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If you have eczema, understanding what’s happening beneath the surface is just as important as treating the visible rash. Because eczema, particularly atopic dermatitis, isn’t simply a problem with dry skin. It’s a complex inflammatory condition involving the skin barrier, immune system and skin microbiome. And understanding how these interact helps explain why eczema can become so persistent. Let’s start with the skin barrier. The outermost layer of your skin is designed to keep moisture in while protecting you from irritants, allergens and microorganisms. In people with atopic dermatitis, this barrier often doesn’t function as effectively. One of the proteins involved is called filaggrin. Filaggrin helps maintain the structure and hydration of the skin barrier. Some people have genetic variants affecting filaggrin production, making their skin more vulnerable to moisture loss and environmental irritants. But not everyone with eczema has a filaggrin mutation. The immune system is also involved. When the skin barrier is compromised, irritants and allergens can interact more easily with immune cells in the skin. In atopic dermatitis, inflammatory pathways involving cytokines such as IL-4 and IL-13 are particularly important. These cytokines contribute to inflammation and can also interfere with normal skin barrier function. So we’re not just dealing with a damaged barrier causing inflammation. Inflammation itself can make that barrier dysfunction worse. Then there’s the skin microbiome. During eczema flares, we often see changes in the microorganisms living on the skin, including increased abundance of a bacterium called Staphylococcus aureus. This bacterium can interact with the immune system and contribute to further inflammation. And this is where the itch-scratch cycle becomes important. Inflammation causes itching. Scratching damages the skin barrier further. That creates more opportunities for irritation, inflammation and additional itching. It’s a cycle that can be incredibly difficult to break. But what about the gut? You’ve probably heard people say that eczema is caused by poor gut health and that fixing your gut will fix your skin. The research is much more complicated than that. There is growing interest in the relationship between the gut microbiome, immune development and atopic dermatitis. However, we cannot assume that every person with eczema has an underlying gut disorder, or that probiotics, restrictive diets or gut treatments will resolve their eczema. This is why clinical assessment matters. We need to consider the severity of the eczema, possible contact allergens, environmental irritants, skin infections, other atopic conditions and how well the skin barrier is being managed. And importantly, moisturisers and appropriate anti-inflammatory skin treatments remain essential parts of evidence-based eczema management. At Nourishing Apothecary, our naturopaths Lainie and Mel work with children and adults experiencing eczema and complex skin concerns, taking an individualised approach alongside appropriate medical treatment. We offer consultations Australia wide via Zoom. Book a free discovery call to find the right practitioner for you. www.nourishingapothecary.com #eczema #atopicdermatitis #skinbarrier #skinmicrobiome #naturopath
If you have eczema, understanding what’s happening beneath the surface is just as important as treating the visible rash. Because eczema, particularly atopic dermatitis, isn’t simply a problem with dry skin. It’s a complex inflammatory condition involving the skin barrier, immune system and skin microbiome. And understanding how these interact helps explain why eczema can become so persistent. Let’s start with the skin barrier. The outermost layer of your skin is designed to keep moisture in while protecting you from irritants, allergens and microorganisms. In people with atopic dermatitis, this barrier often doesn’t function as effectively. One of the proteins involved is called filaggrin. Filaggrin helps maintain the structure and hydration of the skin barrier. Some people have genetic variants affecting filaggrin production, making their skin more vulnerable to moisture loss and environmental irritants. But not everyone with eczema has a filaggrin mutation. The immune system is also involved. When the skin barrier is compromised, irritants and allergens can interact more easily with immune cells in the skin. In atopic dermatitis, inflammatory pathways involving cytokines such as IL-4 and IL-13 are particularly important. These cytokines contribute to inflammation and can also interfere with normal skin barrier function. So we’re not just dealing with a damaged barrier causing inflammation. Inflammation itself can make that barrier dysfunction worse. Then there’s the skin microbiome. During eczema flares, we often see changes in the microorganisms living on the skin, including increased abundance of a bacterium called Staphylococcus aureus. This bacterium can interact with the immune system and contribute to further inflammation. And this is where the itch-scratch cycle becomes important. Inflammation causes itching. Scratching damages the skin barrier further. That creates more opportunities for irritation, inflammation and additional itching. It’s a cycle that can be incredibly difficult to break. But what about the gut? You’ve probably heard people say that eczema is caused by poor gut health and that fixing your gut will fix your skin. The research is much more complicated than that. There is growing interest in the relationship between the gut microbiome, immune development and atopic dermatitis. However, we cannot assume that every person with eczema has an underlying gut disorder, or that probiotics, restrictive diets or gut treatments will resolve their eczema. This is why clinical assessment matters. We need to consider the severity of the eczema, possible contact allergens, environmental irritants, skin infections, other atopic conditions and how well the skin barrier is being managed. And importantly, moisturisers and appropriate anti-inflammatory skin treatments remain essential parts of evidence-based eczema management. At Nourishing Apothecary, our naturopaths Lainie and Mel work with children and adults experiencing eczema and complex skin concerns, taking an individualised approach alongside appropriate medical treatment. We offer consultations Australia wide via Zoom. Book a free discovery call to find the right practitioner for you. www.nourishingapothecary.com #eczema #atopicdermatitis #skinbarrier #skinmicrobiome #naturopath

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