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As the eyes are the reflection of
one's inner health...they
are literally as we know a window into a person's vascular and
neurological system as the only location in the body where the nerves
and vessels can be seen without invasion. Yet, an even more profoundly
evident barometer to one's overall health happens to be the
largest single organ in the human body that is visible. The skin ranges
in thickness from one to two millimeters and varies from 0.6 millimeter
on the eyelid to three millimeters on the soles and palms. It comprises
approximately 12-15% of total body weight and has a surface area of
1-2 meters.
The skin consists of two distinct layers, the outer layer (epidermis)
and the thicker underlying layer (dermis). The epidermis and the dermis
differ in function,
appearance, and origin. Beneath the innermost layer, the subcutaneous layer
(hypodermis) binds the skin to the underlying structures such as the hair,
nails, and sweat glands. Collectively these structures are considered appendages
of the skin, as they are all of epithelial origin. The skin serves as a physical
barrier to protect the inner body from foreign matter while also providing
protection for the internal organs and maintaining moisture within the body.
The skin also plays a large role in the homeostatic changes that affect the
body such as temperature regulation, sensory reception, biochemical synthesis,
protection, absorption, and elimination or detoxification. Receptors in the
skin include those for pain, pressure, and temperature. Meissner's corpuscles
are sensitive to touch, and Pacinian corpuscles are sensitive to pressure.
Specialized skin cells also synthesize melanin and carotenes, which serve as
pigmentation sources and production of vitamin D.
We often judge the health of our pets by the appearance of their coats, if
they are shining and smooth it is said they have a healthy coat and is considered
a reflection of their overall well being. So, whether it is our hair, nails
or skin, human skin also reflects our health as individuals. We have all seen
friends and family that look pale, drawn, and ashen, all reflective of overall
internal balance. Additionally, observing the skin through various disease
processes can sometimes serve as a measurement on the continuum of health along
which the patient is progressing. Homeopaths and Naturopathic physicians are
taught Hering's Law of Cure, which state that a patient's signs
and symptoms of disease will disappear from within outward and in the reverse
order of their appearance, and that the body seeks to externalize disease as
part of the curative process.
Even as holistic physicians we have to find the balance between helping patients
deal with the immediate social consequences of skin problems, while addressing
the deeper underlying causes and factors that have led to the susceptibility
that results in the overt signs of eczema, for instance.
Few people are born
with eczema, and many times eczematous bouts come and go, during a person's
life. By evaluating which triggers are present, nutritional factors and deficiencies,
and external factors such as irritants are all important. After all, the good
physician blends the best of science, nature and good old-fashioned detective
work. So, going back a couple of weeks to months prior to the outbreak or flareup
often points to the true and deeper issues at hand that has so disturbed the
innate health and homeostasis of the body that it has begun to complain in
one of the most obvious of all manners — with a skin manifestation. The
concept of treating eczema with hydrocortisone or other suppressive therapies
is inherently foreign to the holistically minded physician. Doing such, though
palliative, equates to no less than turning a blind eye to the problem and
then believing all is good and well.
Causation
Studies involving the use of double-blind,
placebo-controlled food challenges show that upon repeated exposure
to a known food allergen, eczematous lesions
can result in susceptible patients. The most common foods that exacerbated
the eczema in these patients were…cow's milk, eggs, wheat,
soy peanuts, eggs and fish.1 Removal of these foods from susceptible patients' diets
resulted in remission of eczema symptoms.2 The food allergy-eczema link is
well established, and the most common-sense approach to this association
is allergen avoidance. However, avoidance of foods is not the entire solution,
and new studies are exploring other theories of eczema causation. Atopic
dermatitis is also affected by exposure to other allergens, which follows
the pattern of most atopic individuals suffering from asthma, allergies and
eczema. Allergens such as dust mites, animal dander, and pollens are known
to worsen and bring about an eczematous flare up. Seemingly ubiquitous, these
aeroallergens can be somewhat controlled in the home environment, allowing
for clinical improvement of the patient.3
Another link in the development of eczema may lie in an improperly functioning
epidermal barrier that exposes the patient to rapid dehydration of the skin
due to its inability to retain water, resulting in shrinking and gapping of
the epidermal barrier. Epidermal barrier dysfunction has many suspected causes,
and several studies have implicated psychological stress as a negative influence
on cutaneous barrier function, and may trigger or aggravate skin disease.4
Researchers implicate increased glucocorticoid production, resulting from stress,
as the main factor that causes epidermal permeability homeostasis. Interestingly,
histamine, a body chemical widely implicated for its role in allergic reactions,
has been shown to delay epidermal barrier repair.5 Keratinocytes, a type of
skin cell, have histamine receptors on them, but their functions are poorly
understood at this time. In the same studies, it was noticed that the use of
histamine agonists, which activate the histamine receptors, slowed skin repair
while histamine antagonists, which block the effects of histamine in the body,
allowed for accelerated recovery of skin barrier function.
Prevention
Perhaps the greatest opportunity for
disease prevention occurs in the earliest stages of life, prior to
birth and immediately after, when the human body
is most "impressionable" to external influences and their role
on the body's defenses.
Probiotics
New research surrounding the use of probiotics in the prevention and treatment
of eczema in the unborn is extremely enticing. Probiotics are food supplements
comprised of billions of live microbial organisms that have numerous beneficial
effects on human health, and may be used both prophylactically and therapeutically.
Certain strains have demonstrated powerful anti-pathogenic, anti-inflammatory,
and anti-allergic effects. The early composition and subsequent development
of the gastrointestinal microflora is now considered a pivotal determinant
of both normal gut barrier function (relating to food allergy) and phenotype
of immune response. (It is postulated that signature allergic inflammatory
processes are expressed as a result of unbalanced Th1 and Th2 cytokine production,
with a dominant polarization toward a Th2 phenotype, of which atopic disease
is well-known to be Th2-mediated.)6 Subsequently, a significant improvement
in the clinical course of atopic eczema has been reported in infants given
a probiotic-supplemented diet.
The potential of probiotics to reduce the
risk of atopic disease has been graphically demonstrated in a double-blind,
placebo-controlled study in which probiotics administered pre- and postnatally
for 6 months to mothers at risk for eczematous disease, reduced the prevalence
of atopic eczema to half of that observed in infants receiving placebo.7
Maternal atopy is a clear risk factor for atopic eczema in the infant. Administering
probiotics during pregnancy and breast-feeding offers a safe and effective
mode of augmenting the immunoprotective potential of breast-feeding and provides
protection against atopic eczema during the first 2 years of life.8
Hygiene hypothesis
The hygiene hypothesis postulates an inverse
relationship between hygiene, in its broadest sense, and allergic disease.
This theory suggests that atopic
disease may arise from a lack of counterbalancing microbial exposure at an
early age. Recent studies suggest that many hygiene related factors might
influence immune development in favor of an allergic phenotype. Antibiotics
in the early stages of life have been associated with increased risks of
allergic disease in later childhood, while farming exposures lead to protection.
The role of bowel flora in modifying immune development has been suggested
as an explanation for the risk associated with antibiotic exposure and has
led to various studies exploring the effects of bowel flora modification
with probiotics — both to influence established allergic disease and
to prevent it. Recent findings from these studies indicate alterations in
intestinal microbial concentration are common in infants suffering from allergic
disease and those that develop atopy at a later date, and that probiotic
supplementation strengthens gut defense barrier mechanisms and reduces antigen
load in the gut mucosa.9
Breast Feeding
Exclusive breast feeding in only the first few weeks after birth exerts positive
effects on the incidence of allergic and infectious disorders. In newborn
siblings of children with atopic disease exclusively breast-fed for only
six weeks, the incidence of eczema, recurrent wheezing, elevated serum IgE-antibodies
to cow's milk, complement activation in vivo after milk challenge
and hemagglutinating antibodies to beta-lactoglobulin was significantly lower
compared with formula-fed matched group.10 On the same page, however, infants
that are susceptible to atopic disease can develop eczema from the transfer
of allergy-inducing antigens in breast milk.11 Therefore, it is equally important
that the mother's diet be free from as many suspected food allergens
as possible while breast feeding, and that breast feeding continue for several
weeks postnatally. Because of the strong link between antigens in breast
milk and the occurrence of atopic skin disease in the infant, it is strongly
recommended that serum testing for food allergens be performed prior to birth,
on the mother.
GI integrity
Integral to the treatment of the eczematous
patient is an approximation of gastrointestinal integrity. The concept
of "leaky gut" runs
through the principles of practice for Naturopathic physicians treating patients
in which defective intestinal permeability plays a role. If the eyes and
the skin are the portal through which we may observe the body's internal
health, the gut then is the door through which a majority of disease initiates
its entrance into the body. It goes without saying that many factors in today's
lifestyle compromise the meticulous integrity of the gut lining, namely food
choices and antibiotic therapies.
The first area of treatment then for the patient displaying eczema should be
the gastrointestinal lining, without a doubt. Indigenous gastrointestinal microbes
have a significant effect on the gut-associated immune system and play a large
role in the development and maintenance balance between tolerance to innocuous
antigens and capability of mounting an inflammatory response towards potential
pathogens. Distinctive alterations in the composition of gut microbes appear
to precede the manifestation of atopic disease, which suggests a role for the
interaction between the intestinal immune system and specific strains of the
microbes in the pathogenesis of allergic disorders.12 Restoration of intestinal
permeability, unbalanced gut microecology, improved immunological gut barrier
function, and down-regulation of intestinal inflammatory responses with reduced
pro-inflammatory cytokine production are the goals of gastrointestinally focused
therapies for eczema treatment.13
Conclusion
Wide arrays of natural therapeutics
exist to treat the symptoms of eczema, however by looking into the
underlying causes of the disease's manifestation,
treatment becomes more applicable and multidimensional. Clearly, suppressive
therapies (hydrocortisone) for eczema only serve to prolong actual treatment
of the symptoms. Natural therapeutics may be considered equally palliative
as we learn more about the role of the gastrointestinal system and immune
function in this condition. Studies of probiotic supplementation in pregnant
women bring new light to "treating the cause," as the treatment
is directed at preventing the occurrence of a disease condition in a future
patient! A classical naturopathic therapeutic approach entails "treating
the gut" in a number of disease conditions, and like so much of natural
medicine, scientific research continues to validate what Nature has known
all along.
Correspondence:
Chris D. Meletis, ND
Dean of Naturopathic Medicine
Chief Medical Officer National College of Naturopathic Medicine
cmeletis@ncnm.edu
503-499-4343 #1620
Jason Barker, ND
Second Year Resident, NCNM
jasonebarker@msn.com
503-499-4343 #1811
References
1. Boguniewicz M., Leung DYM: Mangement of atopic dermatitis. In: Atopic
Dermatitis: From Pathogenesis to Treatment. RG Landes, 1996.
2. Boguniewicz, M. Advances in the understanding and treatment of atopic
dermatitis. Curr Opin Pediatr 1997: 9:577.
3. Tan BB et al. Double-Blin controlled trial of effect of house dust-mite
allergen avoidance on atopic dermatitis. Lancet 1996;347:15.
4. Denda M, Tsuchiya T, Elias PM, Feingold KR. Stress alters cutaneous
permeability barrier homeostasis. Am J Physiol Regul Integr Comp Physiol
2000 Feb;278(2):R367-72
5. Ashida Y, Denda M, Hirao T. Histamine H1 and H2 receptor antagonists
accelerate skin barrier repair and prevent epidermal hyperplasia induced
by barrier disruption in a dry environment. J Invest Dermatol 2001
Feb;116(2):261-5
6. Matsuda H, Suda T, Hashizume H, Yokomura K, Asada K, Suzuki K, Chida
K, Nakamura H. Alteration of Balance between Myeloid Dendritic Cells
and Plasmacytoid Dendritic Cells in Peripheral Blood of Patients with
Asthma. Am J Respir Crit Care Med 2002 Oct 15;166(8):1050-4
7. Laiho K, Hoppu U, Ouwehand AC, Salminen S, Isolauri E. Probiotics:
on-going research on atopic individuals. Br J Nutr 2002 Sep;88 Suppl
1:S19-27
8. Rautava S, Kalliomaki M, Isolauri E. Probiotics during pregnancy
and breast-feeding might confer immunomodulatory protection against
atopic disease in the infant. J Allergy Clin Immunol 2002 Jan;109(1):119-21
9. Kalliomaki M, Isolauri E. Role of intestinal flora in the development
of allergy. Curr Opin Allergy Clin Immunol 2003 Feb;3(1):15-20
10. Chandra RK. Prospective studies of the effect of breast feeding
on incidence of infection and allergy. Acta Paediatr Scand 1979 Sep;68(5):691-4
11. Murray, M., Pizzorno, J. Encyclopedia of Natural Medicine, 2nd
Edition. Rocklin, California, Prima Publishing, 1998.
12. Rautava S, Isolauri E. The development of gut immune responses
and gut microbiota: effects of probiotics in prevention and treatment
of allergic disease. Curr Issues Intest Microbiol 2002 Mar;3(1):15-22
13. Cucchiara S, Falconieri P, Di Nardo G, Parcelii MA, Dito L, Grandinetti
A. New therapeutic approach in the management of intestinal disease:
probiotics in intestinal disease in paediatric age. Liver Dis 2002
Sep;34 Suppl 2:S44-7
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