Embark on a scientific odyssey into the intricate world of autoimmune skin conditions – eczema and psoriasis. As a dedicated functional physician, my mission is to unravel the underlying complexities of these disorders, comparing and contrasting their autoimmune origins, exploring triggers, and outlining both conventional and functional approaches for managing these conditions.
Understanding Autoimmunity in Eczema and Psoriasis:
Eczema and psoriasis, though distinct in appearance, share a common thread of autoimmunity. In both conditions, the immune system mistakenly attacks healthy skin cells, leading to chronic inflammation and skin lesions. Let’s delve into the unique characteristics of each, starting with their autoimmune underpinnings.
Eczema (Atopic Dermatitis):
Eczema is often associated with dysregulation in the adaptive immune system, particularly the overactivity of T-helper 2 (Th2) cells. This immune response triggers an inflammatory cascade, leading to the hallmark red, itchy, and inflamed skin patches.
Psoriasis:
Psoriasis, on the other hand, involves the hyperactivity of T-helper 17 (Th17) cells and their signature cytokine, interleukin-17 (IL-17). This Th17-driven immune response accelerates skin cell turnover, resulting in the characteristic plaques and scales observed in psoriasis.
Comparing Triggers – Lifestyle, Biological, and Environmental:
Autoimmune skin conditions are often triggered by a combination of genetic predisposition and environmental factors. Let’s explore the diverse triggers for eczema and psoriasis, highlighting both commonalities and distinctions.
Lifestyle Triggers:
Lifestyle factors such as stress, lack of sleep, and poor skincare practices can exacerbate both eczema and psoriasis. Chronic stress, in particular, can activate the release of pro-inflammatory cytokines, contributing to flare-ups in susceptible individuals.
Biological Factors:
In the case of eczema, chronic infections, particularly recurrent bacterial or viral infections, can act as triggers for flare-ups. Staphylococcus aureus, commonly found on the skin, can colonize and exacerbate eczema by producing toxins that elicit an immune response, intensifying inflammation. Viruses like herpes simplex may also contribute, with studies linking their presence to increased eczema severity. Moreover, certain childhood immunizations, while crucial for overall health, can potentially stimulate the immune system in a way that influences the development or exacerbation of eczema in predisposed individuals.
For psoriasis, chronic infections, especially streptococcal infections, are strongly implicated in triggering or worsening the condition. Streptococcus pyogenes, responsible for various infections, has been associated with the onset of guttate psoriasis or the exacerbation of existing plaques. Immunizations, particularly those that elicit a robust immune response, may also influence psoriasis. For instance, the immune-stimulating effects of vaccinations can potentially trigger the activation of T cells and cytokines involved in psoriatic inflammation, although the overall impact remains a subject of ongoing research.
Mold toxins, known as mycotoxins, produced by certain fungi, have been implicated in various health issues, including immune-related disorders. Exposure to mold toxins can occur through contaminated indoor environments or ingestion of contaminated food. Mold toxins may contribute to inflammation and immune system dysregulation.
These few examples of chronic infections only scratch the surface of possible infections that trick the immune system to staying activated and targeting the body’s cells as a persistent enemy.
Environmental Toxins:
Exposure to environmental toxins, including pollutants, allergens, and certain skincare products, can act as triggers. Heavy metals, such as mercury, lead, and cadmium, have been associated with increased prevalence and severity of psoriasis, with studies suggesting a potential link between metal exposure and the activation of inflammatory pathways in the skin. Phthalates, commonly found in plastics and personal care products, have been implicated in eczema development, potentially disrupting the skin barrier function and promoting inflammatory responses. Additionally, bisphenol A (BPA), an industrial chemical used in plastics, has been linked to autoimmune disorders, with evidence suggesting its role in triggering immune dysregulation. The ability to measure these environmental toxins through sophisticated panels and assays provides a quantitative understanding of their impact on autoimmune skin conditions, aiding in the development of targeted interventions aimed at minimizing exposure and mitigating their influence on disease progression.
The role of glyphosate, a widely used herbicide, and mold toxins in the context of autoimmune skin conditions such as psoriasis and eczema is a subject of ongoing research, and their potential contributions are complex and multifaceted.
Glyphosate, the active ingredient in the herbicide Roundup, has been associated with disruptions in the gut microbiome and the potential for increased intestinal permeability (leaky gut). Some studies suggest a link between glyphosate exposure and autoimmune disorders, as alterations in gut integrity may contribute to immune dysregulation
Inflammatory Markers, Interleukins, and Cytokines:
The molecular landscape of autoimmune skin conditions involves a symphony of inflammatory markers, interleukins, and cytokines that come from immune cells in the body. Precision in measuring these components provides insights into the severity and progression of eczema and psoriasis.
Eczema Inflammatory Markers:
- IgE Antibodies: Elevated immunoglobulin E (IgE) levels indicate an allergic response, often observed in eczema patients.
- IL-4 and IL-13: Th2-driven responses, marked by elevated interleukin-4 (IL-4) and interleukin-13 (IL-13), contribute to the inflammation seen in eczema.
Psoriasis Inflammatory Markers:
- IL-17 and Th17 Cells: Psoriasis is characterized by elevated levels of interleukin-17 (IL-17) and the involvement of T-helper 17 (Th17) cells. IL-23 plays a crucial role in supporting the survival and expansion of IL-17-producing immune cells. This Th17-driven immune response accelerates skin cell turnover, resulting in the characteristic plaques and scales observed in psoriasis.
- Tumor Necrosis Factor-alpha (TNF-α): Elevated TNF-α levels contribute to the inflammatory cascade in psoriasis, supporting the rapid turnover of skin cells.
Psoriasis and Eczema Markers
- Tumor Necrosis Factor-alpha (TNF-α): is a proinflammatory cytokine that plays a central role in orchestrating inflammation. Elevated levels of TNF-α are commonly observed in both psoriasis and eczema, promoting the recruitment of immune cells and amplifying the inflammatory response.
- Interleukin-1 (IL-1): is a potent proinflammatory cytokine involved in the regulation of immune responses.
- Interleukin-6 (IL-6): is a multifunctional cytokine involved in the regulation of immune responses and acute-phase reactions.
- Interleukin-8 (IL-8): is a chemokine,a protein that acts as a messenger, guiding immune cells to specific locations within the body in response to infection, inflammation, or tissue damage.
Lifestyle and Dietary Approaches to Lower Inflammation:
Harnessing the power of lifestyle and dietary interventions is pivotal in managing autoimmune skin conditions. Here’s a detailed exploration of strategies that promote lower inflammation in the body:
Anti-Inflammatory Diets:
- Mediterranean Diet: Rich in omega-3 fatty acids, antioxidants, and anti-inflammatory foods, the Mediterranean diet has shown promise in reducing inflammation associated with eczema and psoriasis.
- Anti-Inflammatory Foods: Incorporating foods like turmeric, ginger, and green leafy vegetables can help modulate inflammatory pathways
- Vegan: Proposed reasons why vegan diets can be low in inflammation include: high antioxidant content; omega-3 fatty acids from plant sources such as flaxseeds, chia seeds, and walnuts; fiber to help support a healthy gut microbiome; flavonoids and polyphenols, which have been shown to possess anti-inflammatory properties; and reduced intake of animal saturated fats.
Supplements (Naming a Few):
- Omega-3 Fatty Acids: Supplementation with omega-3 fatty acids, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), has demonstrated anti-inflammatory effects in autoimmune skin conditions.
- Vitamin D: Maintaining optimal vitamin D levels supports immune regulation and may alleviate symptoms in psoriasis patients.
- Quercetin
- Turmeric
- Reseveratrol, found in the skin of grapes.
- Green tea extract
- Bromelain, found in pineapple
- Probiotics
- Selenium
Immune-Based Medications:
In recent years, immune-based medications have revolutionized the treatment landscape for eczema and psoriasis. Understanding the mechanisms of these medications is crucial for tailoring effective therapeutic approaches. Medications are evolving to include a few new players named below.
- Eczema Medications:
- Dupilumab: This monoclonal antibody targets IL-4 and IL-13, key players in the Th2-driven inflammation observed in eczema. By modulating these cytokines, dupilumab helps alleviate symptoms.
- Psoriasis Medications:
- Secukinumab and Ixekizumab: These biologics specifically target IL-17A, inhibiting the inflammatory cascade associated with Th17-driven responses in psoriasis.
- TNF-α Inhibitors: Medications like etanercept and adalimumab block TNF-α, reducing inflammation and slowing down skin cell turnover.
Conclusion:
In the intricate tapestry of eczema and psoriasis, understanding the autoimmune roots, triggers, and treatment modalities is essential for effective management. As functional physicians, we navigate the scientific nuances, offering a holistic approach that encompasses lifestyle modifications, dietary interventions, and the strategic use of immune-based medications. Here’s to unlocking the mysteries of autoimmune skin conditions, paving the way for a future where comprehensive, personalized care transforms the lives of those affected.
