Living with eczema
Eczema is a term for a group of medical conditions that cause the skin to become inflamed or irritated. The most common type of eczema is atopic dermatitis.
SHIKIN Arshad, 30, was delighted when she found out that she was pregnant.
When her daughter Sasha was born, Shikin was expecting a baby with smooth, unblemished skin.
However, when her baby developed eczema at four months of age, the nightmare began for Shikin and her husband as they tried numerous ways to try and deal with baby’s unpredictable skin flare-ups.
Shikin shares, “When people looked at my baby, we would often be asked, ‘What’s wrong with her? Have you tried this, have you done that?’ My dream is to stop using steroids as I want to see some strong, healthy skin. The question is how?”
The word eczema originated from the Greek word ekzein, meaning to “erupt” or to “boil over”. It is a condition where the skin erupts into a reddish rash, characterised by areas of severe itching, redness, scaling and loss of the surface of the skin. In severe cases, the skin may be infected.
What is eczema?
Eczema affects people of all ages, but is primarily seen in early childhood.
Atopic dermatitis is the most common of the many types of eczema. Also known as atopic eczema, this genetic condition results from an interaction between a number of genes and environmental factors.
In most cases, there will be a family history of either eczema or one of the other “atopic” conditions – allergic rhinitis or asthma.
Infants who are just six to 12 weeks old can get atopic eczema as a patchy facial rash.
It can become red and scaly, and it may appear on the forehead or scalp, on arms and trunk. Moisture from drooling makes it worse.
In some cases, the condition goes away by age two. But about half of the people who had atopic eczema as a child will have it as an adult.
In adults, eczema usually presents as scaly, leathery patches on the skin.
Patients who have atopic eczema have been found to have a hypersensitive immune system, which leads to a tendency for the skin to flare up.
This sometimes happens from a reaction to irritants or allergens, but more typically there are no obvious external causes.
The prevalence of atopic eczema is about 20% in Malaysia and Singapore.
It is a chronic condition of significant burden as individuals and family members struggle with time-consuming treatment regimens for the disease, as well as dietary and household changes.
The financial impact of atopic eczema can also be great. In the United States, it is estimated that the direct cost of atopic eczema is almost US$1bil (RM4bil) per year.
Managing eczema
The treatment of atopic eczema is centred on rehydrating the skin, coupled with cautious use of topical steroids to reduce inflammation and itching.
Oral antihistamines may be helpful in breaking the “itch-scratch” cycle. Since secondary infections can aggravate the rash, topical or oral antibiotics may also be indicated occasionally.
Recent developments in microbial studies have found that the significant collection of bacteria living in and on the human body play an important role in the maturation of the human immune system.
Humans are made up of 10 trillion human cells. In contrast, there are 100 trillion microbial cells living everywhere within humans – on the skin and in the gut, eyes, nose and genito-urinary tract.
This huge collection of bacteria forms an important “organ” that helps us fight bad bacteria, produce vitamins and improve digestion, besides playing a role in the maturation of the immune system.
The term “microbiome” refers to the combined collection of genetic microbial material in a particular environment. The entire collection of microbes within humans is known as the human microbiome.
The increasing prevalence of allergic diseases today bears an important connection to the way humans are influencing the microbiome they are harbouring.
Scientists have found that there are three key human insults to the microbiome, namely, caesarean-section delivery, antibiotic use and formula feeding.
When bacteria in the body are disrupted by these factors, different immune disorders (eczema, allergic rhinitis, sinusitis) can result. For example, studies have suggested that babies delivered by caesarean section may be more susceptible to allergies and asthma, and that the administration of probiotics from birth until six months reduced the incidence of allergy at age five years in those born through caeserean section.
Probiotic therapy
Probiotics are live microorganisms that impart benefits to their host (humans).
Although well known for their benefits to the digestive tract, specific probiotics also present a valuable opportunity to address the bacterial imbalances within the immune system.
However, with so many probiotics in the market, it isn’t surprising that consumers are confused about which to choose, often basing their choices on the probiotic’s colony forming unit (cfu) count.
For this reason, the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) set up a series of guidelines for the evaluation of probiotics in food (including supplements) in 2002.
A probiotic that is intended to be used for therapeutic purposes needs to meet all of the requirements of these guidelines, which include having to be specifically named (with its genus, species and strain specificity), proven to survive the harsh environments of the digestive tract, and most importantly, substantiating its clinical indications with specific clinical studies.
Lactobacillus fermentum is a single strain probiotic that satisfies all the requirements of the FAO/WHO panel.
As an immune-regulating probiotic, it has been shown in clinical studies to be effective for moderate to severe cases of atopic eczema.
When Lactobacillus fermentum was given to babies with moderate to severe eczema, studies found that it helped to improve the condition in 92% of babies over a course of eight weeks. As it is resistant to antibiotics, it can be taken concurrently with such medicines.
This article is brought to you by the Nuvaceuticals Division of Nuvanta Sdn Bhd. For more information, call 03-5636 3758 or 1300 88 1712, or e-mail: pharmacist@ nuvanta.com.