Backgrounder

The skin barrier

• The skin barrier is the outermost layer of skin which protects the body from the environment¹
  
• In normal skin the skin barrier is thick and consists of several layers of cells, skin cell binders (corneodesmosomes) that break down only in the very top layers to peel off dead skin and strong lipid layers which cement cells together²
  
• In eczema prone skin the skin cell binders breakdown throughout all skin barrier layers, the lipid layers are incomplete and there are less layers of skin cells ie a thinner ski n barrier²
  
• In eczema prone skin the addition of irritants such as soap and detergents further breaks down the skin barrier allowing the entry of other irritants and allergens which triggers an eczema flare²
  
• Bath oils and creams that contain no soap can help repair the damaged lipid layers in eczema prone skin²

Skin barrier influencers

Genetics

• A child with one parent who has eczema has a 20% chance of developing the disease²
  
• A child with two parents who have eczema has a 50% chance of developing the disease²
  
• People prone to eczema produce high levels of proteins that dissolve skin cell binders leading to breakdown of the skin barrier¹

The acid mantle (acidic pH of skin)

• Helps maintain good barrier function of skin¹
  
• A healthy skin pH for adults is ~ 5.51
  
• The acid mantle protects against infection with “bad” microbes (germs)¹
  
• the acid mantle helps with skin barrier recovery¹
  
• Higher pH (lower acidity) of skin is linked to eczema and other forms of skin inflammation¹
  
• Higher pH affects the skin lipids that bind skin cells together¹

Soaps, detergents and cosmetics

• Soaps and detergents increase skin pH (up to 7.5) and dissolve skin lipids¹
  
• Soaps and detergents are one of the most common causes of irritant contact dermatitis of the hands and can trigger flares of eczema¹
  
• Soaps and detergents have been shown to reduce skin barrier thickness by 40%²
  
• Cosmetic preparations can have both positive and negative effects if used incorrectly (e.g. emollients used for washing should not be left on skin)¹
  
• Mild / low concentrated products should be used in cases where detergent use cannot be avoided eg shampoos¹

Non-steroidal creams

• Do not cause break down in the skin barrier1 or thinning of the skin³
  
• Act extremely superficially on the skin and are specific to the T-cells which cause redness and itching in eczema very early on in the cycle^4,5,6
  
• Intermittent use of non-steroidal creams at the first sign of flare keeps patients flare-free for significantly longer⁷

Steroid creams

• Have anti-inflammatory effects but skin thinning can occur with excessive use¹
  
• Are effective in controlling severe flares of eczema¹

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Eczema, sensitive skin and irritant contact dermatitis

• Eczema (atopic dermatitis) is a common, recurring, non-infectious, inflammatory skin disease in which the skin becomes red, dry, itchy or scaly and may weep, bleed and crust over
  
• Australia has one of the highest incidences of eczema world-wide, with more than a million Australians suffering from eczema in 2006⁸
  
• Around 60 per cent of people with eczema develop the skin disease within the first 12 months of life⁷
  
• Around 90 per cent of people with eczema develop symptoms by the age of 5 years⁹
  
• Approximately 50 per cent of adults complain of sensitive skin2
  
• Sensitive skin results in burning, stinging and / or itching following application of soap and bath products and cosmetics²
  
• Irritant contact dermatitis occurs in people with very sensitive skin where soap products and detergents cause redness, severe dryness and cracks in the skin²
  
• A large proportion of adults with sensitive skin and / or irritant contact dermatitis had atopic eczema when they were children²
  
• Children who “appear to grow out” of atopic dermatitis may develop irritant contact dermatitis and / or sensitive skin later in life²
  
• The incidence of eczema and contact dermatitis has tripled in the last 50 years and has been linked to a range of environmental factors¹

Body areas most commonly affected by eczema

• Babies < six months – face and scalp
  
• Older children – skin folds in front of elbow and behind the knee
  
• Adolescents – 21% have eczema on the eyelids
  
• Adults – face and neck
  
• Thinner areas of skin including eyelids, back of ears, face and genitals

Non-allergic eczema versus allergic eczema

• Non-allergic eczema occurs in up to 66% of children with atopic dermatitis and not in 20% as previously believed²
  
• In non-allergic eczema there are no high levels of allergic antibodies (IgE) ²
  
• In allergic eczema there are high levels of allergic antibodies (IgE) resulting from reacting against allergens eg grasses and pets²
  
• Non-allergic eczema can lead to allergic eczema with time¹
  
• Severe skin barrier breakdown increases the chances of a person with non-allergic eczema developing allergic eczema¹

The cost of eczema and contact dermatitis:

• People with eczema can spend up to $2,000 annually on treatments¹⁰
  
• Eczema has a significant impact on quality of life and may affect daily routines¹⁰
  
• On average people with eczema spend 1 out of every 3 days in a flare¹¹
  
• During flares people avoid everyday activities, suffer from sleep disturbances and have to take time off school / work⁷

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For further information please contact Kirsten Bruce or Ruby Archis from viva! communications on 02 9884 9011 or m. 0401 717 566 / 0413 834 906.

1. Cork et al. New perspectives on epidermal barrier dysfunction in atopic dermatitis: gene-environment interactions. J Allergy Clin Immunol 2006; 118: 3-21.
   
2. Cork et al. Predisposition to sensitive skin and atopic eczema. Community Practitioner 2005; 78, 12: 440-442.
   
3. Therapeutic Guidelines Dermatology, Version 2, 2004.
   
4. Hultsch T et al. Dermatology 211, 2005: 174-187.
   
5. Grassberger M et al. A novel anti-inflammatory drug, SDZASM981, for the treatment of skin diseases in vitro pharmacology. Br J Dermatol 1999; 141(1): 264-73. III F 47 156.
   
6. Meingassner J et al. A novel anti-inflammatory drug, SDZ ASM 981, for the topical and oral treatment of skin diseases in vivo pharmacology. Br J Dermatol 1997; 137(1):568-76.
   
7. Meurer M et al. Dermatology 2002; 205: 271-277.
   
8. ABS (Australian Bureau of Statistics), (3222.0) Population Projections, Australia, 2004 to 2101.
   
9. Su J et al. Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997; 76: 159-162.
   
10. Department of Dermatology, St Vincent’s Hospital, Melbourne. Atopic Eczema Health Survey,
    January 1999 – February 2000; sample size 85.
    
11. Zuberbier T et al. Patient perspectives on the management of atopic dermatitis (ISOLATE). J Allergy and Clin Imunol 2006; 118: 226-32.