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Ask the Ecz-perts: TSW, dry skin, leaky gut, vaccines, allergies

In this edition of Ask the Ecz-perts, we asked leading medical professionals to answer your questions about dry skin, eczema and gut health, vaccines, Dupixent for seasonal allergies, and topical steroid withdrawal.

Ask the Ecz-perts: TSW, dry skin, leaky gut, vaccines, allergies

In this edition of Ask the Eczperts, we asked leading medical professionals to answer your questions about dry skin, eczema and gut health, vaccines, Dupixent for seasonal allergies, and topical steroid withdrawal.

Q: How can I get rid of dry skin for good?

Follow these tips to combat dry skin:

  1. Cleanse the skin daily in a five- to 10-minute lukewarm water soak with a gentle liquid cleanser such as Vanicream Free and Clear liquid cleanser. If you have very predictable “eczema seasons” and hate the feeling of liquid cleansers, then on the off season, you can use a liquid body wash such as Dove Baby or CeraVe body wash.
  2. Pat dry the skin vs. wiping completely dry.
  3. Within three minutes of getting out of the bath or shower, lock in the moisture your skin absorbed from the bath/shower with your moisturizing cream and/or medicated treatments.
  4. Be intentional about moisturizing often and liberally. My patients have had the best success with CeraVe moisturizing cream and Vaseline jelly.
  5. When needed, follow the instructions for anti-bacterial control, i.e., dilute bleach baths. If your skin barrier is disrupted by overgrowth of skin bacteria, this can disrupt the ability of your skin to heal and increase risk of developing skin infections.
  6. Stay hydrated with water throughout the day, and if you live in a dry climate, consider using a cool mist humidifier in your room.
  7. Lastly, I would be remiss if I did not ask you to follow your health care provider’s instructions specifically. Utilize NEA’s Eczema Provider Finder to find a clinician specializing in atopic dermatitis who you can build a trusting relationship with.org

Samantha B. Casselman, pediatric nurse practitioner at Phoenix Children’s Hospital  

Q: Is there any true link between gut health and eczema?

While there are still many unanswered questions here, there is reasonable evidence that suggests that gut health and skin health are closely related. Indeed, if you think about it, as you follow your skin to your lips, the same lining just continues on into your gut: it’s really all part of the same epithelium.

There are studies that suggest “leaky gut” (increased permeability of the gut) is related to the “leaky skin” (weak skin barrier) of eczema. We wrote an article about it a few years ago that has lots more information: https://nationaleczema.org/leaky-gut-and-atopic-dermatitis/

One important thing that I have learned is that to truly be healthy, all the systems have to be working well and working together, much like an orchestra. Many times, when one system starts to falter, others will follow, which is why we think a more holistic approach is always an important consideration.

Peter A. Lio, MD, assistant professor of clinical dermatology and pediatrics dermatology at Northwestern University Feinberg School of Medicine

Q: Are my seasonal allergies and eczema all connected, and could they be treated with one medicine like Dupixent instead of multiple meds?

Dupixent (dupulimab) is currently approved for both asthma and atopic dermatitis in patients over 12 years of age.  Dupulimab has not been studied for seasonal allergies, however, in theory, it would improve both indicated conditions (asthma and atopic dermatitis) at the same time.

Dupixent, when studied for asthma, led to an increase in lung function and a decrease in severe asthma exacerbations, but it does not treat acute bronchospasm. You will still need your albuterol as needed. It was also used in patients with moderate to severe disease who were on inhaled corticosteroids for their asthma. There is no data if it would improve patients with mild asthma or seasonal allergies.

For the treatment of seasonal allergies, in theory, Dupixent should work as it blocks the interleukin (IL) 4 and IL13 pathways. But there is no data at the current time to prove it. When treating with dupulimab or potential other biologics, if the diseases use the same pathway (for allergies—Th2 pathway), the medication might work for multiple diseases as the medication is available systemically.

However, it is very important to remember that you cannot stop your asthma medications or other medications. You need to talk to your physician before you can wean off any medications as you might have increase of symptoms or side effects.  

Jonathan Spergel, MD, PhD, chief of the allergy section at Children’s Hospital of Philadelphia

Q: How come there aren’t any treatments that specifically target topical steroid withdrawal?

Topical steroid withdrawal (TSW) is a serious condition that appears to be relatively new. We are still learning about why it happens, which patients are most susceptible, and hopefully how best to treat it. Unlike eczema—a disease for which we have descriptions over hundreds and perhaps even thousands of years—cortisone itself was discovered in the 1920s, with little information about it published until almost 1950.

One of the hardest parts is that many people are able to use topical steroids safely. TSW seems relatively rare, though we really don’t know how widespread it is, which adds to the problem. Another problem is that we don’t have a clear way to diagnose it. Many times, it’s hard to know if it is the underlying eczema or TSW, although some recent papers are making headway into better identifying TSW.

With hope, as we gain better understanding of this terrible condition, we will identify and develop targeted treatments to give relief. Meanwhile, it is our great hope that better education and careful monitoring will prevent others from developing TSW in the first place. Visit https://practicaldermatology.com/articles/2015-sep/the-challenges-of-topical-steroid-withdrawalogy? to read a paper we wrote about TSW.

Peter A. Lio, MD, assistant professor of clinical dermatology and pediatrics dermatology at Northwestern University Feinberg School of Medicine

Q: Are people with eczema more likely to have a vaccine reaction due to formaldehyde and aluminum ingredients? Is there a way to test allergies to these ingredients, and would that be a reason to avoid a particular vaccine? Could giving a vaccine with these irritants cause a person’s eczema to get worse?

People with eczema are not more likely to have a vaccine reaction to these ingredients. Aluminum and thimersol are possible contact allergens in vaccines. If you suspect you have a contact allergy to these ingredients, then you should have patch testing done. Contact allergy to these ingredients is not a contraindication to vaccination.

There is no literature indicating eczema could get worse after vaccines. I was able to find a single case report of systemic contact dermatitis after a formaldehyde-containing vaccine indicating how rare this phenomenon is. Kuritzky LA, Pratt M. Systemic Allergic Contact Dermatitis After Formaldehyde-Containing Influenza Vaccination. J Cutan Med Surg. 2015 Sep-Oct;19(5):504-6

 Kanwaljit K. Brar, MD, pediatric allergist and immunologist at National Jewish Health

Do you have a question for our ecz-perts? Email them to editor@nationaleczema.org

 

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