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.

The Star Malaysia - - COMPLIMENTARY HEALTH -

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.

— Nu­vanta

In­fants who are just six to 12 weeks old can get atopic eczema as a patchy rash. It can be­come red and scaly, and it may ap­pear on the fore­head, scalp, arms, and the trunk.

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