The Rash to End All Rashes

Today’s topic is eczema. A lot of us have had eczema at one time or another or had a child who had it. The NIH says there are about 15 million people in the United States on a yearly basis affected by eczema. That’s not insignificant. Eczema tends to be more prevalent as a child. The good news is that it usually diminishes as we get older. But, as you know there are some people who have just a terrible time with eczema. My daughter didn’t get it classically as a infant. She was probably 7 or 8 before she got it. Then she had it horribly for a number of years. Some people get it when they get older. In some it doesn’t show up until they are adults.

What is eczema? It’s always interesting to look at some of the really big diseases that affect a whole lot of people. With all the billions of dollars that we do in medical research every year and all we think we know, a lot of times we still don’t know a lot about some diseases. Eczema is one of those that we don’t know why people get it.

Some people think skin allergens. Other people think dust mites. Others think chemicals. Part of it is probably a disordered immune response. It is just not well defined. It usually appears as a rash on kids on forehead, cheeks, forearms and scalp. On adults it’s a more classical case of appearing on the neck, elbows, knees and ankles. It looks a little different in adults and children.

The good news is that it’s not contagious. You don’t have to worry about catching it. The bad news is, if your mom or dad had it and your grandma and grandpa you’ll have some pretty good odds that you’ll have some trouble with it, too. There is certainly a genetic component to it.

Prevention ideas include trying to prevent coming into contact with whatever it is that is stirring you up first. If it’s wool, change to polyester. If there are a lot of dust mites in the home you try to change the environment. If there are chemicals, remove those. In the prevention/treatment arena you can moisturize those areas with lotions and creams to try to keep those physical things from encountering the areas of concern. At the same time moisturizing is believed to help eczema, not just prevent it. I can’t honestly say I’ve seen a lot of results from that when I’ve treated eczema, but that’s the first thing you want to do medically.

It’s interesting that sudden temperature changes seem to stir eczema up. It’s one of those observed phenomena that medicine doesn’t have a clue as to why that would be so. Sweating and overheating is thought to, but I see a lot of it in winter. One thing for sure is that we absolutely know that stress encourages and makes people with eczema get worse or pop out when they haven’t been having any trouble with it lately. Some people believe there are food allergies involved. Again, there is a lot we don’t know.

Next post I’ll talk about what we can do, medically, to treat eczema.

Get Rid of Your Allergies

Earlier this week I talked about allergies and their causes.  I wanted to add a note about bronchitis before we talk more about treatments. While allergies certainly cause a good deal of discomfort in the nasal passages, they can also be the cause of many cases of bronchitis.  Everything I said about the nose and nasal passages relates to the lining of the lungs and the bronchi, too.  Even though your nose filters out a lot of those particles of pollen, a lot of them still do get down into the bronchi and lungs and they land there.  The same response is going on in the lungs that is going on in the nose (which you can read about in the last post) except your lungs have all these little hair-like fibers that brush the mucous and pollen up toward the throat when you, for lack of a nicer way to describe it, hock it up and clear your throat to spit it out. 

What are some treatments for allergies? Standard medical treatment relates first of all to making a proper diagnosis of whether it’s an infection or whether it’s allergy.  The common practice is to treat bacterial infections with antibiotics even though that may not always be prudent or wise.  That’s frequently what’s done.  We probably need to reserve antibiotics for more severe conditions, longer-term bronchitis, or even pneumonia and let the body heal itself in most of the other instances.  If the white blood count does show that it is allergic or if the doctor’s clinical examination wisdom along with your history provide that information, that’s good. 

After that, the standard medical treatment are anti-histamines and steroids.  Steroids have gotten a pretty bad name because of the medical steroids that we use, the artificial steroids.  If I’m ever going to put a patient on steroids, I like to use what the human body makes and that is cortisol or hydrocortisone.  That can be used with relative safety and impunity especially for short periods of time as opposed to the artificial steroids.  As long as we can use a very, very identical thing to what the body is making usually we don’t get into a whole lot of trouble.  

There are some good homeopathics for allergies.  You may want to consult a good homeopath because there are some practical homeopathics.  Some beneficial supplements include Vitamin C, which has been known to help allergies and allergy-related issues, as well as bioflavonoids.  If you are having allergic reactions you should probably avoid aspirin and ibuprofen and drugs like that.  Of course you want to avoid cigarette smoke and things like that which are very irritating to the bronchi and sinuses.

You should consider the possibility of keeping your windows closed and using good air filtration.  If you don’t have a central furnace you might want to consider a room HEPA filter.  Frankly, the more you pay for those filters, or the finer particle it filters, probably the better you are.  Live plants in the house can help filter some things.  There is a caveat there.  Sometimes if you are watering them too much you can grow your own mold and mildew and create your own problems.  A word of caution there.

It is interesting to note, medically, that people with a bacteria in their stomach (helicobacter pylori) have a significant association with allergies.  In other words if you take 1000 patients with seasonal allergies (rhinitis, bronchitis, sinusitis) and test them for helicobacter pylori a dramatically more significant percentage of those will have that bacteria than if you just test a random population without any sinus problems.  That bacteria is associated with allergies for whatever reason.  We don’t know that connection.

Other natural things that can be used are echinacea, golden seal, and bromelain.  One very practical thing to do is good old saline nasal spray.  Just washing those allergens off of the membranes in your nasal passages can have a significant benefit.  If you’ve been outside a good thing to do is take a shower before going to bed.  Your hair is a great pollen magnet.  You lay that on your pillow and rub your nose in it as you go along in your sleep.  Those are just some practical things to do.

Finally, as I mentioned last post, stress reduction and stress avoidance is the most significant thing that we can do.  Any overflow of stress can exacerbate allergies and cause them to manifest. 

What Are You Allergic To?

In a few months the temperature will start warming up and Spring will be upon us. Spring is traditionally the season for allergies, when pollen and other foreign particles are in the air in huge quantities.  Rhinitis, sinusitis, bronchitis during this time of year can all be allergy related.  It’s not just a little problem.  It’s the fifth leading cause of chronic disease in North America.  It causes more than 15 million doctor visits each year.  An estimated $8 billion dollars is annually expended on costs related to allergies.  It’s just astronomical the numbers related to this.  It’s probably the leading cause of absenteeism in work.  I struggle with that because I also hear that back pain is the most common, but it’s right up there at the top.  It’s nothing to sneeze at!

A lot of people don’t even know that they have it.  I was with my mother in Athens, Georgia some time ago. We were talking about allergies and springtime allergies.  I said, “Don’t you have some?”  She said, “No.  I seem to finish every winter with a little cold right as spring arrives, but no, I don’t have allergies.”  Well, I hate to tell you, Mom, but if you have a seasonally recurring cold that seems to happen about the same time every year including stuffy, runny nose, sneezing, wheezing, it may well not be a cold at all.  It’s probably allergies.  

Why does it seem so much like a cold?  Because your body is responding to foreign invaders in your body, particularly in the sinus passages and in the lungs.  There is an altered immune response to the effect of your body attacking pollen just like it would a bacteria or a virus.  So for all intents and purposes it is almost impossible for you to tell the difference sometimes.  You may relate it to the yellow stuff landing on your car or when you see the ragweed floating through the air in little pollen pods in the fall.  If you take an anti-histamine and notice that it gets better, you’ll know it’s an allergy.  If no one else has a cold or it’s not cold season it is sometimes then related to allergies and we have an ah-ha moment.  “This may not be a cold.”

The very same process happens with pollen as it does with bacteria and viruses.  There are something called mast cells in your skin that when they come in contact with these foreign particles they release histamine.  That’s where the famed anti-histamine works as a treatment.  But your basophils, a type of white blood cell, also release histamine.  The purpose of basophils is to dilate small blood vessels so that more white blood cells can get out of the blood vessel and into the tissue to fight these foreign invaders.  The white blood cells come there and they attach these particles creating the stuffiness and the inflammation and drainage you get from allergies.  

A lot of people get a very inflamed nose.  I’ve had a lot of people when I did family practice who would come in and say “My throat is so dry and scratchy.”  I would look in the back of the throat and it was just slimy, red and wet, if I can be that descriptive.  It was because the drainage from their nose was very caustic.  The reason why drainage occurs is because the body is making this material to kill bacteria, fungi, and viruses, so of course it’s going to be caustic material.  It has hydrogen peroxide in it.  It has histamine in it.  It has all kinds of cytokines and chemokines that are really designed to kill cells.  No wonder it is irritating to the front of the nose when you blow your nose and to the back of the throat as it drips down.  

It’s interesting, the percentage of the population having significant allergies have doubled about every 15-20 years.  There is something going on out there.  We have so many new things in our environment, all the way from plastics to MTBE in your gasoline. There are hundreds of new toxic substances created every year and we don’t even realize a lot of times what they are or where they’re coming from.  We now literally have thousands and thousands of man-made chemicals that didn’t exist in organic chemistry.  Our bodies had never had a chance to look at or respond to them until just a short span of time relative to human history and bio-development, certainly in the last few decades in relationship to modern history. 

In the end, the rise of allergies in our population may have as simple an explanation as the good old “s” word, stress.  Every year the government produces a productivity index.  Since they’ve been keeping that, the productivity of Americans have gone up, (except for recently with the recession).  What does that mean?  That means that you’re doing more in less time.  That sounds like a good definition for stress to me.  As we do more in less time, certainly our stress level goes up.  So that in and of itself would be a valid cause for immune dysfunction.  

I'll talk more in my next post about one of the side effects of allergies: bronchitis. Stay tuned.