Sunday, 31 January 2016

Anti-inflammatories part 1: Hydrocortisone, the Thug

The Thug

Hydrocortisone is prescribed to most eczema sufferers. The box says 'Effective relief for inflammation, irritation and itching.' True enough. The leaflet inside warns of two possible side effects: allergic reactions and stretch marks. Mmm, not quite the whole story.

Hydrocortisone (cortisol) is a glucocorticoid. Raised levels lead to:

Weight gain and obesity. Cortisol provides a potent fat storage signal especially in the abdominal region. An enzyme in belly fat converts inactive cortisol back to active cortisol. Not good.

Immune system suppression: susceptibility to colds and infections, slow wound healing, food allergies, cancer and autoimmune diseases.

Gastrointestinal problems

Cardiovascular disease. Constricts blood vessels and raises blood pressure.

Fertility problems. Disrupted sex hormones.

Reduce collagen synthesis.

Calcium store depletion. Inhibits bone healing.

Fluid retention.

Insomnia and mood disorders.

Now the doctors will very likely tell you that the levels of hydrocortisone in the creams are low and safe for long term use, but a number of the conditions above lead to the production of yet more cortisol in a positive feedback loop. And is it just coincidence that after 20 + years of topical steroid use Grace has at least seven of the above? In particular she has become more susceptible to skin infections, and also experienced some autoimmune blistering.

And now the shocker: steroid addiction.

The creams that initially suppressed the problem can become the cause of the problem. Localised rashes become widespread. Steroid resistance develops. Higher strengths are used. The problem escalates till there is nowhere left to go but withdrawal.

Withdrawal is a protracted and highly intense process. Steroid rebound is often described as hellish. It lasts for months to years. The ITSAN site advocates complete withdrawal and gives advice and support to sufferers. Everyone using or prescribing steroids should take account of this, but much more research needs to be done. When there is insufficient data doctors can become invested in a particular position and it is difficult to see the true picture. Looking at the evidence of bloggers gives a mixed picture with some achieving remarkable healing and others struggling with frequent flares.

Grace ran out of TS two weeks ago and is already in the early stages of withdrawal. So what to do?


Is it possible to achieve a softer landing by tapering TS?

Does TS cause a significant increase in circulating cortisol? To what extent does it suppress adrenal function?

Thursday, 14 January 2016

Hitchhikers - the good and the bad

Bacteria are thought to influence eczema in various ways. I want to address that with the first part of my new regime. I've just finished a course of antibiotics for infected eczema so I want to rebalance my bacteria. This is my starting point. Not good is it?

I'm hoping to do that with:

No artificial sweeteners
High fibre diet with fermented foods
No meat, no dairy

Here’s the reasoning:

The autoimmune bit

How does the immune system work?

The body’s immune system is designed to recognise and neutralise threats. Sometimes it gets confused; result: friendly fire. The body attacks itself.

We are not alone.

90% of the cells in our bodies are hitchhikers. Bacteria and parasites (our biome) crowd every space in the vehicle. All we do is drive. They pay for the lift by helping our vehicle to run smoothly. One of the most important things they do is to regulate our immune systems. It's better for us if we have a wide range of helpers.

Most of our bugs live in the gut. A recent report on Horizon showed that lower levels of Bifidobacteria are found in children with allergies. So it seems logical that bringing in the right kind of helpers can do no harm and may do good.

So how do we pick up the good guys and send the baddies rolling down the road?

Ways we mess up our biomes

Mistake 1

We tend to drive straight down the motorway, picking up a handful of similar types. Much better if we went along country lanes and off road and filled our car with many different types of hitchers. In other words, get around and get mucky; it’s good for you. We’re talking country living, organic gardening, wild food, mud, pets etc; the type of activities that expose you to good bacteria; not sending your kids to play near a sewage outlet.

Mistake 2

We routinely poison our helpers with antibiotics, often given for something that the body would deal with by itself given time. In other words, bear up, it’s only a cold.
 Mistake 3

Bug paranoia. It’s common sense not to chop raw chicken and salad with the same knife, but there’s no need to constantly wipe and spray every surface including yourself with anti-bacterials. If you’re immune-compromised or a surgeon go ahead and wipe.

Mistake 4

Using artificial sweeteners. Don’t. They change gut bacteria. It’s possible that this has an effect on the immune system. It’s known that they favour bacteria that make weight gain and diabetes more likely.

Mistake 5

High intake of refined food and low intake of fibre. There’s a 75% reduction in bacterial diversity on a low fibre diet.

Mistake 6

Eating factory farmed meat and dairy. Cramped conditions and stress lead to disease. The animals are routinely given antibiotics at low doses as a preventative. Result: resistant strains of bacteria and imbalances pass down the food chain to us.
 Ways to rebalance our biome


There are many different brands available offering different levels and types of bacteria. We picked Bio-Kult advanced multi-strain because it contains 14 different types of bacteria (including bifidobacteria which can be low or absent in children with eczema). When choosing a probiotic read the reviews looking for evidence that the bacteria are surviving to populate the lower GI tract. When this course is finished I may try a brand containing more soil bacteria just to get as wide a range as possible.

Fermented foods

Fermented foods such as kimchi and yoghurt contain high levels of good bacteria. (I'm trying dairy-free and haven't got hold of any fermented veg yet).

High fibre diet

As above. Eat lots of fibre. It’s bug fodder.

Skin bacteria

Some research implicates the common skin bacteria staphylococcus aureus as the cause of eczema. It’s said to produce a biofilm which blocks sweat ducts activating the immune system to cause itching and irritation in people with a particular genetic profile.

Numbers and diversity of bacteria seem to play a role in eczema. Diversity falls during flare-ups. Levels of staphylococcus increase. There is insufficient research in this field but it would seem sensible to maintain a skin environment which supports diversity while discouraging the
overgrowth of staphylococcus.


Is it possible to take a differential approach to skin bacteria? Can we discourage staph aureus whilst encouraging diversity?

How are gut bacteria and skin bacteria linked?

Dermatologists, bacteriologists, please respond.

Monday, 4 January 2016


Some time last year my daughter said to me, 'I'm broken.' When your child says that, no matter what their age, it's your job to fix them. This is a joint blog about our efforts to fix her.

Grace's eczema arrived with blue hyacinth soap. She was a meticulous baby and a big fan of soap. Maybe it was a coincidence but that soap seemed to trigger her first bout of itching and redness. After that it got worse. She couldn't sleep for the itching and scratched herself raw. The doctor prescribed steroid creams and emollients. We tried bran baths and exclusion diets. Nothing gave long term relief. So for over 20 years she has suffered.

People tend to think of eczema as a mild illness: a chronic itch, a rash, nothing too distressing. Severe eczema is extremely distressing. The skin is the largest organ in the body. It is what you present to the world. It is in a state of extreme irritation and reactivity. It weeps, it scabs, it bleeds, it gets infected, it hurts where your clothes touch, it is hyper-reactive to all kinds of environmental, chemical, emotional and internal stimuli. And then there's the way it looks. With steroid creams and antihistamines and make-up it is acceptable. During flare ups and particularly when it is infected it makes a mockery of the people who agonise over a pimple or a bad hair day.

The medical advice is designed to dampen symptoms. It does nothing to address causes. We're going after causes. The first things we're going to try are:

Diet - high in anti-inflammatories, low in wheat, dairy and sugar
Biome - rebalance the gut and skin biome
Environment - remove known and potential triggers: dust, moulds, chemicals
Emotional - reduce stress
Topical - gradually reduce steroids, use of natural products

We'll be scouring the internet for the latest research and linking to other eczema blogs. The journey starts here.