Skin in Health and Disease
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Topics from the book
Skin in Health and Disease

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Skin Design
Skin Nutrition
Skin Care Products
Eczema
Hives (Urticaria)
Contact Dermatitis
Psoriasis
Aging Skin
Ultra Violet Radiation
Acne Rosacea
Dermatitis Herpetiformis
Skin Infection
Antihistamines

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Introduction to Eczema

Eczema is a descriptive term that refers to itchy, red, thickening and scaling skin eruptions. Dermatology texts will list a number of conditions under the term eczema and the classification can be confusing. Itching is the dominant symptom and can be severe. 

Atopic dermatitis is the prototype of food allergic skin disease. This type of eczema often appears on the face as patches of reddish, scaling skin. As eczema worsens, the skin becomes itchier, red, thickened, grooved, and may blister, weep, and crack. The typical distribution of eczema is on the face, behind the ears, on the front of the elbows, the back of the knees, the hands, neck, and trunk. Food allergy probably accounts for much eczema; the rest is external allergy-irritants, infection, and injury to the skin through vigorous itching. House dust mite allergy is an important external cause of eczema. Infection with staphylococci is a common cause of sudden worsening of eczema. 

Eczema can become a severe disease that involves generalized symptoms of food allergy and symptoms from complicating infections. Atherton summarized food allergic skin disease in 1984 putting urticaria and eczema at the top of his list. Eczema has always been included with hay fever and asthma as an atopic disease. Atherton emphasized the distinction between immediate and delayed food reactions and recommended a trail of an low-allergy diet; a simple set of foods that have low allergy risk. This approach is taken in the Alpha Nutrition Program.

Eczema begins in infancy and is common in toddlers. The most common type of eczema is a topical dermatitis and occurs in people of all ages with an allergic disposition. Some people have a life-long tendency to develop eczema and tend to have periods of skin activity lasting months to years, interspersed with normal periods. Eczema  sometimes merges with other skin conditions - hives are common and occasionally psoriasis and eczema will overlap. Diaper rash is commonly associated in infants. We find it helpful to think in terms of the origin of the problem and classify eczema in a simple way; the skin condition is either allergic (immune -mediated) or something else is going on. If allergic, the triggers are either food or surface contact materials or both.

If the skin is reacting in an allergic manner, you ask; where is the trigger - on the surface or in the food supply? Your speculations should lead you to a solution by eliminating the cause. Sure, there are treatments, but none of the treatments are satisfactory and all are short-term. Removing the cause has to be your best bet, even if the task seems difficult.

Solution - Diet Revision and Alpha ENF

Villaveces and Heiner reported remission of symptoms in six patients with severe atopic dermatitis by replacing food with an elemental nutrient formula for at least a week and then reintroducing foods to determine reactivity. Ratner et al reported similar success in 16 children and 14 adults with moderate to severe eczema. Sixty percent achieved significant remission after 3-12 days on an elemental nutrient formula. They noted that half the food challenge reactions were immediate and the other half delayed.

Although eczema is included in the atopic group, its mechanism clearly goes beyond type 1 hypersensitivity. Chronic inflammatory changes in the skin, eosinophilic recruitment, circulating IgA, IgG, IgE immune complexes, and demonstrations of associate increased gut permeability implicate all four hypersensitivity mechanisms in the pathogenesis of this common skin disorder. IgG complement-fixing immune complexes have been demonstrated in children with eczema. Complete diet revision is the best way to treat this disorder rather than selective elimination of foods either by history or skin test.

An Italian study of 5500 newborn infants with a family history of allergy found 4677 with elevated IgE levels in cord blood. The parents of these infants were encouraged to take preventive action to prevent atopic disease; breast feeding with reduction in the maternal diet of cow's milk, egg, tomato, fish was recommended for six months. Soya formula was used beyond six months -13.3% of infants on the prescribed regime developed atopic disease; 54.7% of the non-compliant group developed AD. 73.3% of the afflicted infants had skin involvement. Zeigler et al demonstrated a lower incidence of atopy at 12 month in infants whose diet and mothers diet excluded cow's milk, wheat, corn, soya, and citrus.

A prospective, randomized control study of 120 infants showed that avoidance of allergenic foods and smoke prevents allergy. Lactating mothers avoided milk, egg, fish, nuts and excluded these foods as well as soy, wheat, and orange in the infant's diet for the first 12 months. The restricted group had significantly less eczema and asthma.

James et al performed double-blind food challenges in a group of 320 children with atopic dermatitis and conformed food allergy in 64% of patients who had cutaneous reactions; itchy red rashes and urticaria.

Learn More About Eczema
Eczema in Infants
Eczema In Children
Food Allergy Center

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Skin in Health and Disease

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