Monthly Archive for May, 2011

Solveeczema.org in Summary

Soap is not the problem, it is often the solution. Image: Sujin Jetkasettakorn / FreeDigitalPhotos.net

My understanding and philosophy about eczema have changed and grown over time. I’m working on updates to the site — and working on a campaign to fund a medical study, stay tuned — but here’s what I believe in a nutshell:

First, these are my opinions — based on an extensive review of medical literature and much discussion with chemists, microbiologists, medical professionals, and many, many parents of children with eczema over the years, but my opinions nevertheless, not accepted medical views. I am not a doctor.

Based on everything I have seen and read, I believe the majority of infantile eczema results from high levels of (often unrecognized) detergents in the environment, especially the home environment. These substances affect the permeability of skin, have a startling physiological impact at even very low levels of exposure, affect people in “atopic families” more, and are absorbed at much higher rates by infant skin. Detergents increase skin permeability, antigen penetration, and thus antigen load. (I describe what I mean by detergents on the web site, it’s not what most people think.)

As children get older, their skin becomes naturally less permeable, they spend less time with their faces on their parents’ clothing and against their hair, and less time crawling across surfaces, and can seem to “outgrow” the eczema, but a lot of these children will go on to develop asthma and allergies, the so-called “atopic march”. As they go through these transitions, kids are also becoming more active, and breathing in more and more — to sensitive lung tissue, the optimal function of which depends on biological surfactant — large amount of synthetic surfactants from indoor environments (dust comprised mainly of skin cells, lint, hair, etc., all of which come with detergents in modern environments).

I have observed and heard over and over again in the years since I put up my site that:

1) When people make the changes I recommend on my site, not only are they able to get rid of the eczema, they go from thinking of it as a random problem to understanding exactly when and why their families are affected, how to prevent breakouts, and how to end them quickly if the exposures can’t be avoided.

2) Along with eliminating the eczema, people see the skin begin to heal and become more substantial, normal, and less dry over a period of about two months.

3) Because entire households have to make the changes for them to be effective, and because atopic families benefit most, I hear frequently that changes made for the benefit of a child with eczema have a marked beneficial effect on other family members’ skin problems, allergies, and asthma.

4) If someone is very focused about it, the changes can be effected for an entire household in as little as a week. People with hard water typically underestimate the impact of water hardness on their ability to make the changes (but many persist). Even if the recommendations address the sole source of the eczema, sometimes infected eczema has to be treated for the problem to go away.

5) Most people have incorrect assumptions, particularly about how green or “natural” what they are already using in their homes is, that contribute to their difficulty coming to this solution on their own. The most effective are those who read through all the information and understand it.

I do not believe environmental detergents are the sole cause of eczema. I do, however, believe that there are only a few other causes and that those causes tie in with this one. I do not believe that there are many causes of eczema, as I so often hear — there are many “triggers” when the cause is not eliminated, but I believe there are only a few causes and that they are related by an underlying biological basis.

Our bodies make detergents for various biological purposes. For lack of standard terminology, I call them biological surfactants. One of these maintains proper pulmonary function (“surfactant” in the lungs). Biological surfactants help us control skin membrane permeability. This is why I believe sodium lauryl sulfate — a chemical analog of biological surfactants — is so problematic.

Another function of biological surfactants is to denature proteins in the blood stream. I believe this is why one segment of people gets full-body eczema from ingesting certain foods, particularly protein-rich foods like milk, especially when their guts are immature (or otherwise compromised) — the “leaky gut” phenomenon may result in increased circulating biological detergent (coupled with unnatural detergent levels in the gut and on the skin from environmental sources). Skin permeability is dramatically and unnaturally increased, antigen penetration and load increases, etc., similar to when the gut isn’t a factor.

Probiotics, beneficial bacteria, have been shown to reduce eczema rates in infants if given to pregnant women. This leads some people to try them when their children get eczema and abandon them if they don’t “work”, but I think they could be used more effectively with a better understanding of when and why they sometimes work. I believe the probiotic effect ties in with the observations I have made on my web site, and with my theories about why eczema and asthma have risen so dramatically in recent decades. I won’t go into this more here, but I would note the following:

1) Probiotics, beneficial bacteria, secrete biological surfactants that help repair gut membranes (see last paragraph).

2) We have evolved to need some bacteria to turn on certain genes in infant intestines for proper digestion.

3) In the last 100 years, we have significantly altered our relationship with natural intestinal flora and with certain fungal species, particularly yeasts, which can degrade gut membrane function under certain conditions.

4) The medical literature is full of references to antifungal medications helping in some cases of very severe eczema, but somehow not curing it.

5) Fungal organisms more closely resemble human skin cells than they do other microbial organisms like bacteria.

We do know that following some viral illnesses, children especially will develop full-body eczema — and I have seen at least one research paper describing high levels of circulating biological detergent following such viral illnesses.

From everything I have seen, people can track down the cause of their eczema and solve it. I don’t mean chase after triggers their whole lives, I mean find, understand, and have control over the underlying reason for their children’s eczema.

Here is what one mom wrote to me recently (I’m perpetually bad about posting feedback, but she graciously sent photos and permission to share, I will post them soon):

“I wanted to take a moment and thank you for your reply and let you know how successful we’ve been at clearing up our daughter’s eczema. She is now 15 months and has beautiful, clear skin. It’s not just the broken patches on her skin that have cleared up- it is her complete skin tone. Previously she always had underlying red patches on her face, even those have gone now. This is really a miracle, because we’ve tried EVERYTHING (probiotics, elimination diet, olive and flaxseed oil, bleach and salt baths) since she was a few months old and would scratch herself bloody everyday. … This is what I’ve wished/prayed/cried for, for a long time. I only wish we had found your site a year earlier.”

http://www.solveeczema.org

My take on dilute bleach baths and eczema

If you follow developments in eczema treatment, you’ve seen this recommendation to try bathing your child regularly in diluted bleach baths to reduce eczema severity.  I thought this article in MedPage Today summed it well.

If you understand the Solveeczema.org approach, then you probably also know my take on it.

bath bubblesI discuss in Solveeczema.org‘s solutions page the necessity of treating infected eczema in the problem-solving stage.  Even if the detergents are the source of the eczema, sometimes the infected skin has to be treated before the eczema will go away.

But my approach is to eliminate what I believe is the source of the eczema at the same time, so that treating the infected skin brings it back to normal and the skin can remain normal.  This study is suggesting regular bleach baths as a treatment to reduce but not eliminate eczema.

Additionally, my observation has been that when the approach in Solveeczema is properly implemented, along with potentially eliminating the eczema, the skin changes and becomes healthier and more substantial — in children whose eczema is being eliminated, as well as in other members of the household (even if they don’t have eczema).  These skin improvements typically take place over about a two-month time period after the eczema is eliminated.

A few diluted bleach baths could be a helpful “reset” button at the start.

In the study, the researchers observed a reduction of eczema as compared to placebo over time, but only on the parts of the children’s bodies submerged in the diluted bleach water, not the face and neck, and apparently not overall a hugely convincing improvement.  A review article in the British Journal of Dermatology stated, “the difference could have been explained by regression to the mean.”

A doctor who conducted the bleach bath study felt the improvements were the result of knocking out staphyloccocus on the skin, which is known to be a problem for children with eczema, though the above review article found no evidence that managing staphylococcus aureus alone had any “clinically helpful” impact on eczema.

I personally believe fungi/yeast can be a part of the abnormal microbial picture, too, since babies do not fight yeast infections on the skin especially well.  I also — obviously — believe the skin microbial imbalances are a result of the abnormal environmental influence, the increases in membrane permeability from detergents on the skin and the problems that causes.  The more conventional belief is that the eczema and microbial imbalances are the result of a defect in the skin and that perhaps the staph plays a more causative role, though again, no clinical improvements have been directly associated with controlling the staph.

Although it is certainly also mainstream to see the eczema epidemic as primarily environmental because the rapid rise cannot be reconciled with a purely genetic cause (again, see Solveeczema for reference), this observation conflicts with the skin “defect perspective.”

My concerns:

While I am glad to see a potential new tool for dealing with infected skin on a short-term basis, I have concerns about using these bleach baths as a chronic treatment.

First of all, it doesn’t eliminate the eczema and it must be done regularly.

And, I don’t think clinical recommendations can be made from such limited study of such small numbers anyway and safety has not been established.

Secondly, I would note that bleach in the water would help remove detergent residues from the skin of these children better than water alone.  How much of the improvement they noticed was the result of inadvertently regularly mitigating detergent on the skin of these children?  The researchers wouldn’t even have been aware of this issue.  (I would personally see this kind of bleach-bath treatment as a problem-solving step, not an ultimate treatment modality to pursue.)

Thirdly, children and babies have very permeable skin, and chlorine is absorbed by the skin and mucous membranes.  Real concerns about bleach and safety are not hard to find, for example, in this California Environmental Protection Agency sheet on safe sanitizing in childcare centers.  While I personally think doing this kind of bath once or twice might be a reasonable trade-off, I have real concerns about kids regularly bathing in and breathing the fumes from a bleach bath, especially if it’s not actually eliminating the eczema.

Kids with eczema are more at risk of developing asthma.  And breathing chlorine fumes (swimming in chlorinated pools) increases risk for kids of  getting brionchiolitis, asthma, and allergy.   I have inserted one link there, but type “bleach asthma” into the journal search box and you will find a long list of journal articles on this topic.

To the best of my knowledge, the researchers conducting the bleach bath study have not made clinical recommendations.  I would personally recommend against experimenting with anything with the potential safety concerns of bleach.  However, for someone currently eliminating detergents in the household who has concerns of persistently infected skin from past eczema, trying a few of these diluted bleach baths — ONLY after discussing it thoroughly with your child’s pediatrician! — might be helpful and potentially gentler than an oral medication approach.

I’d like to make a parenthetical note here that if the results of this study are reproducible, it contradicts the interpretation of other bath studies ostensibly supporting the hygiene hypothesis.  Previous studies found that infants who were excessively bathed had more eczema, and the conclusion in some quarters has been that these kids were “too clean” and “sterile” skin can lead to allergies.

I personally did not find that interpretation logical, as I have said on Solveeczema.org, the skin of these children would be so breached from all that bathing, they would have more microbial problems, not fewer.  This bleach bath study directly refutes that interpretation, as the bleach (which would have sterilized the skin) seemed to at least moderately improve the eczema over time.

Update:  October 3, 2016

Since this is perennially one of my most popular posts, I feel I should update it with a caveat that many bleach products contain copious amounts of detergents.  While I am a fan of Chlorox brand bleach because I have found the product to be consistent and good quality (I experienced some surprising variation when I used to use whatever was at the store), most of the bleach products they make now have detergents in them.  Chlorox is quite open about sharing the ingredients in their products on a website they provide (on the bottle), so it’s possible to find the ones that don’t have detergents in them.  Their straight bleach products don’t.  Obviously, if you read SolveEczema.org and want to follow the strategies, if your child’s doctor recommends these diluted baths, I would recommend always reading ingredients and taking care to stick with products that are only bleach.  (My positive words about Chlorox brand are my own opinion not an endorsement of any brand.)

Update:  September 12, 2017

I discovered recently that only one Chlorox bleach product has a slate of ingredients that I can verify as meeting SolveEczema criteria.  Currently, the Chlorox product I can recommend as meeting SolveEczema site criteria for laundry because of the ingredients is the “Germicidal” bleach, available at Costco, Home Depot, and Loew’s.  It is concentrated and contains: Sodium hypochlorite, sodium chloride, sodium carbonate, sodium chlorate, sodium hydroxide.  I called the toll-free number on a bottle of Regular today and the agent told me they don’t recommend the Germicidal for laundry.  However, the Chlorox website says it’s fine for laundry   Q. “Can I use this [Germicidal] bleach on my clothes like Chlorox Regular Bleach?”  “A. … YES”

The agent also told me that they do not recommend the use of bleach at all for diluted beach baths, i.e., for this purpose.  (I wish this was described more accurately not as “diluted bleach baths” but as a small amount of bleach heavily diluted by water, because many products are concentrated now.  If your physicians prescribes diluted bleach baths, please be very careful to make sure their instructions are correct given the way different brands are now concentrating their products, and how hazardous bleach and its fumes can be.)  As I wrote above, I have many reservations and concerns about using bleach in this way with children, especially since I believe eczema is otherwise eminently solvable.  But there are all kinds of circumstances, such as MRSA infections, where one’s physician may may have good reasons and there may not be other, as effective, alternatives.  I believe families should make decisions best for them in consultation with their physicians.  (I do not know off-hand how much more concentrated the recommended dilute baths would be than in swimming pools, but I can’t imagine it would be much.  Please let me know if that is wrong.)

Again, these are my opinions and not intended as an endorsement of any brand.  Just be aware that many, if not most, bleach products out there contain detergents other other ingredients, and that many brands are not as easy to identify the other ingredients in the products as Chlorox.