Skin health, eczema, and preventative strategies

Townsend Letter for Doctors and Patients, May, 2003 by Chris D. Meletis, Jason Barker

As the eyes are the reflection of one's inner health...they are literally as we know a window into a person's vascular and neurological system as the only location in the body where the nerves and vessels can be seen without invasion. Yet, an even more profoundly evident barometer to one's overall health happens to be the largest single organ in the human body that is visible. The skin ranges in thickness from one to two millimeters and varies from 0.6 millimeter on the eyelid to three millimeters on the soles and palms. It comprises approximately 12-15% of total body weight and has a surface area of 1-2 meters.

The skin consists of two distinct layers, the outer layer(epidermis) and the thicker underlying layer (dermis). The epidermis and the dermis differ in function, appearance, and origin. Beneath the innermost layer, the subcutaneous layer (hypodermis) binds the skin to the underlying structures such as the hair, nails, and sweat glands. Collectively these structures are considered appendages of the skin, as they are all of epithelial origin. The skin serves as a physical barrier to protect the inner body from foreign matter while also providing protection for the internal organs and maintaining moisture within the body. The skin also plays a large role in the homeostatic changes that affect the body such as temperature regulation, sensory reception, biochemical synthesis, protection, absorption, and elimination or detoxification. Receptors in the skin include those for pain, pressure, and temperature. Meissner's corpuscles are sensitive to touch, and Pacinian corpuscles are sensitive to pressure. Specialized sk in cells also synthesize melanin and carotenes, which serve as pigmentation sources and production of vitamin D.

We often judge the health of our pets by the appearance of their coats, if they are shining and smooth it is said they have a healthy coat and is considered a reflection of their overall wellbeing. So, whether it is our hair, nails or skin, human skin also reflects our health as individuals. We have all seen friends and family that look pale, drawn, and ashen, all reflective of overall internal balance. Additionally, observing the skin through various disease processes can sometimes serve as a measurement on the continuum of health along which the patient is progressing. Homeopaths and Naturopathic physicians are taught Hering's Law of Cure, which state that a patient's signs and symptoms of disease will disappear from within outward and in the reverse order of their appearance, and that the body seeks to externalize disease as part of the curative process.

Even as holistic physicians we have to find the balance between helping patients deal with the immediate social consequences of skin problems, while addressing the deeper underlying causes and factors that have led to the susceptibility that results in the overt signs of eczema, for instance. Few people are born with eczema, and many times eczematous bouts come and go, during a person's life. By evaluating which triggers are present, nutritional factors and deficiencies, and external factors such as irritants are all important. After all, the good physician blends the best of science, nature and good old-fashioned detective work. So, going back a couple of weeks to months prior to the outbreak or flareup often points to the true and deeper issues at hand that has so disturbed the innate health and homeostasis of the body that it has begun to complain in one of the most obvious of all manners -- with a skin manifestation. The concept of treating eczema with hydrocortisone or other suppressive therapies is inhe rently foreign to the holistically minded physician. Doing such, though palliative, equates to no less than turning a blind eye to the problem and then believing all is good and well.

Causation

Studies involving the use of doubleblind, placebo-controlled food challenges show that upon repeated exposure to a known food allergen, eczematous lesions can result in susceptible patients. The most common foods that exacerbated the eczema in these patients were.. .cow's milk, eggs, wheat, soy peanuts, eggs and fish. (1) Removal of these foods from susceptible patients' diets resulted in remission of eczema symptoms. (2) The food allergy-eczema link is well established, and the most common-sense approach to this association is allergen avoidance. However, avoidance of foods is not the entire solution, and new studies are exploring other theories of eczema causation. Atopic dermatitis is also affected by exposure to other allergens, which follows the pattern of most atopic individuals suffering from asthma, allergies and eczema. Allergens such as dust mites, animal dander, and pollens are known to worsen and bring about an eczematous flare up. Seemingly ubiquitous, these aeroallergens can be somewhat controll ed in the home environment, allowing for clinical improvement of the patient. (3)

Another link in the development of eczema may lie in an improperly functioning epidermal barrier that exposes the patient to rapid dehydration of the skin due to its inability to retain water, resulting in shrinking and gapping of the epidermal barrier. Epidermal barrier dysfunction has many suspected causes, and several studies have implicated psychological stress as a negative influence on cutaneous barrier function, and may trigger or aggravate skin disease. (4) Researchers implicate increased glucocorticoid production, resulting from stress, as the main factor that causes epidermal permeability homeostasis. Interestingly, histamine, a body chemical widely implicated for its role in allergic reactions, has been shown to delay epidermal barrier repair. (5) Keratinocytes, a type of skin cell, have histamine receptors on them, but their functions are poorly understood at this time. In the same studies, it was noticed that the use of histamine agonists, which activate the histamine receptors, slowed skin repai r while histamine antagonists, which block the effects of histamine in the body, allowed for accelerated recovery of skin barrier function.