4-part series on What Causes Your Child’s Eczema – Defective Skin Barrier

Restoring Defective Skin Barrier (taken from nationaleczema.org, article by Peter Elias M.D.)

This is a 4-part (a little more technical) series inspired by a review article “Features of childhood atopic dermatitis” by Hugo Van Bever and Genevieve Illanora. The article summarizes 4 players involved in atopic dermatitis, and I’ve tried to understand whatever I could from the article and other research papers published online and hopefully digested the information accurately for you to read.

Why does my baby get eczema?

I’ve asked the same question countless times and I know it’s something to do with the genes (if you read my family tree post here); but exactly what causes eczema? Medical professionals are still trying to find the answer as finding the right answer can help them to find the right way to prevent/treat eczema. Apparently, it has all along been thought that eczema has something to do with a hyperactive immune system, which being too sensitive has wrongly thought that matters not harmful to the skin/body are harmful. Now, there’s a new outside-in hypothesis that it is the defective skin barrier that leads to more irritant and allergen penetrating the skin, inducing the immune system to increase production of IgE (that work as antibody). Too much IgE will lead to skin inflammation, asthma, hayfever and food allergy.

But why is the skin barrier defective?

This is caused by a few types of proteins, the most commonly cited one being the filaggrin (FLG), which serves to produce and protect the skin barrier. In people with eczema, there is lower level of FLG, resulting in flatter skin surface cells, disrupted protective fatty layer, reducing the moisturizing function of the skin and increasing water loss from the skin. Reduced FLG also increases the skin pH and leads to increased skin inflammation. The FLG does not explain all cases, because there are people without defective FLG but still has eczema and people with eczema, but no defective FLG. (Thus, it’s currently accepted as a few possible factors such as the gene, environment, allergy reacting together, in some way that we don’t know yet)

The Implication

In the table above, there are some current ways to restore our baby’s skin barrier mainly by moisturizing, FROM DAY ONE. This is because if the outside-in hypothesis is true, then the stronger the skin barrier, the less chances of allergen/irritant penetrating the body to cause the body to react hypersensitively. There is a chance then for us to stop the allergic march in our children, where eczema is replaced by asthma and rhinitis. Humidifier also helps to ensure that the environment is not too dry for the skin, especially during winter or if your air-con is on.

If you are interested in reading the details, click here and here.

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