Missing Skin Proteins May Hold Key to Finding Cure for Eczema

By Judy Hu, M.D., F.A.A.D

Missing proteins may be the trigger for eczema, a recurrent, inflammatory skin condition, according to the latest research. The finding could bring new hope – and, eventually, a cure – to the millions of people who now suffer from the disorder. A study, published in the journal Nature Genetics in June 2017, indicating a genetic mutation is behind the loss of a protein that plays a critical role in protecting skin from invading microbes, allergens and environmental pollutants. The study was conducted by a team of scientists from the National Institute of Allergy and Infectious Diseases (NIAID).
Without this protein, the skin becomes ‘leaky,’ allowing water to escape and irritants to penetrate it.
In a second study published in May 2017 in the Journal of Allergy and Clinical Immunology, scientists from Newcastle University in the United Kingdom pointed to a missing skin-barrier protein called filaggrin as a key element in development of eczema.

What’s so encouraging about these studies is that they are helping us learn more about this skin disease and leading the way to development of more targeted – and effective – treatments.

Researchers have long suspected a combination of genetic and environmental factors as playing a role in eczema, but lack of a comprehensive understanding of the condition has made it difficult to find completely effective treatments.

Eczema, also called atopic dermatitis, causes skin to become red, dry and, oftentimes, intolerably itchy – and painful. The disease, which is not contagious, affects as many as 15 million Americans and tends to occur in families. Most eczema patients are infants and children, many of whom eventually outgrow the disease, but some 2 percent to 10 percent of adults suffer from the condition.

Sometimes called the “itch that rashes,” eczema can occur almost anywhere on the body, but most frequently on the neck and the flexures of the arms and legs. In addition to intense itching and sometimes a burning sensation, the condition is characterized by a red rash with bumps that may ooze and become crusty when scratched.

I advise parents of children with a suspicious skin condition and adult patients to see a dermatologist for any rash that does not clear up within a few days. Although eczema is normally more bothersome than dangerous and, in some cases, cosmetically unsightly, the disorder can lead to complications, especially if the irritated skin breaks down and becomes infected or the patient has a weakened immune system or a medical condition like diabetes or cancer.

Although no permanent cure for the condition has yet been found, eczema can be controlled and flare-ups of the disorder minimized with appropriate use of prescribed and over-the-counter topical creams, moisturizers and medications. These can include anti-inflammatory drugs, steroidal creams, antibiotics and anti-itch creams preferably containing pramoxine and menthol.

I also recommend that patients with the disorder:

• Bathe briefly in warm, non-soapy water and apply an emollient to the wet skin to “seal in the moisture.”
• Take short, lukewarm showers or baths and use only a mild, fragrance-free soap or body wash to prevent dry skin.
• Refrain from heavy exercise during flare-ups of the condition because sweating only further irritates the rash.
• Apply a nonprescription steroidal cream to the eczematous skin two times to four times daily.  Otherwise, follow the directions of a topical medication prescribed by your dermatologist.
• Limit scratching; the dermatologist can suggest an antihistamine cream or a medication in pill form to counter the itching sensation.

Eczema patients should try to moderate their lifestyle as well by refraining from wearing tight-fitting clothes, practicing relaxation techniques to lower stress levels and avoiding certain foods and other substances that can cause allergic reactions.

Judy Hu, MD, FAAD, is a board-certified physician and a fellow of the American Academy of Dermatology
Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.