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The Biology Behind Eczema and Psoriasis
By: Claudia C. Aguirre, PhD
Posted: June 29, 2012, from the July 2012 issue of Skin Inc. magazine.
Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that affects most of the body surface.
Eczema and psoriasis are some of the most challenging skin conditions encountered by skin care professionals. Often, there will simply be a little red rash on the skin and you may be left scratching your own head trying to figure out how it came to be. Up to 20% of the world’s children suffer from eczema1, 2 and up to 3% of adults suffer from either eczema or psoriasis.3 Given that the world population just reached the 7 billion mark, that’s a lot of people. Eczema, along with asthma and allergies, are on the rise; in fact, eczema is much more common today than it was 30 years ago, especially in children. This rapid spike in apparent incidence is cause for concern, and may be due to many factors, such as inadequate diet, pollution and other environmental stressors. The truth is, it isn’t known exactly what causes eczema or psoriasis. The good news is, more and more is being learned about these inflammatory skin diseases and strategies are being developed to effectively manage their symptoms.
It is significant to note that neither condition is contagious, nor are they infections; and they aren’t transmitted by external contact or exposure. The origins of eczema and psoriasis are genetic; however, the triggers that cause their distressing and visible symptoms may include stress and environmental factors.
A rash by any other name is still a rash. The terms “eczema” or “dermatitis” are very broad and can mean a whole family of skin conditions, ranging from dandruff, to contact dermatitis to atopic dermatitis. This can lead to many a confused client and skin care professional. In dermatology and skin care, the word “eczema” typically refers to atopic dermatitis (AD), a chronic inflammatory skin disease. It causes dry, itchy, irritated skin that requires daily care. Genetic defects in eczema result in abnormal skin cell differentiation. During differentiation, keratinocytes move from the basal cell layer of the epidermis through the granular layer to a group of flattened dead cells in the stratum corneum. This process of epidermal differentiation, or keratinization, involves a variety of proteins responsible for different functions at each stage.
One of these proteins, filaggrin, plays a major role in epidermal homeostasis; it has two main functions. First, it stacks the keratin filaments into dense bundles, allowing for easy desquamation. Imagine how much easier it is to move flattened boxes than propped-open boxes. It is then converted into the skin’s natural moisturizing factor (NMF) along with other byproducts. So if filaggrin does not work very well, it can have adverse effects, not only on the process of epidermal differentiation, but also on the skin’s natural moisture levels and protective lipid barrier. This seems to be the biological basis of dry skin.
In the past five years, researchers have established the link between filaggrin mutations and developing ichthyosis vulgaris4, atopic eczema5 and, most recently, peanut allergies.6 Ichthyosis is another skin disease characterized by very dry skin. The word itself is Greek for “fish,” suggesting the scaly nature of the lesions. Indeed, scientists are getting closer to understanding the genetic connection between allergic diseases, bringing hope for a future therapy not only for eczema clients, but also for those with allergies and ichthyosis.
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