tag:theconversation.com,2011:/fr/topics/eczema-2258/articlesEczema – The Conversation2023-10-13T18:04:37Ztag:theconversation.com,2011:article/2153262023-10-13T18:04:37Z2023-10-13T18:04:37ZAn itching paradox – a molecule that triggers the urge to scratch also turns down inflammation in the skin<figure><img src="https://images.theconversation.com/files/553357/original/file-20231011-23-fpzuw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2168%2C1381&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Itching, and the subsequent urge to scratch, can make eczema worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/scratching-chest-royalty-free-image/1463546524">Kinga Krzeminska/Moment via Getty Images</a></span></figcaption></figure><p>Itching can be uncomfortable, but it’s a normal part of your skin’s immune response to external threats. When you’re itching from an encounter with poison ivy or mosquitoes, consider that your urge to scratch may have evolved to get you to <a href="https://doi.org/10.1083/jcb.201603042">swat away disease-carrying pests</a>. </p>
<p>However, for many people who suffer from chronic skin diseases like eczema, the sensation of itch can <a href="https://eczema.org/information-and-advice/living-with-eczema/itching-and-scratching/">fuel a vicious cycle</a> of scratching that interrupts sleep, reduces productivity and <a href="https://nationaleczema.org/eczema-emotional-wellness/">prevents them from enjoying daily life</a>. This cycle is caused by <a href="https://nationaleczema.org/blog/why-does-eczema-itch/#">sensory neurons and skin immune cells</a> working together to promote itching and skin inflammation.</p>
<p>But, paradoxically, some of the mechanisms behind this feedback loop also stop inflammation from getting worse. In our newly published research, my team of immunologists and neuroscientists <a href="https://profiles.ucsf.edu/marlys.fassett">and I</a> discovered that a specific type of itch-sensing neuron can <a href="https://www.science.org/doi/10.1126/sciimmunol.abi6887">push back on the itch-scratch-inflammation cycle</a> in the presence of a small protein. This protein, called <a href="https://doi.org/10.1016/j.jaci.2013.10.048">interleukin-31, or IL-31</a>, is typically involved in triggering itching. </p>
<p>This negative feedback loop – like the vicious cycle – is only possible because the itch-sensing nerve endings in your skin are closely intertwined with the millions of cells that <a href="https://doi.org/10.4049/jimmunol.1801473">make up your skin’s immune system</a>.</p>
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<figcaption><span class="caption">Your skin has its own immune system.</span></figcaption>
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<h2>IL-31: An itchy molecule</h2>
<p>The protein IL-31 is key to the connection between the nervous and immune systems. This molecule is <a href="https://doi.org/10.1038/ni1084">produced by some immune cells</a>, and like other <a href="https://my.clevelandclinic.org/health/body/24585-cytokines">members of this molecule family</a>, it specializes in helping immune cells communicate with each other. </p>
<p>IL-31 is rarely present in the skin or blood of people who don’t have a history of eczema, allergies, asthma or related conditions. But those with conditions like eczema that cause chronic itch have significantly <a href="https://doi.org/10.3389/fmed.2021.638325">increased skin production of IL-31</a>. There is strong evidence that IL-31 is one of a small set of proteins that immune cells produce that can bind directly to sensory neurons and <a href="https://doi.org/10.1016/j.cell.2013.08.057">trigger itching</a>. Small amounts of purified IL-31 injected directly into skin or spinal fluid leads to impressively <a href="https://doi.org/10.1016/j.jaci.2013.10.048">rapid-onset itching and scratching</a>.</p>
<p>However, when my colleagues and I induced rashes in mice by exposing them to dust mites, we found that itch-sensing neurons turned down the dial on inflammation at the site of itching instead of promoting it. They did so by secreting <a href="https://doi.org/10.1007/978-1-61779-310-3_1">small molecules called neuropeptides</a> that, in this context, directed immune cells to respond less enthusiastically. In sum, we had discovered an inverse relationship between itching and skin inflammation, tethered by a single molecule.</p>
<p>But if IL-31 triggers itching, which can worsen inflammation by making patients scratch their skin, how does it reduce inflammation? </p>
<p>We found the answer to this paradox in a little-known function of sensory neurons called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/neurogenic-inflammation">neurogenic inflammation</a>. This nerve reflex triggers sensory neurons to release various signaling molecules directly into tissues, including <a href="https://doi.org/10.1111/1523-1747.ep12455620">specific neuropeptides that promote signs of inflammation</a> like increased blood flow to the skin. Neurogenic inflammation acts within the same nerves that transmit sensory information like itch, pain, touch and temperature, but differs by the path it takes: away from the brain rather than toward it.</p>
<p>We discovered that IL-31 can induce neurogenic inflammation, <a href="https://www.science.org/doi/10.1126/sciimmunol.abi6887">mapping a direct pathway</a> going from IL-31 through sensory neurons to repress immune cells in the skin. When we engineered mice to be unresponsive to IL-31, we similarly found that they had more activated skin immune cells that produced more inflammation. This means the net effect of IL-31 is to blunt overall inflammation.</p>
<h2>IL-31 as potential treatment</h2>
<p>Our study shows that IL-31 causes sensory neurons in the skin to perform <a href="https://www.science.org/doi/10.1126/sciimmunol.abi6887">two very different functions</a>: They signal inward to the spinal cord and brain to stimulate an itching sensation that typically leads to more inflammation, but they also signal back out to the skin and quell inflammation by inhibiting certain immune cells.</p>
<p>Although paradoxical, this makes evolutionary sense. Scratching an itch can feel very satisfying but doesn’t have much utility in the modern world where we’re more likely to suffer from compulsive scratching than encounter stinging nettles. In contrast, unchecked inflammation underlies many chronic autoimmune diseases. Therefore, turning off an immune response in inflamed tissue can be as important as turning it on.</p>
<p>Our discoveries raise important questions about the implications of modifying IL-31 to treat different diseases. For one, it isn’t clear how IL-31-sensing neurons interface with <a href="https://doi.org/10.1038/s41590-019-0493-z">other neuronal circuits</a> that also regulate skin inflammation. Furthermore, some patients have <a href="https://doi.org/10.1056/NEJMoa1606490">higher levels of allergic proteins</a> in their blood or <a href="https://doi.org/10.1111/jdv.17218">develop asthma flares</a> when taking existing drugs that target IL-31. IL-31 is also found in some lung and gut cells – how and why would an itch-inducing molecule be present in internal organs? </p>
<p>Anatomical niches where sensory neurons and immune cells converge are present throughout the human body. If an itchy molecule like IL-31 can use neuronal circuitry to dampen an immune response in the skin, similar molecules like those used in <a href="https://migrainetrust.org/live-with-migraine/healthcare/treatments/gepants/">migraine drugs</a> could be repurposed to treat skin conditions, too.</p><img src="https://counter.theconversation.com/content/215326/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marlys Fassett receives funding from the National Institutes of Health/National Institute of Arthritis, Musculoskeletal and Skin Diseases. She also serves as a grant reviewer for the National Eczema Association.</span></em></p>Itch-sensing neurons in your skin are intertwined with your immune cells. Counterintuitively, the molecule that connects them triggers responses that both worsen and improve skin conditions.Marlys Fassett, Associate Professor of Dermatology, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2083632023-07-12T02:17:21Z2023-07-12T02:17:21ZWhy is eczema sometimes treated with a diluted bleach bath? And what do I need to know before trying it?<figure><img src="https://images.theconversation.com/files/533621/original/file-20230623-15-xi7q7.jpg?ixlib=rb-1.1.0&rect=8%2C33%2C5621%2C3722&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Diluted bleach baths are a common treatment doctors and nurses use for patients with more severe eczema. It is important to note they may not replace other treatments and may not be suitable for everyone. </p>
<p>This treatment should only ever be used under the guidance of a dermatologist or doctor, who can advise if it’s appropriate and tailor the dilution ratio to suit the individual’s condition.</p>
<p>So why and how does it work for some eczema sufferers? And what should one know before trying it?</p>
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<h2>Germs can colonise damaged eczema skin</h2>
<p>Eczema is a genetic condition that causes a person’s skin to be easily inflamed by certain triggers, such as hot water or soaps. The person’s skin barrier becomes damaged and itchy, allowing germs to get established and cause even more problems.</p>
<p>The most common germ found in the damaged eczema skin is <em>staphylococcus aureus</em>. Certain toxic materials known as “membrane-bound vesicles” are released by the staph germ, which causes an even more profound reaction in the skin, <a href="https://pubmed.ncbi.nlm.nih.gov/27910159/">worsening the eczema</a>. Treating – or at least reducing – the amount of staph in the skin can help the eczema recover.</p>
<p>When eczema is very active, the skin literally bubbles with fluid and can begin to weep. Bacteria love to colonise and infect this type of eczema. This process is known as “impetiginisation”. </p>
<p>When this process occurs without eczema, it is called impetigo (also known as school sores). </p>
<p>A solution of water and sodium hypochlorite (in other words, bleach) will rapidly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1580803/pdf/amjphnation01146-0053.pdf">kill</a> germs. And we know from <a href="https://pubmed.ncbi.nlm.nih.gov/17015593/">studies</a> on wounds that simple washing of a wound reduces the number of bacteria. </p>
<p>So it’s likely a gentle washing action is part of the effect, in some cases, and could be made more effective with subtle water jets.</p>
<p>For example, using a water squeeze toy for young children to create a gentle wash of water could help remove some of the build-up of body fluids in the broken eczema areas. </p>
<p>This would obviously need to be done very gently so it was not uncomfortable. Friction and rubbing of eczema – particularly with cloths and towels – generally makes things much worse.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535989/original/file-20230706-1723-hte9mu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Friction and rubbing can make eczema worse.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Reducing inflammation</h2>
<p>Researchers have also shown sodium hypochlorite can <a href="https://doi.org/10.1172/JCI70895">reduce inflammation</a> in the skin. This is another reason the treatment is recommended.</p>
<p>Eczema often involves a vicious cycle of inflammation, where redness and increasing itchiness leads to scratching and even more irritation. The skin breaks even more and the eczema worsens, leading to yet more inflammation. </p>
<p>A diluted bleach bath can help break this vicious cycle.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535995/original/file-20230706-27-g7af4c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The bleach should be diluted in the bathwater to ensure it is safe for your skin.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>You need to know what you’re doing</h2>
<p>Diluted bleach bath instructions need to be tailored to the eczema, so don’t try it at home unless you’ve been advised by a dermatologist or doctor. An example of how to perform a bleach bath might look like this:</p>
<p><strong>1. Dilution ratio:</strong> The bleach should be diluted in the bathwater to ensure it is safe for your skin. A typical dilution ratio may be ½ cup (120 ml) of household bleach (containing 5-6% sodium hypochlorite) per 150 litres of lukewarm water. However, the exact dilution ratio may vary based on the severity of your eczema, age and other factors. Children may need less bleach in their bath. Check with your doctor because getting the ratio wrong can cause pain and harm.</p>
<p><strong>2. Soak time:</strong> The recommended soak time in the bleach bath is usually around ten minutes. During this time, gently pat or submerge your affected skin areas in the water. Avoid scrubbing or rubbing the skin vigorously, as it may further irritate or damage the skin.</p>
<p><strong>3. Rinse thoroughly:</strong> After the designated soak time, carefully rinse off the bleach solution from your body with cool water. Make sure to remove all traces of the bleach, as residual bleach left on the skin may cause irritation.</p>
<p><strong>4. Moisturise:</strong> After the bath, promptly apply a moisturiser or emollient to your skin while it is still slightly damp. This helps lock in moisture and maintain hydration, which is crucial for eczema management.</p>
<p><strong>5. Frequency:</strong> The frequency of bleach baths can vary depending on your specific condition. Typically, they are done two to three times a week, but this may vary.</p>
<p><strong>6. Monitoring and follow-up:</strong> It is essential to monitor your skin’s response to bleach baths. If you notice any increased redness, irritation or discomfort, discontinue the baths and talk to your dermatologist.</p>
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<p class="fine-print"><em><span>Michael Freeman does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When eczema is very active, the skin literally bubbles with fluid and can begin to weep. Bacteria love to colonise and infect this type of eczema.Michael Freeman, Associate Professor of Dermatology, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035752023-06-20T02:22:42Z2023-06-20T02:22:42ZCan I put cortisone on my face? The right advice on creams to fix irritated skin<figure><img src="https://images.theconversation.com/files/530540/original/file-20230607-17-118jjr.jpg?ixlib=rb-1.1.0&rect=49%2C32%2C5378%2C3607&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/skin-care-young-man-putting-face-1643342416">Shutterstock</a></span></figcaption></figure><p>Topical corticosteroids, also referred to as corticosteroids or cortisone, are the <a href="https://pubmed.ncbi.nlm.nih.gov/33719380/">go-to treatment</a> for many skin disorders including eczema, dermatitis and psoriasis. They can be found in <a href="https://www.ncbi.nlm.nih.gov/books/NBK532940/">various forms</a> such as creams, ointments, and solutions. </p>
<p>These medications <a href="https://ijdvl.com/topical-corticosteroids-in-dermatology/">work</a> by entering the skin cells and mimicking natural hormones, <a href="https://www.verywellhealth.com/how-topical-steroids-work-1068833#citation-1">blocking inflammation</a> and constricting blood vessels. Topical corticosteroids come in <a href="https://www1.racgp.org.au/ajgp/2021/september/selection-of-a-corticosteroid">different strengths</a>, from mild (such as 0.5% Hydrocortisone, available over the counter) to very potent prescription formulations. </p>
<p>But the way different people react to topical steroids can be unpredictable. While some people might get significant relief with short-term use, others could need continuous care.</p>
<p>So, how should you use cortisone creams and ointments? And why is there conflicting advice about their long-term use?</p>
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<h2>‘Use sparingly’</h2>
<p>Patients are currently recommended to use cortisone formulations “sparingly” or “thinly”. But this can increase the risk they won’t work effectively. Treatment failure can add to “<a href="https://pubmed.ncbi.nlm.nih.gov/34287768/">steroid phobia</a>” and stop people getting the medication they need. </p>
<p>Such warnings ignore the fact many patients are prescribed modest-strength topical steroids, which are <a href="https://doi.org/10.1111/j.1365-2133.2008.08479.x">safe and effective</a> when used properly. <a href="https://www.tandfonline.com/doi/full/10.1080/09546634.2019.1620502">Adverse effects</a>, such as when the formulations damage or irritate skin, are not typical. </p>
<p>From the patient’s perspective, the <a href="https://pubmed.ncbi.nlm.nih.gov/18294314/">current warnings</a> lump all steroids together regardless of their potential for side effects. Also, the advice tends to support false concerns: that topical and ingested (orally taken) corticosteroids carry the same dangers, which <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2796.2005.01467.x">they do not</a>.</p>
<h2>Mixed messages</h2>
<p>Should you use a weaker formulation for longer? Or hit the problem hard with a stronger concentration for less time?</p>
<p>At the moment, some treatment recommendations – such as for scalp <a href="https://pubmed.ncbi.nlm.nih.gov/31138038/">psoriasis</a> – say patients should use a high-dose cortisone formulation for four weeks and increase frequency of use if it’s not effective. If cortisone is extensively used, it is advised adults and children should be examined yearly for side effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&rect=46%2C46%2C5106%2C3305&q=45&auto=format&w=1000&fit=clip"><img alt="person rubs white skin cream on to hand" src="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&rect=46%2C46%2C5106%2C3305&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529006/original/file-20230530-23-2qp4o2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some conditions need long-term cortisone treatment – so breaks might be needed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/applying-emollient-dry-flaky-skin-treatment-551219659">Shutterstock</a></span>
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<p>Skin atrophy (or deterioration) is the <a href="https://pubmed.ncbi.nlm.nih.gov/16384751/">most common side effect</a> of topical corticosteroids and manifests as tiny degenerative alterations within a few weeks. The patient’s age, body site, cortisone potency and the existence of any coverings, all have an impact on the extent of skin damage. </p>
<p>Reduced skin cell growth, decreased collagen development and stimulation of tiny vessels and capillaries in the skin are the <a href="https://pubmed.ncbi.nlm.nih.gov/25396122/">main features</a> of such skin atrophy. Thinner skin, more moisture, higher temperatures, and partial blockage make areas where skin folds on the body (for example, the armpits, between fingers, the groin) particularly vulnerable. These are also often the sites of skin irritation needing treatment. </p>
<h2>Skin thinning</h2>
<p>Topical steroids cause the skin to reabsorb a type of connective tissue building block, called <a href="https://www.histology.leeds.ac.uk/tissue_types/connective/connective_groundS.php#:%7E:text=The%20'ground%20substance'%20of%20extracellular,even%20larger%20molecules%20called%20proteoglycans.">mucopolysaccharide ground material</a>. Repeated use in the same spot on the body <a href="https://onlinelibrary.wiley.com/doi/book/10.1002/9780470750520">results in alterations</a> to the skin’s connective tissue and epidermal thinning. </p>
<p>That can result in lax, translucent, wrinkled skin as well as striae (stretch marks), fragility, hypo-pigmentation (fading) and the prominence of underlying veins. </p>
<p>More research is needed to help specialists choose the best corticosteroids for a given condition. High-potency cortisone formulations, long-term use and sun exposure have been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910795/">implicated</a> in chronic fragile skin syndrome, which is increasingly common and features the symptoms outlined above.</p>
<p>However, if best <a href="https://www.nice.org.uk/guidance/cg153/chapter/5-Other-versions-of-this-guideline-full-guideline">practice guidelines</a> are followed, these side effects can be reduced by using lowering the potency of corticosteroids and stopping treatment when the patient has fully recovered. </p>
<p>Corticosteroids should only be used for a maximum of three months. For some conditions, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300730/">vitiligo</a>, they need to be used for longer periods, so regularly taking several weeks’ break is advised. </p>
<p>The good news is that once topical corticosteroids are stopped, short-term atrophy from treatment <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779293/">can be reversed</a>, although skin normalisation may take months.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cream on scratched up skin" src="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/530523/original/file-20230607-23-ca22fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patients need reassurance and guidance on how much cortisone cream to use and for how long.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cortisone-cream-spread-on-irritated-skin-1658002459">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drugs-and-the-sun-your-daily-medications-could-put-you-at-greater-risk-of-sunburn-170559">Drugs and the sun – your daily medications could put you at greater risk of sunburn</a>
</strong>
</em>
</p>
<hr>
<h2>Can you use it safely on your face?</h2>
<p>Due to the substantial risk of steroid-induced skin deterioration, the guidelines recommend against using potent and very potent corticosteroids on the face, flexures (parts of the body that bend, such as elbows) or genitalia. So, mild to moderate-potency corticosteroids are the main treatment option. </p>
<p>Using strong cortisone creams or ointments on the face can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/31138038/">steroid dependence</a>. Patients who are dependent on steroids and have acne, rosacea, perioral dermatitis or telangiectasia (widened blood vessels on the skin) continue to use the drug because they worry stopping the drug could worsen their condition. </p>
<p>Topical steroids on the face can cause symptoms sometimes referred to as “red face syndrome”, dermatitis rosaceaformis steroidica or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885178/">steroid addiction</a>. And stopping <a href="https://pubmed.ncbi.nlm.nih.gov/21393945/">steroid use on the face</a> after an extended period can have considerable rebound effects including erythema (redness), burning and scaling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-sodium-lauryl-sulfate-and-is-it-safe-to-use-125129">What is sodium lauryl sulfate and is it safe to use?</a>
</strong>
</em>
</p>
<hr>
<h2>The bottom line</h2>
<p>When used correctly, cortisone creams, ointments and lotions can be safe and effective. </p>
<p>Clear instructions could include estimating dosage in “<a href="https://pubmed.ncbi.nlm.nih.gov/23097521/">fingertip units</a>”, with a chart showing the number of units needed for various body parts, such as <a href="https://patient.info/treatment-medication/steroids/fingertip-units-for-topical-steroids">one unit to treat skin on an adult’s hand</a> but seven units to treat skin on their back.</p>
<p>To avoid skin damage, corticosteroids should only be used on skin affected by a skin disease. Better education and information <a href="https://www.racgp.org.au/afp/2017/may/general-practitioners-knowledge-about-use-of-t-2">is needed</a> to reflect the minimal risks from topical corticosteroids that are low to moderate strength and how important it is to use enough medication to treat a condition. </p>
<p>Finally, treatment should be customised based on the person’s symptoms, the body parts affected and how long treatment might be required.</p><img src="https://counter.theconversation.com/content/203575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yousuf Mohammed receives funding from U.S FDA grants. This article reflects the views of the author and
should not be construed to represent views or
policies.</span></em></p><p class="fine-print"><em><span>Khadeejeh AL-Smadi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Patients and some doctors have an inflated sense of the risks of low-to-moderate strength cortisone cream and might not use enough to be effective.Yousuf Mohammed, Dermatology researcher, The University of QueenslandKhadeejeh AL-Smadi, PhD Candidate, Frazer Institute,, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1935092023-01-19T13:37:05Z2023-01-19T13:37:05ZCold weather brings itchy, irritated, dry and scaly skin – here’s how to treat eczema and other skin conditions and when to see a doctor<figure><img src="https://images.theconversation.com/files/498142/original/file-20221130-16-t58j7l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5342%2C3564&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some skin conditions, keeping hydrated is key.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-image-of-mother-holding-kids-hands-royalty-free-image/1398092187?phrase=eczema%20child&adppopup=true">Yuliya Shevtsova/EyeEm via Getty Images</a></span></figcaption></figure><p>In many parts of the U.S., the winter months bring frigid temperatures and drier conditions that can wreak havoc on the skin.</p>
<p>The primary role of the skin, as the largest organ in the body, is to act as a physical barrier to the external environment. When your skin is healthy, it helps protect you from allergens and infections. But in winter, when the outside temperature and humidity drop, skin can become especially irritated. </p>
<p>We are a <a href="http://dermatology.pitt.edu/people/sonal-choudhary-md">dermatologist</a> and a <a href="https://dom.pitt.edu/jeffrey-chen-awarded-prep-fellowship/">medical student</a> who study a <a href="https://scholar.google.com/citations?user=OFQxFnMAAAAJ&hl=en">broad range of common skin conditions </a> and the effects of the environment on skin health. </p>
<p>Heading into the winter months, a handful of common dermatological conditions can develop or worsen in response to the cold. These include eczema, chilblains, Raynaud’s phenomenon, cold urticaria and cold panniculitis. All are conditions that can be irritating and uncomfortable, and some are harder to treat than others. So it’s helpful to know when to manage these conditions on your own and when to see a dermatologist.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7LKDLu07KgA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Although eczema often affects infants, one form affects people 60 and older.</span></figcaption>
</figure>
<h2>Eczema</h2>
<p>Eczema is an inflammatory skin condition that causes dry and itchy skin and may be triggered by soaps and detergents, environmental or food allergens, hormonal changes and skin infections. There are numerous types of eczema, which often have overlapping symptoms. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pinkish splotches of eczema appear on an extended right arm." src="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504514/original/file-20230113-14-njqskz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">According to the Cleveland Clinic, eczema affects more then 30 million Americans.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/eczema-allergy-skin-atopic-dermatitis-royalty-free-image/1270933857?phrase=eczema&adppopup=true">tylim/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p><a href="https://www.ncbi.nlm.nih.gov/books/NBK549807/">Asteatotic eczema</a>, also known as winter itch, is common in older adults. During the winter months, skin can become drier and, in some instances, cracked, fissured and inflamed. </p>
<p>Severe dryness may lead to itchiness and scratching. In turn, this can create open wounds that may allow allergens and bacteria to penetrate the skin and cause a rash or an infection. </p>
<p>This type of eczema typically occurs on the lower legs, but eruptions can occur anywhere on the skin, such as the trunk, arms and hands. </p>
<p>Keeping the skin hydrated is the primary treatment. Water-based lotions may worsen skin drying, so <a href="https://nationaleczema.org/eczema/treatment/moisturizing/#:%7E">applying moisturizers with a high oil content</a> – like petroleum jelly, mineral oil or Vaseline – on wet or damp skin is recommended. Hypoallergenic and anti-itch moisturizers designed specifically for eczema are also available. </p>
<p>Other tips include replacing long hot baths with quick warm showers, switching to a milder soap, and using a room humidifier if the climate is dry. If itchiness and dryness persist, seek care from a dermatologist, who may prescribe a topical steroid.</p>
<p>Hand eczema may also worsen in the winter as your <a href="https://eczema.org/information-and-advice/types-of-eczema/hand-eczema/">hands are frequently exposed to cold, dry air</a>. Scaling, fissuring and bleeding on the hands is common. Minimizing exposure to hard or antibacterial soaps, along with using gentle cleansing products followed by applying a petroleum-based unscented moisturizer can improve symptoms. </p>
<h2>Chilblains</h2>
<p><a href="https://doi.org/10.1024/0301-1526/a000838">Chilblains</a>, also known as pernio, are small, itchy patches that can occur when the skin is exposed to cold and damp weather, resulting in swollen and painful bumps that affect the fingers, toes, ears and face. Poor circulation, <a href="https://doi.org/10.1016/j.amjmed.2009.07.011">blood vessel constriction</a>, a history of autoimmune disease and being underweight may predispose people to chilblains. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Against a blue background, a woman's hand shows chilblains -- swollen, bright red markings on her middle and ring fingers just below the nails." src="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504517/original/file-20230113-24-7wuq83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Although they usually heal if protected from cold, chilblains can be painful.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/chilblains-on-the-fingers-royalty-free-image/1372816804?phrase=chilblains&adppopup=true">Elizabeth Fernandez/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Afflicted areas are painful, itchy, swollen and usually have a blueish to purple hue. In severe cases, blisters and ulcers may occur. But for most people, the condition tends to spontaneously resolve within one to three weeks. </p>
<p>Until that happens, it’s important to keep affected areas protected from the cold. If the sensitive area starts to blister, or if fevers, muscle aches and chills develop, it’s best to see a dermatologist or physician.</p>
<p><a href="https://doi.org/10.1111/bjd.19243">Pseudo-chilblains</a>, also known as “COVID toes,” can be caused by COVID-19 infection. Chilblains associated with COVID-19 resemble the rash in chilblains – painful red to blue-colored nodules on the toes – but it is not specific to winter. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FKRjNLqZrsU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dry, cracked skin can lead to infections.</span></figcaption>
</figure>
<h2>Raynaud’s phenomenon</h2>
<p>Like chilblains, <a href="https://doi.org/10.1016/S0140-6736(00)05118-7">Raynaud’s phenomenon</a> is a skin condition characterized by a significant constriction of blood vessels in the fingers and toes in response to cold exposure. The digits may turn red or blue, but they quickly flush red upon rewarming. Afflicted areas may also be numb or painful, and when severe, may develop ulcers.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Against a black background, an adult hand with a pale middle finger displays Raynaud's phenomenon." src="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504518/original/file-20230113-15-z93hrw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Although Raynaud’s phenomenon typically affects fingers and toes, it can also affect the nose, ears and lips.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adult-hand-and-fingers-raynauds-phenomenon-royalty-free-image/1387926245?phrase=Raynauds%27s%20phenomenon&adppopup=true">Barb Elkin/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>To treat Raynaud’s phenomenon, it’s necessary to avoid cold-weather exposure. Ideally patients with Raynaud’s should dress for the cold in layers. At a minimum, make sure to wear gloves and insulated footwear. Avoid tobacco, caffeine and decongestants; they may cause <a href="https://europepmc.org/article/med/7748770">blood vessels to constrict more</a>. If symptoms don’t improve quickly – Raynaud’s due to cold typically gets better after only a few minutes – see a dermatologist or your physician, as Raynaud’s phenomenon can also be a manifestation of <a href="https://doi.org/10.1016/S0140-6736(00)05118-7">a more serious systemic disease</a>, including cancer, infections and/or trauma.</p>
<h2>Cold urticaria</h2>
<p><a href="https://doi.org/10.1111/all.14674">Cold urticaria</a> is a skin rash believed to be triggered by an autoimmune response, which leads to the release of inflammatory molecules, including histamine. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman's arm covered in the blotchy red marks known as hives." src="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504520/original/file-20230113-20-eq8ps2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cold urticaria is more commonly known as hives.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-with-urticaria-royalty-free-image/1389641807?phrase=hives&adppopup=true">Elk Scott/i Stock via Getty Images</a></span>
</figcaption>
</figure>
<p>Soon after the skin is exposed to sudden drops in temperature, wheals – also known as hives – may develop. These are reddish, itchy and swollen areas of skin. Such episodes can last for approximately two hours. Occasionally, other symptoms accompany the outbreak, including headache, chills, shortness of breath, abdominal pain and diarrhea. </p>
<p>People can test for cold urticaria using the <a href="https://doi.org/10.1046/j.0022-202x.2001.00028.x">ice cube test</a>. This is done simply by placing an ice cube on an area of skin for five minutes; if you have cold urticaria, the skin will raise and itch within five to 15 minutes. Treatment involves avoiding cold exposure and using over-the-counter antihistamines. </p>
<p>For those who have experienced cold urticaria, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1927430/">swimming in cold water</a> can be dangerous, as it can lead to loss of consciousness and drowning. </p>
<h2>Cold panniculitis</h2>
<p><a href="https://doi.org/10.1016/j.det.2008.05.015">Cold panniculitis</a> – which appears as enlarged, red and painful nodules on the skin – develops 12 to 72 hours after cold exposure. </p>
<p>Cases of cold panniculitis have been documented in <a href="https://www.consultant360.com/article/popsicle-panniculitis">children eating Popsicles</a> and in adults undergoing <a href="https://doi.org/10.1016/j.jdcr.2018.02.010">whole-body cryotherapy</a>, which is often used as treatment for chronic inflammatory conditions such as rheumatoid arthritis, or for improving post-exercise recovery. </p>
<p>Cold panniculitis is more common during childhood and usually resolves on its own by avoiding cold exposure and direct contact with frozen products.</p>
<p>Symptoms from winter skin conditions are often self-limiting and resolve on their own with adequate protection from the cold. But if symptoms do not resolve, you should see a licensed dermatologist, as cold-induced rashes may be a sign of a more concerning underlying health condition. </p>
<p>If visiting your dermatologist in person proves difficult, you may consider seeing a dermatologist virtually, as many academic medical centers and private practices now <a href="https://doi.org/10.1016/j.jaad.2019.11.055">offer telehealth dermatology</a>.</p><img src="https://counter.theconversation.com/content/193509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sonal Choudhary is a speaker for Regenron Pharmaceuticals and Sanofi, a pharmaceutical and health care company. Their atopic dermatitis drug Dupixent could potentially benefit from an article which mentions worsening of eczema in winters. There is no direct mention of the drug in the article.</span></em></p><p class="fine-print"><em><span>Jeffrey Chen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although most skin conditions aren’t dangerous, they can be painful, irritating and frustrating to deal with.Sonal Choudhary, Assistant Professor of Dermatology and Dermatopathology, University of Pittsburgh Health SciencesJeffrey Chen, Medical Student, University of Pittsburgh Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1811382022-04-15T18:01:27Z2022-04-15T18:01:27ZWhat is that rash? Genetic fingerprints can help doctors diagnose and treat skin conditions more effectively<figure><img src="https://images.theconversation.com/files/458016/original/file-20220413-23-kvcimv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Skin conditions like psoriasis and eczema can have rashes that are difficult to distinguish by eye.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/dermatitis-eczema-texture-of-ill-human-skin-royalty-free-image/1270950737">tylim/iStock via Getty Images Plus</a></span></figcaption></figure><p>Rashes can be thought of as a dysfunctional community of skin cells. Your skin harbors <a href="https://dermnetnz.org/topics/the-structure-of-normal-skin">dozens of distinct cell types</a>, including those that form blood vessels, nerves and the local immune system of the skin. For decades, clinicians have largely been <a href="https://doi.org/10.1097/01.pcr.0000117274.16187.de">diagnosing rashes by eye</a>. While examining the physical appearance of a skin sample under a microscope may work for more obvious skin conditions, many rashes can be difficult to distinguish from one another.</p>
<p>At the molecular level, however, the differences between rashes become more clear. </p>
<p>Scientists have long known that <a href="https://doi.org/10.1038/jid.2009.71">molecular abnormalities</a> in skin cells cause the redness and scaliness seen in conditions like psoriasis and eczema. While almost all the various cell types in your skin can release chemicals that worsen inflammation, which ones leads to rash formation remains a mystery and may <a href="https://doi.org/10.1016/j.immuni.2018.05.012">vary from patient to patient</a>.</p>
<p>But molecular testing of skin rashes isn’t a common practice because of technological limitations. Using a new approach, my colleagues and I were able to analyze the <a href="https://www.science.org/doi/10.1126/sciimmunol.abl9165">genetic profiles of skin rashes</a> and quantitatively diagnose their root causes.</p>
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<figcaption><span class="caption">Skin is a complex organ that performs a wide variety of functions.</span></figcaption>
</figure>
<h2>High-res skin profiles</h2>
<p>Traditional genetic analyses work by averaging out the activity of <a href="https://doi.org/10.1038/jid.2014.28">thousands of genes across millions of cells</a>.</p>
<p>Genetically testing tissue samples is standard practice for conditions like cancer. Clinicians collect and analyze tumor biopsies from patients to determine a particular cancer’s unique molecular characteristics. This genetic fingerprint helps oncologists <a href="https://doi.org/10.1016/j.semcancer.2017.08.010">predict whether a cancer will spread or which treatments might work best</a>. Cancer cells lend themselves to this form of testing because they often grow into recognizable masses that make them easy to <a href="https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment">isolate and analyze</a>.</p>
<p>But skin is a complex mixture of cells. Collapsing these unique cell communities into a single group may obscure genetic signatures essential to diagnosis.</p>
<p>Recent technological advances called <a href="https://doi.org/10.1016/j.jdin.2020.08.001?">single-cell RNA sequencing</a>, however, have enabled scientists to preserve the identity of each type of cell that lives in the skin. Instead of averaging the genetic signatures across all cell types in bulk, single-cell RNA sequencing analyses allow each cell to preserve its unique characteristics.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/k9VFNLLQP8c?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Single-cell RNA sequencing is used to analyze samples where many different types of cells are present.</span></figcaption>
</figure>
<p>Using this approach, my colleagues and I isolated over 158,000 immune cells from the skin samples of 31 patients. We measured the activity of about 1,000 genes from each of those cells to create detailed molecular fingerprints for each patient. By analyzing these fingerprints, we were able to pinpoint the genetic abnormalities unique to the immune cells residing in each rash type. This allowed us to quantitatively diagnose otherwise visually ambiguous rashes. </p>
<p>We also observed that some patients had treatment responses consistent with what we expected with our predicted diagnoses. This suggests that our concept could viably be expanded for further testing.</p>
<p>To make our approach available to clinicians and scientists, we developed an open source web database called <a href="https://rashx.ucsf.edu/">RashX</a> that contains the genetic fingerprints of different rashes. This database will allow clinicians to compare the genetic profile of their patients’ rashes to similar profiles in our database. A closely matching genetic fingerprint might yield clues as to what caused their patient’s rash and lead to potential treatment avenues.</p>
<h2>Open source diagnostics</h2>
<p>The <a href="https://www.scientificamerican.com/article/biologics-the-pricey-drugs-transforming-medicine/">rapid development of drugs that target the immune system</a> in recent years has inundated doctors with difficult treatment decisions for individual patients. For example, while certain drugs that act on the immune system are known to work well for conditions like psoriasis or eczema, many patients have atypical rashes that can’t be precisely diagnosed. </p>
<p>An <a href="https://rashx.ucsf.edu/">open source database</a> like ours could help enable clinicians to profile and diagnose these rashes, providing a stepping stone to choose a suitable treatment. </p>
<p>Furthermore, <a href="https://doi.org/10.1126/science.abf3041">chronic inflammatory diseases</a> that affect organs other than the skin share similar genetic abnormalities. Lab tests that can illuminate the root causes of skin diseases can likely be expanded to many other conditions.</p>
<p>Our <a href="https://rashx.ucsf.edu/">RashX</a> project initially focused on just two very common types of rashes, psoriasis and eczema. It is unknown whether <a href="https://www.aad.org/public/diseases/a-z">other types of rashes</a> will have similar genetic profiles to psoriasis and eczema or instead have their own unique fingerprints. It is also unclear which parts of the fingerprint would best predict drug response.</p>
<p>But <a href="https://rashx.ucsf.edu/">RashX</a> is a living web resource that will grow more useful as more scientists collaborate and contribute new data. Our lab is also working to simplify the process of developing genetic profiles of rashes to make participating in this area of research more accessible for clinics around the world. With more data, we believe that projects like RashX will make precision testing for rashes an essential next step in diagnosis and treatment.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=science&source=inline-science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/181138/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Raymond J. Cho, MD, PhD receives funding from the LEO Foundation, the National Psoriasis Foundation, the National Eczema Assocation, Sun Pharmaceutical Industries, Sanofi, and Pfizer. </span></em></p>Many doctors currently diagnose skin conditions by eye. Advances in molecular testing could lead to more precise and accurate diagnoses for ambiguous rashes and skin lesions.Raymond J. Cho, Associate Professor of Dermatology, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1705592021-12-22T21:05:18Z2021-12-22T21:05:18ZDrugs and the sun – your daily medications could put you at greater risk of sunburn<figure><img src="https://images.theconversation.com/files/432801/original/file-20211119-19-1nls6j1.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5447%2C3506&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>With summer holidays underway, it’s time to think about the sun and your skin. Australia has the <a href="https://www.wcrf.org/dietandcancer/skin-cancer-statistics/">highest rate of skin cancer</a> in the world, so we need to be doing more to protect ourselves from the damaging effects of ultraviolet radiation.</p>
<p>Unfortunately, some medicines can increase your risk of sunburn, because they either enhance UV absorption in your skin or cause you to have a light-activated reaction. </p>
<p>It’s important not to skim over the information provided with your medication, to speak to your pharmacist for on-the-spot advice and to take extra precautions if required.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-cant-get-sunburnt-through-glass-shade-or-in-water-right-5-common-sunburn-myths-busted-150640">I can't get sunburnt through glass, shade or in water, right? 5 common sunburn myths busted</a>
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</em>
</p>
<hr>
<h2>What happens to your skin</h2>
<p>There are two main ways that medications can increase your risk of sunburn; a <a href="https://www.skincancer.org/risk-factors/photosensitivity/">phototoxic reaction and a photoallergic reaction</a>. </p>
<p>A phototoxic reaction is the most common way for a medication to cause an increase in sun sensitivity. This is where the drug molecule is able to absorb UV light, and then releases it back into the skin. Once the oral medication has been absorbed into the blood stream, or after the topical medication is applied to the skin, a phototoxic reaction can occur anytime within minutes or hours of sun exposure. Typically, only the skin that is exposed to the sun will react.</p>
<p>The second, less common mechanism, is via a photoallergic reaction. This can occur with certain medications that are applied directly to the skin, or that are taken by mouth and then circulated to the skin. </p>
<p>After exposure to the sun, a drug can undergo structural changes. Once these structural changes happen, small proteins in our body can bind to the drug, resulting in our immune system recognising it as a foreign substance. Then antibodies are produced to fight it. </p>
<p>The resulting reaction in many cases resembles eczema or a red rash. This type of reaction can take anywhere between one to three days to occur, and will only occur on the parts of the body that are exposed to the sun.</p>
<p>Importantly, both phototoxic and photoallergic reactions are damage to the skin from UV exposure that can increase the risk of later developing skin cancer.</p>
<p>There are also some types of medicines that can cause heat sensitivity and increase your risk of dehydration. This can occur if a medicine has effects that increase urination, prevent sweating, or reduce blood flow to the skin. Examples of these medications include diuretics, some types of antihistamines and stimulant medications for ADHD.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist with medications." src="https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432800/original/file-20211119-23-1vn7n38.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your local pharmacist can give you advice on medications and sun sensitivity.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-260nw-704036482.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<h2>Which medicines can affect your skin?</h2>
<p>There are many medicines that can affect your skin and make you more sensitive to the sun, so it’s important to know which ones to look out for. </p>
<p>The first are the antibiotics. Tetracycline-based drugs are particularly known to cause sensitivity. An example is the drug <a href="https://www.nps.org.au/medicine-finder/apo-doxycycline-tablets">doxycycline</a> which is used to treat infections, acne, and as a malaria prophylactic (or prevention) for those who are going to a tropical location (lots of sun). </p>
<p>Other antibiotics known to cause sun sensitivity are <a href="https://www.nps.org.au/australian-prescriber/articles/fluoroquinolone-antibiotics-and-adverse-events">fluoroquinolones</a>, like ciprofloxacin, and <a href="https://www.nps.org.au/medicine-finder/bactrim-ds-tablets">sulfamethoxazole</a>, which treat a broad range of illnesses such as urinary tract infections, pneumonia or gastroenteritis.</p>
<p>The antifungals griseofulvin and voriconazole are known to cause sun sensitivity. You may be taking these medicines for skin or <a href="https://www.healthline.com/health/fungal-nail-infection">nail fungal infections</a>.</p>
<p>For people who suffer from skin conditions such as acne, psoriasis, or eczema, the oral retinoid medications including acitretin and isotretinoin and the topical cream pimecrolimus will leave you sensitive to the sun.</p>
<p>Non-steroidal anti-inflammatory drugs, like diclofenac, can leave you sun sensitive, especially if applied on the skin, so you need to be sure you adequately protect those areas. The same applies for some opioid-based pain patches, <a href="https://www.nps.org.au/radar/articles/fentanyl-patches-durogesic-for-chronic-pain">like fentanyl</a>. When you remove the patch, the skin underneath will be sensitive to the sun.</p>
<p><a href="https://www.nps.org.au/australian-prescriber/articles/amiodarone">Amiodarone</a> is a drug used to treat irregular heart beats and <a href="https://www.nps.org.au/medicine-finder/azathioprine-an-tablets">azathioprine</a> is an immuno suppressing drug used for people who have inflammatory immune conditions or organ transplants. Both are known to cause sun sensitivity.</p>
<p>Finally, a large number of drugs used in <a href="https://blog.uvahealth.com/2019/07/21/chemo-and-sun-sensitivity-how-to-protect-your-skin/">cancer chemotherapy will sensitise your skin</a>. These include: 5-fluorouracil, 5-aminolevulinic acid, vemurafenib, imatinib, mercaptopurine, and methotrexate.</p>
<p>It is important to note that not all people who use one of these medicines will have a sun sensitivity reaction – but extra precautions should be taken. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman wearing hat putting on sunscreen" src="https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=369&fit=crop&dpr=1 600w, https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=369&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=369&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=463&fit=crop&dpr=1 754w, https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=463&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/432799/original/file-20211119-13-1ezdr9g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=463&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">It is much better to be sun safe than sun sorry.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-bottle-sunblock-outside-on-680463682">Shutterstock</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
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<h2>Protect your skin</h2>
<p>If you are taking a medicine that can make you more sensitive to the sun then always ensure you are <a href="https://www.sunsmart.com.au/">sunsmart</a>.</p>
<p>Remember the five S advice from the <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/be-sunsmart">Cancer Council</a>: </p>
<ul>
<li>slip on suitable clothing</li>
<li>slop on sunscreen that is rated SPF30 or higher to exposed skin, especially on your face and arms</li>
<li>slap on a hat</li>
<li>seek shade when you can</li>
<li>slide on sunglasses.</li>
</ul>
<p>And if you are concerned a medicine you are taking may be putting you at more risk of sunburn, <a href="https://www.choosingwisely.org.au/resources/consumers-and-carers/5questions">speak to your pharmacist</a>. They can confirm if your medicine does increase your risk of sunburn and discuss options. This could include having your doctor issue a prescription for a different drug. </p>
<p>Never just stop taking a medicine because you are concerned about the risk of sun damage or any other side effects; always discuss it first with your health care provider. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/burnt-is-out-skinscreen-is-in-how-sunscreen-got-a-beauty-makeover-131292">Burnt is out, 'skinscreen' is in. How sunscreen got a beauty makeover</a>
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</p>
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<img src="https://counter.theconversation.com/content/170559/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is science director of the medicinal cannabis company Canngea Pty Ltd, a board member of the Australian Medicinal Cannabis Association, and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Elise Schubert is a registered pharmacist at Royal North Shore Hospital, and a PhD Candidate receiving scholarship from the University of Sydney and Canngea Pty Ltd.</span></em></p><p class="fine-print"><em><span>Lisa Kouladjian O'Donnell is a registered consultant pharmacist (independent) and a research fellow in geriatric pharmacotherapy from The University of Sydney. </span></em></p>In Summer, you may need to be extra sun smart if you’re swallowing certain medications or putting them on your skin.Nial Wheate, Associate Professor of the Sydney Pharmacy School, University of SydneyElise Schubert, Pharmacist and PhD Candidate, University of SydneyLisa Kouladjian O'Donnell, Research Fellow in Geriatric Pharmacotherapy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1663822021-08-20T15:17:41Z2021-08-20T15:17:41ZFood allergy and intolerance: five common myths explained<figure><img src="https://images.theconversation.com/files/417089/original/file-20210819-17-10d74kr.jpg?ixlib=rb-1.1.0&rect=8%2C4%2C2709%2C1795&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/childs-hand-holding-peanuts-isolated-on-596715836">2YouStockPhoto/Shutterstock</a></span></figcaption></figure><p>Food allergies seem to be on the rise, but misconceptions abound, often getting in the way of a condition being properly diagnosed and treated. According to <a href="https://publications.aston.ac.uk/id/eprint/38791/1/Why_do_people_misdiagnose_themselves.pdf">recent research</a>, up to 35% of people misdiagnose themselves (or their children) with a food intolerance or allergy then try to manage it themselves rather than seek proper medical advice. So it’s time to set the record straight on five of the most popular misconceptions that persist.</p>
<h2>1. I have symptoms after food so it must be an allergy</h2>
<p>Not necessarily. Adverse reactions to food can occur for a variety of reasons, and all fall within the umbrella term “<a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-food-intolerance">food hypersensitivity</a>”. This includes reactions that involve the immune system, termed <a href="https://www.nhs.uk/conditions/food-allergy/">food allergy</a>, but also a range of others that don’t – often called “<a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-food-intolerance">food intolerance</a>”. </p>
<p>Allergic reactions that involve the antibody <a href="https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Definition-Immunoglobulin-(IgE)">Immunoglobulin E</a> are often referred to as IgE-mediated (IgE) allergies and are estimated to affect up to <a href="https://www.allergyuk.org/assets/000/001/369/Stats_for_Website_original.pdf?1505209830">10% of the UK population</a>. These cause <a href="https://www.nhsinform.scot/illnesses-and-conditions/nutritional/food-allergy#symptoms-of-a-food-allergy">symptoms</a> that range from mild, such as itchy eyes, to severe, such as anaphylaxis – a serious, swift allergic reaction that can cause severe throat or tongue swelling, difficulty breathing, low blood pressure and ultimately death. These symptoms usually occur rapidly after eating the food in question and when severe, require immediate medical attention. </p>
<p>Other reactions that involve the immune system (called non-IgE mediated allergy) may cause <a href="https://www.nhs.uk/conditions/food-allergy/symptoms/">symptoms</a> that are either immediate or slower onset and more chronic in nature – such as red, itchy skin, heartburn or loose stools. Some of these may be similar to <a href="https://www.nhs.uk/conditions/food-intolerance/">symptoms</a> caused by food intolerances. While totally excluding the trigger food is usually required in IgE allergy, restricting it may be sufficient in other forms of hypersensitivity, but this will depend on the underlying cause.</p>
<h2>2. I can just go online and get an allergy test</h2>
<p>A trip to the chemist or a browse online for a diagnosis is likely to provide you with a bill and a long list of foods that are apparently causing your symptoms. Many of the <a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-intolerance-testing">tests</a> offered are not evidence-based for food allergy or food intolerance. These can lead to unwarranted self-imposed dietary restrictions that not only increase the risk of nutritional deficiency, but can cause anxiety, have a detrimental effect on your social life by making eating out tricky, and ultimately affect your quality of life.</p>
<p>The only <a href="https://www.bda.uk.com/resourceDetail/printPdf/?resource=food-allergy-intolerance-testing">evidence-based allergy testing</a> currently available is for IgE (immediate reaction) allergy. These are skin-prick tests and specific IgE blood tests. However, even if IgE testing is offered, the results require careful interpretation as a positive test does not necessarily mean allergy. An “oral food challenge”, where precise and increasing doses of the suspect food are given, is considered the best method of diagnosis for food allergy, but these must be performed with medical supervision. </p>
<p>Diagnosis starts with a thorough, allergy-focused history that will point towards appropriate testing if required. This needs to be undertaken by a medical professional with experience in allergy. So if you are concerned about your symptoms, talk to your GP.</p>
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</figure>
<h2>3. I need to avoid lots of foods to help control my eczema</h2>
<p>This is unlikely. Food does not cause eczema and there are many <a href="https://eczema.org/information-and-advice/triggers-for-eczema/">environmental triggers</a> implicated in flare-ups, making it difficult to ascertain if cutting out specific foods is actually helping. You don’t need to look far to find books and websites that suggest a variety of implicated foods, but for most people, appropriate <a href="https://www.nhsinform.scot/search?q=eczema&locpt=&ds=&tab=inform">medical treatment</a> is the key to controlling the condition.</p>
<p>That said, some people with <a href="https://patient.info/skin-conditions/atopic-eczema">atopic eczema</a> may need to avoid certain foods due to fast onset and potentially severe IgE food allergy. Additionally, excluding specific foods may be beneficial for some and may involve non-IgE food allergy. However, this needs careful assessment so if you feel your current treatment for eczema isn’t keeping it under control, speak to your doctor before making any dietary changes. </p>
<h2>4. ‘May contain’ warnings are there to protect manufacturers</h2>
<p>Allergen food labelling has improved in recent years with the implementation of the <a href="https://www.legislation.gov.uk/eur/2011/1169/contents">2014 EU legislation</a> which continues to be relevant in the UK as <a href="https://www.foodstandards.gov.scot/business-and-industry/safety-and-regulation/labelling">Scotland</a> and the <a href="https://www.food.gov.uk/safety-hygiene/food-allergy-and-intolerance#allergen-information-and-labelling">other nations</a> update and improve it in this post-Brexit era.</p>
<p>However, it has limitations. In fact, “precautionary allergen labelling” (trace warnings) is not specifically regulated under the legislation beyond the requirement that voluntary information must not mislead the consumer, be ambiguous or confusing. The wording of warnings is not standardised and crucially, doesn’t give an indication of the level of risk.</p>
<p>So it’s perhaps unsurprising that this kind of warning is regarded with suspicion by some while being a cause of angst for others, particularly those with potentially severe IgE allergy where even very small amounts of a specific food may cause immediate symptoms. The safest and for some, necessary, approach is to avoid all products with these warnings. In the end how this is managed is down to personal choice; but understanding what is and isn’t required on food labelling is essential to making a fully informed decision about managing what you eat and foods to avoid.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
</strong>
</em>
</p>
<hr>
<h2>5. Food allergy: you just need to avoid the trigger food</h2>
<p>Many people following restricted diets would disagree. Not only is there potential nutritional risk, excluding certain foods requires careful planning and constant vigilance. For those with fast onset IgE allergy in particular, where accidental exposure to the trigger food may cause severe symptoms, this can result in considerable anxiety.</p>
<p>In fact, there is evidence that having potentially severe food allergy has a detrimental effect on <a href="https://theconversation.com/how-psychologists-can-help-people-coping-with-life-threatening-food-allergies-127933">quality of life</a> in terms of health. So proper advice and appropriate management is a must.</p>
<p>With an abundance of information available thanks mainly to online sources, it is more important than ever to make sure you use credible, reliable sources and seek proper medical advice and treatment if you are concerned about food-related symptoms.</p><img src="https://counter.theconversation.com/content/166382/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marian Cunningham does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Up to 35% of people misdiagnose themselves (or their children) with a food intolerance or allergy. It’s time to set the record straight.Marian Cunningham, Lecturer in Human Nutrition and Dietetics, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1458932020-09-10T14:49:08Z2020-09-10T14:49:08ZLive bacteria spray is showing promise in treating childhood eczema<figure><img src="https://images.theconversation.com/files/357301/original/file-20200909-24-155gm7p.jpg?ixlib=rb-1.1.0&rect=25%2C25%2C4249%2C2805&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A physician examines a 7-month-old infant with eczema. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/photo-essay-at-the-department-of-dermatology-at-the-bocage-news-photo/151054958?adppopup=true">BSIP/UIG Via Getty Images</a></span></figcaption></figure><p>Here’s a shorthand way to think of my research: Using bugs as drugs may one day bring hope to soaps. </p>
<p>Patients with <a href="https://www.niaid.nih.gov/diseases-conditions/eczema-atopic-dermatitis">atopic dermatitis</a>, more commonly known as eczema, suffer from dry, itchy skin and rashes, and have a higher risk of developing hay fever, asthma and food allergies. The cause of eczema is still unknown, but studies completed by <a href="https://doi.org/10.1172/jci.insight.120608">my team</a> and <a href="https://doi.org/10.1126/scitranslmed.aah4680">others</a> continue to suggest that manipulating the skin microbiome – the community of all the bacteria and other microorganisms living on the surface of the skin – may offer therapeutic benefits to patients. </p>
<p><a href="https://stm.sciencemag.org/content/12/560/eaaz8631">We hypothesized that if we directly sprayed live bacteria</a> named <em><a href="https://insight.jci.org/articles/view/120608">Roseomonas mucosa</a></em> - a naturally occurring skin microbe - on the skin of patients with eczema, those healthy bacteria might make for healthy skin. </p>
<h2>How might the bacteria help?</h2>
<p>I am an allergy and immunology physician who <a href="https://www.niaid.nih.gov/research/ian-myles-md-mph">explores the intersection of the microbiome</a>, the skin and the environment in order to identify why allergic diseases have become more common in modern times.</p>
<p>All our scrapes, scratches, scrubbing and soaps take a toll on our skin. The natural oils that our skin makes are <a href="https://doi.org/10.1016/j.jdermsci.2019.12.002">part of the normal processes</a> the skin uses to repair itself after these insults. </p>
<p>Using human cells and mice, my colleagues and I were able to uncover additional evidence that oils from bacteria that reside on the skin may also play a role. The oils from <em>Roseomonas</em> induce a <a href="https://doi.org/10.1016/j.cell.2016.06.028">specific skin repair pathway</a>, in part through influencing molecules that are more frequently associated with our nerves than our skin. These oils also <a href="https://doi.org/10.1172/jci.insight.86955">help kill</a> <em>Staphylococcus aureus</em>, a bacteria known to make <a href="https://doi.org/10.1111/bjd.15409">eczema worse</a>. </p>
<h2>What do patients want?</h2>
<p>Our hope is that a topical treatment using this bacteria will be an improvement over current eczema treatments.</p>
<p>In 2013, the U.S. Food and Drug Administration (FDA) began soliciting direct input from patients and patient advocacy groups for events known as <a href="https://www.fda.gov/industry/prescription-drug-user-fee-amendments/fda-led-patient-focused-drug-development-pfdd-public-meetings">Patient-Focused Drug Development</a> meetings (or PFDD, for short). </p>
<p>In September of 2019, the FDA conducted a <a href="https://www.aafa.org/media/2628/more-than-skin-deep-voice-of-the-patient-report.pdf">PFDD for eczema</a>. One of the major findings was that itching was the symptom of primary concern for patients and their families. This stands in contrast with the FDA’s current practice of approving new drugs based solely on the improvement in how bad the rash looks, instead of how bad the rash feels. Patients also reported a high rate of complications from their current treatments and expressed particular concerns about using topical steroids. </p>
<p><a href="https://www.aafa.org/media/2628/more-than-skin-deep-voice-of-the-patient-report.pdf">Overall</a>, patients said that eczema substantially decreased their quality of life because of the need to apply medications frequently. Eczema also drained their emotions and deprived them of sleep due to unmanageable itching in either them or their children.</p>
<p><a href="https://theconversation.com/applying-live-bacteria-to-skin-improves-eczema-95920">Two years ago</a>, my colleagues and I reported our results from 10 adults and five children who were at least 9 years old. </p>
<p>Since eczema most often afflicts children who are younger than 7 years old, our newest study enrolled an additional 15 children as young as 3 years old. Overall, <a href="https://stm.sciencemag.org/content/12/560/eaaz8631">our patients achieved a 60-75% improvement</a> in their rash and itch by applying <em>Roseomonas</em> two to three times per week for 4 months. </p>
<p>Patients and their families also reported needing to apply topical steroids less often and a better quality of life as they slept more and itched less. One patient complained of mild itching during the minute or so it took the spray to dry on their arms, but there were no other complaints related to treatment. Thus, taken together with some of our <a href="https://pubmed.ncbi.nlm.nih.gov/30719426/">safety studies in mice</a>, <em>Roseomonas</em> continues to appear safe.</p>
<h2>Is this a cure?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=467&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=467&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=467&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=587&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=587&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357306/original/file-20200909-20-jr720w.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=587&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Left: Inner elbow of a child with eczema before <em>Roseomonas mucosa</em> therapy. Right: The same patients after four months of treatment.</span>
<span class="attribution"><span class="source">NIAID</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>One of the more promising findings of our new study was that patients’ symptoms improved for up to eight months after stopping the bacterial spray medication. The advantage of using live bacteria is that the microbes can take up residence on the skin. We found that the bacteria lived on the skin at least eight months after treatment and likely continued to provide clinical benefit without the need for constant application.</p>
<p>While not cured, many patients in the study described their symptoms and “muted.” Their typical day was better than ever, and while eczema flares still occurred, they were less frequent and less severe. Theoretically, applying our treatment as soon as symptoms manifest might prevent future disease and thus be “curative” – however, for now, such thinking is speculation. </p>
<p>Yet, even if <em>Roseomonas</em> is more treatment than cure, our findings are still directly aligned with <a href="https://www.aafa.org/media/2628/more-than-skin-deep-voice-of-the-patient-report.pdf">the goals laid out in the PFDD</a>: “sustained relief from itch,” a reduced need for topical steroids and an overall improved ability to “go about daily life.”</p>
<h2>What comes next?</h2>
<p>Starting this month, we are expanding our clinical <em>Roseomonas</em> study to include many more patients in a <a href="https://clinicaltrials.gov/ct2/show/NCT04504279">placebo-controlled trial</a>. <a href="https://www.atopicdermclinicaltrial.com">In the new clinical study</a>, half the 120 or more patients that enroll will get our <em>Roseomonas</em> spray while the other half will get only a sugar water spray. </p>
<p>The knowledge that bacteria like <em>Roseomonas</em> can help patients with eczema will also allow us to examine which environmental exposures might harm these microbes. According to a <a href="https://www.epa.gov/assessing-and-managing-chemicals-under-tsca/introduction-chemview">2016 report</a> from the Environmental Protection Agency, there are over 8,700 chemicals on the U.S. market. Not all of these are common and not all are used on the skin, but the number of possible combinations and concentrations of chemicals we may expose our skin to on a daily basis could be near infinite. </p>
<p>By systematically evaluating which exposures help, which hurt and which are benign, we may be able to “bathe smarter” and identify the best way to keep ourselves clean without disrupting the balance of the bacteria that keep us healthy.</p><img src="https://counter.theconversation.com/content/145893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Myles does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Can a naturally occurring skin microbe help millions who suffer from eczema?Ian Myles, Head, Epithelial Therapeutics Unit, National Institute of Allergy and Infectious DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1251292019-12-08T18:52:32Z2019-12-08T18:52:32ZWhat is sodium lauryl sulfate and is it safe to use?<figure><img src="https://images.theconversation.com/files/298865/original/file-20191028-113998-r2j8b7.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SLS is a known irritant to human skin. But if it's only in contact with your skin for a short time, it's probably OK. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>If you’ve ever Googled the causes of a skin complaint or damaged hair, chances are someone on the internet has pointed the finger at SLS, or sodium lauryl (or laureth) sulfate, a common ingredient in beauty products, washes, toothpastes and even cleaning products.</p>
<p>So what does this ingredient do, why is it in everything, and what does the evidence say about how safe it is? </p>
<h2>Why SLS?</h2>
<p>When we use a wash or beauty product on our skin, it’s probably a liquid made of a water phase and an oily phase. As we know, oil and water don’t mix, so something is required to keep the ingredients together. </p>
<p>That something is called a surfactant. A surfactant allows the oil and water molecules to bind together – it’s what’s found in soaps and detergents so we can wash our oily faces or dishes with water and get the grime to disappear.</p>
<p>Sodium lauryl sulfate is a surfactant, and its efficacy, low cost, abundance and simplicity mean it’s used in a variety of cosmetic, dermatological and consumer products.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299627/original/file-20191031-187898-uvkcac.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your toothpaste, shampoo and body wash probably all contain SLS.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-should-i-eat-to-improve-my-skin-94905">Health Check: what should I eat to improve my skin?</a>
</strong>
</em>
</p>
<hr>
<h2>Is it harmful?</h2>
<p>Our skin’s outermost layer is specially designed to keep harmful stuff out, and this is where a surfactant can cause problems. Using a chemical that weakens this defence mechanism can <a href="https://www.researchgate.net/publication/302244511_Sodium_Lauryl_Sulfate_Water_Soluble_Irritant_Dermatitis_Model">potentially cause our skin harm</a>. </p>
<p>And some surfactants are more irritating to our skin than others. For something to be harmful, irritant or allergenic, it has to fulfil <a href="https://espace.library.uq.edu.au/view/UQ:719752">two criteria</a>.</p>
<p>It has to have been found in studies to irritate human skin, and it has to have the ability to penetrate the skin. SLS ticks both of these boxes.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1034/j.1600-0536.2003.480209.x">Researchers from Germany tested</a> 1,600 patients for SLS irritancy and found 42% of the patients tested had an irritant reaction.</p>
<p>Another <a href="https://www.ncbi.nlm.nih.gov/pubmed/16283906">study</a>, on seven volunteers over a three and a half month period, found regular contact caused irritation, and the irritation subsided once the skin was no longer exposed to SLS.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/7758326">Another study found</a> the warmer the water used with SLS, the more irritating it will be.</p>
<p>In fact, SLS is so known to cause irritation, it’s used as a <a href="https://www.sciencedirect.com/science/article/pii/S0022202X9091287L">positive control in dermatological testing</a>. That is, new products being tested to see how irritating they might be to human skin are compared to SLS - something we know definitely to be irritating.</p>
<p>If a person is sensitive to SLS, they might find the area that has been in contact is red, dry, scaly, itchy or sore.</p>
<p>It’s also important to note there’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651417/">no scientific evidence</a> SLS causes cancer, despite what you may read on the internet.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299625/original/file-20191031-187934-17swv0k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you suspect you are sensitive to SLS, stop using the product and consult your GP or pharmacist.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>So why is it allowed?</h2>
<p>So if it’s known to be irritating to human skin, why don’t the regulatory authorities ban its use? </p>
<p>For SLS to be considered dangerous, it would have to be in contact with the skin for a long period of time. Generally, with consumer products such as washes that contain SLS, it’s assumed they won’t be on the skin for very long, meaning the chance of your skin being affected is pretty low. So authorities don’t ban its use, but instead cap the maximum percentage at which it can be used in products. </p>
<p>This cap varies based on how long the product is likely to be in contact with the skin. So products that will be on the skin for a prolonged time can contain no more than <a href="https://www.accessdata.fda.gov/scripts/cder/iig/index.cfm?event=BasicSearch.page">0.05-2.5% SLS</a> in most countries.</p>
<p>All consumer and cosmetic product manufacturers are required to conduct thorough testing and include any adverse findings in the form of warnings on their labels. So on products containing SLS, you should see something like “if this product causes any skin redness or irritation, discontinue use and consult a medical practitioner”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-hives-the-common-skin-condition-that-gives-you-itchy-red-bumps-121693">What are hives, the common skin condition that gives you itchy, red bumps?</a>
</strong>
</em>
</p>
<hr>
<h2>Who should avoid SLS?</h2>
<p>People with a history of sensitive skin, hyperirritable skin and patients suffering from skin conditions such as atopic dermatitis (eczema), rosacea and psoriasis are best to avoid products containing SLS. </p>
<p>There are many safer alternatives available (look for fatty alcohol ethoxylate, alkyl phenol ethoxylate or fatty acid alkoxylate on the label). If you think it might be SLS causing a skin irritation, stop the use of the product and ask your pharmacist or GP for advice. Skin care products also have hotline numbers on the packaging that can be contacted to report adverse effects.</p><img src="https://counter.theconversation.com/content/125129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yousuf Mohammed receives funding from the U.S. Food and Drug Administration through grants 01FD005226,U01FD006946 and U01FD006700. The views expressed here are those of the author and do not reflect the official policies of the U.S. Food and Drug Administration. . </span></em></p>If you looked at the ingredient list on your body wash, shampoo, toothpaste and cleaning products, you’d probably find most contain sodium lauryl sulfate (SLS). It is a known irritant to human skin.Yousuf Mohammed, Dermatology researcher, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1197842019-08-09T14:41:54Z2019-08-09T14:41:54ZMedical skin creams could be a lethal fire risk when soaked into fabric – here’s what you need to know<figure><img src="https://images.theconversation.com/files/287362/original/file-20190808-144868-rwrhqu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3000%2C1989&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-women-applying-lotion-on-hand-438938872?src=r7YjXez6vBkiIIF9byXniQ-1-40">Rarin Lee/Shutterstock</a></span></figcaption></figure><p>Care providers were alerted to a house fire involving one of their patients at 4am on May 30, 2015. The fire and rescue services discovered a 74-year-old lady who had succumbed to a blaze that developed rapidly while she was still lying in bed. She had been bed bound, known to smoke in bed and was being treated for a skin condition. </p>
<p>A year later, a 61-year-old man who was also a smoker, bed bound and had emollient applied to his skin by carers was found dead in his bed after an intense fire. A year after that, an 82-year-old man died with third degree burns when his dressing gown came into contact with a lighter. He was also receiving daily applications of a cream and ointment.</p>
<p>What do all of these tragic deaths have in common? The victims were all being treated with creams for their skin conditions. While the fires were caused by smoking, the authorities reported that they were made more intense by the presence of these emollients. </p>
<h2>A hidden danger</h2>
<p>In the UK, one in five children and one in 12 adults will suffer <a href="http://www.eczema.org/about-us">from eczema</a> and <a href="http://www.bad.org.uk/for-the-public/patient-information-leaflets">2-3% of the population have psoriasis</a>. Medical creams, lotions and ointments are widely used to treat these conditions and can be prescribed or bought over the counter. They often include instructions to apply liberally, with multiple applications during the day. This results in the product soaking into clothing, dressings and bedding.</p>
<p>Several deaths from fires have been linked with the use of these skin emollients. A <a href="http://www.bbc.co.uk/news/uk-39308748">BBC freedom of information request</a> revealed that 37 fire deaths since 2010 have been linked to creams that contain paraffin. But fire reports don’t require such information to be included and not all fire services responded to questions. So the actual number of deaths and injuries may be higher.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-batteries-have-started-catching-fire-so-often-68602">Why batteries have started catching fire so often</a>
</strong>
</em>
</p>
<hr>
<p>It isn’t just products that contain lots of paraffin that pose a risk – those with a low paraffin content and even those without paraffin at all could be dangerous. <a href="https://www.uk-afi.org/seminars/annual-training-conference-2019">Our research shows</a> that all fabrics ignited quicker after contact with emollients – regardless of the paraffin level – than completely clean fabrics. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0379711218303400">In our initial tests</a>, we let a flame directly touch cotton sheeting that emollients had dried into for 24 hours. The fabric ignited too quickly to measure, but once we had the flame positioned 7cm from the edge of the soaked fabric, we found that ignition happened after only ten seconds, compared to over a minute with the same cotton sheeting that was completely clean.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=335&fit=crop&dpr=1 600w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=335&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=335&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=421&fit=crop&dpr=1 754w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=421&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/287222/original/file-20190807-144868-v87ih6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=421&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fabric test burns after 20 seconds. The non-paraffin cream ignited at eight seconds, the 21% paraffin base cream at 11 seconds and the clean cotton at 52 seconds.</span>
<span class="attribution"><span class="source">Sarah Hall</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The fabrics we tested included various thread counts of cotton and polyester blend sheeting and t-shirts – all are common in households and all ignite much quicker when skin creams are present. We also found that once the flame has extinguished, some of the fabrics smoulder for longer when the products are present – potentially burning for longer near the skin, causing significant burns and life-threatening injuries.</p>
<p>These findings have spurred the NHS and fire and rescue services to <a href="https://www.gov.uk/government/news/emollient-cream-build-up-in-fabric-can-lead-to-fire-deaths">reassess their safety advice</a>. Flammable residues are thought to be removed from fabrics if <a href="https://www.nationalfirechiefs.org.uk/News/latest-research-shows-hidden-fire-risk-of-emollients/220630">they’re washed at the highest temperature</a> possible, but research is still ongoing.</p>
<p>It’s important to remember that these products – on their own and in containers – aren’t a fire risk. The risk emerges when fabrics are soaked with them and allowed to dry. As the creams have soaked into fabrics, reducing the time it takes for the garments to ignite, <a href="https://www.judiciary.uk/wp-content/uploads/2015/10/Hills-2015-0317.pdf">elderly and immobile</a> victims haven’t been able to remove their clothing quickly enough to prevent injury or death. </p>
<p>People shouldn’t stop using much-needed medication, but they should know how to use the products safely. Our advice is to wash your clothes at high temperatures as often as you can to reduce the build up of the creams. Most importantly, keep any fabrics away from naked flames and cigarettes – you’re likely to have less time to react in the event of a fire than you think.</p><img src="https://counter.theconversation.com/content/119784/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Hall conducted this work with research assistant Kirsty Blackburn.
</span></em></p><p class="fine-print"><em><span>Joanne Morrissey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Common emollients used to treat skin conditions are a hidden fire risk in most homes.Sarah Hall, Senior Lecturer and Head of the Forensic and Investigative Sciences Research Group, Anglia Ruskin UniversityJoanne Morrissey, Senior Lecturer in Crime and Investigative Studies, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1210292019-07-31T11:43:05Z2019-07-31T11:43:05ZWhat’s the scoop on kids and dirt? Get enough to help, but not enough to hurt, a doctor advises<figure><img src="https://images.theconversation.com/files/285900/original/file-20190726-43118-1ac4jda.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kids may need more exposure to dirt and microbes than previously thought.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-funny-little-girls-playing-large-1021241443?src=Lk3KlOpQIiD7C_w_CR42yw-1-22&studio=1">MNStudio/shutterstock.com</a></span></figcaption></figure><p>Whenever I am asked what I do for a living, the phrase “I’m an allergist” is almost immediately followed by “So, <a href="https://www.cdc.gov/asthma/asthmadata.htm">where are all of these allergies coming from</a>?” </p>
<p>Maybe I’ll get sick of that question some day, but I haven’t yet. As a clinician and researcher on allergies and public health, I first explain that when a society begins to become aware of a disease, the <a href="https://jamanetwork.com/journals/jama/fullarticle/1734702">reported prevalence will go up</a>. This is understandable. People who have medically unexplained symptoms wonder “Could I have this allergy that’s being talked about?” and try on the diagnosis. Sometimes an allergy really is at the root of their problems, and sometimes it’s not. </p>
<p>For example, <a href="https://www.sciencedirect.com/science/article/pii/S0091674914006721">at least 50% of patient-reported</a> food allergies are only presumed. They have not been evaluated thoroughly enough to know for sure whether the patient is allergic. Research also demonstrates that, in many cases, we presume wrongly. The symptoms fit better with an intolerance than an allergy, or the events were coincidental. While 11%-12% of patients currently report a food allergy, only about 5% of adults and 8% of children likely <a href="https://www.sciencedirect.com/science/article/pii/S0091674914006721">have true food allergy</a>. Around 8% of patients report a penicillin allergy, but fewer than <a href="https://jamanetwork.com/journals/jama/article-abstract/409362">five out of 100 patients</a> who report a penicillin allergy can be shown to be allergic when tested. </p>
<p>Many people next ask whether allergies are genetic, but allergies in one’s family appear to explain only <a href="https://www.sciencedirect.com/science/article/abs/pii/S0749379702005895">10%-40% of a person’s</a> increased risk for allergies. Allergic diseases are also increasing at rates that are inconsistent with genetic diseases. </p>
<p>More interesting is that there appear to have been different waves in which <a href="https://www.sciencedirect.com/science/article/pii/S0091674915005849">allergies appeared in historical records</a>. Hay fever (environmental allergies) first appeared in the 1800s, followed by more recent increases in asthma and food allergy.</p>
<h2>What’s changed, and what’s dirt got to do with it?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285901/original/file-20190726-43109-12tap5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Much of childhood eczema could be prevented by using barriers, such as petroleum jelly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-boy-scratching-his-allergy-462854470?src=7n9Nt-9WUtI5ouJVY0MyEQ-1-65&studio=1">all_about_people/shutterstock.com</a></span>
</figcaption>
</figure>
<p>So if genetics don’t fully explain the rise in allergy, what does?
Some of the most consistent risk factors for allergic diseases include <a href="https://www.ncbi.nlm.nih.gov/pubmed/31149702">overuse of antibiotics</a>; <a href="https://www.ncbi.nlm.nih.gov/pubmed/29733679">acute viral respiratory infections</a> in childhood; birth by <a href="https://www.ncbi.nlm.nih.gov/pubmed/30322585">cesarean section</a>; nutritional disorders; second-hand smoke exposure; pollution; and the <a href="https://clintransmed.springeropen.com/articles/10.1186/s40169-018-0195-4">environment where you grew up</a> </p>
<p>To organize these risks into categories, two conceptual hypotheses currently seem to be of value – the <a href="https://www.sciencedirect.com/science/article/pii/S0091674903023704">barrier hypothesis</a> and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/">hygiene hypothesis</a>.</p>
<p>Imagine that your immune system is an army behind a castle wall. The castle wall is your skin, your respiratory tract and your gastrointestinal tract. The army is composed of your white blood cells in addition to other cells in the body that can activate these gung-ho Marines to defend you. </p>
<p>The central tenet of the barrier hypothesis is that when our skin, respiratory tract and gastrointestinal tract are chronically injured, your castle wall is broken down. The soldiers of the immune system are activated to aggressive defense, yet allergens can penetrate, and people can begin to experience allergic inflammation in those areas. This has been most clearly demonstrated with the allergic skin disease known as <a href="https://www.sciencedirect.com/science/article/pii/S0091674903023704">eczema</a>.</p>
<p>Research has also shown that activities in these barrier sites can <a href="https://www.sciencedirect.com/science/article/pii/S0091674916304985">flavor the immune response and profile</a> of a person, especially in childhood. Many risk factors for allergic disease, such as viral infections, nutritional disorders, smoke exposure and pollution, affect the health of our barriers. Studies have indicated that up to <a href="https://www.sciencedirect.com/science/article/pii/S0091674914011609">50% of childhood eczema,</a> a barrier disease, can be prevented simply by applying protective emollients like petroleum jelly to protect babies’ skin when we bathe them. </p>
<h2>The role of hygiene in allergy</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=474&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=474&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=474&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285902/original/file-20190726-43140-1qsofds.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Protecting babies’ skin with a protective barrier can help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-cleaning-little-baby-bathtub-sponge-155189309?src=oDrw5ODjKUulJx2ZcfNPsw-1-0&studio=1">FotoAndalucia/shutterstock.com</a></span>
</figcaption>
</figure>
<p>The central tenet of the hygiene hypothesis is that we have gone a bit too far and inadvertently killed off our good bacteria along with the bad. As our society progressed from one that was chronically burdened with infectious diseases caused by poor sanitation, the thinking goes, we reduced our exposures to the things that gave our immune system an appropriate training and tolerance. Historically, our totally rational fear of dying from a cholera epidemic led to <a href="https://www.sciencedirect.com/science/article/pii/S0091674915005849">sewage and water management</a>, but may have kicked off the allergy epidemic.</p>
<p>Our overuse of antibiotics and C-sections affects the set of organisms called the <a href="https://clintransmed.springeropen.com/articles/10.1186/s40169-018-0195-4">microbiome</a> that an infant is exposed to growing up. Both have been shown to increase the risk of childhood allergic diseases. </p>
<p>Growing up in a rural area exposed to farm animals appears to confer a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1398-9995.2010.02397.x">decreased risk of allergies and asthma</a> for your entire lifetime, even among <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1508749">genetically similar populations</a>. Studies in mice have shown that inhaling certain molecules from soil-dwelling bacteria can set off a beneficial cascade promoting an immune system which focuses more on threats rather than nonthreats, such as <a href="https://science.sciencemag.org/content/349/6252/1106.abstract">allergens</a>.</p>
<p>Vaccinations appear to be a crucial exception to the rule of the <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.94.6.985">hygiene hypothesis</a>. They confer protection against diseases without any associated increase in the risk of allergic disease, likely because they, unlike antibiotics, are very specifically targeting only the worst disease-causing organisms.</p>
<h2>Our current prescription</h2>
<p>The data currently paints a picture that we might prevent allergies in the future by protecting our barriers and introducing the right <a href="https://www.nejm.org/doi/full/10.1056/nejmoa1414850">tolerizing exposures at the right time</a>, such as early introduction of peanuts. However, I can’t currently tell you how much dirt or what kinds of bacteria your child needs to safely experience while growing up. It’s too soon for that, but many wonderful scientists around the world are working on these questions, thanks to support from a variety of governments and foundations. </p>
<p>Until then, I will share with you the broad-brush advice that I currently give my friends and patients. </p>
<ul>
<li> Let your kids play outside, get dirty, try new foods and be exposed to a variety of things. Advocate for them to have outside recess time in school as much as possible.</li>
<li> Use plain soap and water; you don’t need to sanitize everything.<br></li>
<li> Talk to your doctor about watchful waiting to respond to an illness, rather than take antibiotics.<br></li>
<li> Be judicious about what you put on your body’s barriers, and become an advocate for clean air, clean water and a clean environment for everyone. </li>
<li> Get all of your routine vaccinations. The healthiest children in the U.S. are the ones who are fully vaccinated.</li>
</ul><img src="https://counter.theconversation.com/content/121029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cosby Stone, Jr. MD, MPH currently receives funding from K12HS026395-0 via the Agency for Healthcare Research and Quality and has previously received funding from the National Heart, Lung, and Blood Institute and the National Institute of General Medical Sciences for his research in allergy. </span></em></p>Can your kids be too clean? Increases in allergies suggest so. But how much dirt is too much? A pediatric allergist explains the fascinating reasons the immune system needs dirt for training.Cosby Stone, Instructor in Allergy/Immunology, Vanderbilt University Medical Center, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1157422019-05-01T11:36:49Z2019-05-01T11:36:49ZChildren with eczema: the link to food allergies is not clear cut<figure><img src="https://images.theconversation.com/files/270902/original/file-20190425-121224-d7dvpx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/food-allergy-can-cause-baby-toddler-704891131?src=jfDSGwcMqt3eSe6DdRG12A-1-18">TassaneeT via Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/eczema">one in five children</a> have eczema – and even mild cases can have a big impact on both the child and their family. For many, symptoms will come and go before they start primary school, but for others it can indicate the beginning of a genetic tendency to develop allergic conditions such as hay fever or asthma (or both).</p>
<p>We also know that children with eczema are <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cea.12406">more likely to develop food allergies</a>, especially if the condition starts in the first few months of life and is severe. Often parents will make the allergy diagnosis themselves – at the sudden onset of vomiting, diarrhoea or rash after eating scrambled egg, for example. </p>
<p>This can be frightening, but doctors can usually easily confirm the cause of these immediate reactions by talking to the parents and offering a confirmatory allergy blood or skin prick test.</p>
<p>In the absence of such obvious physical reactions however, a different question sometimes arises for parents: “Is a food allergy contributing to my child’s eczema and would an allergy test help to find out?” </p>
<p>GPs diagnose and treat most children with eczema – and parents often ask this question, worried that something in the child’s diet (or the diet of a breast-feeding mother) is contributing to their dry, itchy and inflamed skin. But it can be difficult to link any given food to a worsening of eczema, as symptoms may not appear for hours or even days after eating it.</p>
<p>On top of this, the value of allergy tests in these circumstances is uncertain since we don’t really know how commonly food allergy worsens eczema symptoms. Although eczema and food allergy often occur together, food allergy is not thought to be the main cause of eczema. In fact, many experts believe that it is <a href="https://www.nih.gov/news-events/news-releases/scientists-identify-unique-subtype-eczema-linked-food-allergy">eczema which leads</a> to the development of allergy to foods. </p>
<p>A second uncertainty about the value of allergy tests in children with eczema is that a child with a positive test may be “sensitised” rather than “allergic” to any given food. This means they can actually eat that food without any apparent ill effect. So testing could potentially lead to unnecessary and unhelpful dietary restriction.</p>
<p>For children with early onset, difficult to treat eczema, guidelines steer GPs in the UK towards referral for food allergy tests or special diets in case exposure to food allergens might be worsening the eczema. However, for older children or those with milder forms of eczema, it’s not so straightforward. </p>
<p>Sometimes parents don’t raise their concerns at all, or if they do, they may feel their concerns are being dismissed. Even when parents and doctors agree that further investigation is needed, access to specialist advice on the NHS is not guaranteed. Most allergy services in the UK have waiting lists of several months and don’t have the capacity to see every child with eczema.</p>
<p>So, what happens? As we confirmed in a <a href="https://www.ncbi.nlm.nih.gov/pubmed/30834551">recent online survey</a>, many parents of children with eczema take matters into their own hands. They may exclude foods such as dairy, wheat or eggs without any professional advice. This is not without its own risks as a restricted diet may lead to malnutrition. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/271962/original/file-20190501-113855-1wcp08c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testing times.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-doctor-gives-patient-allergy-test-1215710590?src=xYMovTyE1N1K3pSYYiIgmg-1-85">Shutterstock</a></span>
</figcaption>
</figure>
<p>Although eczema is most commonly linked with allergy to eggs or peanuts, parents often restrict dairy or wheat because these are eaten more regularly. Some doctors advise allergy testing to look for food allergies which might be worsening the eczema. Others think that allergy tests are more likely to cause harm through unnecessary dietary restrictions than to help the eczema.</p>
<h2>Seeking solutions</h2>
<p>To try to unpick the problem a bit more, we’ve just finished recruiting children with eczema <a href="http://www.bristol.ac.uk/primaryhealthcare/researchthemes/test-study/">to a trial</a> exploring the role of routine allergy history and skin prick testing in the dietary management of eczema. </p>
<p>Funded by the <a href="https://www.spcr.nihr.ac.uk">NIHR School for Primary Care Research</a>, 84 children in the English city of Bristol, have been randomised to receive either usual care or an intervention of “test-guided dietary advice”. At the end of the study we expect to have a better understanding of both the feasibility of doing future bigger studies and also the issues from the perspective of both parents and GPs. </p>
<p>In addition, the NIHR recently funded an <a href="https://www.spcr.nihr.ac.uk/themes-SPCR">allergy working group</a> to try to improve the capacity for primary care research in the important but neglected area of allergies more generally.</p>
<p>So what should parents and clinicians do until more research is available to guide them over whether certain foods may be making children’s eczema worse? </p>
<p>At the moment there is no cure for eczema. So the best advice is to use two simple treatments (emollients and topical corticosteroids) to control the disease. However, if there are any immediate reactions to food or, despite good skin care, the child’s skin is causing misery, parents should persist in seeking further help from their family doctor.</p><img src="https://counter.theconversation.com/content/115742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matthew Ridd is funded by an NIHR Post-Doctoral Research Fellowship (PDF-2014-07-013)</span></em></p><p class="fine-print"><em><span>Robert Boyle has received consultancy payment from Dairy Goat Co-Operative (NZ) Ltd. for designing a clinical trial of an infant formula, and for advisory board membership from ALK-Abello (who market tests and treatments for allergy), DBV Technologies (who market treatments for food allergy), and Prota Therapeutics (who develop treatments for food allergy). He also undertakes consultancy work for Cochrane as Senior Editor for the Children and Families Network and has acted as an expert witness in court cases relating to severe allergic reactions or to infant feeding.</span></em></p>Avoiding certain foods risks malnutrition.Matthew Ridd, GP and Senior Lecturer in Primary Healthcare, University of BristolRobert Boyle, Reader in Paediatric Allergy, Imperial College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1136252019-03-15T16:30:03Z2019-03-15T16:30:03ZFood allergies: what you need to know about the role your skin plays<figure><img src="https://images.theconversation.com/files/264150/original/file-20190315-28471-aqzaau.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/davidjlee/9336083592/">David Lee/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Food allergies are on the increase worldwide, ranging from minor inconvenience to possible sudden death, and leading to warnings of an “<a href="https://www.jaci-inpractice.org/article/S2213-2198(18)30036-9/fulltext">allergy epidemic</a>”. The most severe form of allergic reaction – <a href="https://www.aaaai.org/conditions-and-treatments/allergies/anaphylaxis">anaphylaxis</a> – can occur repeatedly or without warning. The reasons for the rise in allergies are complex, but the skin is now recognised to play an important role as a gatekeeper for the body’s immune system.</p>
<p>Human skin is a protective barrier that provides a dynamic covering, ensuring essential fluids (including water, proteins and minerals) remain inside while damaging substances remain outside. The skin barrier is structural – like a brick wall – but it is also living and active, constantly sensing and responding to the external environment. This barrier is made up of multiple layers of interconnected human cells, plus a multitude of <a href="https://www.ncbi.nlm.nih.gov/books/NBK279387/">microbes</a>, the tiny organisms that live on the surface of healthy skin.</p>
<p>Skin forms a continuous lining on the outer surface of the body which joins seamlessly with the lining of the mouth and gut. Human cells are normally introduced to foodstuffs through the mouth, but the body can also be exposed to food on the skin surface. </p>
<p>The <a href="https://www.stanfordchildrens.org/en/topic/default?id=all-about-the-immune-system-90-P01665">immune system</a> – cells and tissues that work together to defend the body against potentially harmful viruses, bacteria and foreign substances – may react very differently when food is first encountered through skin instead of through the mouth. This is because “leaky” skin may confuse the immune system’s capacity to recognise a harmless substance. </p>
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<h2>Of mice and humans</h2>
<p>Mice exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3587010/">egg white</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347216/">peanut</a> through skin have been shown to develop allergic reactions or anaphylaxis to these foods when they are then eaten. Human food allergy may develop in the same way.</p>
<p>When food is consumed we normally develop <a href="https://www.niaid.nih.gov/research/immune-tolerance">tolerance</a>, meaning no immune reaction occurs. But when skin is leaky because of <a href="https://www.nhs.uk/news/genetics-and-stem-cells/new-genetic-clue-to-peanut-allergy/">faulty genes</a> or when skin is damaged by a condition such as <a href="https://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/eczema-food-allergy">eczema</a>, food allergens may pass through. This stimulates immune cells in the skin, which release chemical signals of attack. Then the next time that specific food is encountered the cells are primed to produce an allergic reaction.</p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/more-people-are-experiencing-severe-food-allergies-than-ever-before-108124">More people are experiencing severe food allergies than ever before</a></strong></em> </p>
<hr>
<p>The “leakiness” of baby skin soon after birth (measured by how much water evaporates from the surface) can <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Skin+barrier+impairment+at+birth+predicts+food+allergy+at+2+years+of+age.+Irvine">predict their risk</a> of food allergy at the age of two. And <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=The+nonlesional+skin+surface+distinguishes+atopic+dermatitis+with+food+allergy+as+a+unique+endotype">recent research</a> has shown that people with a food allergy have molecular evidence that their skin is leaky and primed to react, even if the skin looks to be normal. </p>
<h2>Treatment and prevention</h2>
<p>In an emergency situation, a food allergy is treated with drugs that counteract the <a href="https://www.nhs.uk/conditions/anaphylaxis/treatment/">most dangerous features</a> of an anaphylactic response: low blood pressure and airway obstruction. <a href="https://www.wisegeek.com/what-is-adrenaline.htm">Adrenaline</a> (administered outside of hospitals by auto-injector “pen”) causes blood vessels to squeeze tight – to maintain the blood pressure – while <a href="https://www.nhs.uk/conditions/bronchodilators/">bronchodilator drugs</a> cause the airways to open. Steroid treatment can dampen down the harmful effects of an overactive immune response. So <a href="https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/corticosteroids">corticosteroids</a> are also used to limit the production of inflammatory signals in the blood and throughout the body. </p>
<p>Parents and carers often ask what they can do to help prevent the development of food allergy, especially if there is a history of allergies in the family. The Enquiring About Tolerance, or “EAT”, <a href="https://www.nejm.org/do/10.1056/NEJMdo005063/full/?requestType=popUp&relatedArticle=10.1056%2FNEJMoa1514210">study</a>, showed that introduction of peanut and egg into the diet of babies from three months of age could reduce the likelihood of developing an allergy to these foods. The protective effect was less clear with other common foods such as milk, fish, wheat and sesame. This may be because smaller amounts of these foods were consumed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/264117/original/file-20190315-28496-hxha8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Skin conditions like eczema that break the surface of the skin are often associated with food allergies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/580580401?size=medium_jpg&src=lb-59856941&sort=newestFirst&offset=3">Shutterstock</a></span>
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<p>Another <a href="https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-2031-3">ongoing study</a> aims to determine whether the use of moisturisers (known as emollients) on babies can improve the skin barrier to help prevent eczema and food allergies. The results are eagerly awaited, but further research will still be needed to clarify if – and how – food allergy can be prevented.</p>
<p>In the meantime, UK government guidance continues to advise that babies should be <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/benefits-breastfeeding/">exclusively breastfed</a> until six months of age. Although it is <a href="https://www.ncbi.nlm.nih.gov/pubmed/26192405">not known</a> whether breastfeeding protects against food allergy, it is clear that breast milk can provide many health benefits for the baby and mother.</p>
<p>Some people grow out of their food allergies, but for others it becomes a life-long burden of carefully avoiding the offending foodstuff. Attempts to prevent any accidental exposure may fail with disastrous consequences such as in <a href="https://www.bbc.co.uk/news/uk-45679320">the case</a> of teenager Natasha Ednan-Laperouse who had a sesame allergy and died of cardiac arrest after she ate a baguette which she did not know contained sesame seeds.</p>
<p>While accidental exposure to food can be very dangerous, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284278/">immunotherapy</a> – the deliberate application of food substances to the surface of healthy skin – is being tested in clinical trials for the treatment of peanut and milk allergy. </p>
<p>A greater understanding of the causes of allergy will offer the opportunity to develop new treatments – and our own skin may provide a route to prevention as well as treatment for life-threatening reactions.</p><img src="https://counter.theconversation.com/content/113625/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.</span></em></p>With food allergies on the rise, it’s important to understand the role the skin plays in protecting or exposing us to reactions.Sara Brown, Professor of Molecular and Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1117062019-02-19T16:07:22Z2019-02-19T16:07:22ZSeven myths and truths about healthy skin<figure><img src="https://images.theconversation.com/files/259717/original/file-20190219-43258-1yb5wkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-african-woman-wearing-ear-rings-740139493">Shutterstock</a></span></figcaption></figure><p>Skin is <a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">our largest organ</a> and something we may take for granted when it’s healthy. As an academic dermatologist I frequently hear misleading “facts” that seem to be stubbornly enduring. Here are some of the most commonly shared myths that can be cleared up immediately, and some truths you can rely on.</p>
<h2>Skin constantly renews itself</h2>
<p><strong>TRUE</strong> The skin provides a dynamic barrier between your body’s internal environment and the outside world. Cells called keratinocytes in <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the epidermis</a> (the outer layer of skin) are constantly dividing to produce a supply of cells that move up through this layer and are shed from its surface. Skin is a rich source of <a href="https://www.eurostemcell.org/skin-stem-cells-where-do-they-live-and-what-can-they-do">stem cells</a> with the capacity to divide and renew themselves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259730/original/file-20190219-43252-3rpjer.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A good skincare regime starts with removing dirt from skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/side-view-handsome-afro-american-man-582848200">Shutterstock</a></span>
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<h2>Drink two litres of water a day for healthy skin</h2>
<p><strong>FALSE</strong> The amount of water you drink does not directly affect your skin. Water is supplied to the skin by blood flowing through <a href="https://www.dermnetnz.org/topics/the-structure-of-normal-skin">the dermis</a>, the inner layer of skin; water is lost from the epidermis, especially in a dry environment.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259719/original/file-20190219-43291-kmri3j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU1MDYwODk1OCwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTI4NjI0ODYwMCIsImsiOiJwaG90by8xMjg2MjQ4NjAwL2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJpQWVwL1hHa0ViY1NvNUx1TWJicmF1WFBCaDQiXQ%2Fshutterstock_1286248600.jpg&pi=33421636&m=1286248600&src=u1CBEbNYSfJuR53ejxoklA-1-2">Shutterstock</a></span>
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<p>Water is needed to maintain skin hydration and when you become seriously dehydrated your skin appears dull and is less elastic. In a healthy person the internal organs – kidneys, heart and blood vessels – control the amount of water reaching the skin. There is no fixed volume of water that you need to drink, it simply depends on the amounts you are using and losing.</p>
<h2>Stress can make skin unhealthy</h2>
<p><strong>TRUE</strong> There are many health issues in modern life that we blame on stress, but several skin conditions have been shown in scientific studies (see below), to be worsened by life events, possibly via stress hormones including <a href="http://www.yourhormones.info/hormones/cortisol/">cortisol</a> (a steroid hormone made in the adrenal glands). Notable examples are <a href="https://www.dermnetnz.org/topics/alopecia-areata/">alopecia areata</a>, an auto-immune condition where the body’s immunity begins to attack the hair follicles, causing hair to fall out; <a href="https://www.ncbi.nlm.nih.gov/pubmed/29729012">psoriasis</a>, another auto-immune condition that causes skin thickening, scaling and inflammation; and <a href="https://www.ncbi.nlm.nih.gov/pubmed/29023418">eczema</a>, itchy red skin inflammation often occurring alongside asthma, hay fever and other allergies. Unfortunately a flare up of these skin conditions is exactly what you don’t need when you are feeling stressed or under pressure.</p>
<h2>Eating chocolate causes acne</h2>
<p><strong>FALSE</strong> Acne vulgaris, the common “teenage” <a href="https://www.dermnetnz.org/topics/acne-vulgaris">acne</a> which can actually persist into your 30s and 40s, occurs as a result of the interaction between hormonal effects on grease glands in the skin, plus the skin’s immune response to blocked pores and microbes living on the skin.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259724/original/file-20190219-43288-1p7sbld.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Eating a high fat diet is unhealthy for many reasons, but it doesn’t cause acne. In fact some tablets prescribed for severe acne such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Food+increases+the+bioavailability+of+isotretinoin">oral isotretinoin</a> are better absorbed when pills are swallowed with a fatty meal – and that could include chocolate.</p>
<h2>Washing powder causes eczema</h2>
<p><strong>FALSE</strong> Eczema is a condition where the skin is dry, itchy and red. It is caused by a combination of genetic factors (how your skin is made) and environmental effects, leading to inflammation. Soap, detergents and washing powders can irritate the skin and contribute to dryness because they remove oil from the skin (just as washing-up liquid removes grease from your dishes). Biological washing powders contain enzymes – proteins that break down fats and other proteins to remove stains – and these can irritate sensitive skin, so they may worsen eczema. It is important that any washing power is thoroughly rinsed out of clothing before it is worn, to avoid skin irritation.</p>
<h2>White marks on nails = calcium deficiency</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=690&fit=crop&dpr=1 600w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=690&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=690&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=867&fit=crop&dpr=1 754w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=867&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/259768/original/file-20190219-43267-ppulbs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=867&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong>FALSE</strong> Nails are manufactured in the nail matrix, an area under the skin at the top edge of your nail. If the matrix is traumatised, bumped or bitten, an irregularity in the developing nail occurs and air can become trapped. This appears as a white mark as the nail grows out. Calcium is important for healthy nails (as well as bones and teeth) but these white marks are not a sign of deficiency.</p>
<h2>Sunshine is good for you</h2>
<p><strong>TRUE & FALSE</strong> Many people have experienced the feel-good factor of a sunny day, but there are good and bad effects of sunlight. Light from the sun includes a mixture of <a href="https://www.britannica.com/science/sunlight-solar-radiation">different wavelengths of light</a>: some are visible to the human eye, some are shorter than the colours we can see – these are called <a href="https://uihc.org/health-topics/what-difference-between-uva-and-uvb-rays">ultraviolet</a> (UV) – and some are longer, the infrared. Different wavelengths have different effects on skin.</p>
<p>UVB is used by skin to manufacture <a href="https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin-d-from-sunlight/">vitamin D</a> which is essential for bone health. Without sun exposure this vitamin must be obtained from the diet. Dermatologists use specific wavelengths of UVA and UVB in carefully controlled doses to reduce skin inflammation, a valuable treatment for some skin conditions. </p>
<p>But when the skin is exposed to too much UV it can damage the skin cells’ DNA, leading to uncontrolled growth – the basis of cancer. As a simple rule, unless you have a disease or treatment that suppresses your immune system, sunshine is good for you in moderation, but always avoid getting sunburned.</p>
<h2>Keep it simple</h2>
<p>The basic principles of keeping skin healthy are mainly common sense. You should wash your skin regularly to remove dirt, but not so much that you remove the essential moisture and water-proofing substances. Use a moisturiser if your skin feels tight or dry – a greasy ointment works best unless you have acne-prone skin, in which case you should use a non-greasy water-based cream. Avoid stress if possible, eat a healthy diet and drink water when you feel thirsty. And finally, protect your skin from too much sun with a hat and clothing or sunscreen.</p><img src="https://counter.theconversation.com/content/111706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara J Brown receives research funding from the Wellcome Trust, the Tayside Dermatological Research Charity and the British Skin Foundation and is a medical adviser for Eczema Outreach Support.</span></em></p>When it comes to looking after your skin, some stubborn “facts” endure, so a dermatologist sets the record straight.Sara Brown, Professor of Molecular & Genetic Dermatology, Wellcome Trust Senior Research Fellow, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/959202018-05-03T19:01:57Z2018-05-03T19:01:57ZApplying live bacteria to skin improves eczema<figure><img src="https://images.theconversation.com/files/217332/original/file-20180502-153866-1v8yzpi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eczema, which is common in babies, is itchy and painful.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-baby-eczema-on-her-face-616085213">silentalex88/Shutterstock.com</a></span></figcaption></figure><p>With two decades of medical education, training, and research under my belt, I have finally reached the stage in my career when I can proudly state that I intentionally spray people in the face with live bacteria. </p>
<p>Atopic dermatitis, more commonly known as eczema, is an inflammatory skin disease that makes skin dry and itchy, causes rashes and leads to skin infections. The cause is unknown, but <a href="http://doi.org/10.1101/gr.131029.111">earlier studies</a> conclude that the skin microbiome – the community of all the bacteria and other microorganisms living on the surface of the skin – plays a major role. </p>
<p>Yet all current eczema treatments ignore the microbiome. Furthermore, almost every current treatment, like topical steroid creams or lotions are time-intensive and must be applied to the skin at least once a day. Other effective treatments such as the Dupixent, which is injected twice per month, requires fewer applications but is extremely expensive. Our team at the National Institutes of Allergy and Infectious Diseases decided to develop a different approach, with the skin microbiome in mind. </p>
<h2>Why bacteria?</h2>
<p>The first step in looking into whether bacteria could impact eczema was to evaluate <a href="http://doi.org/10.1038/jid.2011.417">past studies</a> that revealed which bacteria make up a healthy <a href="http://doi.org/10.1038/nrmicro2537">skin microbiome</a>. When we compared the locations on the body where patients typically have eczema outbreaks, such as the elbow folds and the back of the knees, with the healthy skin microbiome map, we noticed an intriguing pattern. Body zones prone to symptoms were the same locations where Gram-negative bacteria liked to grow. </p>
<p><a href="https://microbeonline.com/gram-staining-principle-procedure-results/">Gram staining</a> is a general laboratory method for distinguishing bacteria; Gram-positive organisms like <em>Staphylococcus aureus</em> can separated from Gram-negative organisms like <em>Escherichia coli</em>. The primary reason to separate these types of bacteria is to help physicians understand which types of bacteria are present on a person, so they can select the most effective antibiotic. </p>
<p>We suspected that having the “wrong” kind of Gram-negative bacteria on the skin could lead to eczema. To test the hypothesis we used one particular strain of Gram-negative bacteria, <em>Roseomonas mucosa</em>, collected from the skin of healthy people, to see whether this microbe would calm irritated skin. </p>
<p><a href="http://doi.org/10.1172/jci.insight.86955">We studied</a> <em>R. mucosa</em> in petri dishes, and discovered that it directly killed <em>Staphylococcus aureus</em>– a nasty species of bacteria that is common to skin infections, increases inflammation, and worsens symptoms. In mice, <em>R. mucosa</em> from healthy humans improved the barrier function of the mouse’s skin – the ability to seal in moisture so the skin does not get dry, and the ability to keep allergens like pollen out to protect against becoming allergic. The microbe also improved eczema-like rashes in mice. </p>
<h2>Good versus bad bacteria</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=612&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=612&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=612&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=769&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=769&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217593/original/file-20180503-138586-j9c6og.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=769&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The skin is colonized by a varied community of millions of microbes–bacteria, viruses, fungi–that are harmless or even beneficial to their host. An imbalance, or the wrong microbes, can trigger disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/microbiome-microorganisms-bacteria-viruses-microbes-on-771533164?src=s5sGiHity25WpXP2Jj4Mow-1-8">vex/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>In humans, <em>R. mucosa</em> boosted the immune system in human skin cells. In contrast, when <em>R. mucosa</em> was collected from people with atopic dermatitis and tested in the same manner, it had no impact or made the eczema worse. This suggests that replacing “bad” strains of <em>R. mucosa</em> with “good” ones might be the key to treating patients. </p>
<p>What distinguishes the “bad” strains of <em>R. mucosa</em> from the bad? That’s a tricky question. To date we have learned that “bad” strains of <em>R. mucosa</em> produce skin irritants – specifically the histamine relative, histidinol, and monomethylgluterate. In contrast, the “good” bacteria make fatty molecules, lipids, that are known to protect the skin from dryness and <em>S. aureus</em>. It appears that the “good” and bad" the strains differ due to subtle changes in their DNA, but more research is needed. </p>
<p>What we do know is that it appears that all the <em>R. mucosa</em> found on healthy people is the “good” kind, while all the <em>R. mucosa</em> on eczema patients is “bad.” While some of the molecular details separating <em>R. mucosa</em> strains are unclear, our results gave us enough actionable information to design an early stage clinical trial to assess the safety and efficacy of applying a mix of three live <em>R. mucosa</em> strains collected from the skin of healthy volunteers and proven to be “good.” </p>
<p>This was the first study to ever evaluate if directly treating the bacteria on the skin could improve skin disease.</p>
<h2>Microbial medicines</h2>
<p>As part of a <a href="http://doi.org/10.1172/jci.insight.120608">small Phase I/II trial</a>, we treated patients who suffer from eczema with a spray containing sugar water and live <em>R. mucosa</em>. First, 10 adults applied the bacteria twice a week for six weeks. </p>
<p>The most important <a href="https://insight.jci.org/articles/view/120608">finding</a> was that no one suffered any complications. However, the most exciting discovery was that the majority of participants noticed that their rash and itch subsided. Some reported needing fewer topical steroid applications to control their symptoms. After the adults completed the study, we enrolled five children aged 9 to 14 years. </p>
<p>Just like in adults, no one suffered ill effects and most saw their eczema improve. These kids then reduced the number of days they needed to use topical creams. The bacteria treatment also reduced the population of <em>S. aureus</em>.</p>
<p>Seeing such profound results left me with a mixture of emotions. On one hand, it was extremely gratifying to hear patients and parents relay how much better they or their children felt and to see such amazing differences in both their skin and disposition after treatment. </p>
<p>However, no one on our team, myself included, could feel fully satisfied seeing the disappointment in the patients for whom the treatments failed. Every volunteer expressed enjoyment in participating in the study, learning about their disease, and contributing the medical knowledge. However, anything less than 100 percent improvement in 100 percent of patients suggests we still have more work to do. </p>
<h2>Probiotics for the skin?</h2>
<p>Since our results support the <a href="http://doi.org/10.1111/bjd.15390">growing understanding</a> that disruptions in the bacterial balance on the skin directly contribute to eczema, we also explored whether chemicals in common skin care products might aggravate the condition by altering the growth of <em>R. mucosa</em> or <em>S. aureus</em>. Many products with parabens, a common preservative in cosmetics and soaps, and select topical moisturizers, blocked the growth of helpful <em>R. mucosa</em> from healthy skin but did not have the same effects on the growth of <em>S. aureus</em> or eczema-linked <em>R. mucosa</em>. These findings imply that certain products may worsen atopic dermatitis by blocking the growth of the protective <em>R. mucosa</em>.</p>
<p>By using this approach, we hope to offer a way to reduce symptoms and the need for daily treatment – at a reasonable cost. If the good bacteria are capable of colonizing the skin and making it their home, then there is a chance that these microbes could provide long-term benefits long after active treatment stops.</p>
<p>This first phase of our <a href="https://clinicaltrials.gov/ct2/show/NCT03018275">study</a> involved just 15 patients. But based on our results, we plan to launch a bigger trial, likely to include hundreds of patients, to gauge the power of this new treatment. And just as you now buy yogurts that adjust the types and numbers of bacteria in your gut to improve your digestive health, it’s conceivable that we will be using probiotic skin creams to boost the health of the body’s largest organ, the skin.</p><img src="https://counter.theconversation.com/content/95920/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Myles receives funding from The National Institutes of Health intramural program.</span></em></p>In this clinical trial, the first of its kind, physicians explore whether directly applying a ‘good’ strain of bacteria to the skin can heal eczemaIan Myles, Assistant Clinical Investigator, National Institute of Allergy and Infectious DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/949812018-04-19T03:27:40Z2018-04-19T03:27:40ZResearch Check: can baby wipes cause childhood food allergies?<figure><img src="https://images.theconversation.com/files/214940/original/file-20180416-105522-159l8ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Media reports have linked baby wipes to childhood allergies but there is no cause for concern.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hygiene-young-momy-wiping-baby-skin-1066692977?src=DNmjknOoRBLixACCEkbazw-1-5">www.shutterstock.com</a></span></figcaption></figure><p>Parents may have been understandably worried reading recent headlines announcing:</p>
<blockquote>
<p><a href="https://www.theaustralian.com.au/news/latest-news/baby-wipes-linked-to-food-allergies-study/news-story/f7bcde5b0640621a69180a71be145833">Baby wipes linked to food allergies</a> </p>
<p><a href="http://www.news.com.au/lifestyle/parenting/babies/study-finds-baby-wipes-are-contributing-to-childhood-food-allergies/news-story/b8749ffea84931679e204c9be223d268">Study finds baby wipes are contributing to childhood food allergies</a> </p>
<p><a href="https://www.telegraph.co.uk/science/2018/04/06/baby-wipes-cause-food-allergy-new-study-warns/">Baby wet wipes ‘cause food allergy’, new study warns</a></p>
</blockquote>
<p>In Australia, up to one in ten babies and <a href="https://www.sciencedirect.com/science/article/pii/S0091674917304128?via%3Dihub">one in 20 older children have a food allergy</a>. In children with a food allergy, allergic reactions can be severe, and lead to hospitalisation and even, occasionally, death.</p>
<p>But when it comes to baby wipes, parents can rest easy. Because, contrary to the headlines, the study being reported on did not provide evidence that using baby wipes increases a child’s risk of developing a food allergy. </p>
<p>In fact, baby wipes weren’t analysed, nor did they feature, in the study at all. Plus, the study was in mice, not humans. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214939/original/file-20180416-570-k9hy82.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Media representation of the study.</span>
<span class="attribution"><a class="source" href="http://www.news.com.au/lifestyle/parenting/babies/study-finds-baby-wipes-are-contributing-to-childhood-food-allergies/news-story/b8749ffea84931679e204c9be223d268">news.com/screenshot</a></span>
</figcaption>
</figure>
<h2>How was the study conducted?</h2>
<p>The study was published in the <a href="http://www.jacionline.org/article/S0091-6749(18)30233-1/abstract">Journal of Allergy and Clinical Immunology</a>. Its main aim was to look at how damage to the skin barrier, as occurs with eczema, contributes to the development of food allergy.</p>
<p>We know from other studies that skin barrier damage might be an important factor in children’s food allergies. Infants with eczema are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/cea.12406">more likely to develop food allergies</a>. We also know that children with some genetic mutations that affect the skin <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3081065/">have more food allergies</a>. </p>
<p>Researchers used mice to model a type of food allergy in humans, known as IgE-mediated food allergy. People with this allergy develop “sensitisation” to certain foods, such as peanuts. Some of these sensitised people then develop an allergic reaction when they eat the food. </p>
<p>At this stage, it is thought that sensitisation could occur in humans through skin exposure, but studies haven’t yet proven the link. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">What are allergies and why are we getting more of them?</a>
</strong>
</em>
</p>
<hr>
<p>The researchers used newborn mice with genetic defects in skin barrier function genes and took several steps to cause the mice to develop reactions to peanut. </p>
<p>They first applied sodium dodecyl sulfate, a chemical often found in soap, on the mouse’s skin, to stop the next solution from rolling off the skin. </p>
<p>Then they applied drops containing peanut and environmental allergens found in house dust to their skin at regular intervals to cause “sensitisation”. They then gave the peanut orally. </p>
<p>The researchers tested mice for reactions that may indicate food allergy, such as a drop in body temperature after oral peanut exposure. </p>
<p>Environmental allergens from house dust were used because researchers have previously shown that house dust may contain peanut proteins. They also showed that children growing up in environments with more peanut in the dust more often develop peanut allergy, but only if they also have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188983/">genetic mutations</a> affecting the skin barrier. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214941/original/file-20180416-566-zprt5f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The researchers were testing the mice for allergic reactions to peanuts.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-wet-wipes-660356947?src=k_KVKRivIvdQwxgGk2ap1Q-1-48">www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>What were the results?</h2>
<p>The researchers showed they could cause peanut allergy in newborn mice with genetic defects in skin barrier function by exposing the mice to peanut along with house dust allergens through the skin. </p>
<p>Without the house dust allergens, none of the other triggers (sodium dodecyl sulfate, peanut, skin barrier mutations) had any effect.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/introduce-eggs-and-peanuts-early-in-infants-diets-to-reduce-the-risk-of-allergies-65564">Introduce eggs and peanuts early in infants' diets to reduce the risk of allergies</a>
</strong>
</em>
</p>
<hr>
<p>This suggests that sensitisation to peanut can occur through the skin in this mouse model, but only in the presence of environmental allergens. The newborn mice required both genetic defects in skin barrier function and skin exposure to peanut and components of house dust to develop the allergy.</p>
<p>However, it is not clear from this study alone that these same factors are also necessary for food allergy in children. </p>
<h2>What about baby wipes?</h2>
<p>So, where did the idea that baby wipes might be linked to food allergy come from? </p>
<p>The researchers state that the sodium dodecyl sulfate they used to hold the solution in place is found in cleansing wipes. They write: </p>
<blockquote>
<p>… soap components, such as sodium lauryl sulfate, which is sodium dodecyl sulfate (SDS), in cleansing wipes… might facilitate allergen uptake during feeding and cleaning of infants with skin barrier mutations. </p>
</blockquote>
<p>We took a quick look at some common brands of baby wipes, however, and did not find sodium dodecyl sulfate in the list of ingredients. </p>
<p>It is also difficult to know how this relates to the development of food sensitisation in babies who are exposed to baby wipes, even if the wipes did contain the chemical. This would require comparing the outcomes of mice who were exposed to sodium dodecyl sulfate, to those who weren’t. And this was not done in the study.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214942/original/file-20180416-577-ktbnxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The relationship between baby wipes and food allergy was not proven in the study.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-wet-wipes-660356947?src=k_KVKRivIvdQwxgGk2ap1Q-1-48">www.shutterstock.com</a></span>
</figcaption>
</figure>
<h2>What else should we consider?</h2>
<p>It is plausible that having a damaged skin barrier in infancy might increase the risk of peanut components being absorbed through the skin, and that this could lead to an allergy. </p>
<p>While these are interesting observations, convincing evidence that something causes or prevents food allergy can usually only be obtained in a randomised controlled trial. This is when one group that is given a certain intervention (like being exposed to an allergen) is compared to a “control” group, that either is given another intervention or nothing at all. </p>
<p>The only <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=article">such trial</a> for preventing peanut allergy so far showed that earlier introduction of peanut to infants with severe eczema reduced their risk of developing a peanut allergy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-prevent-food-allergies-in-my-kids-88873">Can I prevent food allergies in my kids?</a>
</strong>
</em>
</p>
<hr>
<p>Randomised trials are currently underway looking at whether using creams to improve the skin barrier can prevent infants from becoming allergic to food. This will provide more information about the role of the skin barrier in the development of food allergy in children. </p>
<p>While it is possible that excessive use of soaps or soap-containing products could damage the skin barrier and increase the chances of absorbing food allergens through the skin, further studies are needed to confirm this. </p>
<p>Although using soaps for newborn infants <a href="http://raisingchildren.net.au/articles/bathing_your_newborn.html/context/295">is not recommended </a> because it will dry their skin, there is no convincing evidence that avoiding soap will reduce a child’s risk of developing a food allergy. And there is even less evidence for avoiding baby wipes. <strong>- Jennifer Koplin and Melanie Neeland</strong></p>
<hr>
<h2>Peer Review</h2>
<p>I have reviewed the Research Check and the paper it is based on, as well as some of the supporting literature. I have also and independently checked baby-wipe ingredient lists. </p>
<p>The Research Check is a fair and balanced assessment of the original research. <strong>– Ian Musgrave</strong></p><img src="https://counter.theconversation.com/content/94981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jennifer Koplin receives funding from the National Health and Medical Research Council of Australia. </span></em></p><p class="fine-print"><em><span>Melanie Neeland receives funding from The Thrasher Research Fund.</span></em></p><p class="fine-print"><em><span>Ian Musgrave has received funding from the National Health and Medical Research Council to study adverse reactions to herbal medicines and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. He has collaborated with SA water on studies of cyanobacterial toxins and their implication for drinking water quality. He is a board member of the Australasian Society for Clinical and Experimental Pharmacology.</span></em></p>Reports that a study found baby wipes to be a contributor to childhood allergies were plain wrong. The study didn’t test baby wipes, and was done in mice.Jennifer Koplin, Research Fellow, Population Health, Murdoch Children's Research InstituteMelanie Neeland, Research Fellow, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/915182018-03-20T19:04:37Z2018-03-20T19:04:37ZCommon skin rashes and what to do about them<figure><img src="https://images.theconversation.com/files/209558/original/file-20180308-30983-e4u830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's that rash? Here's what to look for to diagnose a common skin complaint. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>Everyone has had the unpleasant experience of a rash on the skin – pink, red or purple, flat or bumpy, itchy, scaly, pus-filled, or just plain unsightly. This variety isn’t surprising, because the skin is a complicated organ. </p>
<p>Infections, allergic reactions, immune system problems and even bad reactions to medication can all manifest as a rash. </p>
<p>Here are a few of the most common types.</p>
<h2>Drug allergy</h2>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">Almost every prescription medication</a> available can cause a rash as a side effect, and more than 80% of those are “<a href="https://www.dermnetnz.org/topics/morbilliform-drug-reaction/">exanthematous drug eruptions</a>”, meaning a widespread rash accompanied by other symptoms such as headache, fever and feeling generally unwell. </p>
<p>This rash usually appears within two weeks of starting a new medication, as a widespread, symmetrical rash with pink-to-red spots that are flat or elevated and firm, and that might join together in patches. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-lumps-and-bumps-on-and-under-the-skin-what-are-they-59313">Common lumps and bumps on and under the skin: what are they?</a>
</strong>
</em>
</p>
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<p>This type of rash is a hypersensitivity reaction, in which the attacking soldiers of the immune system (called “T-cells”) detect the drug and try to clear it from the body by releasing inflammatory proteins. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exanthematous drug eruption.</span>
<span class="attribution"><span class="source">DermNet New Zealand.</span></span>
</figcaption>
</figure>
<p>Very rarely, a drug can cause a severe and life-threatening rash called “toxic epidermal necrolysis” where the skin begins to peel off in sheets. It’s more common in Han Chinese people with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586963/">specific genetic variant</a>, and requires intensive care or burn unit treatment. </p>
<p>Most drug eruptions <a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">go away within a week</a> once the patient stops taking the problem medication, or within several weeks in protracted cases. In the meantime, or if the drug is essential, steroid creams (which reduce inflammation) and emollient (softening) moisturisers can bring some relief. </p>
<h2>Allergic contact dermatitis</h2>
<p><a href="https://www.dermnetnz.org/topics/allergic-contact-dermatitis/">Allergic contact dermatitis</a> is caused by direct skin contact with a substance to which the person is allergic. The immune system’s T-cells overreact to the allergen and release proteins that call more immune cells to the area, making it red and swollen. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
</strong>
</em>
</p>
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<p>It’s often itchy and can be blistered or dry but bumpy. The reaction is often delayed by 48-72 hours, so it can be difficult to determine exactly what caused the reaction. It should also die down by itself over a few days, as long as the allergen is no longer on the skin. </p>
<p>Contact allergies <a href="https://www.dermcoll.edu.au/atoz/allergic-contact-dermatitis-acd/">can develop suddenly</a> after years of exposure to an allergen. Jewellery containing nickel, fragrances in lotions, household cleaners, preservatives in hair products, and latex in gloves or condoms are common sources. A dermatologist can carry out a patch test to determine whether a substance is the allergen, by applying it to a small patch of skin.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=686&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=686&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=686&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=862&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=862&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=862&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Severe contact dermatitis from a drug patch.</span>
<span class="attribution"><span class="source">Dr. Khatmando</span></span>
</figcaption>
</figure>
<p>Active dermatitis is treated with emollient moisturisers and steroid creams, or with oral steroids or drugs to suppress the immune system if very severe. Further episodes can be prevented by becoming aware of the sources of the allergen, reading labels carefully, and using gloves to handle allergen-containing products. </p>
<h2>Eczema</h2>
<p><a href="https://www.dermcoll.edu.au/atoz/atopic-dermatitis/">Atopic dermatitis</a> or atopic eczema (often just called eczema) is very common in children from three months old onwards, but appears in adults too, often with hay fever and asthma. </p>
<p>Atopic dermatitis features patches of intensely itchy red skin, sometimes with blisters and weeping patches. Children often have open sores and scabs, because it’s so itchy that it’s hard to refrain from scratching. </p>
<p>Over time the skin becomes thickened and rough from frequent scratching and rubbing. Childhood atopic dermatitis tends to improve as the child grows up, but may continue. Far less commonly, atopic dermatitis can also appear first in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122283/">adulthood</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Atopic dermatitis is very common in children, but often improves as they get older.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Atopic dermatitis is a <a href="https://www.dermnetnz.org/topics/causes-of-atopic-dermatitis/">disease of the immune system</a>, in which
structural defects in the skin barrier make it easier for irritants to penetrate into the skin. This throws the delicate balance of the microbial community on our skin out of whack, causing the immune system to go into overdrive. Triggers include stress, sweating, coarse fibres in clothing, inhalation of allergens such as pollen, irritants such as soap or perfumes, and eating food we’re allergic to.</p>
<p>Steroid creams can help treat a bad flare of atopic dermatitis, but shouldn’t be used constantly. In very severe cases, immunosuppressant drugs are prescribed. Ongoing control of atopic dermatitis often includes using emollient moisturisers to combat dry skin, keeping cool, avoiding hot water or irritants, and reducing allergens such as dust mites in the home. </p>
<p>For severe cases that don’t respond to these methods, the drug <a href="https://www.tga.gov.au/prescription-medicines-registration-new-chemical-entities-australia">dupilumab</a> has just been approved for use in Australia. This drug blocks a specific cell receptor to prevent immune cells from detecting two overactive inflammatory proteins.</p>
<p>Atopic dermatitis can have a big impact on quality of life, due to insomnia from the constant itchiness, and restrictions on clothing, body products, pets or activities. Its presence on prominent parts of the body like the face and hands can also reduce self-esteem. Evening sedatives to improve sleep and psychotherapy can help reduce the impact on everyday life. </p>
<h2>Psoriasis</h2>
<p>Psoriasis is another chronic immune disorder. It can start at any age and can be lifelong, and is usually present as red plaques (raised or thickened skin) with well-defined edges and silvery-white scales, ranging from a few millimetres to several centimetres across. The overactive inflammation can also damage the joints and lead to <a href="https://www.dermnetnz.org/topics/psoriatic-arthritis">psoriatic arthritis</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
</strong>
</em>
</p>
<hr>
<p>Often the plaques feel <a href="https://www.dermcoll.edu.au/atoz/psoriasis/">itchy or sore</a>, and because psoriasis is long-lasting and can appear prominently on highly visible parts of the body, it often comes with <a href="https://www.dermnetnz.org/topics/psychological-effects-of-psoriasis">severe psychological effects</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psoriasis lesions are raised, red and often have white scales.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Psoriasis is caused by too many new skin cells being produced and moving up to the surface of the skin <a href="https://www.nhs.uk/conditions/psoriasis/causes/">too quickly</a>. It’s not known exactly why, but there’s usually an overabundance of inflammatory messenger proteins in the skin. </p>
<p>It can be triggered or aggravated by a streptococcal infection such as tonsillitis, smoking, hormonal changes such as menopause, and some medications. Genetics play an important role in susceptibility to psoriasis and also in what treatments are effective.</p>
<p><a href="https://www.dermnetnz.org/topics/plaque-psoriasis/">Chronic plaque psoriasis</a>, the most common form, can be very resistant to treatment. Small areas can be treated with creams containing steroids, coal tar, or vitamin D. If a lot of the body is covered by plaques, oral immunosuppressant drugs are used, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/29369396">phototherapy</a>, which uses targeted UV light to destroy over-active immune cells. Moderate sun exposure sometimes improves psoriasis, but sunburn can worsen it – a tricky balance in Australia’s high-UV environment. </p>
<p>These treatments can usually improve the plaques, but it can be very difficult to clear it completely. There are several <a href="https://www.psoriasis.org/about-psoriasis/treatments/biologics">new drugs</a> coming onto the market for severe psoriasis that hasn’t responded to other treatment.</p>
<h2>Tinea</h2>
<p>Tinea, or ringworm, is not caused by worms at all but a fungal infection. Tinea is usually named according to the body site it’s on, but the same few kinds of fungus can cause tinea in many parts of the body and it can be spread from one part of the body to another, such as by scratching or using a contaminated towel.</p>
<p><a href="https://www.dermnetnz.org/topics/tinea-pedis/">Tinea pedis</a>, on the foot, is an important type because spores can live for weeks in communal showers and changing rooms, making it a common source of infection that can then spread to the trunk, arms and legs (<a href="https://www.dermnetnz.org/topics/tinea-corporis/">tinea corporis</a>) or groin (<a href="https://www.dermnetnz.org/topics/tinea-cruris/">tinea cruris</a>, or jock itch). Cats, dogs and other animals are a common source of ringworm fungus, but many types can be spread between people too.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fungus continues to spread further out while the inner area heals, forming a distinctive ring shape.</span>
<span class="attribution"><span class="source">Grook Da Oger</span></span>
</figcaption>
</figure>
<p>Typically, tinea spreads in a circular or oval patch, often healing in the middle so that it appears to be a red scaly ring of infection. Sometimes it can also become a fungal abscess that looks like a boil, feels boggy, and has pustules. </p>
<p>On the feet it can look like ringworm circles, patchy fine dry scales on the sole, blisters on the instep or a moist, red peeling area between the toes (athlete’s foot). </p>
<p>In the groin, it can have a scaly, red raised border and be extremely itchy.</p>
<p>Tinea is diagnosed by microscopic examination and laboratory culture of skin scrapings. It’s usually treated with antifungal creams, or oral antifungal drugs if it persists. It can become chronic in the warm, moist folds of the body.</p>
<h2>Shingles</h2>
<p>Shingles is a famously painful, blistering rash caused by the reactivation of chicken pox virus, <a href="http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/chickenpox+and+shingles">varicella-zoster virus</a>, usually years or decades after the original infection. </p>
<p>The virus lies dormant in nerves near the spine and migrates down the sensory nerve to the skin when it is reactivated, but it’s not known why the virus is reactivated. Some possible triggers are radiotherapy, spinal surgery, other infections, or cancers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shingles forms a painful, blistered red rash along the line of a sensory nerve.</span>
<span class="attribution"><span class="source">Fisle</span></span>
</figcaption>
</figure>
<p>Shingles <a href="https://www.mja.com.au/journal/2008/188/3/prevention-and-management-herpes-zoster">starts with pain in the skin</a> that is often described as burning or stabbing, followed in one to three days by a rash of raised red bumps that become blisters and then crust over. The rash is usually confined to a narrow arc of skin, along the sensory nerve that was harbouring the virus. </p>
<p>Patients often have a fever, headache and swollen lymph nodes. Recovery takes two to four weeks but the pain can persist after the rash has healed, called <a href="https://www.dermnetnz.org/topics/post-herpetic-neuralgia">post-herpetic neuralgia</a>. </p>
<p>If it’s caught within three days of onset, antiviral medication can reduce the severity of symptoms and length of the infection. Otherwise, treatment consists of powders or solutions to dry out the rash, as well as pain relief and rest. </p>
<p>Australians aged over 70 are eligible for a <a href="https://beta.health.gov.au/services/shingles-herpes-zoster-immunisation-service">free zoster vaccine</a>, which reduces the risk of shingles by half.</p><img src="https://counter.theconversation.com/content/91518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>H. Peter Soyer receives funding from NHMRC and ARC.</span></em></p><p class="fine-print"><em><span>Katie Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s a list of the most common rashes and what you need to look for.H. Peter Soyer, Professor of Dermatology, The University of QueenslandKatie Lee, Research assistant, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/828202017-09-04T02:27:58Z2017-09-04T02:27:58ZHealth Check: is makeup bad for your skin?<figure><img src="https://images.theconversation.com/files/183915/original/file-20170830-5619-9vgg3s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many people cover their face with makeup every day, potentially causing irritation. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Makeup is an everyday item for many people and non-negotiable for some. Is it bad for our skin? As always, the answer is not clear-cut and depends on the individual, their skin type, and the products they use.</p>
<p>With an overwhelming choice of cosmetic products available, most people don’t even know where to start with makeup. Organic? Natural? Fragrance free? Hypoallergenic? Non-comedogenic? Paraben free? What does this all mean, and are they any better?</p>
<p>The term makeup generally describes the group of cosmetics that are used for beautification. Other cosmetics include products that are used to cleanse, treat or protect the skin and hair. These days, though, we commonly see all-in-one products, such as BB or CC creams, which combine makeup for coverage together with other ingredients to provide sun protection and skin benefits. Reducing the total number of products can be helpful for those with problematic skin, but may complicate things for some. </p>
<h2>What does makeup do to our skin?</h2>
<p>While in most cases makeup is harmless, certain products may cause problems for some individuals. It’s very important to use makeup and cosmetics that are suitable for your skin type or skin condition. </p>
<p>Skin types are broadly classified into four groups:</p>
<p>• oily - excess oil production, large pores, blackheads and acne prone</p>
<p>• sensitive - tight, stinging, intolerant to many products and prone to redness</p>
<p>• dry - dull, rough or flaky and prone to itchiness</p>
<p>• normal/combination - may be oily in the T-zone (forehead, nose and chin) but problem-free elsewhere</p>
<p>Although most people have a good idea of their basic skin type, they may fail to recognise the existence of an underlying skin disorder. Conditions such as eczema, contact dermatitis, rosacea and sun damage may cause inflammation and disruption of the skin barrier.</p>
<p>Inflammation causes itchiness or tenderness, redness, lumps and bumps, while barrier disruption results in tight, sensitive, dry and easily-irritated skin. These symptoms can be identical to those caused by reactions to cosmetics, and therefore should be considered before assuming makeup to be the cause. Conversely, an ongoing reaction to products being applied to the skin may explain why the skin is not responding to regular treatment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183917/original/file-20170830-5619-1sltzla.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Skin irritations can cause itchy, scaly red rashes.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Skin problems caused by cosmetics</h2>
<p>Acne cosmetica is a form of acne triggered by the use of certain cosmetic products. It is linked to certain ingredients that cause comedone formation (a blockage in the pore) and typically presents as small rash-like bumpy pimples. A common misconception is that the makeup physically blocks the pore, whereas actually the block is made of dead skin cells. </p>
<hr>
<p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-why-do-i-still-get-zits-29143">Health Check: why do I still get zits?</a>
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<p>Mild inflammation results in excess skin turnover and clogging of the pore, with mineral oils being the most common culprit. It’s not always possible to determine makeup is the cause simply from the ingredient list, as it may be influenced by formulation, quantity and delivery methods.</p>
<p>Irritant dermatitis accounts for the majority of reactions to makeup and other cosmetic products. It can occur in anyone but is more likely in those with pre-existing sensitive skin or in those with underlying barrier disruption caused by a condition like eczema or rosacea. It typically causes an itchy, scaly red rash but can even blister or weep. Symptoms can occur immediately but may take weeks or even months to develop with weaker irritants, making it difficult to identify the cause. </p>
<p>Allergic contact dermatitis occurs when a person has become sensitised to an ingredient that has been applied to the skin. A red, itchy rash sometimes associated with swelling or blisters develops 12-48 hours after exposure, and may become chronic with ongoing use. The allergen can be very difficult to identify, because in some cases the product is used for months or years before sensitisation occurs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183916/original/file-20170830-5593-fowcya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People put many different products on their face, isolating a cause of irritation can be tricky.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Are there ingredients we should avoid?</h2>
<p>Fragrances and preservatives are the most common cause of contact allergy resulting from cosmetics. There are over 5,000 different fragrances used in skin care products, many of which are natural plant extracts and essential oils. </p>
<p>Other common allergens include preservatives, lanolin, coconut diethanolamide (a foaming agent) and sunscreen agents. Preservatives, such as parabens, formaldehyde and Quaternium-15 are required in all liquid products to stabilise them and prevent the growth of microbes. A common misconception is that natural and organic ingredients will not cause allergy or irritation, but in prone individuals these can in fact be quite problematic.</p>
<p>Unless you have a known allergy or sensitivity, there are no specific ingredients that everyone should avoid. But looking for hypoallergenic, fragrance-free and non-comedogenic products is wise. Those with an oily skin type or a history of acne should also limit oil-based cosmetics. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-eczema-and-what-can-you-do-about-it-45318">Explainer: what is eczema and what can you do about it?</a>
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</em>
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<p>Those with a sensitive or dry skin type, an underlying inflammatory skin condition or history of contact allergy should try to avoid irritants and potential allergens. Foaming agents, astringent products (such as toners that remove oils), scrubs and acids (such as alpha hydroxy acids used in acne and anti-ageing) tend to be irritating. Hypoallergenic formulations and those targeting sensitive skin are a good choice. </p>
<h2>What should I do if I think I might have a reaction?</h2>
<p>If you develop a new rash or skin irritation, the first thing to do is to try to confirm the diagnosis. If you suspect you are reacting to one of your cosmetics but not sure which, then ideally you need to stop using all your current products in the problem area. You should try to simplify your daily routine, choosing products that have been specifically formulated for sensitive and allergic skin. </p>
<p>If the problem settles, you can reintroduce your cosmetics one at a time to see whether you can identify the culprit. It’s a good idea to test each one in a small localised area on the neck or face for a week or two before using it all over the face. This process is known as a “repeat open application test”. </p>
<p>If you can’t get to the bottom of it or find cosmetics that don’t irritate your skin, you may need to seek professional help to rule out other skin conditions and formally test for allergies if warranted.</p><img src="https://counter.theconversation.com/content/82820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cara McDonald consults to La Roche Posay. </span></em></p>Many of us cover our faces with foundation and other beauty products every day. Here’s what we know about whether they are doing us damage.Cara McDonald, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/685832016-12-25T20:41:33Z2016-12-25T20:41:33ZHealth Check: why swimming in the sea is good for you<figure><img src="https://images.theconversation.com/files/148990/original/image-20161207-25753-83md7g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bathing in the Dead Sea has long been used to treat psoriasis.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/60584010@N00/23932671816/in/photolist-CsRcwG-RDwB-5smym4-8BNdv2-ksJ1KP-8BNbvP-8BR3h3-cGmfK-7ASfpK-7AW4cJ-5DMQqa-9m711y-qFUNWS-7DXhCj-9m6ZZE-4f5vJq-eYY2H-eYYdK-eYY8j-8BRiM1-3fHwvx-fMgBzw-eYYax-9m3Wez-hd1bJw-4f5ffj-8BRiCN-7ASfNp-8BR3qh-qUe8SN-eYYcv-eYYhr-CnS3KM-gEMVY-8BNcti-daHumF-8BNbPe-7ASfVV-8BRiTJ-ftZjN6-4hqeHz-8BNcZR-34vFX-9m3Wfi-bZ3Hp-eYXX2-fTdDAF-8BMVV8-8BRjh9-3ZWkwx">leiris202/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>If you live near the sea, make frequent trips to the beach, or are planning an island holiday this summer, chances are you’re getting more out of it than just enjoyment. It has long been thought sea frolicking has many health benefits.</p>
<p>Historically, doctors would <a href="https://www.washingtonpost.com/news/wonk/wp/2016/07/03/the-weird-origins-of-going-to-the-beach/?utm_term=.c57b0fb7c182">recommend their patients go to the seaside</a> to improve various ills. They would actually issue prescriptions detailing exactly how long, how often and under what conditions their patients were to be in the water. </p>
<p>Using <a href="https://en.wikipedia.org/wiki/Thalassotherapy">seawater</a> for medical purposes even has a name: thalassotherapy. </p>
<p>In 1769, a popular British doctor <a href="https://en.wikipedia.org/wiki/Richard_Russell_(doctor)">Richard Russell</a> published a dissertation arguing for using seawater in “diseases of the glands”, in which he included scurvy, jaundice, leprosy and glandular consumption, which was the name for glandular fever at the time. He <a href="http://www.theatlantic.com/health/archive/2013/08/the-historic-healing-power-of-the-beach/279175/">advocated drinking seawater</a> as well as swimming in it.</p>
<p>To this day, <a href="http://www.nextavenue.org/top-9-places-healing-waters/">healing and spa resorts</a> by the seaside abound. They are thought of as places where people can not only let go of their troubles but, in some cases, <a href="https://www.spadreams.com/dead-sea-hotels/">even cure arthritis</a>.</p>
<p>But does the evidence actually stack up? Does seawater cure skin conditions and improve mental health symptoms? </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149146/original/image-20161207-18036-5bwgdx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Doctors used to prescribe patients go to the seaside to improve health.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/sea-side?photo=WbBTlOk-CRY">Johnny Chau/Unsplash</a></span>
</figcaption>
</figure>
<h2>Skin conditions and wounds</h2>
<p>Ocean water differs from river water in that it has <a href="https://web.stanford.edu/group/Urchin/mineral.html">significantly higher amounts</a> of minerals, including sodium, chloride, sulphate, magnesium and calcium. This is why it’s highly useful for skin conditions such as psoriasis.</p>
<p>Psoriasis is a chronic, autoimmune (where the immune system attacks healthy cells) skin condition. People with prosiasis suffer often debilitating skin rashes made of itchy, scaly plaques.</p>
<p>Bathing in natural mineral-rich water, including in mineral springs, is called balneotherapy and has long been used to treat psoriasis. There is also evidence for climatotherapy (where a patient is relocated to a specific location for treatment) in the Dead Sea being an <a href="http://www.jaad.org/article/S0190-9622(03)00916-2/abstract">effective remedy</a> for the condition.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=797&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=797&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=797&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1001&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1001&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149013/original/image-20161207-15197-nakoss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1001&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People with prosiasis suffer often debilitating rashes made up of itchy, scaly plaques on their skin.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Patients suffering from psoriasis have themselves reported feeling better <a href="https://blog.23andme.com/23andme-research/what-patients-say-works-for-psoriasis/">after swimming in the ocean</a>, but this may also have to do with sun exposure, which has been found to <a href="http://www.tandfonline.com/doi/abs/10.3109/09546639609089534">improve psoriasis</a> symptoms.</p>
<p>Ocean swimming also has benefits for eczema, another immune-mediated condition. Swimming in the sea can be a good exercise option for those with severe eczema as they often struggle to exercise in the heat and chlorinated pools.</p>
<p>But the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2012.04636.x/full">response of eczema sufferers</a> to saltwater is variable: some find it soothing, others uncomfortable.</p>
<p>There is some evidence to support the idea <a href="http://www.mgwater.com/transdermal.shtml">magnesium absorption</a> is <a href="http://www.progressivehealth.com/learn-how-to-treat-eczema-with-epsom-salt.htm">beneficial for the skin</a> of eczema sufferers – presumably because it makes it less dry – as those using Epsom salt baths will attest. This may happen because <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2005.02079.x/full">magnesium-rich seawater</a> may improve moisture retention in the skin, making it stronger and more rigid. </p>
<p>Because it is rich in other mineral salts such as sodium and iodine, ocean water can be <a href="http://www.abc.net.au/health/talkinghealth/factbuster/stories/2010/03/18/2849271.htm">considered an antiseptic</a>, meaning it may have wound-healing properties. On the other hand, swimming in the ocean with open wounds may expose you to potential bacterial infections.</p>
<h2>Hay fever and sinus issues</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149021/original/image-20161207-25727-fky0w6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people with sinus conditions and hay fever find nasal irrigation with salt-containing solutions helpful.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Nasal irrigation, or flushing of the nasal cavity, with salty solutions is used as a complementary therapy by <a href="https://www.ncbi.nlm.nih.gov/pubmed/14712112?dopt=Abstract">many people suffering from hay fever</a> as well as inflammation and infection of the sinuses.</p>
<p>Ocean swimming and exposure to the salt environment are possibly associated with reduced symptoms of hay fever and sinusitis, as well as other respiratory symptoms. </p>
<p>This is because the <a href="http://www.aafp.org/afp/2009/1115/p1117.html">saline effect on the lining of sinuses</a> may reduce inflammation, although scientific evidence for this is less robust.</p>
<p>The director of clinical services at the medical charity Allergy UK claims people who live by, and swim in, the sea tend to have <a href="http://www.dailymail.co.uk/health/article-2385191/Sea-swimming-add-years-life.html">healthier respiratory systems</a>. </p>
<p>She says because seawater is cleansing and mimics the body’s own fluids in the lining of the airways, it doesn’t irritate them.</p>
<h2>Meditation and relaxation</h2>
<p>Exercising in natural environments has been shown to have <a href="http://www.sciencedirect.com/science/article/pii/S0277953612003565">greater benefits for mental health</a> than exercising elsewhere. This is because it combines the benefits of exercise with the restorative effects of being in nature. Swimming in the ocean is no less the case.</p>
<p>It can be relaxing, meditative and reduce stress. In his 2014 book <a href="https://www.washingtonpost.com/national/health-science/blue-mind-explores-the-calming-effect-that-water-has-on-people/2014/07/28/471d7a5a-11bb-11e4-9285-4243a40ddc97_story.html?utm_term=.1309b168eeb9">Blue Mind</a>, marine biologist Wallace J. Nichols brought together evidence for why people find themselves in a meditative and relaxed state when they are in, on or under water. </p>
<p>One reason is the <a href="http://www.sciencedirect.com/science/article/pii/S0149763405802106">breathing patterns used during swimming</a> and diving. These stimulate the parasympathetic nervous system (the system that controls organ function and quietens the brain) and have effects on brain waves and hormones that influence the brain positively. </p>
<p>The weightlessness of water can also have a <a href="http://bmhmag.com/what-swimming-can-do-for-mental-health/">calming effect on the mind</a>, <a href="http://www.sciencedirect.com/science/article/pii/S105381190800757X">even changing</a> or slowing down brain waves. </p>
<p>It can help provide a distraction from life, giving a sense of mindfulness, which is a state in which one is aware of one’s surroundings in a meditative sort of fashion.</p>
<p>Hydrotherapy (water therapy) and swimming have also been <a href="http://psychcentral.com/blog/archives/2010/08/04/how-swimming-reduces-depression/">shown to decrease symptoms</a> of <a href="https://www.psychologytoday.com/blog/inner-source/201407/cold-splash-hydrotherapy-depression-and-anxiety">depression and anxiety</a>. <a href="https://www.ncbi.nlm.nih.gov/pubmed/20178872">One study showed</a> the effects of balneotherapy were comparable to a commonly used anti-depressant drug called paroxetine.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149022/original/image-20161207-13648-bdnm79.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Being in the sea can be a meditative experience.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/swimming?photo=g0n0FLM3UTg">Jonny Clow/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Cold water therapy</h2>
<p>Hydrotherapy has been <a href="http://www.sciencedirect.com/science/article/pii/S1934148209005516">extensively used in rehabilitation</a>, but here I will focus on the health benefits of swimming in cooler ocean water. </p>
<p>Cold-water swimming <a href="http://journals.co-action.net/index.php/ijch/article/viewFile/17700/20171">activates temperature receptors</a> under the skin that release hormones such as endorphins, adrenalin and cortisol. These have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4049052/">therapeutic benefits</a> for musculoskeletal conditions – <a href="https://theconversation.com/hidden-and-unexplained-feeling-the-pain-of-fibromyalgia-48319">such as fibromyalgia</a>, which is a condition with chronic pain and tenderness all over the body – and skin discomfort. </p>
<p>Recurrent cold water exposure may also lead to enhanced function of the parasympathetic nervous system, which helps with organ function. This has been linked to an increase in the <a href="https://www.ncbi.nlm.nih.gov/pubmed/12546194">release of dopamine</a> and serotonin.</p>
<p>Depending on the temperature, swimming in colder waters will <a href="https://www.ncbi.nlm.nih.gov/pubmed/7068314">use up more calories</a> to preserve body temperature – although the overall effect on fat mass is controversial.</p>
<p>Frequent <a href="http://link.springer.com/article/10.1007/BF00242274">exposure to cold water</a> has also been shown to <a href="http://www.circumpolarhealthjournal.net/index.php/ijch/article/download/17474/19822">increase the body’s immunity</a>.</p>
<p>Overall, you would be wise to make ocean swimming a health habit.</p><img src="https://counter.theconversation.com/content/68583/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sergio Diez Alvarez does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Seawater has been used to treat skin problems, sinuses and mental health issues for centuries. And the evidence largely stacks up.Sergio Diez Alvarez, Director Of Medicine, The Maitland and Kurri Kurri Hospital, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/453182016-02-23T01:17:22Z2016-02-23T01:17:22ZExplainer: what is eczema and what can you do about it?<figure><img src="https://images.theconversation.com/files/106405/original/image-20151217-32606-108jo3x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you or someone in your family has suffered with severe eczema, you've probably tried all sorts of remedies to alleviate the itching.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-270420824/stock-photo-woman-has-itch-on-gray-background.html?src=pp-photo-281163671-OG3ZUW2WABrImPXX79et2A-8&ws=1">Africa Studio/Shutterstock</a></span></figcaption></figure><p>Eczema is a genetic disorder with an environmental trigger, which affects <a href="http://www.asthmaaustralia.org.au/Eczema.aspx">one in three</a> people at some time in their life. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1014&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1014&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1014&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1274&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1274&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106408/original/image-20151217-32600-w4c943.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1274&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-74586262/stock-photo-mechanism-of-eczema.html?src=OG3ZUW2WABrImPXX79et2A-1-57">Alila Medical Media/Shutterstock</a></span>
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<p>People with eczema essentially have sensitive skin that is easily irritated. The irritation produces dryness by disrupting the function of the external waterproof skin barrier, allowing water to leave the skin.</p>
<p>The main gene associated with eczema – or atopic dermatitis, as it’s known clinically – is <a href="http://jcs.biologists.org/content/joces/122/9/1285.full.pdf">filaggrin</a>. Filaggrin mutations reduce the ability of the skin to withstand environmental insults and to repair itself after injury. </p>
<p>Disruption to the skin barrier allows allergens to enter the deeper layers of the skin and activate the immune system. </p>
<p>How the immune system reacts to these allergens determines the severity of the skin inflammation and the duration of the disruption to the skin barrier function. </p>
<h2>What can you do about it?</h2>
<p>If you or someone in your family has suffered with severe eczema, you’ve probably tried all sorts of remedies to alleviate the itching. Here are five tips to calm your skin:</p>
<p>1) <strong>Avoid things that irritate the skin</strong>. No matter how wonderful a hot shower feels on itchy skin, it actually aggravates eczema. Keep showers to five minutes or less and use luke-warm water. </p>
<p>Wash with water alone: no soap, no soap substitute, no soap-free wash and definitely no bubble bath. Just water. </p>
<p>2) <strong>Avoid overheating</strong>. Heat makes the itch worse, irrespective of the cause. Turn the heating down to 18 to 20 degrees Celsius (64 to 68 degrees Farenheit) and put on an extra layer of clothing. </p>
<p>Take the doona off your bed and sleep under good old-fashioned cotton blankets. Overheating at night leads to scratching in your sleep. If there is blood on your sheets in the morning, that is a sure sign your bed is too hot at night.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106410/original/image-20151217-32609-sitrrv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Apply moisturiser frequently and liberally.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-203589715/stock-photo-girl-applying-cream-on-allergic-skin-eczema-treatment.html?src=OG3ZUW2WABrImPXX79et2A-1-4">Kaspars Grinvalds/Shutterstock.</a></span>
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<p>3) <strong>Take a <a href="https://www.aad.org/public/diseases/eczema/atopic-dermatitis">bleach bath</a></strong>. This is a simple method to reduce the bacteria on the surface of your skin. For a full tub of water, use half a cup of bleach. Never apply bleach directly to the skin. (More safety tips and instructions are <a href="https://www.aad.org/public/diseases/eczema/atopic-dermatitis">available here</a>.) </p>
<p>If the eczema is weeping, oozing or has honey-coloured crusts, there is almost always golden staph on the skin surface aggravating the eczema. Bleach baths are a good alternative to antibiotics. </p>
<p>4) <strong>Use lots and lots of moisturiser</strong>. To fix eczema you will also need to restore the skin barrier. That requires frequent and liberal use of moisturiser, including after the eczema appears to have cleared up. </p>
<p>There are lots of moisturisers on the market. Trial and error is the best way to find the right moisturiser for your skin. Keep in mind that if you use a light one, you need to reapply it more often than a heavy one.</p>
<p>While tablets can help stop the inflammation, in general that’s not enough to stop the eczema. </p>
<p>5) <strong>Use your topical <a href="http://www.eczema.org/corticosteroids">corticosteroid</a> creams as directed</strong>. Additives reduce the skin thinning that can occur with prolonged use of potent topical steroids. Your dermatologist is the best person to advise you on this.</p>
<h2>Emerging therapies</h2>
<p>Researchers are investigating whether a new class of drugs, called <a href="https://theconversation.com/explainer-what-are-biologics-and-biosimilars-45308">biologics</a>, could help manage severe eczema. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/106409/original/image-20151217-32590-169wr7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Biologics show promise but they’re still several years away.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-70176649/stock-photo-close-up-of-a-patients-elbow-showing-plaques-of-dry-skin-typically-seen-with-psoriasis.html?src=G3rf0xH0dBoWj_h2TD4Yig-2-69">Quayside/Shutterstock</a></span>
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<p>Biologics try to block critical steps within certain pathways, which can terminate inflammation.</p>
<p>Biologics are most commonly produced from bacteria or yeast cultures. Specific genes are inserted into bacteria and yeast that have been inactivated so they are no longer dangerous to humans. </p>
<p>Production of biologics in this way is slow, low-volume, high-tech and expensive. Consequently, biologics can cost tens of thousands of dollars per patient per year. </p>
<p>A number of <a href="https://www.centerwatch.com/clinical-trials/listings/location/international/Australia/East%20Melbourne/">clinical research trials</a> are underway to test these agents. People with severe eczema, which is not adequately controlled with current treatments, may consider enrolling to participate in a research trial. </p>
<p>It will still take three to five years for the results of these trials to be fully assessed and to know whether biologic agents are safe and effective in the management of eczema. If they are, they could revolutionise the management of severe eczema.</p><img src="https://counter.theconversation.com/content/45318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People with eczema essentially have sensitive skin that is easily irritated.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/403182015-10-07T19:24:44Z2015-10-07T19:24:44ZWhat are allergies and why are we getting more of them?<figure><img src="https://images.theconversation.com/files/95161/original/image-20150917-7521-3ppdou.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Allergies are becoming more frequent in the western world. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/al-stan/3475946574/">Al Fed/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>Allergies are reactions caused by the immune system as it responds to environmental substances that are usually harmless to most people. They may occur in response to a range of different material (called allergens), such as food, pollen, dust mites, animals, insect stings, or medicines.</p>
<p>An allergy can <a href="http://www.allergy.org.au">affect different parts of the body</a>. Allergic rhinitis, or hay fever, for instance, affects the nose and eyes, while eczema affects the skin. Food allergies affect the gut, skin, airways, lungs, and sometimes the entire body through the blood vessels. </p>
<p>Other conditions such as asthma, which affects the lungs, and eosinophilic oesophagitis, which affects the tube from the throat to the stomach, are closely related to allergy. But they have slightly different underlying causes. </p>
<h2>A range of reactions</h2>
<p>While most reactions are only mild to moderate in severity (and can be treated with antihistamines), some can be life-threatening and require emergency medical treatment. The most severe, systemic allergic reactions are known as anaphylaxis. People with known severe allergies should have an <a href="http://www.allergy.org.au">emergency management plan</a> that includes an adrenaline auto-injector for emergency use. </p>
<p>We can confirm whether someone has an allergy by doing a skin-prick testing or a blood test that checks whether their immune system has produced antibodies to an allergen. If the immune system has developed antibodies, it will remember the allergen as a potential threat and is likely to mount a strong immune response on subsequent exposure. </p>
<p>The likelihood of someone having an allergic reaction from future exposures to the allergen is determined by taking their clinical history and these test results into account. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=265&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=265&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=265&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=333&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=333&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95141/original/image-20150917-12695-2a4xns.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=333&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Allergic rhinitis, or hay fever, affects the nose and eyes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/14353437@N06/4515249683/">parrchristy/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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<p>In the case of food allergy, if the probability of an allergic reaction is low, people are given a food challenge. This is when increasing amounts of the offending food are administered while the person is closely observed for any signs of an allergic reaction. Of course, it can result in a reaction.</p>
<p>Allergies are becoming more frequent in Australia and the rest of the western world. <a href="http://www.allergy.org.au/">One in three people in Australia</a> will develop allergies at some time in their life. One in 20 will develop a food allergy and one in 100 will have a life-threatening allergic reaction known as anaphylaxis .</p>
<p>Hospital admissions for anaphylaxis <a href="http://www.ncbi.nlm.nih.gov/pubmed/26187235">doubled in the ten years</a> from 1994 to 2004, and were five times higher in children under five years old over the same period. This suggests the development of allergy in early life is increasing at a faster rate than in adults.</p>
<p>Children are <a href="http://www.abc.net.au/news/2015-07-15/number-of-children-hospitalised-with-food-allergies-on-the-rise/6619752">more likely to develop allergies</a> to eggs, dairy products or peanuts, while adults are more likely to develop an allergy to seafood. </p>
<h2>Possible reasons why</h2>
<p>The reasons for the rising number of allergies are not fully understood, but here are six theories.</p>
<p>1) Decreased exposure to infections or microbes – or both – in early life could lead to an increased risk of allergy. This is commonly referred to as the hygiene hypothesis, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1838109/">first suggested in 1989</a>. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21060319">Research showing</a> children who have close contact with pets or livestock and those who come from larger families are less likely to develop allergies have indirectly supported the hygiene hypothesis.</p>
<p>2) Delayed introduction of allergenic foods, such as eggs and nuts, until later in childhood could also have an impact. This is one of the most recent theories resulting from the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1414850">LEAP study</a>, published in 2015. This randomised trial for early life peanut consumption in a population at increased risk of developing peanut allergies demonstrated that exposure to the nut early in life is protective against developing the allergy.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/95162/original/image-20150917-7517-3j4zx9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A child with a nut allergy only has a 20% chance of the allergy resolving by the time she reaches adulthood.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/aoifemac/8424630783/">Aoife Mac/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>3) Different methods of preparing foods can <a href="http://www.ncbi.nlm.nih.gov/pubmed/19000582">impact the degree</a> to which they invoke an allergic response; roasting peanuts, for instance, greatly increases allergenicity while boiling reduces it. This may in part explain difference in incidence of in peanut allergy between certain countries.</p>
<p>4) Vitamin D deficiency may increase the risk to develop allergies. Several studies show that the further away you live from the equator (hence your lower level of sunlight exposure, which is needed to make Vitamin D) – or <a href="http://www.abc.net.au/health/features/stories/2013/03/07/3710140.htm">low vitamin D blood levels increase your risk</a> of developing allergies. But the value of vitamin D treatment for preventing allergies has yet to be demonstrated. </p>
<p>5) Allergies may develop after exposure to allergens, such as dairy products or nut oils in skin moisturisers, particularly on inflamed sites, such as eczema.</p>
<p>6) Altered gut bacterial species due to low-fibre diets and widespread antibiotic usage may alter the body’s immune function and create an allergy.</p>
<p>Whether your allergy improves over time often depends on the type of allergy you have. A child with eczema, for instance, will often find her eczema improves by the time she’s a teenager. But some people will have eczema even into their adult years. In contrast, a child with peanut allergy only has a 20% chance of the allergy resolving by the time she reaches adulthood.</p>
<p>While we have treatments for the symptoms of allergy, we do not yet have a cure or the ability to prevent them from developing in the first place. We also don’t have a good test for predicting food allergy, unless we feed the person the suspected food allergen. For now, the best you can do is to manage your allergy.</p><img src="https://counter.theconversation.com/content/40318/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Collison receives funding from the NHMRC, Hunter Children's Research Foundation and the Thrasher Research Fund. He is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p><p class="fine-print"><em><span>Joerg Mattes receives/received funding from the National Health&Medical Research Council, the Hunter Medical Research Institute, the Hunter Children's Research Foundation, Asthma Australia, Rebecca L. Cooper Medical Research Foundation. He is a listed inventor on a patent describing a peanut anaphylaxis blood biomarker.</span></em></p><p class="fine-print"><em><span>Rani Bhatia receives funding from the Hunter Children's Research Foundation. She is an inventor on a provisional patent that describes a marker for peanut allergy.</span></em></p><p class="fine-print"><em><span>Elizabeth Percival does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Allergies are reactions caused by the immune system as it responds to environmental substances that are usually harmless. But we don’t yet have a cure or the ability to prevent them from developing.Adam Collison, Post Doctoral researcher - Experimental and Translational Respiratory Medicine Research Group, University of NewcastleElizabeth Percival, Staff Specialist General Paediatrician at John Hunter Children's Hospital, Newcastle, Australia. Conjoint Lecturer & PhD student, University of NewcastleJoerg Mattes, Professor&Chair of Paediatrics | HMRI, University of Newcastle, Australia | Senior Staff Specialist Paediatric Respiratory&Sleep Medicine | John Hunter Children's Hospital, Australia, University of NewcastleRani Bhatia, Senior Staff Specialist in Paediatric Allergy and Immunology at John Hunter Children's Hospital Newcastle NSW Conjoint Lecturer in Paediatrics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/454602015-08-03T10:43:02Z2015-08-03T10:43:02ZAsthma rates falling but eczema and hay fever stand still. What does this tell us about allergies?<figure><img src="https://images.theconversation.com/files/90357/original/image-20150730-25742-ifbu5g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Asthma rates in the UK look to be falling</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=asthma&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=291685250">parinyabinsuk</a></span></figcaption></figure><p>You might have thought that health specialists would closely monitor the prevalence of allergies in the population, especially when they are far more common than they used to be. In fact, it happens less than you would think. For asthma, for example, the government <a href="http://www.hscic.gov.uk/hes">publishes statistics</a> on the numbers of people that are admitted to hospital or die from the condition, but it does not publish a running total of how many people are affected overall. </p>
<p>The University of Aberdeen is one of very places that does regularly publish data on childhood asthma, eczema and hay fever, going back as far as 1964. Though we only survey what is happening in the city, the figures are closely watched because they have a very good record of predicting the incidence of these allergies across the rest of western Europe. </p>
<p>When we published our five-yearly report on July 29, it <a href="http://www.scotsman.com/news/health/child-asthma-sufferers-down-by-nearly-a-third-1-3844603">showed that</a> childhood prevalence of asthma had fallen by a third to around 20% following a long rise over decades. Reasons are likely to include improved air quality, reduced smoking, changing diets and improved diagnosis. </p>
<p>The figures showed something else very interesting too. Since our study began, in line with most other research into the prevalence of allergies, rises and falls in the rate of asthma have been broadly followed by those for eczema and hay fever. Not on this occasion, though. The latter two complaints stayed around their previous levels as asthma rates fell on their own. </p>
<p>This doesn’t look like a freak occurrence. We saw some evidence of this <a href="http://www.ncbi.nlm.nih.gov/pubmed/21068081">in 2009</a>, as did <a href="http://ije.oxfordjournals.org/content/37/3/559.full">another study</a> in Australia the year before. It looks like a trend is developing. So what is going on?</p>
<h2>The allergy debate</h2>
<p>Specialists have for many years debated the nature of allergy. We know that allergies are associated with the immune system producing an antibody called <a href="http://www.worldallergy.org/professional/allergic_diseases_center/ige/">immunoglobin E (IgE)</a>, which binds itself to common things in our environment such as grass pollen and house dust mites when they come in contact with the body. The classic view was that allergic people overproduced this antibody, which in turn produced substances that caused the inflammation and irritation in complaints such as asthma or eczema. In short, asthma, eczema and hay fever were thought to be caused by being allergic. </p>
<p>There’s a flaw in this argument, though. If an organism is going to become allergic to something outside it, it must be exposed through a crack in the skin. For this reason, some specialists <a href="http://www.ncbi.nlm.nih.gov/pubmed/10669837">began arguing</a> from the early 1990s that you became allergic to something because there was a problem with, in the case of asthma, the cells lining the lungs. In this scenario the primary “abnormality” is in these lung cells, which leads to asthma and also does not provide an effective barrier against environmental exposures. The immune system is fundamentally normal and is just doing what it is meant to do and responding to exposures which “leak” through into the body. The immune response then adds to the problem caused by the lung-cell abnormality. </p>
<h2>Stat power</h2>
<p>Public opinion can be hard to change (and medical opinion harder still) but we are now at a point where most medical people would accept that it is not the allergy that causes asthma – though some certainly still believe it. What we don’t have yet is proof, though we will hopefully produce some over the next few years at this university and with colleagues across the UK through our studies into the lung cells of small children. </p>
<p>In the meantime, this is where the divergence in our stats comes in. If being allergic caused allergies, you would expect the rates of asthma, hay fever and eczema across the population to roughly move in unison. In other words, for many years our stats and those from other sources supported the old theory. </p>
<p>At the same time, though, supporters of that theory had to contend with the fact that having one of these allergies has never meant you would have all of them – a correlation you would also expect if the theory were true. In our most recent figures, for instance, only 55% of children with asthma had hay fever, and only 64% of them had eczema. This weakish correlation has always supported the newer theory – and the divergence now backs this up. It adds to the probability that we misunderstood the nature of allergy for a long time. It does leave the mystery of why the allergy rates moved in unison for so long, but that is a matter for another day. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90358/original/image-20150730-25740-xknbct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The eczema/asthma correlation is far from 100%</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&search_tracking_id=W2TCwn9MDm-GiXw0980sig&searchterm=eczema&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=296161622">sumroeng chinnapan</a></span>
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<p>This doesn’t have a huge bearing on our ability to treat asthma. It is more about knowing that we understand a process correctly and this is important to preventing asthma. In terms of treatment, the general view is that asthma can’t be cured. But there is <a href="http://www.davidhideallergyresearch.co.uk/prevention.html">mounting evidence</a> that it can be prevented by exposing babies who are genetically predisposed to the condition to the right environment while they are in the womb and then for the first couple of years of their life. What we still don’t know is what the right environment is, but modifying exposures to cats, dogs, mould, smoking, breastfeeding and weaning diet are likely to be important. </p>
<p>I can see us reaching a point in ten or 15 years where pregnant mothers with at-risk unborn children will be offered a course of “environmental modification” treatment, possibly as simple as a pill. Ensuring that the immune system of children at increased risk for asthma is flooded by exposed to allergens at a sufficiently early stage will switch off any later IgE production. Although they may still have the lung-cell abnormality, at least they don’t get the added hit of an allergic immune system. In this sense at least, a cure for asthma may not be far away.</p><img src="https://counter.theconversation.com/content/45460/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Turner does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There have long been two schools of thought on what causes allergies. New stats are much more helpful to one than the other.Steve Turner, Consultant Paediatrician and Senior Lecturer in Child Health, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.