Eczema and the perfect crime

I'm a fan of "Cold Case Files," that low-budget true-crime show that features slow-pan narrated black-and-white photos of old blood spatters, bad re-enactments of decades-old events, and interviews with neighbors who were always uneasy about Jim Bob's collection of garage-sale Barbies with missing limbs.

I don't follow the show, but I used to watch it when I was on the stationary bike alone in the office exercise room in the basement. I found it added a certain frisson. And so that's how I came to know a few things about the perfect crime: own a property way off in the boonies, dispose of the body in acid, and never leave any traces of either the victim's DNA or your own. They always get you through the DNA.

For those of us with eczema, that poses a challenge. We're always scratching and leaving clouds of DNA-containing skin cells behind us on our clothing, the furniture, and anyone we come in physical contact with. If a cold case officer knows what to look for, I'm toast. That's assuming I'm the perp.

But what if I'm the victim? Then, not that it's going to do me any good personally, but the cops are going to be able to follow my trail or deduce that I was once an unwilling passenger in Jim Bob's trunk.

And there's a third angle to this--if I had any ambition to be a cold-case investigator myself, I'd be a poor choice for the guy collecting evidence. I'd be leaving microscopic fragments of skin all over everything and contaminating the samples. No joke--it's there in Interpol's Handbook on DNA Data Exchange and Practice. People with eczema have to wear special suits if we're tapped for that job--and what detective is going to want to run the risk we'd screw it up?

But that does suggest there are special suits available that I might want to wear if I were, say, considering the perfect crime. I'll just file that trivia away.

Building social bonds to fight eczema: guest post by Eczema Outreach Scotland

A lot has been said about medical treatment of eczema, as opposed to a social approach. Even this blog, End Eczema, suggests that finding a cure for the skin condition, eradicating its tragic effects of which we are all well aware, is only a matter of time. Since eczema is thought to be a part genetic and part environmental issue, it is a very ambitious task. But then again, scientists’ achievements in medical genetics, arguably due to a technical advancement too, have been astonishing.

We at Eczema Outreach Scotland obviously do support the research which is being done with an aim of implementing a successful treatment for eczema. However, we have chosen to follow a different path, of a social character. This is not to suggest that we should drop professional medical advice, quite the opposite.

Eczema Outreach Scotland concentrates on building strong social bonds between eczema sufferers. This approach is well built in our services. We support families by creating connections between them and giving information. Our social outings aim at increasing confidence and self-esteem of children with eczema. Reduction of stigma, which is another Eczema Outreach Scotland goal, is again directly connected to the social relations that we build around us.

The need for strengthening these relations can be well observed in children’s words. Five-year old G said: ‘Before I met K, I used to think I was the only scratchy girl in the world. She is my new friend. She wears bandages too. We had a lot of fun together today and our mummies said we’d keep in touch.’ This is food for thought, and not only for people from outside the eczema world, but also all those with an interest in the cause.

Eczema Outreach Scotland gives room for children and parents to socialise. Our free outings organised in Scotland are an excellent example of this approach. Few weeks ago, for instance, we organised one in Edinburgh. It included allergy-free cookery demonstration and talk hosted by Children and Young Peoples Allergy Network Scotland as well as drama and art workshops. There were lots of opportunities for children to start and nurture new friendships, build self-esteem and enjoy a positive experience connected to their condition. Now we are planning new outings in Elgin and Cumbernauld.

Every family affected by childhood eczema in Scotland is encouraged to join our free membership and we count on each reader of this blog to spread the word!

To learn more about Eczema Outreach Scotland visit: 
Eczema Outreach Scotland website
Eczema Outreach Scotland Facebook
Eczema Outreach Scotland Twitter


Contact: info@eczemaoutreachscotland.org.uk

Lymph node immunotherapy may be simpler, safer

A new, improved method of immunotherapy is emerging: injection of modified allergen, directly to the lymph node--which promises to prevent allergy to specific triggers with only a few treatments and minimal risk.

A group of Swiss, German, and Swedish scientists reports in the latest issue of the Journal of Allergy and Clinical Immunology that they reduced nasal tolerance of cat dander, a major trigger for atopic allergy, by a factor of 74 in a group of 20 subjects, using only three injections over two months. That means it took 74 times as much dander to cause the same amount of allergic reaction--the scientists used the flow of liquid from the nose as their measure--in a treated person as in a subject given placebo.

[This article featured in JACI's Journal Club.]

Immunotherapy for specific allergens currently requires 30 to 80 injections over three to five years and includes a risk of anaphylactic reaction. It is not popular. The new method, if confirmed, looks much more practical.

The researchers, Gabriela Senti of University Hospital Zurich and colleagues, were basically repeating an earlier, successful study that they had done with grass pollen. (I consider cat allergy avoidable but grass pollen is a big deal--you can't get away from it, unless you're in Antarctica.)

But the new study came with a twist--the researchers modified the cat dander allergen with two molecular changes. The first added a short chain of amino acids that helped the allergen enter the cell membrane--essentially, the membrane of B and T cells, since it was injected into the lymph nodes. This seems to have prevented other white blood cells, such as macrophages and mast cells, from encountering the allergen and provoking inflammation.

The second modification ensured that the allergen didn't get immediately destroyed inside the cells, but instead got chopped up and presented on the surface of antigen-presenting cells, which are a key element of the antibody arm of the immune system. Thus, by a process I don't really understand, your immune system becomes "tolerant" to that allergen.

Treatment with the modified cat allergen did not increase IgE antibody levels, or induce any "adverse events" in the treated group, which, it has to be said, numbered only 12. It's possible that in a larger test group some problems might reveal themselves.

If an environmental allergy is a big problem for your eczema, and you can stand nurses injecting things into your lymph nodes, this looks like good news. I don't know how long it might be until the FDA approves this treatment in the US though.

Cool! Weird skin diseases of elite Olympic athletes

If you're into this sort of thing, as I am, an entertaining review just came out in the journal Sports Medicine [media summary], detailing all the skin disorders that Olympic athletes must contend with in addition to trying to beat Michael Phelps or Usain Bolt or any Kenyan marathoner or Cuban boxer. Boy, are there a lot of weird dermatoses out there. Jogger's nipples, rower's rump, cauliflower ear, green hair, swimmer's itch, seabather's eruption, talon noir, jellyfish stings.

Contact dermatitis is a popular one. You run the risk of getting it in all the fighting sports--judo, wrestling, boxing--as well as many of the team sports.

Eczema gets hardly a mention--save for one interesting fact the authors, Jacqueline De Luca of the University of Hawaii and colleagues, mention. "Pre-existing dermatoses can also be aggravated with practice and competition," they say. "This is especially problematic given the fact that prevalence of eczema and atopy are higher in the elite athlete population."

Cool, so eczema makes me more athletic then!

Well, not really. The authors' reference is this article, which was written in advance of the 2008 Beijing Games and mostly considers asthma with only a brief nod to eczema. There was a lot of worry about air pollution at those Games, I remember. The older article points out a higher incidence of asthma in elite athletes, and attempts to explain why--perhaps extreme exercise, with its high air intake, increases allergic sensitization.

So being athletic puts you at higher risk of getting asthma. I'm not very athletic...maybe that's what saved me from becoming asthmatic. Looking on the bright side!

Eczema is not the only rash

Eczema is not the only rash.

Of course I know this, but last week I got a vivid reminder when both my kids came down with different rashes at the same time.

Shmoop had had a fever that peaked at 104F a few days before. Then, on the day before our planned trip to Lake Tahoe (naturally), he suddenly became itchy all over. Wherever he scratched, a red wheal appeared, with raised white welts. Soon he was covered head to toe in something that a cartoonist might have drawn to caricature a sick kid.

Voov, the one who has eczema, developed pinpoint dark red speckles on her arms and cheeks.

I made same-day appointments, took time off work, and drove the kids to the doctor. In the waiting room, as the kids played with toys they found there, I became aware once again that there is probably no better place than a pediatric waiting room to expose yourself to virulent pathogens.

Shmoop had the first appointment. The doctor looked him over and said that the rash was probably the result of his having a fever beforehand. Kids apparently are prone to getting rashes after fevers. Shmoop probably wasn't contagious...anymore. She prescribed Atarax (hydroxyzine HCl) as an anti-itch, and prednisolone if that didn't work. (We'd tried children's Benadryl without success.)

As I type this, I realize that I didn't check out all the side effects of Atarax. It's also used "for the short-term treatment of nervousness and tension that may occur with certain mental/mood disorders (e.g., anxiety, dementia)." It worked immediately to bring the rash down, which was great. It's also great that we got him off it asap. The idea of your kid being on a mood medication is disturbing.

Voov had the second appointment, with a different doctor. "That's hand, foot, and mouth," she announced confidently without even looking closely at the rash. As it turns out, it wasn't. Upon examining it, she said she didn't know what it was, but that Benadryl would probably work. And that kids get all kinds of rashes and this one didn't look like anything serious.

This sounded fine to me. I worry less than I should about things, to make up for my wife, Hidden B, worrying more than she should. Voov's rash did clear up, after briefly spreading to her face.

Through this experience I realized why people who see your eczema often react the way they do: avoid contact, pull their kids away from yours. They don't know what's causing the rash, or if it's contagious.

And neither do doctors. Pediatricians, especially, often have no idea why your kid is sick. And doctors in general often have no idea what is causing a skin problem for anyone, adult or child. The combination of kid & rash makes for maximum uncertainty. Eczema is not the only rash, nor the only rash of which doctors don't know the cause or cure. This is something we have to accept, difficult as it is, as the current state of medicine.