Promising changes in the landscape of eczema treatment
If you’ve got eczema, no doubt you’ve tried everything to get rid of that constant, chronic, life-altering itch and redness. Unless you’ve experienced it yourself, it’s hard to describe how insanely frustrating this condition can be for sufferers. Think of a mosquito-bite x100 that you can’t get rid of. This sensation is coupled with red, raw skin from itching; some sufferers can’t even wash their hands without skin breaking open, others wake constantly during the night with dry skin and itching.
The impact that eczema has on your life is really dependent on what kind of eczema you have and how severe it is. For those that have severe eczema, it can be really difficult to break the itch-scratch cycle, and dependency on steroids, antihistamines and even central nervous system depressants can develop in the day-to-day management of symptoms.
These patients have a much longer route when they seek natural treatment, as the disease progression is much more advanced and the damage and trauma to the tissue itself is very pronounced (and sometimes hard to change). For some with severe eczema, the costs and effort required for natural treatment may not be realistic or possible, and may not make a significant difference to symptoms. Results are not guaranteed, and there are many aspects that complicate the treatment process. This is just something I have learnt and seen in my 10+ years of clinical experience, and a conversation that’s really important to have when considering what will be the most effective treatment route for you.
The good news is that there’s been some really amazing advances in conventional eczema treatment, which is something I discuss with those who have severe eczema and are seeking treatment with me.
But firstly, let’s quickly cover some background about eczema, so that you can start to understand who would benefit most from these conventional treatments.
Eczema arises when epithelial (skin) inflammation occurs, due to immune-mediated inflammatory responses that are constantly being heightened and fed within the body.
Some of these pro-inflammatory responses may be triggered by controllable factors (environmental irritants and influences, allergenic exposure), while some may be chronically activated by more innate problems like dysbiosis and immune dysregulation (where the immune system creates chronic low-grade inflammation which is the major presentation in eczema and is linked to Th2 dominance). Depending on how many factors affect your eczema determines how complex your treatment may be, and how severe your experience of it may be.
What I refer to as “classic eczema“ or “true eczema“ develops due to immune dsyregulation and potentially food or environmental irritants as well. This presents in the ditch of the elbow and knee, the feet, hands, neck or face. The skin is dry, potentially cracked from trauma of itching, and red. It is also prone to secondary soft tissue infections, so may become aggressively flared and require antibiotic support. This usually develops in infancy or childhood, and usually becomes less severe with age (especially if allergies are diagnosed and able to be avoided).
Contact irritant or allergic irritant eczema is a little different. This occurs as a result of the allergic response, which triggers an increase in pro-inflammatory chemicals that create itching, burning and redness of the skin. This can be from food or environmental factors. Common ones I see in the clinic include: dairy allergy, egg allergy, nut allergy, chemical sensitivity and nickel sensitivity or allergy. In this instance, the eczema only appears as a response of contact or exposure to the irritant or allergen. Treatment requires the identification and removal of the irritant/allergen. This can become complicated when there are multiple allergies, but where there is only one, it means this type of eczema is easy to manage, and we don’t have to do all the internal work required where immune dysregulation is involved.
You can have both types of eczema occurring at once, and are more likely to develop irritant dermatitis if you have eczema already, as the skin barrier is intrinsically compromised and sensitivity to environmental or topical irritants increases with exposure over time.
By the way, It has been shown that your risk of developing eczema increases if:
your mother has or had eczema or eczema in her family history (genetic predisposition)
your mother consumed dairy whilst pregnant with you
you live in urban areas with higher levels of pollution
you live in colder climates (due to lack of moisture and irritation to the skin)
When I talk to people in discovery calls, I am ascertaining the severity of their eczema, and whether it is internally/innately driven or irritant/allergen driven (or both).
In severe cases, sometimes I suggest having a simple blood test before discussing if we should work together. Measuring your immunoglobulin E levels via blood pathology is how I understand how severe your allergic response is. Patients with mild or moderate eczema will have a normal or mildly elevated IgE, whereas patients with severe eczema will have a highly elevated IgE. This determines how effective I think my treatment will be on them. This doesn’t mean natural treatment can’t be helpful to people with severe eczema, it just means it takes a lot longer to see these results! As you can imagine, being able to reduce IgE levels by 100 (which is a feat!) in someone who has levels that are 200 is very significant; it will bring them into the normal range for IgE and reflect that there is a reduced allergenic response. Reducing IgE levels by 100 in someone who has levels that are 5000 is not even goign to be noticed, and will not cause symptom resolution. This is important to take into account, as the more severe the eczema the more debilitating it is to live with, and it’s important that the psychological consequences of this chronic and uncurable disease are taken into account. Whatever will give the person the most benefit with the least amount of risk is the best treatment option. For some with severe eczema, this means I am suggesting these new conventional medications as their first place to start.
Inflammation is the entire problem with eczema; specifically certain pro-inflammatory chemicals like interleukins and cytokines. Cytokines are small proteins found in the body, which are produced in response to an immune stimulus (ie. food allergy, bee sting, itchy skin). Cytokines mediate and regulate immunity, inflammation and our blood cell production – as you can see, they play a pretty important role. But in cases of an overactive immune system (which is often seen in eczema), the body’s cytokine activity can go into overdrive, instead of working in a nice, balanced state. And this is where there have been exciting developments in the treatment of eczema. A new prescription medication is available in Australia, which is an injection that reduces the impact of cytokine expression; long story short, the injection stops the skin tissue responding or being affected by the increased amount of pro-inflammatory chemicals (like cytokines and interleukins) which stops the irritation and itch-scratch cycle to start with.
In some patients with severe and multi-faceted eczema where there is already tissue damage, it can be a longer road until results are seen, simply due to the severity of the inflammatory response, without this type of medication. As always, I am pro-choice when it comes to your health decisions and this medication has its risks just like anything.
But, at the end of the day, ethically, I am going to always recommend what I think will be the most effective and the most sustainable for you and your presentation. Many patients I have with severe eczema work with me whilst using this new medication - called Dupixent - to support all those other underlying factors that are contributing to the problem. This can mean that they are getting more obvious results with natural treatment and conventional medicine combined (and, very importantly, the risk of secondary skin infections is massively reduced!).
This is the true meaning of complementary medicine – using all available supports by a multi-faceted health team to help get the best outcome for you and your body.
If this sounds like something you want to have a chat about, book a FREE Discovery Call to see how we can best support your problem skin.
Much love,
Em (Naturopath, Herbalist, Skin-thusiast)
