some eczema is caused by fungal infections as well as bacterial infections.

Candida albicans is the most prevalent human fungal commensal organism and is reported to be the most frequent aetiological organism responsible for infection associated with incontinence-associated dermatitis. …Incontinent participants (n = 53) had a non-significant trend towards greater Candida colonisation rates at the perianal site (43% versus 28%) and the inguinal site (24% versus 14%) compared to continent patients (n = 28). PMID: 27478106

Nutritional deprivation

If one is nutritionally deprived then the immune system does not work properly. When the immune system does not work properly, then the pathogens causing eczema are able to thrive more readily. Here is an example, but any form of nutritional deprivation of vitamins, minerals, amino acids and so on, whether overdose or deficiency has the same effect:

Vitamin D - 25(OH)D deficiency in early childhood is associated with increased risk for persistent asthma, eczema ….. upper respiratory tract colonization with bacterial pathogens, or both. These relationships are only evident if 25(OH)D status is monitored prospectively and longitudinally. PMID: 27726947

Food allergy

People with dermatitis, rash, eczema and other skin manifestations are often found to be allergic to some food stuff, for example:

Atopic dermatitis (AD) is an inflammatory disease of the skin, which is characterised by a chronic relapsing course….The aim of the study was to assign the prevalence of clinically active food allergies among a group of children between 3 months and 7 years of age, with AD…..Food-sensitised patients with moderate levels of sIgE had clinically active food allergy to milk (39.28%) and egg (42.34%) on the basis of positive OFCs. High IgE and eosinophilia had a prevalence of almost 80% and 25%, regardless of concomitant food sensitisation and disease severity. PMID: 27717723

And

Fifteen children with allergy to wheat, barley, rye or oats, confirmed by double-blind placebo-controlled food challenge (DBPCFC), were selected for the study. When exposed to cereals, seven of the children (47%) showed immediate type reactions, such as urticaria, rash or anaphylaxis. Eight of the children (53%) showed delayed type reactions, such as deterioration of atopic dermatitis or diarrhoea. PMID: 19117084

We have a very detailed section on food allergies on the site and it is essential that this is read to gain some understanding of where the food allergies came from – the ultimate cause.

Premature birth

Dermatitis is one of the many complications of premature birth, notice also in the following paper the comorbidities of asthma and allergy

This study aimed to assess pulmonary function and prevalence of asthma, atopic diseases and allergic sensitisation in children born prematurely…. The study included 84 children aged 9.3±2.3 years born at mean gestational age of 31.8±2.4 weeks. The prevalence of

current asthma was 25%, more severe asthma was 15.5%;
rhinitis was 38.1%;
flexural eczema was 8.3%; and
a positive skin-prick test was 69.6%.
positive bronchodilator response was observed in 20.5% of cases, and
altered pulmonary function in 42.9%.

PMID: 27756492

Pharmaceuticals

From what we can see of the evidence a whole range of pharmaceuticals are treated by the body as toxins and expelled either via our urine, via our faeces or via the skin.

The eHealthme site collects the Adverse Drug reports submitted by doctors to the FDA and SEDA in the USA. It then summarises them for ease of use. We originally provided a direct link to Eczema listed on this site and the pharmaceuticals that can cause it, but the eHealthme website developers frequently reorganise the site and thus break the links. Thus in order to find out which pharmaceuticals are implicated in Eczema

Follow the LINK to the eHealthme website
Using the ‘All conditions’ index find the appropriate entry
Now scroll down until you get to the section marked ‘Drugs that could cause ”

The list shows you all the drugs implicated in CAUSING Eczema as well as the number of people who have made a complaint to their doctor and had their case reported by him. Note that it is up to the doctor whether he reports or not.

As of October 2016, about 1,400 pharmaceuticals were in this list.

The chart below shows the number of ADRs received as of October 2016, having pharms as the cause.

Aspirin and pain killers seem to figure prominently on this list, as do Statins, Immunosuppressants, anti-histamines, Proton pump inhibitors, Chemotherapy drugs etc etc For example:

Benzydamine (also known as Tantum Verde and branded in some countries as Difflam), is a locally-acting nonsteroidal anti-inflammatory drug (NSAID).
Ten patients (six females/four males), aged 21-84 years (mean 64.9) had a positive photopatch test to benzydamine [1-5% petrolatum (pet.) from Bial-Aristegui] and to drugs that contain it (Tantum verde oral solution and Momen gel). Nine patients had lower lip cheilitis and one lichenified eczema on photo-exposed sites….. Despite its widespread use and its known photosensitizing capacity, contact dermatitis from benzydamine is probably underdiagnosed. PMID: 20573168

One class of pharmaceutical heavily implicated in eczema are antibiotics. Antibiotics affect the intestinal flora and by doing so effectively destroy the immune response provided by the intestine. As a consequence, pathogens of all sorts can get into the blood stream. As such, although on testing one may find a host of different pathogens in the eczemic pus, unrelated to intestinal flora, if the chain of cause-effects is followed, antibiotics are the cause:

Eczema is frequently the first manifestation of an atopic diathesis and alteration in the diversity of gut microbiota has been reported in infants with eczema. To identify specific bacterial communities associated with eczema, we conducted a case-control study of 50 infants with eczema (cases) and 51 healthy infants (controls). …. We identified four genera enriched in healthy infants: Bifidobacterium, Megasphaera, Haemophilus and Streptococcus; and five genera enriched in infants with eczema: Escherichia/Shigella, Veillonella, Faecalibacterium, Lachnospiraceae incertae sedis and Clostridium XlVa. Several species, such as Faecalibacterium prausnitzii and Ruminococcus gnavus, that are known to be associated with atopy or inflammation, were found to be significantly enriched in infants with eczema. Higher abundance of Akkermansia muciniphila in eczematous infants might reduce the integrity of intestinal barrier function and therefore increase the risk of developing eczema. On the other hand, Bacteroides fragilis and Streptococcus salivarius, which are known for their anti-inflammatory properties, were less abundant in infants with eczema. The observed differences in genera and species between cases and controls in this study may provide insight into the link between the microbiome and eczema risk. PMID: 27812181

Note that caesarean birth can also cause this imbalance.

Treatment

The most obvious and most important first step is to find out the cause of the problem – toxins, viruses, bacteria, food allergies etc etc. Then these steps may also help:

Get treated at home

One study in Norway examined the feasibility and efficacy of establishing a “wound support network” which treated patients outside the hospital environment, a wound in this context included those with ‘chronic wounds’ (lasting >6 weeks and with wound area >1 cm). Hospitals are not healthy places, and as we have seen above the medical profession are carriers of disease, thus the hope was, that it would be cheaper and result in less secondary infection if all wounds were dressed by a home services network. And indeed this is what they found:

A significant improvement was evident in the intervention group in terms of eczema (P = .02), edema (P = .03), and closing of the observational wound (46.7% cases in the intervention group versus 25.0% in the control group)…. A wound support network between the primary home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital. PMID: 27755050

Throw out the steroids

Doctors tend to prescribe corticosteroid creams for eczema – immunosuppressants. Given that some eczema is caused by toxins where the most obvious treatment here is to remove oneself from the toxin, suppressing the immune system is likely to have no effect whatsoever, apart from making the child/person vulnerable to infection. Where the eczema is being caused by a virus or bacteria, for example, to suppress the immune system would seem utter madness. Thankfully people are beginning to get wise about this

Ninety-five forum users involved in 27 discussions relating to topical-corticosteroid use in childhood eczema were identified dating from 2003-2015. … People expressed a general sense of cautiousness about topical-corticosteroids, wide-ranging concerns … about potency or safety of use. They sought advice from other forum users who they perceived as having experiential expertise. PMID: 27753076

But what a very very sad reflection of the medical profession.

Changing your nappies frequently

Incontinence-associated dermatitis can be prevented and healed with timely and appropriate skin cleansing and skin protection. Frequent washes in warm water without soap, attention to drying, ensuring all areas are thoroughly dry and clean and the appropriate use of ‘containment devices’ make a big difference in babies and old people.

This article also looks at HARTMANN incontinence pads that have been developed to absorb the fluids that cause IAD and maintain the skin's acidic pH. The acidic pH of the skin contributes to its barrier function and defence against infection. Therefore, maintaining an acidic pH will help protect the skin from damage. PMID: 27734729

this is not an advertisement it is a type of design, not a make.

Use gloves, overalls and barrier creams

If there is any chance you may be being exposed to toxins or other pathogens use protective clothing, face masks and barrier creams. For example

Six primary research studies investigating the use of barrier products for preventing and managing incontinence-associated dermatitis were reviewed. The aim was to identify the most effective treatments for incontinence-associated dermatitis to enhance the quality of life of patients. The studies identified that there is no significant difference in efficacy between petrolatum, zinc oxide oil and a polymer-based barrier film. PMID: 27440366

Keep warm and sleep a lot

The immune system works better when we are warm, thus although warmth can set off bouts of intense itching, as the immune system opens up the arteries and veins to get the fighting troops in, [the itchiness is caused by the nerve endings being stimulated as the blood flow increases], it is better to suffer the itchiness and keep as warm as possible. Fighting pathogens requires a great deal of energy, thus children with eczema are more likely to get cold, and once they are cold, they won’t be able to sleep and sleeping is ABSOLUTELY KEY to recovery.

We compared overnight polysomnography and distal (finger) and proximal (clavicle) skin temperature in 18 children with eczema and 15 controls (6-16 years). Children with eczema had longer periods of nocturnal wakefulness and lower distal temperatures than controls. PMID: 27823708

So wrap up in as many layers as you can and never get cold, in bed or out of bed. And if you feel sleepy – sleep.

Wash frequently in warm water

Have a warm shower or warm bath on a regular basis to wash away the pathogens from the skin, NO SOAP, just warm water. Pat yourself dry with a clean towel and wash the towel after use so that it is always germ free. Wash away the pus = wash away the pathogens.

Please also refer to skin diseases

References and further reading

An exceptionally important section that is pertinent to this section is that on Anaphylaxis. The reason will become clear if one follows the LINK. The description uses the work of the Nobel prize winner Dr Charles Richet

As the number of references for this article is extremely large covering several pages, we have placed it in a separate section - please follow the link to Eczema references.

Related observations

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