ATOPIC DERMATITIS: HOW GUT HEALTH COULD BE THE MISSING PIECE IN MANAGING ECZEMA

For years, atopic dermatitis (AD) - otherwise known as eczema -was regarded as a localized skin problem, one that for decades was considered treatable with topical creams or corticosteroids. Overtime, a growing body of evidence has challenged the notion that eczema is only “skin deep”. This has been aided by growing interest and the emergence of a new area of research focused on the gut-skin axis, which has opened an entirely new landscape for how we inject ourselves into the assessment and management of chronic skin diseases.

- DR. SHITIJ GOEL

Emerging evidence and ongoing work is revealing that gut microbiome dysbiosis may trigger or play a role in the exacerbation of inflammatory skin diseases.

This is a major shift in thinking that is informing how dermatologists, immunologists, and gastroenterologists think about the treatment and prevention of eczema and the possibility of causing deeper healing within the Gastrointestinal (GI) tract. This degree of shift is also garnering interest from healthcare institutions, biotechnology and pharmaceutical companies, and nutraceutical companies trying to build around microbiome therapies as adjuvant therapies for eczema and other chronic skin illnesses.

According to epidemiological studies reported in the scientific literature, the worldwide prevalence of atopic dermatitis is nearly 20% of children and 10% of adults. It typically starts in infancy, is marked by dry, inflamed, and itchy skin, can last through adulthood, and interferes with quality of life and mental wellbeing. Eczema was traditionally managed symptomatically, with moisturizers, corticosteroids, antihistamines, and biologic agents for flareups. Most treatments addressed only the visible symptoms and immune dysregulation on the surface of the skin. There's a growing literature suggesting that eczema is driven by the gut and is linked to gut dysbiosis. Gut dysbiosis is a microbiome imbalance in the gut. The gut microbiome — trillions of bacteria, fungi, and viruses — appears to regulate immune homeostasis and inflammatory response.

The gut-skin axis refers to the bidirectional network ability for communications between the gastrointestinal tract and the skin. It is a culmination of the pathway formed through the immune system, endocrine signalling, and microbial metabolites.