Mrs. Rodriguez brought his son Jordan to my clinic because of recurrent itching. He was five when I first saw him. His face, especially the areas around his eyes, was red, scaly, and dry; his neck was thick and extremely rough and scaly with a lot of scratch marks on it. The areas in front of his elbows and the back of his knees where also thickened with linear lines and excoriations (tiny spots of removed skin, sometimes with bleeding). The poor kid was scratching incessantly and appeared tired and sleepy. He was irritable, too. Mrs. Rodriguez was complaining that she had sleepless nights trying to comfort Jordan and that she had been to several doctors, but Jordan’s problem remained unabated and seemed to be worsening with time.
Jordan’s problem is skin asthma, known in medical terms as atopic dermatitis or eczema. It is a relapsing skin condition that causes inflammation, redness, and itchy rashes. The bad thing is that there is no known single cause for atopic dermatitis. It is a largely genetic skin disorder characterized by an inherited barrier defect (a defect in the skin’s protective covering function). This barrier failure causes increased permeability of the skin and reduces its antimicrobial function. A loss in this protective covering factor results in flattening of the skin’s surface, disruption of the skin’s lipid organization, and reduction of moisturizing factors. This leads to an increase in the skin’s acidity, which encourages certain enzymes to digest the lipids and proteins that hold epidermal cells together. Increase in these enzymes also triggers cytokine production that promotes more skin inflammation. These result in loss of water, easy penetration of irritants like soap, detergents, dirts, etc.
Skin asthma also results from an imbalance of the immune system. In normal individuals, there is an equilibrium of the two kinds of white blood cells (lymphocytes) — the TH1 and TH2 lymphocytes. In skin asthma, there is a predominance of the TH2 cells and its associated chemical messengers (cytokines), worsening the barrier defect and resulting in the reduction of ceramide (a type of fat molecule found naturally in the top layer of your skin, essential to the healthy functioning of the skin barrier; ceramides play a key role in helping your skin retain moisture) and filaggrin (a type of protein found in the skin). Mutation (a gene mutation is any change that occurs in a cell that can be beneficial to, have some effect on, or be seriously detrimental to an organism) of the filaggrin gene can interfere with the skin’s ability to act as a barrier. This allows water to be lost from the skin, also reduces antimicrobial peptides, leading to colonization of bacteria, thus making infections more difficult to control. This filaggrin mutation also means bacteria and other substances can easily enter, possibly leading to more allergies, irritation, and infection.
How do you know you have skin asthma?
Skin asthma can manifest or show the following: Rough, dry, scaly skin; bumpy skin on the back of the arms and front thighs; changes in skin color; ear discharge; blisters; redness of the skin; crusting; thickened skin after constant scratching; intense itching.
Skin asthma is often worsened by the following triggers: allergies (pollen, dust mites, mold, pet dander, etc.); dry skin; stress; flu or colds; dry and cold air; temperature changes (too hot or too cold); contact with chemicals (hair dyes and perfumes); excess contact with water (swimming in chlorinated pools, baths or showers); synthetic fibers; detergents or soaps; cigarette smoke
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How does one manage skin asthma?
Medication for skin asthma includes antihistamines. Oral antihistamines help relieve itchiness caused by skin inflammation. Topical medicines on the skin are necessary most of the time, like the following: anti-inflammatory ointments or creams, topical immunomodulators, moisturizing creams or lotions.
Some other treatments may be needed in severe cases such as: immunosuppressives (like methotrexate, cyclosporine, mycopheolate mofetil); antibiotic creams or drugs; and phototherapy (exposure to UV light).
Home care must include the following: Moisturize skin regularly. Apply on damp skin for moisture to stay longer. Decrease frequency of bathing. Switch to mild body cleansers and washes instead of harsh soaps. Always use hypoallergenic creams, makeup, cleansers and detergents. Avoid irritants like lanolin and wool. Avoid dusty and dirty spaces. Avoid certain foods such as eggs, chicken, chocolates, etc. Keep stress at bay. Keep track of and avoid common triggers. Make sure to get adequate sleep. Trim the nails regularly and refrain from scratching (persistent scratching worsens the skin irritation). Quit smoking.
Since skin asthma is an autoimmune disorder, an improved and efficient immune system can help a great deal. Natural remedies may therefore help alleviate the condition. Foods rich in omega 3 are good (salmon, flax seeds, spinach, and walnuts are rich sources of omega 3). Exercise to reduce stress. Consume foods rich in vitamin B and zinc to reduce irritation and fortify the immune system. Add a little colloidal oatmeal or baking soda in bath water. This helps to hydrate and cleanse the skin. Drinking oolong tea twice a day may help reduce the symptoms of skin asthma.
Skin asthma is a long-term skin condition that requires regular treatment. Consult a dermatologist or a qualified skin specialist if the condition persists or symptoms are accompanied with fever and pain.
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