Tuesday, May 14, 2013

Words from Chicago Integrative Eczema Center

I just wanted to share this FB status update from the Chicago Integrative Eczema Center.  Rapunzel clearly falls into the "wet eczema" category.  Just looking at her IgE levels, which were over 8000 the last time she was checked, she is clearly hyper-allergic, and reading this just makes me that much more anxious to see the Immunologist.  Just one more week.

Status Update
By Chicago Integrative Eczema Center
I'm thinking about what a "cure" for eczema might look like, and I'm stuck. I want to believe it can and will happen, but I can't even think about what shape it would be. Would it be a cream? A pill? Gene therapy?

How would you use it? Just once and voilà, you're cured!? Or just for a few weeks and then you can stop? I just don't know.

Part of the problem is this idea that there is not just one "eczema". We're looking at several diseases here, at least. The more patients I see with eczema, the more I realize that one size does *not* fit all. In my mind, there are at least two basic types of eczema, something that Chinese medicine has recognized long ago: wet and dry. The truth is that these are not mutually exclusive, and I have seen patients change from one from to the other, so again, this is complex and I'm going to simplify it a bit here.

My sense is that the dry eczema (with very dry, sensitive skin) tends to be more of a primary skin barrier issue, like the filaggrin gene mutation. These folks tend to do well with lots of good moisturization, and seem to be more of the "intrinsic" type of eczema, meaning they have less allergies in general. I feel like I can get most of these folks under great control with little or no steroid use and keep them clear fairly easily.

The wet type of eczema tends to be more red, blotchy, almost hive-like, very widespread, and it gets oozy or "wet" very easily. These folks certainly have secondary skin barrier breakdown, but I feel that moisturizing only goes so far. They tend to get super allergic to many things, and tend to have off-the-charts allergies. These are hard. Steroids--and lots of them--seem to be the only thing that can calm them down at times, and these are the ones that seem to get steroid-dependent on me, making it a constant battle. For them, I think that the immune system is the primary issue and a cure for them would have to focus on rebalancing the immune system.

There are other types of eczema too, but these two showcase why I am so skeptical when folks say that they can "cure" or even treat eczema with one approach. That, to me, is the power of the integrative eczema center: we're trying to integrate approaches from within Western medicine and outside of it to get folks better.

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