New treatments for common skin problem

Conway McLean, DPM

The human body is an amazing thing. By way of an example, might I refer you to a ballerina, twirling through the air, landing like a feather. Or perhaps a football wide receiver, diving for the catch, arm extended fully, a single hand reaching for the ball. There are a thousand other citings of the wonders that our bodies are capable of. So often, these abilities are founded in one’s physical capabilities, talents we are born with. But our bodies are also prone to various problems and conditions, some of which are the direct result of who our parents are and their genetic constitution.

A multitude of variations in our form, color and shape speak to the vagaries of genetics and our individual differences. This extends not only to the cosmetic, but also to the biochemical. Some particular examples exist of inherited skin conditions. One of the most common being the mysterious ailment called eczema. We have all heard the term. In fact, the word eczema is bandied about too easily, with almost any reddened skin irritation labeled as such.

Naturally, not every skin eruption is eczema, although it is an extremely prevalent problem with approximately 30 million Americans afflicted. So a pertinent question is “what is eczema?”. In truth, it’s a rather general diagnosis for a group of particular conditions that cause the skin to become reddened, itchy and inflamed. It is used interchangeably with “dermatitis” by some authorities, meaning simply inflammation of the skin. The word “eczema” comes from a Greek word meaning “to boil over,” an apt description for the red, inflamed, itchy patches that occur during a flare-up.

Eczema has a strong genetic component, but environmental triggers are important, as is the case with most allergies. Allergies are examples of an overactive immune system, in which the body is reacting excessively to substances in the environment that are usually harmless to most people. Obviously, many types of allergic reactions exist, some of which are quite dangerous. The substance which stimulates this over-reaction is called an allergen. This substance “switches on” the immune system, causing skin cells to behave abnormally, resulting in an eczema flare-up.

The most common type of eczema is atopic dermatitis, a severe and long-lasting form. Atopic dermatitis is most common in babies and children, although adults can have it too. Children who are afflicted will sometimes find the problem gets better as they age or it may go away entirely. Yet some don’t develop it until adulthood. Other types of eczema include contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis and stasis dermatitis.

Eczema is not contagious but the cause is not definitively known. It seems to be a combination of both genetic and environmental factors. Eczema may get better or worse over time, but it is often a long-lasting disease. People who have it may also develop hay fever and asthma, with which it seems to have a strong association.

A characteristic symptom of eczema is the itch. For many people, this may be mild or moderate, but in some cases, it can become significantly worse. For some, the itch can become so severe people scratch it until it bleeds, which often makes the eczema worse. This is referred to as the “itch-scratch cycle.” Some of the other characteristic findings include red, dry skin, and scaling.

The most common locations for the eruptions seems to be associated with the individual’s age. It’s most common for babies and children to develop eczema on their face, especially the cheeks and chin, but it can appear anywhere on the body. In adults, eczema flares often appear on the back of the knees.

Clearly, there are important physical consequences of this common condition, but it can have a substantial psychologic and social impact as well. Some patients limit their activities and pursuits because they feel self-conscious about their symptoms. It affects the kind of life they lead. Numerous studies reveal consistently poorer quality of life measures amongst patients with these kinds of visible dermatologic manifestations.

Treatments are many, but often are addressing the symptoms more than the cause. This should be understandable since we are not certain of the exact mechanisms at play. Therapies may include medicines, skin creams, light therapy, although good skin care is a consistent recommendation. You can prevent some types of eczema by avoiding things that irritate your skin, such as certain soaps, fabrics, and lotions.

The traditional techniques consist of either oral or topical administration. Topical steroids (technically called corticosteroids) are drugs that fight inflammation by dialing down the immune system. Steroids can bring short-term relief for the itch and dryness that are the hallmarks of this disease but, if used inappropriately, they can cause a variety of side effects like thinning of the skin and immune system complications.

Pharmacologically, this is being called the “Golden Age of Eczema”. A variety of new drugs have been, and are being, developed, treating both kids and adults for this common condition. In 2017, dupilumab was released, the first of the biologic agents, which are injectable drugs that alter immune system function by binding to signaling molecules. This was the first drug approved for moderate to severe cases.

But some entirely new drugs are on the way, some of which alter the action of enzymes. These are substances which effect some type of reaction or pathway in the body. This is a completely new approach, as is another novel class, the epithelial (skin cell) cytokine inhibitors. These alter the action of cytokines, substances which are secreted by the immune system and alter the activity of other cells.

Some alternative or holistic treatments are being utilized, with honey being an ancient topical remedy receiving renewed attention. A recent study with Manuka honey showed that overnight application to an affected area for just seven days resulted in significant symptom reduction. Another study revealed medical honey treatment three times daily for two weeks produced significant improvement in symptoms, particularly itching, redness and scaling. These studies were small, but warrant further investigation. Even acupuncture has been investigated for treating eczema, with one study finding honey improved the symptoms of mild to moderate cases, primarily helping to reduce itching.

In conclusion, we now know eczema is not an uncommon problem, with millions of Americans suffering with the symptoms on a daily basis. Although eczema can reduce one’s quality of life, it is not considered life-threatening. Yet it is a condition for which we have no cure and still much to learn. Various therapies and medications are effective at treating the symptoms or altering the disease course, especially if of the milder variant. If you suffer from atopic dermatitis or any of the different types of eczema, do some research and see a specialist. Eczema does not have to knock you off your game or lead you to hate your skin. Although we don’t have a cure, help is available.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.