THIS May Destroy Gut Bacteria and Cause Eczema....

Eczema is a Skin Infection

Eczema is a skin disease that commonly affects infants and children and may persist into adult or reappear later in life.

There is evidence to indicate that eczema is caused by the increased permeability of the skin barrier.

This “leaky skin” allows bacteria and fungi to get into the lower layers of the skin. However, the causes of eczema extend beyond the skin.

Besides the leaky skin hypothesis, there is increasing evidence that eczema is also determined by the type of microbes in the gut (gut flora) as well as the immune reaction to increased microbial invasion of the gut and the skin.

With regards to the skin, studies show that 90% of people suffering from eczema are colonized by the bacterium, Staphylococcus aureus. This is a much higher rate of colonization than among healthy people.

Although the presence of S. aureus on the skin does not always lead to skin diseases, more people with eczema actually have active S. aureus infections. Clinical data shows that about 1 in 3 eczema patients suffer from active skin infection from virulent strains of this bacterium.

S. aureus is, however, not the only pathogenic microbe found on the skin in eczema.

People with eczema are also likely to suffer from active fungal infections especially from the yeast, Candida albicans.

Even viruses are not excluded. One of the common skin infections that occur along with eczema is caused by Herpes simplex, the virus that causes cold sores. The presentation of herpes along with eczema is known as eczema herpeticum and it can affect any part of the skin.

Natural Antibiotics in the Skin

To help protect itself, the skin produces certain natural antibiotics during infections. These keep bacteria from colonizing the skin and reduce the chances of skin infections.

These natural antibiotics are antimicrobial peptides that are not normally found on the skin. However, when the skin is increasingly colonized by pathogens, the immune system triggers the production of these peptides to help arrest the infection.

In a study published in the New England Journal of Medicine in 2005, researchers showed that the production of these antimicrobial peptides is impaired in the skins of people with eczema.

They identified and studied 2 of these antimicrobial peptides, LL-37 and HBD-2, in 8 patients with atopic eczema, 11 patients with psoriasis (another common skin disease) and 6 healthy controls.

Microscopic examination of the skin samples taken from these study participants revealed

• no antimicrobial peptides in the skins of healthy controls
• significant amounts of these peptides in the skins of patients with psoriasis
• very small amounts of the peptides in the skins of patients with eczema

The researchers calculated that the psoriasis patients had 10 times more antimicrobial peptides on their skins than eczema patients.

This is most likely the reason why bacterial infections are more common in eczema than in psoriasis.

The researchers went further by introducing S. aureus to the skin samples taken from psoriasis and eczema patients. And they found that the peptides in the psoriasis samples were available in concentrations high enough to kill the bacterium.

For eczema samples, S. aureus thrived because there were not enough antimicrobial peptides to kill it.

In addition, the researchers also found that certain cytokines released by the inflammatory immune response to atopic eczema actually blocked the production of one of the antimicrobial peptides.

In this case, they found that the interleukins, IL-4 and IL-13, suppressed the syntheses of HBD-2 peptide.

This last finding shows that the immune system is impaired in eczema and this impairment affects its ability to mount the right response to protect the skin from increased colonization from pathogenic microbes.

Antibiotics for Eczema

To reduce the level of S. aureus on the skin and prevent the transfer of the germ to other parts of the skin, doctors commonly recommend topical antimicrobial and antiseptic agents.

These can come in the form of medicated bath products or skincare products with antiseptic, antibacterial, antifungal and antiviral agents. Therefore, an eczema patient is normally advised to regularly wash the affected area with the topical solutions and to prevent the skin from drying with medicated moisturizers.

In addition, S. aureus preferentially colonizes the mucosal surfaces of the nose. Therefore, there is a high likelihood of reinfection from there. To prevent this from happening, nasal antibiotics are often prescribed.

When these fail to control eczema, oral antibiotics may be prescribed. However, studies show that antibiotics are not effective for eczema patients who do not also have skin infections.

Antibiotics and Gut Flora

Because the root cause of eczema extends beyond the skin to the gastrointestinal tract, oral antibiotics are believed to provide better results for cases that are unresolved with topical antimicrobial agents.

In fact, it is true that eczema is just as closely tied to the microbes colonizing the skin as it is to the microbes colonizing the gastrointestinal tract. This is because the gut flora is a big determinant of systemic infections and immune reactions.

The normal gut flora is mostly made up of beneficial microbes (majorly bacteria).

These protective bacteria prevent pathogenic microbes from colonizing the gut. Therefore, they establish a delicate balance that protects the structural integrity of the gut mucosa.

However, when this balance is disrupted through the destruction of the healthy gut flora, the gastrointestinal tract is left open to colonization by harmful pathogens that destroy the mucosa and allow themselves, their toxins, undigested foods, and other foreign substances to get into the bloodstream.

The breach in the lining of the gastrointestinal tract can, therefore, lead to infections in different parts of the body. Inflammation results when the impaired immune system scrambles to counter the damage done.

To remove the pathogens in the gut, oral antibiotics are often prescribed. Ideally, they should kill off the pathogens and allow the gut to be recolonized by health bacteria.

Unfortunately, antibiotics can destroy the healthy gut flora along with pathogens and even worsen eczema.

How Antibiotics Can Cause Eczema

To combat pathogenic microbes in the gut, broad-spectrum antibiotics and/or long-term antibiotic therapy are prescribed for eczema patients. Unfortunately, these are equivalent to nuking the gut flora.

Broad-spectrum antibiotics are given because they are effective against a long list of bacteria. Therefore, the odds of killing off the pathogens colonizing the gut are high. On the other hand, they also kill off beneficial bacteria in the gut.

Long-term antibiotic therapy is even worse because the gut flora never fully recovers from prolonged antibiotic therapy.

Therefore, the use of oral antibiotics in the treatment of eczema can significantly and permanently change the nature of the gut flora. They leave the gut open to colonization by the next pathogen after the treatment course. This soon leads to repeated eczema flare-ups.

Just as importantly, prolonged use of broad-spectrum antibiotics can quickly lead to antibiotic resistance.

Antibiotic resistance occurs when the harmful bacteria once destroyed by an antibiotic agent is no longer responsive to the antibiotic. In most cases, antibiotic resistance produces even more virulent strains of the pathogenic bacteria.

Therefore, antibiotic resistance can escalate eczema and make it even more difficult to treat.

Early Antibiotic Use and Childhood Eczema

ISAAC in Spain

A 2010 study published in the journal, Pediatric Allergy and Immunology, found that children given antibiotics early in life are at increased risks of developing eczema later in their childhood.

The researchers gathered data collected by the International Study on Asthma and Allergies in Childhood (ISAAC) in Spain. They specifically looked for the impact of first-year use of antibiotics and paracetamol on diseases with allergic components.

Their data covered almost 14,000 kids aged 6 – 7 years and showed that the prevalence of eczema in that population was 7%.

In addition, they found that the kids who received antibiotics in their first year of life were 66% more likely to develop eczema later than those who did not. Furthermore, they found that the risk of eczema was even higher for kids who suffered from asthma, rhinitis, and conjunctivitis and who also received antibiotics and paracetamol.

The researchers concluded that further studies are needed to determine whether antibiotic use in infants or early-life infection (for which the antibiotics were prescribed) was responsible for the increased risk of eczema.

Another ISAAC Study

A 2000 study published in the journal, Clinical and Experimental Allergy, took data from the ISAAC study to determine whether the use of antibiotics in early childhood increased the risks of asthma and allergic diseases.

The researchers took results from questionnaires and skin prick tests from almost 2,000 kids aged 7 – 8 years.

By comparing children who took antibiotics early in life with those who did not, the researchers found that antibiotic use during the first year of life was significantly associated with eczema (as well as asthma and hay fever).

The researchers concluded that early childhood use of antibiotics can increase the risk of developing eczema (as well as asthma and hay fever) in children with atopic immune responses (immune reactions at sites far from the point of contact).

Since the destruction of the normal gut flora and the colonization of the gut by pathogens can cause atopic immune responses, the use of antibiotics early in life can especially raise the likelihood of eczema in kids with poor gut flora and impaired innate immunity.

West Midlands Cohort

A 2002 study published in the Journal of Allergy and Clinical Immunology provided even new perspectives on the effect of antibiotic use in childhood to the risk of eczema.

For this study, the researchers obtained data for almost 30,000 children from the West Midlands section of the UK General Practice Research Database. Then, for each child, they cross-referenced antibiotics use with personal infection as well as sibling infections while noting incidences of asthma, hay fever, and eczema.

The results of the study showed that

• personal infections or infections in siblings did not protect the children from asthma, hay fever, and eczema.  This shows that these infections did not properly train the immune system to prevent new infections
• antibiotic use increased the risk of asthma, hay fever, and eczema and in a dose-related pattern. Having 4 or more courses of antibiotic treatment in the first year of life significantly increased the risks of all 3 allergic diseases
• the use of antibiotic was strongly associated with early diagnoses of eczema and the other allergic diseases

 The New Zealand Cohort

A 2008 study published in the journal, Clinical and Experimental Allergy, tried to determine whether early antibiotic use caused or was mistakenly linked with increased risks of allergic diseases such as eczema.

For this study, the researchers collected data obtained from over 2,000 children involved in the New Zealand Asthma and Allergy Cohort Study. Specifically, they studied reported antibiotic use in infancy before the first 3 months of life and before 15 months.

The results of the study showed that

• antibiotic exposure before 3 months significantly increased the risk of asthma, slightly increased the risk of contact allergy and did not increase the risk of eczema within the next 15 months
• antibiotic exposure before 15 months significantly increased the risks of eczema and rash thereafter. The increased risk of eczema was still present at 4 years

Pre-Natal Exposure to Antibiotics and the Risk of Eczema

A 2010 study published in the same journal gathered data on the exposure of 773 infants to antibiotics in utero, during breastfeeding and through the first year of life.

The results of the study showed that prenatal antibiotic exposure significantly increased the risk of eczema up to the 4^th year of life. Curiously, the study found that antibiotic exposure during breastfeeding and the first year of life barely increased the risk of eczema and other allergic diseases of childhood.

Even then the results of this study show that the antibiotic exposure of infants begins well before they are born.

In addition, the results show that indirect exposure to antibiotics in the uterus may have even more significance on the risks of eczema and allergic diseases later in childhood.