Explore the correlation between eczema symptoms and gut health

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Health Europe talk to Dr. Peter Lio, clinical assistant professor of dermatology and pediatrics, to find out if dietary changes can alleviate symptoms of eczema.

As the largest organ in the human body, our skin provides an essential barrier against infections. However, dry skin conditions like eczema often mean that the skin barrier is compromised, leaving it vulnerable to inflammation and irritation. Also known as atopic dermatitis, the symptoms of eczema can manifest in different ways depending on its severity. People with mild cases of the disease may experience dry, cracked, and itchy skin, while more severe cases may experience crying, scabs, and bleeding. Although the disease is most often seen in infants, one in 10 adults will experience symptoms of eczema in their lifetime, and for many, it can have a dramatic impact on their lives, affecting sleep, mental health. and the impetus to accomplish daily tasks or hobbies. Indeed, a study published in January 2020 in The Journal of Allergy and Clinical Immunology: In Practice who examined the medical records of more than 500,000 adults with atopic eczema and 2.5 million adults without a skin condition, found that people with eczema were 14% more likely to develop depression and 17 % more likely to develop anxiety.

While there is currently no cure for eczema, recent research has shed new light on the impact diet and lifestyle can have on our overall skin health and symptoms. ‘eczema. Peter Lio, MD, is Clinical Assistant Professor of Dermatology and Pediatrics at the Feinberg School of Medicine at Northwestern University and Director of the Chicago Integrative Eczema Center. He has written extensively on the triggers and potential treatments for eczema, including how the disease relates to our gut health. Health Europe spoke to Dr Lio about ways the foods we eat could impact inflammatory skin conditions like eczema.

What is the impact of gut health and diet on eczema? What do we know about the correlation between leaky gut and symptoms of eczema?

These are exciting questions, and these are questions we are still learning. The link between diet and eczema symptoms is complex and really varies from person to person, which means there isn’t even a single answer here. It is clear that true food allergies (those mediated by immunoglobulin E [IgE] and can cause urticaria, angioedema and even anaphylaxis) are much more common in patients with eczema. In recent years, a very convincing mechanism for this has been described: it is believed that, contrary to what many people previously thought, the damaged skin barrier in eczema (or “leaky skin” as I like it). ‘call) may actually allow allergens – including food allergens like peanuts – to penetrate the skin – and actually lead to a food allergy. Additionally, we now understand that gut health often seems to reflect the health of the skin, and indeed, some studies suggest that abnormalities in gut health are predictive of the development of atopic dermatitis. Additionally, there is some evidence that improving the intestinal barrier may have a positive effect on eczema.

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Regardless, we understand that a healthy microbiome depends on a number of factors, including a healthy diet. Certain foods can themselves contribute to pro-inflammatory conditions in the gut and skin, further complicating this important area.

Are there particular food groups that could exacerbate inflammation? How would you recommend that patients watch out for potential food intolerances or allergies?

Yes, we do believe that there is a whole range of food reactions, from true IgE mediated allergy, to intolerances such as lactose intolerance, to just being pro- (or anti-). inflammatory. Part of the problem is that these foods can be very individualized, and we see so many families trying empirical exclusion diets, often starting with excluding gluten and dairy from the diet. The problem here is that, especially for children, making drastic dietary changes can be very stressful and can ultimately be unsuccessful. Additionally, there is now compelling evidence that excluding foods from the previously tolerated diet may in fact lead to a loss of that tolerance and the development of sensitization leading to a true allergy to that food! It is a disastrous result for patients and families.

So what to do? First, it’s important to have a good allergist to help us understand if there are any true IgE-mediated allergies that need to be managed. Then, it is important to do our best to improve the skin using conventional approaches. Many times it can be nearly impossible to tell if one or more foods are making things worse because the skin is so bad to begin with. By clarifying things, it may suddenly become possible to even begin to consider this issue. I’m happy to report that for many of my patients, foods that they were pretty sure worsened their condition seemed to be good once the skin got better. This may be partly due to a threshold effect: when the skin is very inflamed, the aggravation threshold is very low! Once better, there is often more resilience, and this is important, especially for those who are already on a very limited diet. It may also be helpful to keep a food diary to track flare-ups with certain foods, knowing that it may take days after a food is ingested before there is a measurable flare in some patients. .

For more information on food reactions and their role in atopic dermatitis, see: https://practicaldermatology.com/articles/2021-may/are-we-what-we-eat

Could foods rich in probiotics be beneficial for people with eczema?

May be! It is also a very exciting area, with conflicting data. In general, I think fermented foods and soluble and insoluble fiber – among others, of course – can be helpful in supporting the gut microbiome. Taking oral probiotics also has some pretty convincing evidence of an effect, but the effect appears to be somewhat weak, and it appears that there are still many unknown variables to be addressed.

Apart from diet, are there any preventative or protective lifestyle measures patients can take to reduce their symptoms of eczema?

Exercise can be helpful for many of my patients: it is relaxing and anti-inflammatory for the body. The tricky part is finding an exercise routine that doesn’t make matters worse with heat, sweat, friction, or other exposure.

A gentle bath and good hydration throughout the day really has a powerful and measurable effect on eczema symptoms and the skin barrier. I often find that if patients increase their hydration up to three or even four times a day, they will see dramatic improvement. In part, this is not surprising: more powerful moisturizers can literally act as a temporary skin barrier in addition to helping restore the natural barrier, keep water in, and prevent allergens, irritants. and pathogens to enter.

The references

  1. Nylund L, et al. “DNA microarray analysis reveals marked aberration of the gut microbiota in infants with eczema compared to healthy children at risk for atopic disease.” BMC Microbiol. January 23, 2013; 13:12. doi: 10.1186 / 1471-2180-13-12.
  2. Ismail IH, Oppedisano F, Joseph SJ, et al. “Reduced gut microbial diversity early in life is associated with subsequent development of eczema, but not with atopy in high-risk infants.” Pediatrician Allergy Immunol. 2012 November; 23 (7): 674-81.
  3. Rosenfeldt V, Benfeldt E, Valerius NH, Paerregaard A, Michaelsen KF. “Effect of probiotics on gastrointestinal symptoms and small bowel permeability in children with atopic dermatitis”. J Pediatrician. November 2004; 145 (5): 612-6. doi: 10.1016 / j.jpeds.2004.06.068. PMID: 15520759.

Peter A. Lio, MD
Assistant Professor of Dermatology Clinic and Pediatrics
Northwestern University Feinberg School of Medicine

This article is taken from issue 20 of Europa Health Quarterly. Click on here to get your free subscription today.

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