Yes, classifying different subtypes of eczema DOES help with diagnosis and treatment.
Published On: Sep 2, 2021
Last Updated On: Sep 7, 2021
Your skin is your first line of defense against the outside world — fending off germs, chemicals, allergens and more. But if you have eczema, your skin barrier may be weakened, leading to a cycle of uncomfortable dryness, irritation and inflammation, symptoms which, on their own, can contribute to even further skin barrier degradation, worsening symptoms and so on.
The human skin barrier is basically the uppermost layer of skin containing, among other things, skin cells and specialized immune system cells which make up a physical and functional protection system. Like a wall, this system works to recognize and keep out intruding organisms and substances.
With eczema, however, the skin barrier can’t function as effectively and may be “leaky.” There are a number of reasons for this. One is that many people with eczema actually have differences in the gene that codes for a key protein called filaggrin. In fact, according to the National Institutes of Health (NIH), up to 30% of eczema patients have mutations in the gene for filaggrin. Filaggrin helps structurally, binding keratin filaments together to strengthen and flatten skin cells. If you don’t have enough functioning filaggrin, skin cells can lose moisture, shrink and develop gaps between them (effectively leaving “holes” in the wall of your skin). With loss of moisture, skin also becomes dry and itchy, leading you to scratch or rub, which can further weaken the skin barrier. Inadequate filaggrin production can also impact the skin’s pH, allowing abnormal bacterial growth that can prompt immune responses like inflammation.
Lipids are another important part of your skin barrier. In people with eczema, skin lipids can have a slightly different composition and contain less ceramide, a substance that’s important for locking in moisture. According to a scientific review in the journal Allergy, Asthma & Immunology Research, differences in lipids and inadequate ceramide in people with eczema contribute to dryness, irritation and skin dysfunction.
While this might all sound a bit complicated, Dr. Amy Paller, chair of the department of dermatology at Northwestern’s Feinberg School of Medicine, offers some simple advice to help your skin barrier: “If you are experiencing an active eczema flare, treat it.” Inflammation and dryness, she explains, can ruin your skin barrier so you need to address symptoms correctly with the help of your healthcare professional.
To incorporate bleach baths into your routine, the National Eczema Association recommends ¼ – ½ cup of common 5% household bleach added to a bathtub full of lukewarm water. Soak for no more than 10 minutes two to three times a week. Do not submerge your head and, of course, be careful to avoid getting any of the bath water into your eyes. Supervise children carefully. Rinse off with fresh water and apply moisturizer. If a bleach bath feels uncomfortable because your skin is extremely dry or inflamed. “You can ease discomfort by getting into the bath with dressings still on,” says Dr. Margaret Lee, an instructor in Dermatology at Harvard Medical School and pediatric dermatologist at Boston Children’s Hospital. “This will allow the skin to re-equilibrate and help alleviate some of that initial discomfort of getting into the bath, before you start pulling the wraps off. Another way to help tolerate getting into bleach baths is to put a little antibacterial ointment or petroleum jelly in the cracks of the skin.” Of course, if in doubt, talk to a healthcare professional about whether bleach baths are right for you. More advice on bleach baths can be found here.
Even during an eczema flare, remember, your skin barrier is still doing powerful work to keep your whole body safer and healthier. Nurture it when you can and it will nurture you back.