Eczema (also known as atopic dermatitis) is characterised by an inflammatory process on the skin resulting in patches of rough, dry, and itchy skin. This condition is generally chronic, and can happen at any stage of life. it is most common in very young children, females, and those with atopic tendencies.
There are 2 main types of atopic dermatitis; extrinsic (allergic), and intrinsic.
The pathophysiology of atopic dermatitis can involve numerous different inflammatory cells, but will generally rely on hyper stimulatory T-cells .
In the case of extrinsic atopic dermatitis, T-helper-cell activity towards Th2, and the involvement of interleukin-13-induced B cell activation, and its subsequent IgE production are somewhat characteristic of this form of atopic dermatitis .
Elevated serum histamine levels were also linked specifically to food allergen extrinsic atopic dermatitis .
Differentiating atopic dermatitis from extrinsic (allergic atopic dermatitis) to intrinsic involves investigation of specific serum IgE levels for known allergens, and serum histamine levels. Intrinsic atopic dermatitis has a lower expression of (IL)-4, IL-5 and IL-13 (Tokura, Y., 2010).
- Intensely itchy skin
- Rough, dry patches on the skin
- Commonly associated with asthma
- Dennie-Morgan folds
- Ichthyosis vulgaris (more common with intrinsic AD)
- Mild Palmar hyperlinearity bilaterally (most common with intrinsic AD)
1. Remove Exposure To Allergens
Both doetary and environmental.
- This can be both dietary, or lifestyle avoidance depending ont he allergens discovered in IgE testing. If unknown, remove common allergens such as dairy, gluten, soy products, peanut products, etc. Avoid contact with mould, dust, pets, and pollen wherever possible until sources are identified.
2. Modulate The Immune Response
- Shift focus from Th2 to Th1 response.
- Modulate histamine release.
- Consider using mild immunosuppressants for short term symptom relief
3. Topical Treatment With Antinflammatories And Antiseptics
4. Use Depuratives For Long Term Treatment Aims
- There are many to consider depending on the pathophysioloy of the presenting condition. Liver is a good place to start.
5. Address Possible Gut Dysbiosis
- "Leaky gut" is a major consideration for chronic ecsema, especially if worsened by depurative or chelation therapies.
- Staphylococcus infection
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- Vestergaard, C., Yoneyama, H., Murai, M., Nakamura, K., Tamaki, K., Terashima, Y., ... & Matsushima, K. (1999). Overproduction of Th2-specific chemokines in NC/Nga mice exhibiting atopic dermatitis–like lesions. The Journal of clinical investigation, 104(8), 1097-1105.
- Sampson, H. A., & Jolie, P. L. (1984). Increased plasma histamine concentrations after food challenges in children with atopic dermatitis. New England journal of medicine, 311(6), 372-376.