13e. Skin Health - Atopic Dermatitis Flashcards
What is atopic dermatitis?
Inflammatory skin disease
Altered skin barrier integrity and immune dysfunction
How does AD present clinically?
Pruritis with dry, red areas
Often on flexor/extensor surfaces
Face, scalp, neck, wrists, ankles
Lichenification
Papulovesicular lesions
What are the two types of AD?
Exogenous/extrinsic - IgE mediated
Endogenous/intrinsic - non IgE mediated
What are the two pathways implicated in AD?
Primary epithelial barrier disruption (outside in)
Immune response defect (inside out)
What is the primary epithelial barrier disruption (outside in) pathway in AD?
Disruption of tight junctions
Increased trans-epidermal water loss
Structural protein defects
What could the epithelial barrier disruption in AD be caused by?
Microbial colonisation
Release of inflammatory cytokines
What is the immune response defect (inside out) pathway in AD?
Defects in TLRs
Colonisation with S. aureus = inflammation
IgE mediated allergic sensitisation (secondary to structural epidermal defects)
What are the causes and risk factors for AD?
Th1/Th2 imbalance - hygiene hypothesis, C section, ABx etc
Stress
Filaggrin gene mutations
Nutritional deficiencies
EFA deficiencies/altered metabolism
Dysbiosis
Excess histamine
What can cause an EFA deficiency or altered metabolism?
Reduced delta-6 desaturase activity due to:
FADS2 SNP
Mg/B6/Zn deficiency
IR
Alcohol
High stress
An increase in which bacteria is associated with AD?
Clostridia spp
E. coli
S. aureus
Candida albicans
H. pylori
Which bacteria are seen in lower levels in AD?
Bifidobacterium
Bacteroidetes
Bacteroides
Why does H. pylori cause AD?
Stimulates epidermal cells to secrete thymic stromal lymphopoietin (TSLP)
Cytokine that induces inflammatory Th2 responses
Why can excess histamine be a risk factor in AD?
Disrupts tight junction integrity
What lab testing is done for AD?
FBC
Serum IgE
Allergy/food sensitivity - Cyrex
Comprehensive stool testing
Genetic panels
What are the allopathic treatments for AD?
Topical corticosteroids
Anti-histamines
Immunosuppressants
Naturopathic approach to supporting AD
Elimination of food triggers
Avoid anti-inflammatory foods - sugar, red meat, refined carbs
Address triggers and mediators
Address skin infections
Stress management
Which foods could trigger AD in children?
Cow’s milk
Eggs
Peanuts
Wheat
Soy
Fish
Which foods may trigger AD in older children/adults?
Apple
Carrot
Celery
Hazelnut
Examples of AD triggers and mediators
Environmental allergens - plants, dyes, airborne
Solvents, detergents, topical products
Heat, humidity, excessive bathing
Dietary approaches to supporting AD
Naturopathic diet
Cooling foods
O3 - SMASH fish, flax, chia, spirulina
Quercetin rich foods - red apples, red onions, kale, blueberries
AIP diet - AD not AI but does increase risk
Pre/probiotics
5R protocol
Intestinal barrier support
Immunomodulatory support
What herbs can be used for immunomodulatory support?
Echinacea - 4g
Turmeric - 500-2000mg
Boswelia - 250-500mg
Nutrients to support AD
A
C
E
D
Zn
Se
EFAs
Quercetin
How does vit A support AD?
Epithelial cell differentiation
Collagen synthesis
Dosage of vit A to support AD
5000iu/day
