How Does Our Immune System Impact Eczema?

Systemic inflammation refers to a widespread immune response that can affect various tissues and organs throughout the body. 

In the case of eczema, systemic inflammation may exacerbate eczema symptoms by promoting the release of inflammatory mediators, such as cytokines.^{(ZOT 2016)} Those cytokines travel throughout the body and increase inflammation, including at areas of eczema flares.

In other words, systemic inflammation causes the castle guards to be on edge and can cause eczema symptoms to be worse than they otherwise would be.

Systemic inflammation can be influenced by various factors, with major factors including:

• Diet

• Health of the gut microbiome

• Health of the skin microbiome

• Autoimmune diseases  

If you are concerned about systemic inflammation, please consult with a physician about whether any of these options might be right for you:

• Lifestyle modifications: Maintaining a healthy diet, exercising regularly, and managing stress can help reduce systemic inflammation.
• Probiotics and prebiotics (either topical or ingested): These supplements can help maintain a healthy gut and skin microbiome, which play a crucial role in modulating inflammation.
• Anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may help reduce inflammation in some cases. 

It is important to note that the effectiveness of these interventions may vary among individuals, and a personalized approach may be necessary to address your specific needs.

Skin barrier weakness plays a crucial role in the modulation of immune response and is particularly relevant in the context of eczema. 

The skin barrier provides protection from external threats, such as pathogens, chemicals, irritants, and allergens, which might cause an immune response if they were to pass through to the deeper epidermal or dermal layers of the skin.^{(DermNet - BFAD)}

The skin barrier resembles a microscopic, flexible brick wall. Dead skin cells act as bricks and ceramides, along with several other fats, act as mortar to connect those bricks. The strength, smoothness, and suppleness of your skin is largely controlled by the ceramides and fats. 

Skin barrier barrier weakness is generally thought to be caused by a lack of long chain ceramides, or a disorganization of those long chain ceramides. 

A lack of long chain ceramides in otherwise healthy skin can arise from a genetic defect in the body, poor nutrition, and a number of other factors. Whereas disorganization of the ceramides can be a result of genetic or environmental factors.

In unhealthy or inflamed skin, ceramides are sometimes broken down by the immune reaction or by environmental factors. This helps explain why eczema sometimes “spreads”. The skin near the initial flare loses its long chain ceramides and the new triggers are allowed through in the areas surrounding the initial flare, leading to additional inflammation in the adjacent areas.

The skin contributed to systemic inflammation as well. A flare in one area of the skin will raise overall inflammation levels, which in turn could lead to new flares in another part of the body.

Treatments that focus on improving the skin barrier strength can help alleviate eczema symptoms and prevent relapses.

Our skin is our largest and most active interface with the outside world. Unlike our gut, we cannot always control what comes into contact with our skin. 

Some common environmental triggers for eczema flare-ups include:

• Metals (e.g., chromium, cobalt, chloride, copper, gold, nickel) 

• Exposure to smoke, air pollutants, harsh soaps, fabrics such as wool, and some skin care products 

• Low humidity (dry air) causing skin to become dry and itchy

• Heat and high humidity causing sweating and increased itchiness

• Allergens such as pollen, dust and mold

Continuing our castle analogy - triggers are like invaders coming to the castle walls. Even if the walls are strong and high, with enough invaders, they will get into the castle. At that point, the guards come to our aid and a flare-up is born!

Learn more about identifying, avoiding, and removing triggers and allergens. 

The activity of the immune system results in inflammation. In the skin, this can manifest as eczema. The causes of the inflammation can be considered “triggers” and can come from various aspects of life. The factors affecting the severity of a reaction are the intensity and duration of trigger exposure as well as the sensitivity to a trigger.

Stress can amplify the immune sensitivity, leading to increased severity of eczema symptoms. Dietary and environmental allergies such as pollen, dust and mold can result in immune system reactions in and on the skin, leading to eczema symptoms. Learn more about identifying allergies in the allergy tests page and more about triggers in the triggers page.

The skin microbiome consists of bacteria, viruses, and fungi that together form a complex and dynamic community on the skin's surface. It plays a vital role in fending off disease-causing microorganisms (pathogens), boosting skin barrier protection, and aiding immune defenses. 

The skin microbiome works with the immune system to fight infection and modulate inflammation. A healthy skin microbiome will signal to the immune system that things are ok and will lower inflammation. 

The opposite is true as well: the skin’s microbiome will alert the immune system to harmful bacteria or viruses, inducing a reaction. An unhealthy microbiome can also induce harmful inflammation.

To maintain a healthy skin microbiome, be mindful of the skin care products and household chemicals that you use.

Eczema is not classified as an autoimmune disease as it is not directly a result of a mistargeted immune system, but there can be problems with the immune system that can affect the severity of eczema symptoms. 

In the case of atopic dermatitis, there is often an imbalance of certain immune cells, specifically T cells. In particular, the cytokines interleukin 4 and 13 (IL-4 and IL-13) are considered central to the severity of the symptoms.^{(CHI 2020)} This results in an overproduction of IgE antibodies, which bind to allergens and trigger a stronger inflammatory response.^{(DAV 2011)} 

Allergic eczema sufferers can often have more Th2 cells.^{(MAR 2018)} Th2 cells are responsible for the release of cytokines which instruct immune cells to produce antibodies called immunoglobulin E (IgE) that trigger an allergic response.^{(ANN 2014)}

There are new drugs and therapies that can modulate the above immune concerns. 

Identifying and avoiding triggers that cause or exacerbate eczema is essential for managing immune response. Common triggers include allergens, irritants, and environmental factors such as extreme temperatures or humidity. 

Implementing a thorough skincare routine, using gentle cleansers and moisturizers, and wearing non-irritating clothing can help minimize exposure to these triggers.

Adopting a healthy lifestyle can help modulate the immune system and decrease inflammation. 

Some foods facilitate the modulation of inflammation. Read about adjusting your diet and nutrition when you have eczema here.  

The Th2 response can be mediated by exercise, therefore reducing the sensitivity of the allergic immune response. Sweating can improve skin health by helping to fight infection. Learn more about how to exercise when you have eczema here.

The mind-body connection is powerful: stress can lead to reduced Th1 and increased Th2 immune response which results in increased chance of infection and increased sensitivity to allergens respectively. Learn more about mental health with eczema here.

Topical or ingested probiotics and prebiotics can promote a healthy gut and skin microbiome, which in turn can help regulate inflammation.

To improve skin barrier function, choose skincare products that contain long chain ceramides and other barrier-repairing ingredients. 

Consistently using these products can help to strengthen the skin barrier and reduce the likelihood of triggers penetrating the skin.

The presence of damaging pathogens or imbalance of the microbiome can lead to problematic infections. On the skin, this can lead to increased inflammation and damaged skin barrier resulting in irritation and worsening eczema. It’s important to know how to prevent, identify and treat infections to maintain good skin health. Learn more in the infections in eczema here.

Immune-modulating and suppressing medications can help regulate immune system responses and reduce inflammation in individuals with eczema. Some of these medications include topical corticosteroids, calcineurin inhibitors, and biologic drugs. 

Always consult a healthcare professional before starting any new medication to ensure its appropriateness for your specific condition.