Marcie Mom: In the video, Doctor Claudia explained atopic dermatitis and that elevated IgE (immunoglobulin E) triggered allergic response in certain people. There is no single cause of eczema identified, and no cure for the condition. It is instead a multi-factorial condition characterized by defective epidermal barrier that is more alkaline and has more enzyme activity that reduces the connectivity of the skin layers. Filaggrin is a protein that aids in the formation of skin layers (do watch the video to see the animated filaggrin) and converts to natural moisturizing factors. Dry skin lacks this normal functioning filaggrin gene, and has been linked to atopic diseases such as eczema, asthma and allergies.
Sweat and Eczema
Marcie Mom: Dr Claudia, in the video you mention that sweat is an irritant for many with eczema.
Can you explain how the chemicals in our sweat can cause the allergic reaction? Shouldn’t our skin be used to our sweat?
Dr Claudia: Well an irritant reaction is not the same as an allergic reaction. I explained that sweat can be irritating to eczema skin, as this epidermal barrier may not be fully functional. This is an interesting question though, as we are still understanding the chemical composition of sweat (be that eccrine or apocrine).
In general, sweat is composed of water, minerals (like sodium and magnesium), lactate, ammonia and various amino acids. It could be one of these compounds, the combination of them, the changing pH of the skin, or even the sweat’s water content that can cause the itching and stinging sensations to some people with Eczema. Digging deeper, I found an interesting study that suggested the amino acid composition of sweat is similar to the composition of the protein profilaggrin (which is later converted to filaggrin). This is interesting because scientists can study filaggrin by using human sweat as a potential chemical model. In the end, sweat can make eczema skin uncomfortable, so I suggest bringing a cool damp towel to your workout, or maybe spritzing a hydrating spray, instead of rubbing or scratching this sensitive skin.
Aromatherapy, Stress and Eczema
MarcieMom: Stress is also a common trigger for eczema and suggestion such as aromatherapy is mentioned in the video. Out of curiosity, does the aroma work the same way as fragrance in skin care products, which is to be avoided? Or is there a specific type of aromatherapy for those with eczema?
Dr Claudia: No, aroma in skin care products varies widely. What you want to avoid are synthetic fragrances which can cause an irritant or allergenic reaction in the skin. Some people use perfume for years before they get a skin reaction. Aromatherapy typically employs essential oils, which are natural compounds. However these can be quite potent, so a trained professional with a background in aromatherapy should be consulted before any treatment. The act of breathing deeply alone can also reduce stress.
Water in Skincare Products to be Avoided?
MarcieMom: In the video, you also recommended water-free barrier repairing products and oatmeal compress. Is water to be avoided in skin care due to preservatives being required if there is a high water content or is it because the eczema skin ‘loses’ the more liquid product easily? As for oatmeal compress, do explain to us (I’m using oatmeal bath oil, but not sure how an oatmeal compress works).
Dr Claudia: Great question. I suppose it could be both. Paraben alternatives are preservatives that have a greater potential of being irritating than parabens. So ‘paraben-free’ formulations may actually be more irritating. The amount of water lost to a skin care product from the skin is most likely negligible, so I recommend anhydrous barrier-repairing products because they contain silicones to protect skin. Our skin has a lipid (oil) layer, so you want to replenish those oils to ensure a properly working barrier.
Colloidal oatmeal for Eczema
Colloidal oatmeal is a wonderful ingredient for eczema skin. There are many scientific studies on oats and dermatitis – and this should be your eczema skin’s best friend. Look for clinical colloidal oatmeal for best results. The compress is basically a wet wrap. This is used to lock in moisture and keep the actives on the skin. On wet skin, apply oat or other active ingredient, follow with a damp gauze and cover with dry wraps. This dry covering could be pajamas (good for kids), or other dry covering. Alternatively, a colloidal oatmeal masque is a really nice add-on to a skin treatment for hydrating and soothing skin.
Vitamin D and Eczema
Marcie Mom: Vitamin D has been mentioned much to boost immunity and for the skin.
How exactly can one with eczema get vitamin D, and what’s your recommended minutes of sun exposure for those with eczema?
Doctor Claudia: Everyone has different needs, so there is no single recommended amount of sun exposure. I advise those wanting to know to consult with a dermatologist trained in a bit of photobiology. Or you could ask a scientist (they are hard to find!). At a recent conference I met Prof. Brian Diffey, an expert in this field. In a recent paper, he concluded “Messages concerning sun exposure should remain focused on the detrimental effects of excessive sun exposure and should avoid giving specific advice on what might be ‘optimal’ sun exposure”.
Vitamin D is an essential hormone and we all need a good dose of it. So speak to a dietician or doctor to find which vitamin D supplements are good for you and be sun smart!
Marcie Mom: Thanks Doctor Claudia, your explanation is so helpful, as even though we can’t cure eczema – it doesn’t hurt to understand more of it in order to manage it confidently. I’m looking forward to more of your videos!
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