Monday, October 29, 2012

Upcoming eczema information sessions in Montreal, Toronto, and Calgary

Canadians who have eczema or who are parents of affected children can get cutting-edge information about eczema therapies at upcoming sessions in Montreal (Nov. 8), Toronto (Nov. 12), and Calgary (Nov. 22) put on by the Eczema Society of Canada.

At each session a local dermatologist will speak and an expert panel will take questions.

Tristan Joseph at Atopic Girl told me about the events and advised me to talk to Amanda Cresswell-Melville, president of the ESC. Amanda took time from organizing the sessions to answer my questions by e-mail.

SK: Is this the first time you've had this kind of event?
AC-M: We host these free education sessions each November for our Awareness Month. It is a great opportunity for eczema sufferers to hear from an expert dermatologist in the area of eczema, as well as hear from patients. Perhaps the most dynamic portion of the events is when the expert panel takes questions from the audience.

What are they modeled on?
These are common in the Canadian health care community, and conditions from Parkinson’s disease to Anaphylaxis host similar events throughout the year to reach out to patients. These types of events are a great opportunity to bring people together. With all of the great exchanges in a virtual setting today, such as through Facebook, Twitter, and email, we still get overwhelming responses from people who want to come to live events, and have a chance to ask questions face to face. I think we will do them as long as people want to attend them!

Who will the dermatologists be, and do you have an idea what they'll talk about?
We have a different dermatologist in each city, as we like to use a local dermatologist. The focus lately has been barrier function related to eczema, and how medical management, coupled with self care strategies, can help to control the condition. Eczema was often thought of as an “inside out” condition, and now we are focused on an “outside in” approach – maintaining and repairing the skin barrier, for less flare ups.

Who will be on the panels? What questions do you envision the audience will ask?
The expert panel is different in every city; however, it consists of the dermatologist speaker, the patient speakers, and typically a dermatology nurse who has expertise in the skin care counselling area of eczema management.

The Q&A session is perhaps the most anticipated portion, as some of the questions that seem to fly out of your mind when you are sitting in front of your own dermatologist can be addressed. I was surprised at one event when most of the questions came to a very dynamic young woman who spoke about her battle with eczema. Everyone wanted advice from her!

The questions usually centre on the common concerns: safety of medication, bathing and moisturizing questions, and the relationship between eczema, allergies, and asthma. Of course, if questions get too specific to the individual, they are advised to seek that advice from their own dermatologist or health care provider. Our intention is never to diagnose or create a treatment plan for individuals.

Who do you want to show up? What is/do you expect to be the ratio, among attendees, of parents of children with eczema to adults who have eczema?
While every year, and every city is different, there is usually a balance between parents of pediatric patients and adult patients of all ages. There is a great inclusive environment created, as the adult patients can relate to, and remember the struggles of the parents, as they have been there themselves, and the parents of little ones with eczema often express feeling of hope seeing the adult patients, because they know their children will be able to get through it.

Eczema is not a condition that one wants to advertise--and I myself feel weird about socializing with others when I have a flareup. And it would feel doubly weird to hang out with others in the same situation. What is the best way to reach adults such as myself?
We are very sensitive to maintaining dignity and privacy surrounding these events. We don’t allow any photography or video taping of the events, and we ensure that our language is always respectful. Most of our volunteers, and I, live with eczema on a daily basis, so these events try to respect what that experience is.

We also offer an online and telephone support component for those individuals who either don’t feel comfortable attending an event, or who cannot attend, for geographic or other reasons.

The main goal of these events it to provide information about the condition and its management, and to provide hope. Eczema can be as emotionally draining as it is physically, and we are just trying to support those living in through it, and show stories of people and families who have lived it, are living it, and are getting through it.

Wednesday, October 24, 2012

Kimchi on trial as eczema therapy. Not convinced

Those of you who are fans of probiotics, especially kimchi, will be thrilled to know that scientists recently reported the results of a trial testing kimchi-extracted bacteria as a treatment for eczema.

The researchers, led by Jihyun Kim at Sungkyunkwan University School of Medicine in Seoul, conducted a randomized, double-blind, placebo-controlled test of a strain of Lactobacillus plantarum in 118 eczema patients. L. plantarum is apparently a major species of bacteria found in Korean pickled cabbage, or kimchi, and a previous study showed that it had promise in a mouse model of eczema.

The idea behind probiotics is the hygiene hypothesis: in short, that being dirty is good for you (I'm pretty sure that most research shows that, if this is true, it holds only for kids during the first few years when their immune systems are developing). Proper balance of gut flora might tilt your immune system more toward a type 1 helper T cell-run operation rather than one dominated by type 2 Th cells, which are possibly over-represented in eczema patients. So: eat friendly bugs and reduce your chances of developing allergic disease.

The scientists split their subjects into a test group and a control group. From what I can tell they did as good a job as anyone could to make sure the results were not biased by expectation.

However, while they present their data openly in the paper, they claim it shows that L. plantarum clearly reduced symptoms of eczema, as measured by self-assessed quality of life as well as lab-quantified levels of immune cells and signaling molecules.

When I look at their data it says no such thing. In fact, it says that within experimental bounds, L. plantarum does nothing at all. I am surprised the journal editors allowed them to make those claims--but as always, maybe I'm missing something.

The trial was published in the journal Pediatric Allergy and Immunology, and paid for by the CJ Cheiljedang Corporation, which manufactures probiotic capsules of L. plantarum.

Thanks to reader K.M.O. for the tip.

Monday, October 22, 2012

Product review: CLn Bodywash, the "bleach bath in a can"

A PR firm retained by TopMD Skin Care, a Dallas-based startup company, approached me about reviewing the company's first product: CLn Bodywash, which has been described as a bleach bath in a can.

CLn Bodywash, the company says, was designed to treat bacterial infections of the skin, such as acne and the staph infections that often accompany eczema. The product comes in a small can like shaving cream--when you squeeze it out, it's a gel that you're supposed to rub into a lather and apply in the shower. It contains sodium hypochlorite (bleach) plus some unspecified surfactants, which essentially means detergent.

The idea of bleach baths makes sense to me. That's why I took them up on their offer.

They sent me two bottles in the mail. I like getting free stuff, so this was cool. The thing is, when you get something designed to treat a staph infection, you have to sit around and wait until you get one.

But I have eczema, so that didn't take long. This was the first time in my life I welcomed an outbreak of folliculitis. (Sorry, TopMD, I know you wanted me to test this on my three-year-old daughter, but that ain't gonna happen!)

CLn Bodywash foams up to a less-exciting degree than shaving foam. For me, it was a little bit stringy, like mucus, at first. But you can get it to lather. Then you leave the lather on for 1-2 minutes and rinse.

I used it on some mild folliculitis which appeared first on my left leg. Then, a couple days later, I got it on my right leg too. My first instinct was to use my right leg as an untreated control of sorts. But I hate folliculitis and want it to go away, so I used CLn on both legs.

And my folliculitis went away within a few days. It has not yet returned.

Was this because of CLn? Maybe. In the past, my folliculitis has always gone away. What goes up usually comes down.

On the plus side: CLn didn't make things worse; it didn't dry my skin out unduly; and it didn't smell all perfumy, as so many skin products do.

The obvious place to look for "proof" of whether CLn works is a clinical trial. TopMD claims that CLn has been subject to "extensive clinical testing." I found no evidence of this on the web, and asked the PR firm to send me the link. They kindly sent me a poster that had been presented earlier this year at a conference. The poster describes how the authors tested CLn on 11 subjects (all kids--this is clearly meant for kids) and appears to show that their skin infections largely cleared up.

The thing is--unless I am reading this wrong--the authors were about as scientific as I was. There is no control group, which is one of the most basic requirements for a clinical trial. There is nothing to compare the results to.

The PR rep tells me that there is another clinical trial of CLn just getting started in Houston. [updated 10/30/12]

Until the results of this presumably larger and more rigorous trial come out, I hesitate to recommend CLn Bodywash. I like the idea behind it, but I am not convinced it is any better than a decent soap.

Wednesday, October 17, 2012

Scientists find a molecule that recruits white blood cells to site of allergic itch

A type of white blood cells called neutrophils combines with helper T cells to create inflammation due to skin contact with allergen, a group of scientists led by Raif Geha at Harvard Medical School has shown in a mouse model of eczema.

The researchers showed that by blocking the neutrophils' ability to produce a signaling molecule called leukotriene B4 (LTB4), they could prevent the accumulation of both neutrophils and T cells, and hence inflammation, in skin that had been mildly irritated and exposed to a model antigen.

The research was published in the journal Immunity. [paper] [media summary]

The scientists were investigating the role of neutrophils, which are attracted to the site of scratching. They suggest that blocking LTB4's interaction with its receptor (not necessarily by the drug they used, bestatin) could prevent sudden eczema flares in patients that were exposed to something they were allergic to.

The research doesn't sound immediately useful to me, as the real problem with eczema--or atopic dermatitis--is that in general we don't know the cause, and flares aren't usually triggered by direct exposure to something you're allergic to. But it is interesting to learn that neutrophils are flooding scratched skin, and that they are recruiting other neutrophils and T cells--I would like to see whether a drug reducing this phenomenon might calm down itch. As always, the details are in the drug discovery process: finding something that works, isn't toxic and doesn't have weird side effects.

Thursday, October 11, 2012

Sperm for sale cheap. Only one small problem

Last night I was watching the first episode of the TV series "Parenthood" on Netflix. There's a scene where one of the male characters gets out of bed, where he's just had sex with his girlfriend, and opens the fridge to find a vial of frozen sperm--not his--from a sperm bank. "It's very high-quality," she says (or something like that). "It's from an Olympic athlete who was also a Rhodes Scholar."

Why this successful stallion was selling his baby batter for $50 a pop (I admit ignorance of the going rate) is not discussed, but the scene did make me think.

The prurient aspects of sperm donation disappear into the background when a single woman decides to have a baby. She's concerned only with quality. And from my experience with mothers, they want nothing but the best for their babies, whether it's a stroller, a crib, a nanny...or their DNA.

But what is quality? And, relevant to this blog, if I hypothetically donated to a sperm bank, would any woman want to buy it?

Here are the selling points: I'm a decent-looking guy, in shape, highly educated. No major health problems run in my family.

Or do they? Does eczema count as a major health problem? I think it probably would, for a prospective mother shopping for sperm. There's almost no cash discount that would make any of the yuppie moms I know choose my vial if they knew I was likely to pass on the genes for eczema.

Evidently my wife made the calculation at some level. She wasn't buying it like shoes on Zappos though. Things would have gone differently.

I bet sperm shopping is like a high school dance, but worse. Everyone wants a hot partner, but the reality is that there are only so many to go around. Nevertheless most people find someone to go to the dance with. That's not the case with sperm; the "best" vials are probably in high demand, while the others sit on the shelf. Dog and horse breeders know that you get fine animals only if you start with the best material.

I don't know what point I want to make, only that I would surely correct the errors in my own DNA if I could and if it would do any good; and that this thought experiment makes it clear that all human lives are valuable--especially to the people like me who are living them. Chance and environment play major roles in how a human being turns out.

By saying this, I do not mean that I am in the "pro-life" camp when it comes to abortion or euthanasia, but just that the vast majority of people have something unique and worthwhile to offer, and that in the big picture, eczema doesn't make that much of a difference.

Tuesday, October 9, 2012

Eight new genetic targets for eczema treatment

A group of scientists has found eight new genetic locations linked to eczema in the Japanese population.

Eczema is a disease on which genetics has a strong influence. New data of this type could highlight previously unknown genetic causes for which it might be possible to develop treatments.

The scientists, led by Mayumi Tamari at RIKEN in Yokohama, conducted a genome-wide association study, or GWAS, on a group of about 1500 eczema patients and 8000 controls, and validated their results on a similar group. They published their results in the journal Nature Genetics.

DNA is built of two strands, each of which is a string of molecular fragments called "bases"--A, C, G, and T--paired with its complementary base (the two complementary pairs are A/T and C/G) In a GWAS, researchers select a number of bases (in this study, 600,000) that are known to vary in the human population, and identify which locations, if any, contain bases that are more common in people with a certain trait (in this case, eczema).

The Japanese scientists conducted their study to identify new locations in addition to seven other candidates, including filaggrin, that had previously been found in Caucasian and Chinese patients. The eight new locations were found in or near genes important in skin barrier function; adaptive immunity (white blood cells and antibodies); the inflammatory response; and vitamin D processing.

My own take on this is that GWAS studies in eczema patients continue to highlight the mysterious nature of the disease and how far we are from anything approaching a cure. If there are 15 known, quite different, genetic locations associated with eczema, exactly which ones should scientists focus on to try to develop treatments? The disease is remarkably complex and the best hope for new treatments would seem to be an unanticipated discovery of a new or repurposed drug.

Friday, October 5, 2012

Vitamin D receptor mutation found in severe eczema cases

A set of mutations in the gene for the vitamin D receptor are more common in patients with severe eczema than they are in controls or patients with moderate eczema, a group of German researchers has found.

In a paper in press at the British Journal of Dermatology, the scientists explain that this set of mutations, or "haplotype," likely does not cause eczema but combines with other factors to make the disease more severe.

Vitamin D is widely touted on the internet as a miracle cure for many conditions including eczema. Clinical data on links between eczema and vitamin D is spotty. However, it's known that vitamin D plays an important role in inflammation--and eczema is nothing if not an inflammatory disease.

The mutations of interest occur not in the coding region of the gene, but in an upstream regulatory region, which means that the structure of the vitamin D receptor is not changed, but the amount of the receptor that the body produces is probably reduced. That would indicate to me that consuming excessive vitamin D could be of little help in treating severe eczema, since the body would simply not have the receptors present to react to the supplements

The scientists, led by Margitta Worm at Charité - Universitätsmedizin Berlin, sampled DNA from two groups of adults: a control group of 259, and a group of 265 eczema patients, 142 of whom were classified as severe cases. The scientists found that the odds of the severe group having any one of three particular mutations was about 50% higher than for the control group.

Wednesday, October 3, 2012

Three years of immunotherapy enough for dust mite allergy

Dust mite allergies are a common trigger of eczema flares for many. Dust mites--tiny relatives of spiders--thrive in bedding because they eat flakes of skin. And with the amount of skin that flakes off when you have eczema, it's a catch-22 problem.

From what I can find out, dust mite feces is the major source of their allergens. Eww!

One solution is to get allergy shots: regular injections of allergens at low doses that cause your immune system to develop a tolerance over time. I don't know what the regimen is--how many shots, and when you have to get them--but it is undoubtedly a hassle. Certainly it goes on for years. Doctors have debated how many years, some saying that five were required. A new study concludes that three years is enough. (Not a regime you're going to start on a whim.)

I asked the study's author, Iwona Stelmach, a professor at the Medical University of Lodz in Poland, for a copy of the paper, but haven't got one yet, so all I know is what I've read in the press release and the paper's abstract. It seems that the researchers worked with a three-part study group, totaling 90 asthmatic children, 30 each of whom had either had no immunotherapy, three years of immunotherapy, or five. While immediately after therapy, the five-year group needed less steroid to control a reaction to dust mite allergen, by the time three years had passed, the three- and five-year groups were essentially the same.

If you've got a severe dust mite allergy (and congratulations on figuring that out), it must be a relief to know you only need three years of allergy shots instead of five.