Eczema and the Gut + an Interview with Dr Peter French

It’s always a bumpy ride when skin issues surface.  Particularly when it comes to children.  Thinking about acne and eczema literally makes many parents’ skin crawl (myself included).  My daughter Tamsin suffered from eczema throughout school and into university. When any signs of dryness or red bumps appear on your child’s skin and you've tried so many different products to ease the symptoms, but nothing seems to help it can be very frustrating.

Does your child often feel irritated? Do you both tend to suffer from skin issues? New research has come to light that may be the helping hand that we’ve all been waiting for.

The condition of your skin can say a lot about your health and common skin conditions such as acne, rosacea, eczema, psoriasis and dermatitis can actually be a sign that your gut isn’t functioning properly.

I hear from many parents whose children are suffering from skin problems, two of the most common complaints are eczema and acne. Both can have a negative impact on quality of life both visually and with physical symptoms such as itchiness, pain and lack of sleep.

Fortunately the latest research that scientists are uncovering is the connection between the health of your microbiome and how it can directly affects and impacts your skin. This is welcome relief for many parents who are struggling to find answers that don’t involve hardcore steroid creams or medication.

It’s easy to forget that your skin is actually an organ; in fact, it’s your body’s largest organ. Your skin is part of the integumentary system, which also consists of your hair and nails and its main function is to act as a physical, chemical and antimicrobial barrier.

An important factor in keeping your skin healthy is sebum. Whilst the right amount of sebum protects the skin, too much can result in conditions such acne and too little can result in dry or cracked skin.

Your gut flora have been shown to influence sebum production (an oily secretion that reduces water loss from the skin surface and protects the skin from infection caused by bacteria or fungi) as well as the fatty acid composition of the sebum. Signals sent from your gut flora can communicate with the bacteria on your skin and research is beginning to show these interactions have a major influence on skin conditions such as dryness, collagen production and other skin issues such as atopic dermatitis.

This week I interviewed cell and molecular biologist Dr Peter French, Bioxyne’s Chief Scientist so that I could learn more about this condition that is affecting 10% of the population and find out more about the connections between atopic dermatitis and the gut. Over the years I made my own discoveries too such as the importance of gut health and the prevalence of staph infections in eczema cases. I had always been convinced that this was one of the missing links but it was never confirmed until now.

Even if this post only helps one family it will make my work worthwhile!

What is atopic dermatitis? What are the causes? 

Atopic dermatitis (AD), also known as eczema, is a common inflammatory skin disease affecting 10% of the population, and posing a significant burden on healthcare resources and on the patients’ quality of life. The first signs of AD usually appear early in life (from 6 months of age) and often precede other allergic diseases such as asthma or allergic rhinitis. The majority of cases (at least 60%) arise within the first year of life.

It is an allergic reaction, but the cause is unknown. Both genetic and environmental factors are recognized to play a role in the development of the disease. It is clear that the immune system plays a key role in either the initiation or the maintenance of the disease symptoms. To be specific, the immune response observed during the course of AD is characterized by a biphasic inflammatory response. A Th2-biased immune response is predominant in the initial and acute phase of AD, while in chronic AD skin lesions, a Th1/Th0 dominance has been described (characterised by the cytokines IFN-γ, IL-12, IL-5 and GM-CSF).

In addition, regulatory T cells and the innate immune system in the skin are altered. The innate immune system represents the first line of defense against infections. A decrease in the antimicrobial peptides (one component of the skin innate immune system) has been observed and may explain the susceptibility to infections in AD patients, in particular Staphylococcus aureus which exacerbates or aggravates skin lesions.

How does it affect children and what can parents do to help? 

The symptoms in young children are characterised by dry and scaly patches on the scalp, forehead, and face. These patches are very common on the cheeks.

The urge to scratch in AD/eczema is often acute. There are some fantastic online resources and this website has some great ideas.

How many children suffer from Eczema?

Worldwide, the prevalence of AD is rising, especially in younger children. Approximately one out of every three children with eczema/atopic dermatitis has moderate to severe disease. The prevalence of AD is as high as 20% in children in some countries, including Australia.

Does diet make a difference?

This is controversial. The delay of the dietary introduction of cow’s milk and other foods is still a common recommendation. However, a study showed that delaying foods—particularly cow’s milk—in the first two years of life did not prevent development of atopy. In fact, delaying their introduction was associated with a higher risk for AD. In addition, the elimination of milk in the diets of children with AD may lead to an unnecessary dietary deficiency. This was also true for other food products tested. The American Academy of Pediatrics has changed their guidelines on food restrictions in children, including children with AD, citing a lack of evidence that diet manipulation among pregnant or breastfeeding mothers can either cause or prevent allergy in a child.

Are there any preventative measures? 

The American Academy of Pediatrics suggests that lactating mothers with infants at high risk of developing AD should avoid peanuts and tree nuts, and should consider eliminating eggs, cow’s milk, and fish from their diets. The World Health Organization also recommends breastfeeding infants up to 2 years of age.

Some studies show that taking specific probiotics during pregnancy can reduce the incidence of eczema in infants.

How is gut health connected?

Probiotics are defined as live bacteria that, when administered in adequate amounts, provide a health benefit for the consumer. Usually they’re members of the Lactobacillus or Bifidobacteria families. The mechanism by which probiotics function to impact human health is thought to be related to their ability to alter the composition of the gut microbiota and modulate the human innate immune system[3].

Given the extensive involvement of the immune system in AD, it is possible that probiotics may provide a treatment option. A recent meta-analysis demonstrated an association between the consumption of probiotics during pregnancy and early childhood and a relative risk reduction for AD of 21%.[4] However, it’s important to note that not every probiotic performs equally. Their effect on the immune system is specific to particular strains of bacteria.

So if not all probiotics are created equal, what is proTract’s mechanism of action?

Essentially it works by acting on the mucosal immune system tissue that is located in the gastrointestinal tract. ProTract contains PCC^®, Bioxyne’s proprietary probiotic. It is a Lactobacillus fermentum.

Two clinical studies have shown that Lactobacillus fermentum probiotics have an effect on alleviating the symptoms of AD in infants[5]^,[6]. One of the studies⁷ used Bioxyne’s patented probiotic, PCC^®. PCC^® ‘s scientific name is Lactobacillus fermentum VRI-003.

Researchers in Western Australia reported that significantly more infants (aged 6 to 18 months) who were given Bioxyne’s strain of (PCC^®) at a dose of 1 billion CFU daily sprinkled as a powder on their food had an improvement in their AD symptoms compared to placebo. Notably, the improvement in atopic dermatitis symptom severity with PCC^® treatment was still evident 2 months after the treatment was ceased. In a follow up study[7] the effect of PCC^® on atopic dermatitis symptoms was shown to be associated with significant increases in the capacity for Th1 interferon gamma responses (a measure of activation of the innate immune response. The study authors concluded: “this study provides evidence that oral PCC may improve the severity of AD in young children and shows that these effects persist after cessation of supplementation.”

For more information about ProTract visit their website here.

3 Aktas B, De Wolfe TJ, Safdar N, Darien BJ, Steele JL The impact of Lactobacillus casei on the composition of the cecal microbiota and innate immune system is strain specific. PLoS One. 2016; 11(5):e0156374.

4 Pelucchi C, Chatenoud L, Turati F, Galeone C, Moja L, Bach JF, La Vecchia C. Probiotics supplementation during pregnancy or infancy for the prevention of atopic dermatitis: a meta-analysis. Epidemiology 2012; 23: 402-14

5 Wang I-J, Wang J-Y Children with atopic dermatitis show clinical improvement after Lactobacillus exposure. Clin Exp Allergy 2015; 45: 779-87.

6 Weston S, Halbert A, Richmond P, Prescott SL. Effects of probiotics on atopic dermatitis: a randomised controlled trial. Arch Dis Child 2005; 90:892-7.

7 Prescott SL, Dunstan JA, Hale J, Breckler L, Lehmann H, Weston S, Richmond P. Clinical effects of probiotics are associated with increased interferon- responses in very young children with atopic dermatitis. Clin Exp Allergy 2005; 35:1557-64.