If we do not evolve … we will soon be an extinct species of medical practitioner, Dermatology Times Editorial Advisor says in his column this month. He shares his experience and considerations with negotiating the sale of his practice to a venture capital backed firm.
Dermatology Times – Dermatology
Tag Archives: perspective
Drugs in Perspective: Otezla (apremilast)
Otezla (apremilast), a small-molecule inhibitor of phosphodiesterase 4 (PDE4), was approved by FDA on March 21, 2014, for the treatment of adult patients with active psoriatic arthritis. On September 23, 2014, it was approved for a second indication, the treatment of patients with moderate-to-severe plaque psoriasis who are candidates for phototherapy or systemic therapy
Modern medicine – American Academy of Dermatology
A SolveEczema Perspective: “The Cure for Dishpan Hands” – Part 1
Over the years, I have been thanked by many people who used SolveEczema.org just to solve a dry skin problem, even if they did not have eczema. I have been thanked by many parents and more than one doctor who realized they could wash their hands frequently when necessary, without drying their skin out. As I am very clear about on my website, I am not a doctor, this is based on my own personal observation and research. Getting results relies on capitalizing on that new perspective.
I am writing this to share what we — and now many others — have done using the Solveczema.org perspective to get unexpected, out-of-the-box results with ameliorating dry skin, for those who maybe can’t seem to find any moisturizing cream thick enough to prevent painful cracked skin during the winter or on travel, or who struggle with washing the dishes even with gloves.
Obviously, I can’t promise a “cure” without a traditional medical study, the title above is just a restatement of the usual idiom and my opinion about its applicability, although this is a perfect set up for a clinical study. I believe this perspective could not only improve the health of health providers’ skin, but also improve compliance with handwashing, and thus help reduce hospital-borne infection.
If you are ready to try this, first read the SolveEczema site disclaimer, watch the SolveEczema site video linked from the home page (note, I made it for a long-concluded crowdfunding for my book and haven’t been able to update the ending, it’s an amateur effort — sorry, it puts me to sleep, too — but it’s only about 45 minutes and is still a good summary of the site). Read everything here, use your judgment, talk with your physician as needed for health and safety issues, and don’t make any changes until you understand how different this is. It’s not about individual products, it’s about learning how to have optimal skin health without treatments or moisturizing, by understanding what, in my observation, is really going on.
I need to mention here again an open source paper I posted online about SolveEczema, giving a rough description of how it relates to the eczema and allergy epidemic of recent decades, and summarizing many of the novel observations: https://thewinnower.com/papers/3412-abnormal-ampli-fication-observations-from-applying-the-engineering-method-to-solving-eczema-and-atopic-disease
It’s only two pages — please refer to the Analysis and Observations section for essential novel observations.
Again, with my apologies for the presumption of giving this a personal, alliterative name like this in hopes of making it more memorable, I also need to restate this very different-from-traditional view of why skin becomes dry after washing, per my own observations, because it’s crucial for getting results:
Lumsdaine’s Law: For most people, under most conditions, eczema and dry skin are more the result of what is left on the skin than what is stripped from the skin by washing.
Water alone on the skin increases the membrane permeability. Membrane permeability is basically just how easily certain substances — like water molecules — can pass through the membrane, from within and without. If you wash your hands in the winter and don’t dry them well afterwards, your hands chap even if you only washed in water, because the water left on the skin increases the permeability and accelerates water loss.
Under normal conditions, the restoration of water in the skin is quite rapid; if someone washes and it takes days for the skin to rehydrate, my contention is that it’s because of what is on the skin in the meantime, not usually from what was stripped from the skin by normal washing. Detergents on the skin (see the paper) in combination with a small layer of water, including from sweat, dramatically increases permeability and subsequent water loss.
Continued in Part 2…
Don’t Forget the Soap: A SolveEczema.org Perspective on “The Farm Effect” and Eczema
Swiss Cows
Until I can finish a book or publish papers, I really can’t do this topic justice. And I’m not really sure users of my site (SolveEczema.org) really need much explanation. Once people really read and understand the site, and put the strategies into practice, what I’m about to say is pretty obvious.
A lot has been written in recent years about the “Farm Effect” — an astute observation made by early eczema researchers that people who live on farms tend to have less eczema than people who don’t. This led to speculation about whether the reason had to do with dirt or microorganism exposure.
While I am not discounting microbial involvement — please see SolveEczema.org discussions for a different take on probiotics and eczema, and the last part of this very short paper that I wrote https://thewinnower.com/papers/3412-abnormal-ampli-cation-observations-from-applying-the-engineering-method-to-solving-eczema-and-atopic-disease — I also think people are making this far too complicated (with far too much contradictory evidence that isn’t explained).
Take for example the popular interpretations of this well-done study from 2012:
http://www.jacionline.org/article/S0091-6749(12)00519-2/fulltext
Researchers found a far higher rate of allergy, asthma, and eczema among children aged 6-12 who were from families of Swiss non-farmers than Swiss farmers. They also found the Swiss farmers had a higher rate than Amish in the US (who tend to be farmers, though not all). Researchers may have chosen the comparison with Amish in the US because they originally came from Switzerland, and may be genetically similar.
http://www.reuters.com/article/us-kidsallergies-idUSBRE8431J920120504
“As for why the Amish kids have even lower allergy and asthma rates than the other farming kids, “that piece of the puzzle we really haven’t explained,” [Indiana allergist who treats Amish patients] Holbreich told Reuters Health.”
So, to summarize: The Amish had the lowest rates of allergy, asthma, and eczema. The Swiss farmers had less allergic diseases than non-farmer general population, but higher than the Amish. This relative difference was true also for allergic sensitization to various allergens on testing.
The significant difference between the Amish and the farm families suggests the need to consider other influences.
Swiss cows everywhere and up close in Switzerland
Additionally, Switzerland is such a small country where farming and the farming community is simply not that isolated from the rest of the nation. It’s nothing like the US where you might have to drive hundreds of miles to see a cow (or a farmer).
Swiss horses in the path
While Switzerland is an extremely clean country, let’s face it, the dairy industry is pretty important — it’s hard not to notice that there are a great many animals and a great many flies because dairy is so well integrated into the landscape. I just can’t see making a strong case that any population is that well isolated from any other there microbially.
Swiss goats are everywhere, too.
But in terms of lifestyle, the general Swiss population of non-farmers is using the same kinds of new surfactants that everyone else in the industrialized world is using where eczema and asthma are so high. They spend more time in homes breathing the detergent “dust” from this use than do farmers, who spend more time outdoors.
Swiss farmers may or may not be using less of such products. While I doubt they are making their own soap anymore — though I do not know — they do spend more time outdoors, away from breathing such dusts. Recall that these substances increase antigen penetration of membranes, including lung, i.e., to the immune system, it’s as if there is more allergen in the environment.
In the US, farming communities gave up making their own soap later than everyone else. In some farming communities, soapmaking remains a strong tradition. The Amish are one of those communities, probably the most significantly so. Although acceptance of the modern can vary among Amish communities, there is a strong tradition of soapmaking among the Amish. This essay about Amish life in the 19th century (search on the word “soap”) describes the process. While it can be truly difficult to get specific data, it’s very unlikely that this tradition has changed much, if at all.
This relatively new environmental factor — the use of these highly hydrophilic modern surfactants that I believe are amplifying “normal” allergic processes — has a much more consistent and close ecological link to allergy, asthma, and eczema increases than any of the other explanations, across time and geography. This factor should be included in these types of studies, because of the potential to reconcile so much seemingly contradictory evidence, not just when it comes to the “Farm Effect”, but also when it comes to the research on allergy and exposure to pets like dogs and cats (especially the contradictory evidence when it comes to cats), or studies of allergy in households that handwash versus dishwasher wash the dishes. Getting into details is a long discussion for another day. However, because these surfactants can so powerfully influence human membranes in a way that is known and directly speaks to allergy, I think it’s too bad the studies don’t include anything at all about this factor. Especially since, as in the study above, there is likely to be a big difference in usage between the populations.
The SolveEczema.org perspective reconciles the major inconsistencies in the research of most of these different factors, such as the Farm Effect. And the SolveEczema.org strategies, from experience, happen to lead to dramatic reduction of asthma and allergies in concert with eczema amelioration, not just for the child with eczema, but everyone in the household. And it doesn’t require getting dirty or rolling around in cow or horse … um … microbes.
This room was one part of a structure also housing a mountain café, where day hikers frequently stop for tea or hot cocoa. Note the nearly brand new calf. OK – this isn’t a common sight in Switzerland – but cows (and their microbes) are.
Eczema from an Indian perspective- Our daughter’s story
Our lovely customers are spread out around the globe, which always serves to remind me that there are people suffering from eczema all around the world. Today we hear from one of our amazingly brave mums in India, Anindita. Her story of how their family has united to help cope with their daughter’s eczema is heartbreaking but also incredibly inspirational.
This is our daughter’s story of her ongoing struggle with severe eczema over the past few years. We have survived some very tough and uncertain times especially in the last couple of years. However, in spite of all the trauma and pain we have faced, we have come through it all with the help of invaluable support from close family and friends and her doctors. Most importantly, our daughter’s spirit remains intact and whoever interacts with her cannot help but notice her positive outlook and her sunny smile. This is what keeps us going, especially me, since I spearhead our family’s efforts to bring her eczema under control with the help of my extremely supportive husband who is also a doting father to his darling daughter.
I have captured our entire journey from the beginning in details in my blog “eczema-anindianperspective.com” through various posts. Here I have encapsulated our story for Gail Palmer’s blog at her gracious invitation. I have been purchasing products for eczema on her website EverythingForEczema.com for some time now and have found it very useful to be able to find various products under one roof.
Aiyana
Our daughter Aiyana was born on the American Independence Day, 4th July, 2006 in Mumbai, India (where we reside) after a completely hassle free pregnancy. She was a happy, healthy baby and until she was 1 year old we did not have any inkling about how our lives would change forever because of eczema (Atopic Dermatitis) in the years to come.
In India at that time eczema was uncommon and awareness was very poor and even had I came across anyone with this skin condition, I wouldn’t have even realised it. When Aiyana was about 6 months old I had to get back to full time work. I weaned her off my milk and introduced cow’s milk as is the custom in India (again very few people had allergies to dairy or may not have even be aware whether they were allergic to dairy and dairy products). However, by the time she was one year old we realised that her skin was mostly rough all over and which never completely went away no matter how much we took care of her skin. Her pediatrician diagnosed her with Atopic Dermatitis and we took her to a dermatologist who confirmed the same. Thus started our journey with eczema.
How it all began
In the first few years till Aiyana was about 5 years, her eczema was mostly under control with moisturizers and minimal topical application. It all changed when we went to Rajasthan (a northern state in India) for a religious occasion in October 2011 for a few days. Since Rajasthan is mostly a desert with a very dry climate, her eczema worsened. However, even after we came back to a tropical climate like in Mumbai, her eczema did not let up and her skin condition went downhill from there in spite of all our efforts. When she reached a state of erythroderma (extreme shedding of skin with red exposed skin all over the body due to constant itching) in July 2012, we had no choice but start her on oral steroids (prednisolone). Aiyana was taken off the oral steroids and started on an immunosuppressive drug, cyclosporine which had a limited impact and once it was stopped in early 2013, she had be put back on oral steroids since her eczema was out of control. By this time we had tried various treatment options with varied success like Narrow band UVB, topical steroids and immunomodulators and were already following elaborate eczema safe skin care and bathing routines for her.
Our daughter’s struggle for survival
We decided to take her to see an experienced pediatric dermatologist at Great Ormond Street Hospital for Children in London during the summer of 2013. Since eczema is much more common in UK we hoped that experience of the doctors there would be able to help us control her eczema. However we soon came to realise that ultimately one has limited control of the outcomes in one’s life no matter how many precautions we take and all our planning. The dermatologist that we visited did all the requisite tests that need to be done before starting a patient on the immunosuppressive medication, Azathioprine, since one of the serious and sometimes life threatening side effects of this can be “bone marrow suppression” where the bone marrow simply shuts down and stops producing red and white blood cells. This is what we feared and is precisely what happened with our daughter though the medication was started only after her tests proved to be completely in the normal range. She was admitted to the Intensive Care Unit of a premiere hospital in Mumbai with a life threatening infection since her bone marrow had stopped producing white blood cells completely and could not fight any infection. However, our brave daughter fought back with the help of her doctors, the hospital staff and our family and friends who came and donated blood and platelets whenever required. After a nerve wracking 2 weeks she was finally declared to be out of danger. I have captured our experience and learning in my blog (“eczema-anindianperspective.com”) in the post – http://eczema-anindianperspective.com/2013/10/27/the-tough-get-going-part-2/
This traumatic experience has brought our family closer and I can see in my daughter a strength and maturity much beyond her age and which helps her to cope with this condition on a daily basis. I find that I am inspired by my daughter to continue to look for a better way of controlling her eczema and help her lead a normal life.
Our life today
Today Aiyana is on the immunosuppressive medication Methotrexate after having been on another immunosuppressive medication, Cyclosporine and the oral steroid, Prednisolone (alternatively as well as together at times) to keep her eczema under control. In the past few years we have made radical changes in our lifestyle right from skin care and bathing routines to detergent free clothes and dish washing amongst others. We have tried various products like moisturisers, creams, therapeutic clothing which have helped to some extent but we are still far from bringing Aiyana’s eczema under control.
Anindita and her daughter Aiyana
However, my role like any other mother is one of a never ending search for a better and healthier life for my children and my family. I have been doing a lot of research on the effects of diet and eczema and have only now come across one that I wanted to try on her by an Australian Nutritionist, Karen Fischer. I have started Aiyana on diet a couple of weeks back and we have a long way to go yet. This is where we are at the moment.
Be happy for this moment, this moment is your life
And in the end, this is what matters. How well we lived our life, how well we loved, how often we counted our blessings along the way; how well we learned to accept the things we simply cannot change and faced our most difficult moments. This is the lesson I strive to teach my children, one lesson that I am myself learning every day of my life.
“Will my child outgrow their eczema?” A clinical perspective of the development of atopic dermatitis
By Fatima Lakhani, BS and Peter A. Lio, MD (see bio below) Eczema or atopic dermatitis (AD) is often thought of as a skin problem mainly affecting infants and young children, most of whom will outgrow the condition [Abuabara]. However, relatively few studies have been conducted to validate these beliefs, and the concept of “outgrowing […]
It’s an Itchy Little World