Professor Michael Tirant Presents on Atopic Dermatitis

Professor Michael Tirant Presents on Atopic Dermatitis

Professor Michael Tirant is teaming up with the Australian Traditional Medicine Society (ATMS) to present “An Integrative Approach to the Treatment of Atopic Eczema”, this Tuesday 15th October 2019. The webinar will be presented to naturopathic and integrative practitioners from around the country and will cover some of the latest research in regards to the understanding of and treatment of Atopic Dermatitis.

For more information head see here: https://login.redbackconferencing.com.au/landers/page/40b63e

Eczema and Psoriasis: Same same but different

cream for Eczema

Have you ever noticed that most creams available over the counter for eczema, also say that they are for psoriasis?  This can be a little confusing given they are 2 completely different skin conditions. One condition presents with a broken, fragile skin barrier and the other with dry and thickened skin.  One is dominated by an allergic immune response and the other by autoimmune processes…

So how is it so many creams claim to improve both?  The answer is, most likely, they don’t!

Many of these creams can help with symptomatic relief such as reduced itch or dryness, which are symptoms that both conditions can share.  However, a topical treatment to help heal or clear eczema or psoriasis would require completely different actions.

For instance;

Eczema responds better to gentle treatments with minimal ingredients. This reduces the likelihood of an allergic or contact irritation response.  Skin barrier supporting ingredients, including hypoallergenic fatty acids and oils that mimic the natural fatty content of the skin are often very beneficial.

Psoriasis improves with treatments which include keratolytics.  These are ingredients that help to break down the skin, reduce scale build up and shedding. By removing the surface scale, moisturising ingredients can then reach the deeper layers of the skin.  Psoriasis skin is generally much more tolerant of active ingredients including herbal extracts, which have anti-inflammatory, antioxidant and antimicrobial actions.

Customising creams for optimal results:

Having your cream customized to not only match your skin condition, but the presentation of your condition, can help ensure you are getting the most out of your daily moisturising routine.  For instance, psoriasis or eczema which presents on the feet, should be treated very differently to that which presents on the face. This is due to differences in skin thickness and absorption between the two areas.

This is why PEC practitioners compound all topical creams according to the condition AND presentation, providing you with a customized formula which recognizes these unique differences.  And best of all, helps you avoid a bathroom cabinet filled with thousands of dollars of creams which claim to treat your skin condition, but don’t! �

Eczema News: Are you steroid resistant?

Eczema News - Steroid resistant

Jessica Simonis, Practitioner Integrative Dermatology (BHScNutMed, AdDip WHM)

Chances are you are familiar with the term ‘antibiotic resistance’ but what about topical steroid resistance?  Yes, it is a thing, and here is what you need to know…

Topical steroids have been the basis of eczema treatment for over 50 years and can provide fast acting anti-inflammatory benefits.  Whilst short term use can be beneficial, long term use can be associated with various side effects, including a gradual reduction in effectiveness over time (aka topical steroid resistance).

One of the explanations for this resistance is related to the bacteria Staphylococcus aureus, a common bacteria which can become pathogenic in up to 90% of eczema cases.  Research has found S. aureus produces toxins (AKA Superantigens) which can be found in the lesions of eczema skin.  These toxins are responsible for the release of significant amounts of inflammatory cytokines which correlate with the severity of eczema, including symptoms of itch as well as a resistance to the anti-inflammatory effects of topical steroids.  Studies have shown that a combination of anti-inflammatory treatments with antibiotic therapy works better than just the anti-inflammatory on its own, suggesting that the Staphylococci bacteria and their toxins may play a role in suppressing the benefits of topical steroid treatments.  aren’t working,

So if antibiotics and steroids stop working, what’s left?

The answer lies in nature of course! New research has found that herbal bioactive ingredients, including thymol and farnesol, have demonstrated a direct action on S. aureus bacteria and superantigens, including antibiotic resistant strains.  These ingredients are found in extracts of herbs such as thyme and the peel of citrus fruits.  Topical application of these ingredients has shown great benefit in the treatment of chronic eczema presentations. Read more here

The Psoriasis Eczema Clinic specializes in the treatment of chronic skin conditions resistant to conventional therapies. Our topical treatments contain a unique combination of herbal bioactive ingredients, shown to be effective in the treatment of superantigen associated skin conditions, including eczema and psoriasis. For more information on PEC Founder, Professor Tirant’s research into Superantigens and Skin conditions, see here

Professor Michael Tirant Awarded 3rd Professorship

Professor Michael Tirant and Professor Torello Lotti
Professor Michael Tirant and Professor Torello Lotti, Hanoi, July 2019

Professor Tirant is honored to have been awarded his 3rd Professorship at the Hanoi Medical University; one of the oldest and most prestigious universities in Vietnam. As part of his professorship, Professor Tirant will be involved in lecturing, research and publications, with a special focus on using herbal bioactive ingredients to target superantigens and antibiotic resistant infections in dermatological conditions. We can’t wait to share with you the latest in Integrative Dermatology research!

Is Stress Triggering Your Skin?

Stress Triggering Your Skin
Stress Triggers
Learn how to better identify and manage your stress triggers

Stress is a well-documented trigger AND comorbidity of many skin conditions including psoriasis, eczema, rosacea and acne.  But stress is very much a subjective term.  Learning what it is that your mind and/or body finds stressful is the key to managing your flares and the answer might surprise you…

The skin is innervated by a network of cutaneous nerves and research has discovered that certain neurochemicals play a significant role in many skin conditions by modulating inflammation, cellular growth, immune response and wound repair.  Certain characteristics of chronic skin conditions such as symmetrical distribution, sparing of de-nervated skin and initiation of a flare after stress indicates nerves may play a significant role in the pathogenesis of multiple chronic skin conditions, including psoriasis, eczema, rosacea, acne and more.

What types of stress can flare the skin?

There are 3 stages of stress to be aware of when it comes to skin flares, as different stages can have a different effect on the health of your skin.

  1. Alarm – This stage is also known as fight or flight.  It is the acute stage of stress where your cortisol, heart rate and blood pressure increase as a protective mechanism.  Due to the anti-inflammatory nature of cortisol, you may not experience any symptoms during this phase.
  2. Resistance – During this stage, the body attempts to adapt to the stressful situation.  If the stressful event ceases, the body returns to normal.  If not, the body continues to produce stress hormones, creating imbalances in the endocrine, immune and nervous systems.  This is where symptoms may begin, often with new lesions appearing in new places.
  3. Exhaustion – After extended periods of stress, the body becomes exhausted from trying to maintain a balance in stress hormones.  Your immune system can becomes vulnerable to infection, fatigue and lack of concentration set in and feelings of anxiety and depression are common.  This is where a skin flare can become chronic.

Identifying your stress:

Many of us associate stress with a negative emotional experience, such as a relationship break up, argument, loss of job, financial difficulty and so on.  These are certainly stressful events, but they have something more than negative emotions in common….CHANGE.

As a practitioner of many years, I have found that change is a major driver of skin flares, and what we consider a “Primary” or “Initiating” Trigger.  The interesting part is that the change may even be a positive one, such as taking on a promotion, giving birth to your first child, buying your new home or getting married.  Patients with chronic skin conditions are often very sensitive to changes in their environment.  Even simple changes in weather or temperature can be enough to initiate a flare. 

However, once the patient has adapted to the change, the skin should clear, right?

If it doesn’t clear, this indicates that “Secondary” or “Exacerbating” triggers are still present.  This can include everyday stressors such as being busy, poor sleep, poor diet, nutrient deficiencies, obesity and so on.  These place not only a mental but a physical stress on the body, again exhausting its defense mechanisms. 

So how can you manage your stress, even if you don’t feel stressed?

The answer is ROUTINE!  The nervous system loves routine.  Creating a pattern around when you go to bed, when you wake up, when you eat, what you eat and when you exercise, takes a lot of pressure off your nervous system and the stress response, allowing it to adapt, rather than stay in a constant state of alarm.  Of course, if your routine is not so unhealthy, you may need to make some initial dietary and lifestyle changes, such as less caffeine, less technology, more time outdoors, more vegetables, less processed foods, more water and less alcohol (Read more here).  But once you have, keeping them consistent enough to create a new habit, will give your nervous system the rest it needs, in order to start healing. 

If you are suffering from depression or anxiety and need support, please follow this link for more information.

Jessica Simonis

Clinical Skin Nutritionist

Practitioner Integrative Dermatology

Circadian Rhythm and Chronic Skin Conditions – What’s the link?

Circadian Rhythm and Chronic Skin Conditions

Keeping a chronic skin condition stable when your hormones are running wild can feel like a constant uphill battle.  Not only do we have fluctuating male and female hormones to contend with, but there are stress hormones, sleep hormones and glucose regulating hormones to name a few, all of which work together to create our natural internal rhythm or “circadian clock”.

When we are in balance, our circadian rhythm responds to external cues appropriately.  For example, we are energetic during the day light, sleepy at sun down, hungry during the middle of the day and if female, menstruating in a 4 weekly pattern.   In modern day life, where blue lit screens are often the last thing we see before bed, gyms are open 24/7 and the working day starts and finishes in the dark, it’s no wonder our rhythms go awry. 

So how does this affect the skin?

 Like many organs, the skin is regulated by a central clock known as the suprachiasmatic nucleus which receives light through the retina and passes messages along to other internal clocks via neural and hormonal pathways. It also has its own internal clock system which regulates changes in activity according to the time of day.  For instance, research has shown skin to do the majority of DNA and cellular repair work during the night time.  Skin cells also divide and proliferate more at night, are less hydrated, more acidic and at a slightly higher temperature than during the day, often setting the scene for an uncomfortable night’s sleep for many eczema and psoriasis sufferers.

What can you do to regulate your circadian rhythm and improve your skin?

It’s all in the timing:  Research has shown that the application of topical skin treatments is best timed at night to not only help alleviate the symptoms but to also help optimize repair at a time where the skin needs it most.

Routine, routine, routine:  A regular routine is essential to a healthy circadian and hormonal rhythm.  Chronic disruption to routine such as through shift work, irregular eating patterns or frequent travel can contribute towards flares.  Do your best to time activities within your control, such as regular meal times, breathing exercises, and limiting blue light exposure and/or caffeine before sleep.

Rise with the sun:  The best way to reset your rhythm is to rise with the sun.  Get your 15 minutes of vitamin D exposure and enjoy what nature has to offer before – there’s no better way to start your day. =2

How can gut health affect your immunity?

Immune Health

Immune health plays a key role in multiple skin diseases, including psoriasis and eczema, but what does gut health have to do with your immune system? 

The health of our gut plays a significant role in determining the health of our immune system.  Gut associated lymph tissue (GALT) is the largest immune organ in the body, and the primary route of exposure to pathogens.  Essentially GALT acts as the gate keeper, keeping the balance between health promoting microbes (eg.probiotics) and disease promoting microbes (eg. pathogenic bacteria, fungi, yeasts and viruses).   When we are healthy, the gate keeper is fairly tolerant, ignoring a certain amount of nasty microbes as long as the balance is in favour of probiotics.

When we experience an imbalance in the gut microbes, the gate keeper becomes intolerant and hyper responsive leading to imbalances in the immune system, including chronic inflammation, allergy, autoimmunity and vulnerability to infection.

How will I know if my gut is out of balance?

Research has shown that those with chronic skin conditions such as eczema, psoriasis and acne, demonstrate alterations in their gut bacteria.  Symptoms of an imbalanced gut microbiome are not always expressed in digestive symptoms and therefore further investigations via stool testing may be required. 

So, how can you keep your gut in balance?

Frequent exposure to a diverse range of probiotics is important in order to keep the nasty microbes in check but also to help maintain the health of the gate itself (aka the gut barrier).  Ways to increase your microbial diversity include:

  • Increase consumption of plant based, fibrous foods (fruit, vegetables, nuts and seeds)
  • Include fermented foods, such as yoghurt and kefir (these are best kept to small amounts for those with inflammatory skin conditions due to histamine content)
  • Spend plenty of times outdoors immersed in nature (get your hands dirty!)
  • Avoid unnecessary antibiotics and opt for antibiotic-free/organic  meat and dairy products where possible
  • Avoid high sugar and high fat diets, which promote inflammation and growth of pathogenic microbes

If you would like to know more about how your gut health could be affecting your immune system, contact the Psoriasis Eczema Clinic today.

PROBIOTICS AND ECZEMA

Probiotics and Eczema

What do probiotics do?

A balanced microbiome plays an important role in maintaining our immune health, including regulating allergies, autoimmunity and reducing infection.  Certain gut microbes have also been shown to influence mental health and our appetites.  With research into the microbiome now the next big thing, it seems there is a specific probiotic for almost every condition you can think of, but what does the research say about using probiotics for eczema?

Probiotics are helpful bacteria which protect us against harmful bacteria.  They occur naturally all around us and are found in particularly high amounts in fermented foods such as yoghurts, pickled foods, kombucha, kefir, Sauer Kraut and more.  For the last few decades, modern medicine has relied on antibiotics as a main stay of treatment in skin disease, with the focus on ‘killing the bad guys’ so to speak.  More recently, in the face of increasing antibiotic resistance, science is turning its attention to increasing the ‘good guys’ instead. 

Patients with eczema, as with many other skin conditions such as acne, rosacea and psoriasis, have been found to have alterations in their gut microflora when compared to healthy controls.  It is also well established that an early exposure to diverse microbes via natural birth, breast feeding, early animal exposure, and avoiding a sterile home environment are protective factors against the onset of allergic diseases.  This understanding has highlighted the importance of microbes in the regulation of allergic disease and led to multiple studies which have investigated the use of oral supplementation of probiotic bacteria as a potential eczema treatment. 

Do probiotics work?

The strongest evidence to support probiotics in eczema was from a 2015 study which found that a specific strain of probiotic helped to reduce the incidence of eczema when given to pregnant mothers towards the end of pregnancy, and directly to the infant up to 1 year of age (Rather, I., et al, 2016)

A more recent 2017 study investigated the use of the same strain of probiotic combined with oral immunotherapy in reducing anaphylactic reactions to peanuts.  Results demonstrated a significant reduction in anaphylactic and other allergic reactions to peanuts, which were maintained for at least 4 years after treatment (Hsiao, K.C., 2017).  Again, this suggests a vital role in bacterial exposure and immune regulation.

However, evidence to support the use of probiotics as a treatment of established eczema in older age groups remains elusive.   It is important to note that certain probiotic strains may also make your symptoms worse through due to their effect on the release of histamine.  Therefore, it is important to choose the right probiotic for your age and your condition.

Can eczema patients take probiotics with other medications?

At the PEC our Integrative Practitioners are trained in the field of nutritional medicine and can help you find the right dietary/nutritional solutions for your eczema.

To book an appointment, contact us at info@psoriasiseczema.com.au or call 03) 9770 5337

References:

Hsiao, K.C., Ponsonby, A.L., Axelrad, C., Pitkin, S., Tang, M.L.K (2017).  Long-term clinical and immunological effects of probiotic and peanut oral immunotherapy after treatment cessation: 4-year follow-up of a randomized, double-blind, placebo-controlled trial.  The Lancel: Child & Adolescent Health, 1 (2), p97-105

Rather, I. A., Bajpai, V. K., Kumar, S., Lim, J., Paek, W. K., & Park, Y. H. (2016). Probiotics and Atopic Dermatitis: An Overview. Frontiers in microbiology7, 507. doi:10.3389/fmicb.2016.00507

Professor Michael Tirant’s Ho Chin Minh Leadership Award.

Prof. Michael Tirant with Professor Thuong
Prof. Michael Tirant with Professor Thuong

Since 2015, Prof. Michael Tirant has been cooperating with Professor Thuong at the Hanoi National Hospital of Dermatology and Venereology in Vietnam. During this time, he has presented on Psoriasis and Eczema on several occasions and has also been involved in the focused coordination of educational events such as the organization of the first World Summit of Dermatology.

Educational Events by Psoriasis Eczema Clinic

In appreciation of Professor Michael Tirant’s contribution to Vietnamese Dermatology, he was awarded a Statue of Ho Chim Minh.