One of the possible manifestations of atopic dermatitis
Do you know what medical students are taught when they first go to the supervision of skin and venereal diseases? Correctly communicate with the patient and examine him correctly. A typical student who sees skin with unsightly crusts or redness immediately moves back one and a half meters and makes round eyes. And then, almost with a stick, he tries to poke at the patient, trying not to approach. It upsets people, especially considering the fact that most of the patients there are not at all sick with something scary and infectious.
Often there are some rather unpleasant looking chronic diseases that are not radically treated, but can be controlled with the right approach. Psoriasis or atopic dermatitis is very difficult to treat due to two reasons:
- The underlying cause has to do with genetic defects that we cannot fix yet, despite all the success of gene therapy.
- There are tons of obscure factors that can trigger this process.
As a result, you can try to drive the disease into permanent remission. Today we will talk:
- What is this pathology that about 20% of people face.
- What breaks down in the body of atopics.
- How is it related to allergies.
- What is better to smear on the skin.
- Why antidepressants can help a lot.
There will be several photos of damaged skin under the cut, but not horror-horror, as you asked.
What is atopic dermatitis?
Unfortunately, this disease is one of the most common skin lesions in developed countries. It's not that the poor have this type of dermatitis, but other pathologies like yaws affect the statistics there . It is such a tropical relative of syphilis, which is transmitted through everyday life. In Europe or the USA, such diseases with skin manifestations are almost impossible to meet, because they are most often treated in a couple of weeks with conventional antibiotics.
And there is also a lot of evidence that such diseases of an allergic nature are somehow related to the levelwelfare of the country. If you live in a hut made of sticks and straw, you will most likely suffer from malaria, but atopic dermatitis and hay fever are probably not for you. But in developed countries, for example in Russia, almost every tenth adult is faced with this pathology.
Atopic dermatitis in a child
Atopic dermatitis, also known as atopic eczema, or neurodermatitis, refers to immune diseases of an allergic nature. It is not contagious, but it usually looks rather unpleasant. The skin is cracked, inflamed, easily injured by scratching, and can be complicated by a bacterial infection.
It usually starts in childhood. Very often combined with bronchial asthma, allergic rhinitis and food allergies. Actually, it is the allergic component that underlies this disease.
Let's start with genetics
Thanks to advances in medicine, we are gradually accumulating more and more negative mutations in our population. Why people have such a skin problem is not fully understood. But it is clear that the hereditary factor is one of the key ones. For example, if one of a pair of twins has atopic dermatitis, then the second will show it sooner or later in 85% of cases . Most genetic defects do not mean that you are guaranteed to get a problem. It is more like a decrease in the "strength" of the body in one form or another. If a person with an ideal genotype can lead an unhealthy lifestyle with rather impunity, then another, with congenital genome defects, risks getting sick even with minimal exposure to a damaging factor.
Atopic dermatitis is not triggered by any particular mutation, but rather an unfortunate combination of them. A slightly defective skin structure, a little more nervous and aggressive T-lymphocytes, and now a person is continuously poured with moisturizers and eats one dietary buckwheat. One of the most common groups of mutations is associated with a violation of filaggrin synthesis.
The epidermis is so flat in the upper layers because of filaggrin
Filaggrin is a key structural protein in the skin, whose task is to bind another structural protein, keratin. Filaggrin in the form of a monomer binds to it into a single structure, stitching individual fibers together into a strong framework. As a result, the cell flattens and turns into a kind of shield, with which the body covers the tasty and nutritious deep layers of the skin from hungry bacteria and fungi. It is filaggrin that largely ensures the protective function of the upper, stratum corneum of the epidermis. Sometimes a defect occurs in the first pair of chromosomes, for example, mutations R501X or 2284del4, which are carried by about 10% of Caucasians.As a result, the protein is synthesized, but not correctly. The mutation is not fatal and is successfully transmitted to children in the next generation. Due to the improper structure of filaggrin, the protective barrier is defective, contributing to light damage to the skin from the most common factors, for example, from bleach in the pool or a rough washcloth. Also, this mutant form of this protein, apparently, leads to a violation of the structure of the lung tissue. Thus, studies show a significant increase in the risk of developing bronchial asthma in carriers of this mutation and its more severe course.
In addition, ceramides are reduced in patients with atopic dermatitis. in the stratum corneum of the epidermis. Ceramides are fats from the sphingolipid class. They are an essential component of the cell membrane in all cells. The skin contains special varieties of these molecules that play a key role in the formation of a protective layer. Violation of their synthesis and quantitative ratio is an additional factor for the onset of atopic dermatitis.
Allergy
It's not enough just to break the skin. This is unpleasant, she will be prone to injury, but the real combo is obtained in a situation where a person has genetic defects associated with the immune system. Normally, the body should react to the spores of mold, bacteria and other pathogens that have flown in, which only sleep and see how to grow mycelium somewhere in your warm and moist maxillary sinus. Normally, this does not happen due to the fact that immune responses actively resist such invasions. This is a very complex mechanism, which involves a huge number of different immunocompetent cells, chemical markers and other mechanisms. And everything is fine exactly until something breaks down in the immune balance. If the immune reactions are not strong enough, then we get an immunodeficiency with the same mycelium, which vigorously begins to grow somewhere in the lungs,and the most severe course of any infectious disease. But there is also the opposite option, when the body looks like a nervous psychopath with large-caliber weapons. And then with a cry: "The pollen fell!" - a whole troop of immune cells is landed, the release of histamines, immunoglobulins of class E begins, and as a result, a bunch of uncomplicated cells and tissues are shot that were unlucky enough to be next to a particle of pollen that sat on the epithelium. Then there is a condition called allergy.who were unlucky enough to be next to a particle of pollen that sat on the epithelium Then there is a condition called allergy.who were unlucky enough to be next to a particle of pollen that sat on the epithelium Then there is a condition called allergy.
In the scientific classification, this type of reaction refers to immediate type (type I) hypersensitivity. It is closely tied to the already mentioned IgE, which immediately binds to a foreign antigen and causes the release of many inflammatory mediators into the blood. This is the type of allergic asthma, atopic dermatitis, food allergy and hay fever. Unfortunately, more dangerous forms such as angioedema and anaphylactic shock are of the same nature.
EMSY - a protein associated with high risks of allergic reactions
The key factor is still the same - the accumulation of genetic defects and anomalies. Where a sickly teenager would have already been eaten by hyenas, we get an adult who constantly takes antihistamines, has children quite successfully, and passes on anomalies further. The 11th chromosome has the C11orf30 locus. In the case of an increase in the expression of this region, for example, with the C11orf30-rs2155219 mutation, the synthesis of the EMSY protein increases. This ultimately doubles the risks.polysensitization. In the severe version, people with a "life allergy" are obtained, who cannot use cosmetics, almost all types of gloves, must wear only certain types of fabrics, and when washing are forced to rinse the laundry repeatedly before wearing. In addition to this gene, STAT6, SLC25A46, HLA-DQB1, IL1RL1 / IL18R1, TLR1 / TLR6 / TLR10, LPP, MYC / PVT1, IL2 / ADAD1, HLA-B / MICA were also noted, although C11orf30 is a key one.
Complex set of reasons
As a result, atopic dermatitis is a disease that occurs at the junction of three factors: genetic defects, immunological problems and an unfriendly environment. For example, if you wash your skin every day with a hard washcloth and bars of laundry soap, the box of which has been stored on the mezzanine since the times of the USSR, then the skin will not thank you for breaking the protective lipid layer. Similar negative factors will be contact with bleach, aggressive detergents, synthetic underwear, in which you constantly sweat, and the like. There may be less obvious factors, such as drinking hard water with an increased concentration of calcium carbonate. The reason is not clear, but there is a correlation . Moreover, in different countries where the study was conducted: Japan, Great Britain and Spain.
What to do with the skin?
Patients with atopic dermatitis cannot live normally without emollients (emollients). This is a type of gels and creams, the task of which is to saturate the skin with moisture and soften it. Patients need many of these drugs to provide the level of protection they need. Lots of. Consumption can reach 600 grams per week for an adult during an exacerbation. In remission, the amount may decrease slightly, but still, the drugs must be applied at least twice a day.
First of all, you need to protect the areas of the body that are prone to damage. The exposed areas of the body - the hands and face - suffer the most, since they are more exposed to weather factors than others. In addition, the hands still suffer from washing. It is necessary from a hygienic point of view, but the skin of atopics does not tolerate any detergents that wash off its protective layer. Therefore, the general treatment should be immediately after normal bathing in a gentle shower, before swimming in pools with chlorinated water and after every hand washing. If necessary, the frequency of application can be increased up to seven times a day.
Naturally, we could not pass by such a market, especially since humidification and transdermal transport are the specialties of our laboratory. We had both a moisturizer and an Intensive Regeneration healing agent , which we once wanted to put almost in the ISS first aid kit. But "Intensive-Regeneration" turned out to be relatively expensive, and we were looking for other market niches. And there are procedures that are aggressive to the skin, such as chemical peels. In the first phase, the task is to relieve the inflammatory process and "feed" the skin cells to help the regeneration process. The skin requires hyaluronic acid salts for normal epithelialization and hydrophilic compounds. Any hydrophobic oil textures will only interfere here.
Hyaluronic acid salts bring bound moisture on their huge molecules. Somewhere on the third or fifth day after aggressive peeling, the skin epithelizes, but begins to resemble a cracked desert.
A clayey saline desert with characteristic cracking.
At the same time, people begin to itch, and more often than not with sterile nails. Against the background of such procedures, Staphylococcus aureus can fly. The skin needs to be somehow moisturized, the crusts softened and covered with a protective layer. If everything is done correctly, then after a while the crusts fall off, and under them there will be new pretty skin, which we wanted to get after the peeling. If you send the patient just to spray D-panthenol in the face, then there is a great risk that he will comb everything anyway, and as a result, he will get minor defects in the form of scars and age spots. Remember how it was forbidden to rip off the crusts with chickenpox? Here is something similar.
We have developed the Ceramide SkinSaver formula especially for this business .The most important thing is the complete absence of water in the composition. Instead of water - a stable emulsion of low molecular weight silicone and lipids. Ceramides - sphingolipids, which are important for the formation of a protective layer, act as a lipid fraction. We added them together with fatty acids and phytosterols.
As a result of research, it suddenly turned out that this composition just perfectly fits the problem of atopic dermatitis, although we developed it for other purposes. But first, I'll tell you what makes it different from other emollients.
What we put inside
As I said before, skin with genetic defects initially has an inadequate barrier function and needs continuous protection. First-generation emollients solved this by creating a hydrophobic film based on petroleum jelly, paraffins and waxes, which in fact tries to mimic a natural barrier so as not to release moisture outside and keep evil bacteria inside. The problem with using such drugs, especially on the face, is that they clog the ducts of the sebaceous glands and provoke the formation of comedones. As a result, we seem to be solving one problem, but at the same time we get massive multiplication of anaerobic Cutibacterium acnes, which are only happy with the lack of oxygen and can cause acne if they multiply strongly in the ducts of the sebaceous glands.
We avoided this problem due to the fact that we took two polysiloxanes as a base - cyclopentasiloxane and dimethiconol. The first, due to the small size of the molecule, is quite volatile and can evaporate, and the second forms a gas-permeable protective barrier, acting as a texturizer. At the same time, dimethiconol allows the skin to breathe, but reduces moisture loss. As a result, when applied, the product has a characteristic oily sheen, but very quickly the main part of the silicone base evaporates, and the skin becomes matte without a greasy feeling. Cutibacterium acnes also do not try to multiply beyond reasonable limits, as oxygen continues to penetrate and inhibits their reproduction and the formation of comedones. The bonus of such a light texture was the low consumption. Instead of 600 grams per week for people with atopic dermatitis, the dosage is 2–2.5 times lower.
In addition, we did not add urea, which is contained in many products for atopic skin, since with frequent use it loosens the epidermis and, conversely, provokes itching.
Chamomile flowers.
In addition to phytosterols and ceramides, which are key in the remedy and are needed to restore the protective layer, we have added bisabolol. It is terpene, which is abundant in flowers from the chamomile genus. In its pure form, it smells very pleasantly of something floral, but the smell is weak. But for us, it is not its perfumery properties that are important, but its anti-inflammatory and antimicrobial properties. Thanks to him, itching and inflammation go away.
Vitamin E - alpha-tocopherol
We also added calendula oil extract, which was stabilized with vitamin E so that it does not oxidize. Vitamin C is usually the traditional antioxidant in formulations, but this time it was impossible to put it in. Ascorbic acid and its salts are insoluble in oils and silicones. Therefore, we used fat-soluble vitamin E, which perfectly protects delicate organic components from oxidation. At the same time, it, together with vitamin A, covers the damaged skin from free radical damage, inhibiting the lipid peroxidation of cell membranes.
In addition, the composition contains squalane, a triterpene hydrocarbon, whose own analogue is synthesized by the skin. It also has anti-inflammatory effects and helps to form a protective layer.
Well, for the sake of perfectionism, we added a complex of polyunsaturated fatty acids, which is also sometimes called "vitamin F". Although somewhere in 1930 it was moved from vitamins to the group of essential fats and fatty acids. This group is better known as Omega-3 and Omega-6 unsaturated acids. In our case, their source is a complex of natural vegetable oils, which at the same time improve the structural properties of the product.
And some antidepressants
Finally, I would like to share an interesting observation in the treatment of atopic dermatitis. I have a familiar atopic who has been suffering from skin manifestations on the skin under the knees for 15 years. The whole classic picture is inflammation, dried lichen skin and constant itching. It so happened that a neurologist prescribed him antidepressants for the treatment of another pathology. Suddenly, after about six months, the patient noticed that the skin problems had almost completely disappeared.
I looked for scientific publications on this topic and came across an interesting articlewhere low-dose bupropion was used in patients without clinical depression. As a result, 60% of people with atopic dermatitis experienced significant improvement. It seems that the peripheral nervous system, in particular noradrenergic neurons, can significantly influence the course of the disease. And here's another good review article on this topic.
Important! Whatever you do with your body, be sure to first go to the doctor. Do not take antidepressants just like that and do not try to treat chronic skin lesions with advice from the Internet. First - the doctor, then - the rest. Well, if you would like to learn a little more about the chronicles of our laboratory, visit our Telegram channel (@geltek_cosmetics). There we tell interesting things about our work.