Live chat med Dr Peter Lio

The Eczema Company er et amerikansk firma, der sælger cremer, tøj og andet til børn og voksne med eksem. De har også en Facebook side og tilfældigvis så jeg at de havde arrangeret en times chat med Dr Peter Lio, der arbejder på en eksemklinik i Chicago. Det var kl 21 lokal tid, hvilket så var kl 3 i nat, så det stod jeg altså ikke op til, men det har været spændende at læse spørgsmål og svar her til morgen. Det er jo mange af de samme spørgsmål som vi stiller hinanden.

Her har jeg samlet dem lidt sammen ellers kan hele tråden læses her:

Om eksem er et stigende problem:

Spørgsmål: it seem like the number of people with ezcema is growing? If so, is there any research about why? Environment, our food, etc ?

Svar: Such an important question: there does seem to be a huge increase in the amount of eczema cases each year. Provocatively, it seems very limited to developed countries. A friend who is a dermatologist in Australia talked about the tremendous distinction: in the indigenous people, there is almost no eczema at all, but in the cities, it is rampant!

Om “leaky gut”:

Spørgsmål: I come from a crunchy circle of moms and find it a lot on FB too but so many people talk about “Leaky Gut” causing eczema. Is there hard science on that?   

Svar: The “Leaky Gut” question is super interesting! I am literally putting the finishing touches on a paper about it now. Short answer: Yes, there is some real science to it and this is an exciting area of study that I am very interested in. Slightly longer answer: It’s really complex, however, and difficult to know what types of interventions will make a big difference. Importantly, there is “leaky skin” with eczema–and that is something closely related to the leaky gut, and something we have to work on repairing. Good news: moisturizers help leaky skin! And inflammation makes it much worse, so anti-inflammatory treatments and anti-bacterial treatments also help leaky skin. Whew! Lots to talk about there… it’s such an important question!

Spørgsmål: Advice on how to treat leaky gut?

Svar: Treating leaky gut: this is HARD! But we think that probiotics can make a big difference in some cases (lactobacillus GG is a good one!) and almost certainly the types of foods we eat (less processed, more “whole”, and fermented ones are probably good too). Problem: little kids are picky picky picky and so this is tough for many!

Spørgsmål: And it’s separate from becoming sensitized to food someone is currently eating while being inflamed with eczema?

Svar: And yes, this is separate from food allergy and intolerance–it’s that the lining of the gut is literally leaky–letting proteins and other substances through that it should keep out–just like Leaky Skin!

Spørgsmål: Do you think treatments that only address the “leaky gut” can make a difference with eczema? I was on crazy elimination diets with my son and it made little difference with his eczema.

Svar:  I think you bring up a key point: In my experience, *only* treating the gut is generally not enough… you almost always have to treat the skin as well. I think they are both important!

Spørgsmål:  I guess my follow up question about Leaky Gut is whether it corresponds to the equivalent of “Leaky Skin”…it was our experience that my 2 yr old suddenly had a host of food allergies found through skin tests but 6 months later had completely different results on tests done at National Jewish Health and if they follow a belief that “once the skin is calm, then test”, that would mean the gut isn’t really problem. My son was eating collard green & kale soups while on a strict elimination diet (at age 2) so not too picky.

Svar:  Yes, I think that leaky skin and leaky gut are intimately related, but I honestly think that the leaky skin is the part we can best approach and–for eczema–the most important. We are so limited with what we can do with the gut directly and have so many options for the skin. And your experience fits with my general understanding: once we get the skin better (even ignoring the gut), the patients often do great and everything falls back in line. On the other hand, I’ve seen some pretty intense diets not work well, so that is why I put my emphasis on the skin. Humørikonet smile

Om probiotika:

Spørgsmål: Do you have any probiotics you recommend that you’ve seen results with? Maybe some with the strain you mentioned, lactobacillus GG?

Svar: The probiotic that I have the most experience with is Culturelle–it’s pretty inexpensive and has the most research that supports it. It’s not very “glamorous” and is sometimes perceived as “generic”, but I do like it.

Om behandling i bade:

Spørgsmål: There is lots of talk of sea salt baths particularly Celtic Sea salt.. What are your thoughts on this?

Svar: I like sea salt baths (Dead Sea, Epsom salts, etc). There is some data that they can help. In my experience, the salts by themselves can soothe the skin a bit, but are generally not dramatic treatments. GOING to a place like the Dead Sea or the baths at Avene can be dramatic, but it’s a pretty big deal to do that.

Spørgsmål: Sea salt baths vs bleach baths vs antimicrobial soaps . . Which do you advise?

Svar: I like bleach baths the best! I really don’t care for the antimicrobial soaps as people can get irritated by them and they are terrible for the environment.

Svar: I love dilute bleach baths–turns out they are not just anti-bacterial, but they also have anti-itch and anti-inflammatory effects! Triple win for eczema! I have my patients do them nightly when they are flaring and then 3x per week when better.

Læs i øvrigt et indlæg han har lavet om bade på en blog her.

Om cremer: (amerikanske, så måske ikke så relevante)

Spørgsmål: Dr. Lio, what moisturizer is your favorite? 

Svar: I love love love moisturizers! I could talk about them for hours… and that would put everyone to sleep–except my children who are still running around like crazy people!I don’t have one favorite, but have many that I love: Eucerin Eczema Relief, CeraVe, Aquaphor, Theraplex, Un-petroleum Jelly, Vaniply, Curel… so many great ones depending on what you like.

Læs i øvrigt også om brugen af essentielle olier på Health Ambition her.

Om andre infektioner og udbrud:

Spørgsmål: Why do illnesses make ezcema flare? And is it true teething does as well?

Svar: Yes, illness and teething really do seem to make eczema flare, as do bacterial infections. Anything that sets off the immune system can be a trigger–part of why it’s so maddening!

Om allergener og antihistamin:

Spørgsmål: How would you go about protecting a child’s skin from environmental allergens when playing outside. He is literally allergic to everything outdoors and it causes flares.
Also, do you believe a daily antihistamine like Zyrtec really helps with the intense itch caused by eczema?

Svar:  I hear you–so many of my patients are “pan-allergic” (i.e., allergic to practically everything!) that it’s overwhelming. I think the best approach: a daily antihistamine can help for those who have allergic triggers (but I think your skepticism is right: it doesn’t do much at all for the itch of eczema), and using good moisturizers to protect the skin is key. I also find that a quick bath or shower after being outside, followed by good moisturizer is a powerful way to wash off the itch.

Om histamin i fødevarer:

Spørgsmål: Speaking of antihistamines and diet, do you have any thoughts on low histamine diets? I have a book from the library now, The Eczema Diet, that says daily antihistamines cause the liver and skin to do more waste managment. We are thriving on Dr Aron but wonder about this some. Have you seen patients follow this model (with skin care too) and see changes?

Svar: I have read that book and it is interesting, for sure. I’ve not found low histamine diets to be helpful for eczema, but it can help for certainly allergies and for hives. Big diet changes probably do a lot of different things in the body, and they often are changes towards healthier foods as well, but I just haven’t seen much great success.

Om Staphylokokker:

Spørgsmål: Is there a lot of research now looking at the role of staph and how it acts on eczema skin? I know there is research going on at NIH regarding staph and eczema. I think this will be the key to understanding and treating eczema in the future so I’m curious if researcher are studying it.

Svar: Hi Chris, lots of research on the role of staph–it’s a gigantic breaking area and tons of new papers are out each day. So many people are studying it now and trying to figure it out–me included! It’s super complex because there is the understanding that staph is a “bad guy” among a community of bacteria… it’s like a society on our skin and it raises the question: how to keep society happy and functional? As we know from living in a human society: this is really tricky!