An extensive review study of the scientific literature has concluded that swallowing capsules of evening primose oil and borage oil will not relieve your eczema symptoms.
Evening primrose oil and borage oil are "gamma-linoleic acids," or long-chain fatty acids that have a kink in the sixth bond in the chain. They are also called omega-6 fatty acids and have long been touted as beneficial in reducing inflammation and treating autoimmune diseases when taken in capsule form.
A team led by Joel Bamford at the University of Minnesota Medical School
read through 27 academic studies, in which 1596 patients had taken
part, and concluded that taking evening primrose oil or borage oil had
provided no benefit.
I've taken evening primrose oil capsules myself. They were expensive and did nothing for me.
This review seems like it could be the final word on the issue. However, the overall total number of participants is quite low--each study would have had around 50 participants. So it's possible that the authors of this review have just combined a whole lot of garbage results and the overall conclusion is not solid...but if there were some kind of real beneficial effect you'd think a review of this size would detect it.
I'm skeptical of supplements in general. In my experience, eczema is a condition in which diet is indeed important--but the importance lies in leaving out foods that can trigger allergy or inflammation, rather than in consuming certain foods and expecting them to make your skin better.
Tuesday, April 30, 2013
Thursday, April 25, 2013
The "Eczema App." Neat, useful, but a heavy advertising touch
I have an iPhone but I’m not crazy about apps. You won’t find me playing Angry Birds or one of those flashy bloop-de-bloop games during my commute. I’ve figured out how to listen to audiobooks and that’s good enough for me.
Still, I was intrigued when I saw the National Eczema Association had developed a free “Eczema App” together with pharma giant Bayer. I decided to check it out. It took seconds to download from the App Store to my iPhone 5.
The Eczema App is three things at the same time: a flare tracker and reporter; an information reference; and an advertisement for Bayer’s topical steroid Desonate.
The flare tracker and reporter seems like it could be pretty useful, especially to a parent trying to figure out what is triggering his or her child’s eczema. The app lets you register when a flare starts and stops. In between, you can note what you think might be triggering it, and take pictures of the damage. You can email a flare report, images and notes included, to your doctor or nurse.
And you can set up profiles for as many as five people—I set up one for myself and one for my daughter.
My only quibble with this section was that I had trouble finding the button that would let me report that my flare had ended. (This function is hidden in the Tracker > Update > Flare-up details tab.)
The second, the info-and-news section, is a nice little package of basic facts and advice for patients with eczema or parents of affected children. It’s pitched toward someone who hasn’t encountered eczema before. Me, I’ve had it for 41 years and I blog about it, so my first reaction was that this section was too dumbed-down, but I can see that it could be useful to a newbie.
I do wish the info section didn’t mention antihistamines though. They do not help prevent the itch of eczema and their only utility is that they can make you drowsy and might make it easier for you to go to sleep.
The Desonate advertising section is placed toward the bottom of the app. It is semi-discreet. But it still seems like pushy pharma marketing to me. I hope the NEA got some decent sponsorship funds in return for the exposure.
My overall impression of the app was colored by the advertising. It's great that you can use your iPhone to collect and report medical data. But the app is much like a free mug or pen you might pick up at a convention. You drink your coffee or scribble your notes, and it gets the job done, but that logo is always staring at you from your desk.
When I tweeted about the Eczema App, I heard back on Twitter from Emma Williams, a nurse in Swansea, Wales who operates a specialty eczema clinic. She too has an eczema app, "Eczema Expert." I took a glance at it in the App Store but was put off by a couple glaring mistakes—one of the questions in the diagnostic section was “Do you itchy skin?” and there was a mention of “tropical” steroids. I couldn’t bring myself to spend $1.99 because the typos gave a shoddy impression. Let me know when you’ve fixed the app, Emma!
Still, I was intrigued when I saw the National Eczema Association had developed a free “Eczema App” together with pharma giant Bayer. I decided to check it out. It took seconds to download from the App Store to my iPhone 5.
The Eczema App is three things at the same time: a flare tracker and reporter; an information reference; and an advertisement for Bayer’s topical steroid Desonate.
The flare tracker and reporter seems like it could be pretty useful, especially to a parent trying to figure out what is triggering his or her child’s eczema. The app lets you register when a flare starts and stops. In between, you can note what you think might be triggering it, and take pictures of the damage. You can email a flare report, images and notes included, to your doctor or nurse.
And you can set up profiles for as many as five people—I set up one for myself and one for my daughter.
My only quibble with this section was that I had trouble finding the button that would let me report that my flare had ended. (This function is hidden in the Tracker > Update > Flare-up details tab.)
The second, the info-and-news section, is a nice little package of basic facts and advice for patients with eczema or parents of affected children. It’s pitched toward someone who hasn’t encountered eczema before. Me, I’ve had it for 41 years and I blog about it, so my first reaction was that this section was too dumbed-down, but I can see that it could be useful to a newbie.
I do wish the info section didn’t mention antihistamines though. They do not help prevent the itch of eczema and their only utility is that they can make you drowsy and might make it easier for you to go to sleep.
The Desonate advertising section is placed toward the bottom of the app. It is semi-discreet. But it still seems like pushy pharma marketing to me. I hope the NEA got some decent sponsorship funds in return for the exposure.
My overall impression of the app was colored by the advertising. It's great that you can use your iPhone to collect and report medical data. But the app is much like a free mug or pen you might pick up at a convention. You drink your coffee or scribble your notes, and it gets the job done, but that logo is always staring at you from your desk.
***
When I tweeted about the Eczema App, I heard back on Twitter from Emma Williams, a nurse in Swansea, Wales who operates a specialty eczema clinic. She too has an eczema app, "Eczema Expert." I took a glance at it in the App Store but was put off by a couple glaring mistakes—one of the questions in the diagnostic section was “Do you itchy skin?” and there was a mention of “tropical” steroids. I couldn’t bring myself to spend $1.99 because the typos gave a shoddy impression. Let me know when you’ve fixed the app, Emma!
Wednesday, April 24, 2013
New type of white blood cell identified; may play role in eczema
Scientists have identified a new type of white blood cell found in the upper layers of the skin that can either trigger or shut down inflammation.
The research was carried out in mice, which are commonly used as models for the human immune system. There is no proof that the same cells exist in humans, but these results will certainly impel researchers to look for them. It is possible that the newly identified cells play a role in eczema.
The cell type, “group 2 innate lymphoid cells” (ILC2), protects mice against parasitic worms called helminths. In mice, the cells appear to be the main source of the signaling molecule IL-13, known to be important in type 2 immunity—the arm of the immune system that is over-active in allergic disease and eczema.
The scientists took video that showed ILC2 cells moving around in the skin and occasionally stopping to make physical contact with mast cells. Mast cells play an important role in the early stages of inflammation. They are suppressed by IL-13.
However, the researchers also introduced ILC2 cells into mice that had no B or T cells (the white blood cells responsible for much of the immune response). In these mice, stimulating ILC2 cells caused inflammation with symptoms that looked like eczema.
So it appears that ILC2 cells can increase or decrease inflammation, depending on the signaling molecules they secrete. Potentially, drugs might be discovered to control ILC2 cells in the skin and, through them, manage eczema.
The research was performed by a joint Australian/New Zealand/American team led by Wolfgang Weninger, a professor of dermatology at the University of Sydney. It was published in the journal Nature Immunology.
The research was carried out in mice, which are commonly used as models for the human immune system. There is no proof that the same cells exist in humans, but these results will certainly impel researchers to look for them. It is possible that the newly identified cells play a role in eczema.
The cell type, “group 2 innate lymphoid cells” (ILC2), protects mice against parasitic worms called helminths. In mice, the cells appear to be the main source of the signaling molecule IL-13, known to be important in type 2 immunity—the arm of the immune system that is over-active in allergic disease and eczema.
The scientists took video that showed ILC2 cells moving around in the skin and occasionally stopping to make physical contact with mast cells. Mast cells play an important role in the early stages of inflammation. They are suppressed by IL-13.
However, the researchers also introduced ILC2 cells into mice that had no B or T cells (the white blood cells responsible for much of the immune response). In these mice, stimulating ILC2 cells caused inflammation with symptoms that looked like eczema.
So it appears that ILC2 cells can increase or decrease inflammation, depending on the signaling molecules they secrete. Potentially, drugs might be discovered to control ILC2 cells in the skin and, through them, manage eczema.
The research was performed by a joint Australian/New Zealand/American team led by Wolfgang Weninger, a professor of dermatology at the University of Sydney. It was published in the journal Nature Immunology.
Tuesday, April 23, 2013
Scalp eczema therapy: a work in progress
Last year I wrote about scalp eczema. The post is one of the most-read on this blog. Good news: I’m going to write about it again! The reason: once again, scalp eczema is a problem for me.
My scalp trouble seems to follow a yearly cycle, and it might have something to do with pollen, since I had it last spring. Or it might be just that I started swimming again a few months ago. There’s no getting around the fact that swimming is bad for my skin. (I swim, nevertheless, because it’s good for my back.)
I just get this ridiculously dry scalp that starts breaking out into itchy patches. It is extremely hard not to pick at and scratch.
It seems to be a three-part problem: inflammation, dryness, and bad habit.
To treat the inflammation I rub in steroid, which is bad because 1) it’s quite strong (fluocinonide ointment) and 2) it hardly works at all.
I also use a tar shampoo, T-Gel. I love tar shampoo—it’s got a great bite to it and knocks the itch out for a few hours. But it’s a shampoo, made from detergents, which wash oils out and leave my scalp screaming dry.
I realized that the tar shampoo was part of the problem, so now I use it only once a week.
I used to follow tar shampoo with jojoba oil. Jojoba is an expensive, fine-grade natural oil that comes from the seeds of a Mexican desert plant. It is my conclusion that jojoba is a waste of time and money. It doesn't do much besides run down behind your ears and make your neck greasy.
Now I follow my tar shampoo with Aveeno Daily Moisturizing lotion. That's right, I rub it all over my head. It dries to a shellac and makes me look like my grandfather when he used Brylcreem back in the 1950s. Aveeno is good both because it contains soothing oatmeal extract and dimethicone, a rubbery polymer that holds moisture well.
This is not a perfect solution, and a bit disgusting. But it’s better than rubbing in strong steroid ointment out of desperation, I think.
In order to use the Aveeno lotion (to get more of it on my scalp and less on my hair), I buzz my hair short. I’ve got a home barber kit for this. I use the 0.5” or 0.75” attachments. I gave myself a haircut last week, after waiting several months for my scalp eczema to go away so I could go to the barber.
I’m not super-keen on Aveeno for this though. I am going to try shea butter, which at least has the virtue of being a bona fide hair product.
I am surprised that very few commercial companies, if any, make moisturizing scalp lotion. You’d think there would be a market for it. Cosmetics companies seem to approach this as a conditioner problem, as if we’re all worried about how beautiful and manageable our hair is. Well I’m not. I’m a 41-year-old balding man and I have no use for conditioner.
Ironically, Kamedis, the Chinese herbal therapeutics company whose skin lotion I reviewed recently (and none too positively) makes scalp lotion for eczema. Maybe I should give that a shot!
Let’s not forget that my bad habit of picking at dry skin and scabs on my scalp is part of the problem too. I know that it’s possible to quit the habit to some degree by undergoing habit-reversal training.
There are two phases to habit reversal. In the first, you count how many times you touch, pick, or scratch yourself during the day. In the second, you train yourself to recognize that you're about to scratch, and to resist the urge, either by clenching your hand or digging your nails into your palm.
Here’s the barrier that prevents me from self-training—I don’t own a simple digital counter that would enable me to keep track of how many times I am scratching. Last time I tried habit-reversal, I made pencil marks on the back of a business card. I touch my head more than 500 times a day, apparently. It's a pain to have to keep making pencil marks.
I just looked on Amazon. This is what I want. Isn’t it ridiculous that I am not able to stop picking at my scalp because I don’t have a little clicker device that costs less than $7.00? I just bought it.
My scalp trouble seems to follow a yearly cycle, and it might have something to do with pollen, since I had it last spring. Or it might be just that I started swimming again a few months ago. There’s no getting around the fact that swimming is bad for my skin. (I swim, nevertheless, because it’s good for my back.)
I just get this ridiculously dry scalp that starts breaking out into itchy patches. It is extremely hard not to pick at and scratch.
It seems to be a three-part problem: inflammation, dryness, and bad habit.
To treat the inflammation I rub in steroid, which is bad because 1) it’s quite strong (fluocinonide ointment) and 2) it hardly works at all.
I also use a tar shampoo, T-Gel. I love tar shampoo—it’s got a great bite to it and knocks the itch out for a few hours. But it’s a shampoo, made from detergents, which wash oils out and leave my scalp screaming dry.
I realized that the tar shampoo was part of the problem, so now I use it only once a week.
I used to follow tar shampoo with jojoba oil. Jojoba is an expensive, fine-grade natural oil that comes from the seeds of a Mexican desert plant. It is my conclusion that jojoba is a waste of time and money. It doesn't do much besides run down behind your ears and make your neck greasy.
Now I follow my tar shampoo with Aveeno Daily Moisturizing lotion. That's right, I rub it all over my head. It dries to a shellac and makes me look like my grandfather when he used Brylcreem back in the 1950s. Aveeno is good both because it contains soothing oatmeal extract and dimethicone, a rubbery polymer that holds moisture well.
This is not a perfect solution, and a bit disgusting. But it’s better than rubbing in strong steroid ointment out of desperation, I think.
In order to use the Aveeno lotion (to get more of it on my scalp and less on my hair), I buzz my hair short. I’ve got a home barber kit for this. I use the 0.5” or 0.75” attachments. I gave myself a haircut last week, after waiting several months for my scalp eczema to go away so I could go to the barber.
I’m not super-keen on Aveeno for this though. I am going to try shea butter, which at least has the virtue of being a bona fide hair product.
I am surprised that very few commercial companies, if any, make moisturizing scalp lotion. You’d think there would be a market for it. Cosmetics companies seem to approach this as a conditioner problem, as if we’re all worried about how beautiful and manageable our hair is. Well I’m not. I’m a 41-year-old balding man and I have no use for conditioner.
Ironically, Kamedis, the Chinese herbal therapeutics company whose skin lotion I reviewed recently (and none too positively) makes scalp lotion for eczema. Maybe I should give that a shot!
* * *
Let’s not forget that my bad habit of picking at dry skin and scabs on my scalp is part of the problem too. I know that it’s possible to quit the habit to some degree by undergoing habit-reversal training.
There are two phases to habit reversal. In the first, you count how many times you touch, pick, or scratch yourself during the day. In the second, you train yourself to recognize that you're about to scratch, and to resist the urge, either by clenching your hand or digging your nails into your palm.
Here’s the barrier that prevents me from self-training—I don’t own a simple digital counter that would enable me to keep track of how many times I am scratching. Last time I tried habit-reversal, I made pencil marks on the back of a business card. I touch my head more than 500 times a day, apparently. It's a pain to have to keep making pencil marks.
I just looked on Amazon. This is what I want. Isn’t it ridiculous that I am not able to stop picking at my scalp because I don’t have a little clicker device that costs less than $7.00? I just bought it.
Thursday, April 18, 2013
Eczema product review: TOPICMedis Calming Lotion (traditional Chinese herbal)
My take on traditional Chinese medicine (TCM), of the herbal variety, is that the theory is bullshit. Yin/yang? The "five elements" being wood, fire, earth, metal, and water? "Energy meridians"? Medieval thinking.
Herbal medicine, though, is a major foundation of modern pharmacy. TCM herbs contain molecules that are biologically active--what Western medicine would call drugs.
This is why I doubt that the TCM practice of dosing with several (sometimes nine or ten) herbs in combination is a good idea. The potential for side effects and drug interactions is too high.
I acknowledge that empirical, practical knowledge is a powerful way to solve problems, and that TCM could work for certain conditions in the right circumstances. You would need to have a very experienced TCM practitioner treating a patient for a condition that the expert was familiar with. You could get results--even though the theory is bunk.
But I am skeptical when companies market TCM herb-containing products directly to consumers. The treatment can't be tailored to the patient. The dosing and quality control are dubious. How do you know what the active ingredients are, and are they consistent from batch to batch?
And most importantly, who has verified that these things work and aren't toxic?
The answer is: nobody.
Recently I was asked whether I would review TOPICMedis Calming Lotion, a product of the Israeli company Kamedis. The lotion contains four TCM herbal extracts. I was intrigued, and agreed--because I wanted to learn which TCM herbs might be useful in treating eczema.
So what's in TOPICMedis Calming Lotion?
The first three ingredients listed are "water, glycerin, dimethicone & cyclotetrasiloxane & polysilicone-11."
I like dimethicone. It's a rubbery polymer that Aveeno includes in their Daily Moisturizing Lotion and I find it seals moisture into my skin. Not exactly a traditional herb though.
The lotion contains extracts from four herbs: Rheum palmatum, Scutellaria baicalensis, licorice root, and Cnidium monnieri. I couldn't find any information about how much of any of these was actually in the product.
Right now I have eczema in a number of places including the backs of my hands. I rubbed Kamedis lotion into my left hand, and used the usual stuff on my right hand: Eucerin and Aveeno. I tried this for three days. I saw no difference between my right hand and my left. (No improvement in either.)
As weak as my trial was as a scientific exercise, I did better than Kamedis in one respect: I used a control. Kamedis tells me they have conducted a clinical trial that shows their lotion improves symptoms in 20 patients with eczema. They did not use a control group: either a group that received no treatment or a group that received a standard treatment. Therefore their trial is of no value.
This prompted me to look at how TCM herbs regulated in the United States. I hadn't thought about this before. I was surprised--and appalled--to learn that to a great degree TCM herbs are not regulated at all.
Amazing, isn't it? Drug companies pay huge settlements when it turns out that a new drug has a fatal side effect in a tiny subset of users. Drugs must undergo an enormous battery of tests to verify efficacy and non-toxicity in animals and humans. Drug manufacturers employ stringent quality control to ensure the same dose is in every pill or ointment. TCM herbs don't have to pass any tests. We're supposed to rely on folk wisdom and the goodwill of the company selling the product.
We can thank the Dietary Supplement Health and Education Act of 1994 (DSHEA) for tying the FDA's hands when it comes to regulating dietary supplements. The Kamedis lotion isn't a supplement, it's a cosmetic, and the FDA is supposed to regulate cosmetics, but TCM falls into a category that isn't controlled strongly if at all--and I am sure there are loopholes that companies can use to get pretty much any products on the shelves in stores or on the internet.
If anyone knows more than I do about TCM regulation in the United States, I would appreciate clarification.
I remain appreciative of TCM's potential, but it is a jungle out there. There's way too much potential for quackery (expensive placebos), danger for side effects and drug interactions with TCM components and conventional therapies. And even if you have the right TCM herb, how can you ensure the same amount of active ingredient is in each batch?
I appreciate the opportunity Kamedis gave me to test their lotion--at the very least, it alerted me to four herbs that (I'm guessing) TCM practitioners have used over the ages to treat eczema. Maybe one or more of them contain novel molecules that can be formulated to provide real, quantifiable benefit.
Herbal medicine, though, is a major foundation of modern pharmacy. TCM herbs contain molecules that are biologically active--what Western medicine would call drugs.
This is why I doubt that the TCM practice of dosing with several (sometimes nine or ten) herbs in combination is a good idea. The potential for side effects and drug interactions is too high.
I acknowledge that empirical, practical knowledge is a powerful way to solve problems, and that TCM could work for certain conditions in the right circumstances. You would need to have a very experienced TCM practitioner treating a patient for a condition that the expert was familiar with. You could get results--even though the theory is bunk.
But I am skeptical when companies market TCM herb-containing products directly to consumers. The treatment can't be tailored to the patient. The dosing and quality control are dubious. How do you know what the active ingredients are, and are they consistent from batch to batch?
And most importantly, who has verified that these things work and aren't toxic?
Recently I was asked whether I would review TOPICMedis Calming Lotion, a product of the Israeli company Kamedis. The lotion contains four TCM herbal extracts. I was intrigued, and agreed--because I wanted to learn which TCM herbs might be useful in treating eczema.
So what's in TOPICMedis Calming Lotion?
The first three ingredients listed are "water, glycerin, dimethicone & cyclotetrasiloxane & polysilicone-11."
I like dimethicone. It's a rubbery polymer that Aveeno includes in their Daily Moisturizing Lotion and I find it seals moisture into my skin. Not exactly a traditional herb though.
The lotion contains extracts from four herbs: Rheum palmatum, Scutellaria baicalensis, licorice root, and Cnidium monnieri. I couldn't find any information about how much of any of these was actually in the product.
Right now I have eczema in a number of places including the backs of my hands. I rubbed Kamedis lotion into my left hand, and used the usual stuff on my right hand: Eucerin and Aveeno. I tried this for three days. I saw no difference between my right hand and my left. (No improvement in either.)
As weak as my trial was as a scientific exercise, I did better than Kamedis in one respect: I used a control. Kamedis tells me they have conducted a clinical trial that shows their lotion improves symptoms in 20 patients with eczema. They did not use a control group: either a group that received no treatment or a group that received a standard treatment. Therefore their trial is of no value.
This prompted me to look at how TCM herbs regulated in the United States. I hadn't thought about this before. I was surprised--and appalled--to learn that to a great degree TCM herbs are not regulated at all.
Amazing, isn't it? Drug companies pay huge settlements when it turns out that a new drug has a fatal side effect in a tiny subset of users. Drugs must undergo an enormous battery of tests to verify efficacy and non-toxicity in animals and humans. Drug manufacturers employ stringent quality control to ensure the same dose is in every pill or ointment. TCM herbs don't have to pass any tests. We're supposed to rely on folk wisdom and the goodwill of the company selling the product.
We can thank the Dietary Supplement Health and Education Act of 1994 (DSHEA) for tying the FDA's hands when it comes to regulating dietary supplements. The Kamedis lotion isn't a supplement, it's a cosmetic, and the FDA is supposed to regulate cosmetics, but TCM falls into a category that isn't controlled strongly if at all--and I am sure there are loopholes that companies can use to get pretty much any products on the shelves in stores or on the internet.
If anyone knows more than I do about TCM regulation in the United States, I would appreciate clarification.
I remain appreciative of TCM's potential, but it is a jungle out there. There's way too much potential for quackery (expensive placebos), danger for side effects and drug interactions with TCM components and conventional therapies. And even if you have the right TCM herb, how can you ensure the same amount of active ingredient is in each batch?
I appreciate the opportunity Kamedis gave me to test their lotion--at the very least, it alerted me to four herbs that (I'm guessing) TCM practitioners have used over the ages to treat eczema. Maybe one or more of them contain novel molecules that can be formulated to provide real, quantifiable benefit.
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