Q & A with Dr. Peter Lio from the Chicago Integrative Eczema Center

Q & A with Dr. Peter Lio from the Chicago Integrative Eczema Center

AD RescueWear is honored to feature Dr. Peter Lio on our blog. He has kindly agreed to a question/answer interview to educate our readers on eczema.

Dr. Peter Lio is a Clinical Assistant Professor in the Department of Dermatology and Pediatrics at Northwestern University, Feinberg School of Medicine. He is the co-founder and co-director of the Chicago Integrative Eczema Center and very passionate about finding safe treatments that work for eczema. Dr. Lio received his medical degree from Harvard Medical School, completed his internship at Boston Children's Hospital and his dermatology training at Harvard. He has had formal training in acupuncture under Kiiko Matsumoto and David Euler, and has held a long interest in alternative medicines. He currently serves on the Scientific Advisory Board for the National Eczema Association. His clinical office is located at Dermatology & Aesthetics of Wicker Park.

Thank you Dr. Lio for answering these essential questions. We hope they will help our readers and customers manage the symptoms of eczema in their children.

1. What are the main symptoms of eczema?

The most fundamental symptom of eczema is itch. Sometimes it is called "the itch that rashes" because generally people are itchy, then they scratch and the characteristic lesions of eczema appear. Because of the terrible itch, sleep problems are very common both in the patient as well as the rest of the family. Dry skin is also very common in eczema, as are allergies to foods and environmental triggers. The characteristic rash: dry, scaly, and red, can become open and oozing very easily. Oftentimes, eczema lesions become infected by bacteria such as staphylococcus as well.

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2. What are the most common triggers of eczema?

To be honest, I think the most common trigger is unknown. Most of the time, my patients will not have a clear idea about what triggers them. However, many triggers are known and these include certain foods, stress, weather changes, fragrances, seasonal allergies, and even exposure to certain fabrics such as wool. The fact that there are so many possible triggers makes this disease extremely difficult to control, even when certain triggers are known.

3. How do genetics play a role in eczema? Can you tell us about the filaggrin mutation in eczema?

We think that there is more than one "eczema", and that there are probably different combinations of genetics and environmental causes for different subtypes of the disease. However, there are some very exciting developments in genetics which suggest that at least a sizable group of patients has a genetic mutation in a gene that encodes the protein filaggrin. This protein is incredibly important in keeping the skin's barrier function in working order: it helps in a structural way, it is a key component in what is called Natural Moisturizing Factor, and it even helps regulate enzymes which can degrade the skin barrier. For individuals with a mutated gene, this means they are at a significantly higher risk of developing eczema than someone with a normal gene. However, this does not explain everyone with eczema and there are some individuals who have a mutated gene but do not develop eczema, so there is a lot of work yet to be done to fully understand this. Still, it offers hope that we may one day truly understand why people get this disease and be able to better help them.

4. Can you explain what causes the itch in eczema?

The itch of eczema remains a deep mystery. We know that it is fundamentally different than the itch of hives which is mediated by the chemical histamine. That is probably why many patients find that the antihistamines--even powerful ones--do not offer much help for the itch of eczema. We do know that the nerve endings in patients with eczema are fundamentally different and have much lower threshold for sending the itch signal. This appears to be a secondary development, however, and may even be able to revert back to normal over time. Ultimately, it probably has to do with inflammatory signals in the skin, possibly due to the water loss and the invasion of allergens and bacteria due to the damaged skin barrier.

6. What is the best way to manage eczema?

We try very hard to utilize all of the tools to manage eczema for each individual. There is probably not one universal treatment approach to this complex disease. In general, we want to make sure we are supporting the skin barrier function using oils and moisturizers to both fortify the barrier and to nourish it. This is fundamental. We also want to keep the skin bacteria from becoming abnormal. Generally, this means that we want to keep staphylococcus overgrowth down, but we also want to keep the normal skin bacteria happy and healthy. To do this, we try to use a combination of things like dilute bleach or apple cider vinegar baths to keep staphylococcus down, along with natural oils and probiotics to fortify the "good" bacteria. Next, we need to keep inflammation and itch under control. We desperately need new treatments here, and I'm excited to say that some new ones are in the pipeline and coming soon. For now, we rely heavily on topical corticosteroids to calm the inflammation and itch and allow the skin to heal. The secret here is to use them briefly--for only a week or two at most--and then let the skin recover. For more severe cases, we often need to use a non-steroid anti-inflammatory such as tacrolimus or pimecrolimus, and those can be of great help. For the most severe cases, where patients are missing work and school, cannot sleep, and are getting hospitalized frequently, we may need to use more powerful systemic treatments to give them some relief. Importantly, we also work with allergists to ensure that we're avoiding any and all possible triggers, and trying to support the patient and family during these difficult times.

7. Can you please explain how wet wrap therapy works as a treatment for eczema?

Wet wrap therapy is a very powerful treatment that we often use in severe cases. It's so powerful that for some patients it can mean avoiding much more dangerous systemic immunosuppressants! We think that it works by keeping the water in the skin and by pushing the topical medicine deeply into the skin. It also has a direct cooling and soothing effect, and tends to minimize new scratching since it protects the open areas. It can be truly dramatic, even when used without steroids, so there is more to it than simply pushing the medication into the skin.

8. The Chicago Integrative Eczema Center will have a meeting on May 24th that will focus on A Natural Approach to Eczema. Can you please tell us about the meeting's topics and how someone can sign-up?

Every other month we have a free meeting on a Saturday morning usually based around a theme. We have time to discuss an aspect of eczema in great depth, and have a wonderful question and answer period. Afterwards, we have a support group session that is sponsored by the National Eczema Association.

9. In March the Chicago Integrated Eczema Center had a meeting on Healing Foods for Eczema. Can you tell us what is best to avoid and what is best to eat if you have eczema?

We had a great meeting in March, and talked about a lot of different things. As I mentioned above, there is probably not one easy answer for everyone... So much so that, if someone recommends a "cure all" treatment, you can and should be immediately skeptical. However, we talked about the importance of a healthy, plant-based diet, avoiding processed foods, avoiding sugary foods and those with a high glycemic index (simple carbohydrates). We talked about the fact that Dairy can be inflammatory in some individuals and can be worth trying to avoid, even if one is not "allergic" in the traditional sense. We also discussed gluten and how this, too, may be inflammatory in certain individuals. Most of all, we stressed avoiding "fads" like going gluten-free but still eating gluten-free cookies and pizza, which truly seems to negate the helpful effects for most of our patients who do not have true celiac disease (i.e., specific gluten allergy). We talked about how fish can be a healing food, certain berries such as blueberries, and some fermented foods such as sauerkraut, coconut yogurt (non-dairy), and kimchi.

Thanks again Dr. Lio!

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