What We Know About Eczema

               At the Acne Treatment Center, we witness a lot of other skin conditions of clients who have come to us for help with acne. One of the most common is eczema. We must be very mindful of eczema because many of the treatments for acne can exacerbate eczema.

               Technically known as Atopic Dermatitis, eczema is not well understood by the medical community, but in the last 20 years, several research findings have shed light on this mysterious condition. Fortunately, some valuable things have been learned, which can guide those of us in the esthetics world with topical care for eczema sufferers.

               Eczema most typically begins in infancy and resolves during adolescence, but for many it is a life-long condition. Some people don’t develop it until their 20s or 30s. While the condition is not caused by allergies, eczema flares can and do result from allergens. People who suffer from eczema also seem prone to other allergies not associated with the skin, such as asthma, hay fever and/or food allergies.

               The condition is characterized by groups of unusually dry patches of skin that may be red or itchy and while the patches usually go away for a while, they almost always recur.  The medical community is beginning to understand that these patches come from breaks, in what is known as the barrier function of skin.

               The outer portion of human skin, called the epidermis, has a barrier function. It protects the cells of the skin, making it more impermeable to microbes, allergens, and toxins, and also stops water from evaporating from inside the body through the skin.  Without an intact barrier function, the skin cannot do its main job effectively, which is to protect the internal organs of the body.  In addition to the skin cells in this layer called the stratum corneum, this barrier is comprised of cholesterol, waxy lipid molecules called ceramides, oils, and proteins.  This barrier is assisted by the acid mantle, which is a mildly acidic coating with a pH of between 4.2 and 5.6, which also makes the skin more resistant to microbes and allergens.

               With breaks in this barrier, there will be increased water loss, making the dry skin of eczema understandable.  These breaks also allow more allergens, microbes and toxins to penetrate, leading to itchiness and inflammation.  It has been noted that the skin of eczema sufferers typically has higher pH than the skin of those that don’t.  Higher pH means the skin is less acidic and therefore less able to defend itself against microbes and allergens. 

                One of the most important proteins that comprise the barrier function is called filaggrin which is short for filament aggregating protein, and it lives in the cells of the epidermis.  It is encoded in the cleverly named FLG gene and develops in the layers of the epidermis.  People with normal FLG genes produce a large protein molecule called Profilaggrin which is cut apart (“cleaved” in scientific terms) into either 10, 11, or 12 copies of the protein filaggrin.  People whose genes are coded to have smaller profilaggrin that can cleave into only 10 filaggrins tend to be more likely to develop eczema than those whose profilaggrins can cleave into 11 or 12.

                Filaggrin affects the barrier function in several interesting ways.  It increases the skin’s ability to retain moisture and to produce its natural moisturizing factor.  The molecules of this natural moisturizing factor don’t just provide moisture, but are part of what creates the acidity of the skin.  Filaggrin also aids in the flattening and tightening of the skin cells of the epidermis, helping to create a physically stronger layer that stops transmission of bad things in and good things out.

                Some people, for whatever reason, end up with mutations in their FLG genes.  Mutations in one copy of the gene seems to make people twice as likely to develop eczema, and mutations in both copies of the gene seems to make them three times as likely.  People with mutations in both genes tend to develop more severe forms of eczema. 

               There are 40 known mutations that are associated with eczema.  These mutations typically lead to the production of shorter profilaggrin that cannot be cleaved into as many filaggrins, or sometimes into any filaggrins, both of which result in filaggrin deficiency in the skin.

               But let’s be clear here – a gene with mutations does not mean you will definitely get eczema.  Lots of people with mutations do not develop eczema, and about half of eczema sufferers do not have mutations.  There are other genetic and environmental factors at work, such as living with a cat or using tobacco.  You are just more likely to get eczema if you have mutations.

               Mutations in the FLG gene also can lead to asthma, but oddly enough only in individuals who also have eczema.  They can increase the risk of hay fever, skin sensitivity to nickel, and food allergies — most notably to peanuts, irrespective of whether the person has eczema.

               FLG mutations also strongly increase the likelihood of developing ichthyosis vulgaris, a condition which results in very dry, scaly skin and affects between one in 80 and one in 250 people.

               While so far correcting filaggrin deficiency is not possible, there are things we can do topically to help restore the barrier function: we can help adjust the pH to make the skin more acidic to help it defend itself better, and we can replace some of the known lipid components in a topical application. 

               We appear to be having success in adjusting the pH by using exfoliating serums that have lactic acid in them, and we are having success replacing the lipids with our specially formulated moisturizers.

               In order to affectively repair the barrier function, you need three key ingredients in a formulation: ceramides, cholesterol, and fatty acids.  However, these key ingredients have to be in the right proportions in order to work.  Our Barrier Restore Cream and the lighter version, Barrier Restore Lotion, are great moisturizers for our clients who have eczema. To be most effective these moisturizers should be reapplied several times a day.

               When my daughter, who suffers greatly from eczema, has an especially bad patch on the back of her knees or arms, we go a step further.   I apply a layer of the Barrier Restore Cream and then follow with a layer of Vaseline. The Vaseline will occlude the spot and drive the product down further into the skin resulting in deeper and more thorough barrier repair.  This works best as an overnight treatment.

                 We are Licensed Master Estheticians, and Licensed Estheticians at the Acne Treatment Center.  We cannot diagnose or cure eczema.  We can offer topical relief.  If your eczema does not respond to specially formulated moisturizers, we strongly recommend you seek a physician’s guidance.  If your eczema is accompanied by allergies, we also recommend medical intervention for dealing with those.

Written by Celeste R. Nirschl, LME, Lead Esthetician
Jane N. Dudik, LME, Owner