25.01.2021

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Baby, News, Remedies, Skin care

Atopic dermatitis and its natural remedies


Prof. Luca Valgimigli


Atopic dermatitis is a chronic inflammatory skin disorder that owes its name to the fact that it is not localized in a specific place (a-topic = non-localized), but occurs in different areas of the body or face.

For example, it can occur in the area around the mouth and eyes, in the back of the hands and feet, in the arms, in the folds of the elbows and knees. Although it is more frequent in the first years of age, it can nevertheless occur in children even later in time or even in adulthood.

It can have a chronic relapsing course, that is, it arises in the pediatric age and then fades over time until it disappears, then it recurs even after many years.


How does atopic dermatitis manifest itself?


The most common symptoms of atopic dermatitis are dry skin, cracking, redness, severe itching, peeling. It can manifest itself in the form of erythema and present the formation of blisters: it is also called atopic eczema.

. Itching is one of the most annoying and critical aspects, because it induces scratching, thus causing greater inflammation and triggering a vicious circle that aggravates the situation. Scratching can also cause abrasions and injuries that can pave the way for infections by Staphylococcus and other microorganisms that normally live on the skin or in the area under the nails. 

Although atopic dermatitis is not an infectious disease and cannot be transmitted, it can nevertheless be aggravated by the onset of this type of infection.


What are the causes of atopic dermatitis?


The causes of atopic dermatitis are not yet fully understood, although much has been discovered and it is now certain that it is due to the combination of numerous factors, including: genetic (predisposition), environmental, metabolic, dietary and psychosomatic factors.

In recent years, its frequency seems to be increasing at all ages, even if the reasons are not at all clear.

This suggests the importance of environmental factors such as the presence of increasing pollution, as well as their influence on the emotional state (stress, anxiety), but it seems also linked to the change in what we eat.

An important role seems to be played by the immune system: most of the subjects with atopic dermatitis show an excessive reaction to external stimuli, allergens and irritants, mainly mediated by type E immunoglobulins (IgE), not very effective in defending the organism and normally involved in the onset of allergies.

. It is not clear, however, whether this behavior of the immune system is the cause of atopic dermatitis or a consequence of other factors.

Several studies indicate that dietary factors play an important role in atopic dermatitis and a recent study, in particular, highlights how the mother’s diet and the incorrect balance of polyunsaturated lipids during pregnancy cause a family predisposition to atopic dermatitis in the child.


The importance of the lipids of the stratum corneum and the hydro-lipid barrier


Several studies show that at the base of atopic dermatitis there are alterations in the composition of the skin’s lipids.

Among the most significant alterations, in atopic dermatitis there are differences in the content of essential fatty acids compared to normal skin, with an increased presence of monounsaturated fatty acids (MUFA) at the expense of polyunsaturated fatty acids (PUFA); in addition, the internal balance of polyunsaturated fatty acids is also altered, with a reduced content of long-chain essential fatty acids such as docosahexaenoic acid (DHA) and with an altered ratio between omega-3 and omega-6.

In atopic dermatitis, the reduced activity of an enzyme, the delta-6-desaturase, is observed, which causes an increased content of alpha-linolenic acid and a reduced content of gamma-linolenic acid and stearidonic acid which have an anti-inflammatory action and regulate the function of the immune system

Some studies show that these variations are not simply coincident but are the cause of the main manifestations related to atopic dermatitis, such as dryness of the skin, flaking and alteration of the physiological hydro-lipid barrier, which constitutes the main defense of the skin from external agents.


What are the consequences of atopic dermatitis?


In addition to itching, which is sometimes difficult to bear, atopic dermatitis often leads to thickening of the skin with hyperkeratosis and the formation of papules and indurations (lichenification), which are very difficult to reverse.

But the consequences may not only be localized to the skin: a recent study shows that adults with atopic dermatitis have a greater risk of bone fractures, proportional to its severity. So it is important not to underestimate it, even if it is mild, and to treat it promptly.


Remedies for atopic dermatitis: how can it be treated?


There is no definitive drug therapy for atopic dermatitis.

In the acute phase it can be treated with anti-inflammatories such as cortisone and hydrocortisone or with more powerful corticosteroids.

However, the effectiveness is reduced over time, requiring an increase in the dosage with important side effects, including impaired immune defenses. Often it is necessary to stop the treatment and alternate it with cycles in which only a moisturizer is applied to keep the skin soft and reduce itching.

Infusions of lemon balm, valerian, escolzia, passionflower and hops or food supplements that contain them, such as Tranquilla Menteâ, relieving anxiety can act on psychosomatic causes. In addition, supplements rich in anti-inflammatory plant extracts such as Leni Malâ, rich in Boswellia, Turmeric and Tanacetum, can help.

Some studies show that the intake of gamma-linolenic acid (GLA) reduces the manifestations of atopic dermatitis and the need for corticosteroids. Therefore, a diet that includes borage oil, and blackcurrant very rich in GLA could help. Algae like Schizochytrium or DHA-rich bluefish could also alleviate the condition.

BeC has formulated a specific treatment unique of its kind: the lino-dÉrmAâ  cream rich in algal DHA, gamma-linolenic acid and stearidonic acid, as well as essential fatty acids from blackcurrant, borage and echium oils, in an exclusive highly bioavailable form, and carefully dosed to restore the correct balance of omega-3 and omega-6.

The formula aims to rebuild the physiological hydro-lipidic barrier. In addition, it contains a synergy of plant extracts with an anti-inflammatory action such as chamomile, eucalyptus, cumin and aloe, and has demonstrated a soothing action identical to the hydrocortisone ointment, while being completely natural and free of side effects.

The moisturizing and emollient active ingredients keep the skin hydrated and elastic, eliminating itching.

Due to its unique characteristics it could represent the ideal natural remedy for atopic dermatitis at all ages.

Cyclooxygenase, lipoxygenase and the inflammatory process

Cyclooxygenase and lipooxygenase are the two families of enzymes that are commonly involved in the inflammatory process, through a complex of reactions which is called arachidonic acid cascade. This complex of reactions develops as follows: a first enzyme, a phospholipase cleaves the phospholipids of biological membranes, releasing arachidonic acid, a polyunsaturated fatty acid with 20 carbon atoms (eicosa-5Z,8Z,11Z,14Z-tetraenoic acid ; C20:4; ω-6). The arachidonic acid is then transformed by two parallel enzymatic pathways, that is, by two families of enzymes: the cyclooxygenase which transforms it into prostaglandins and thromboxanes and the lipooxygenase which transforms it into hydroperoxides which in turn transform into leukotrienes .
There are two cyclooxygenase isoforms indicated with type 1 and type 2, briefly COX-1 and COX-2. COX-1 is the enzyme present in most cells (except red blood cells), and is constitutive, that is, it is always present. COX-2 is an inducible cyclooxygenase isoform: it is constitutively present in some organs such as brain, liver, kidney, stomach, heart and vascular system, while it can be induced (i.e. developed if necessary) following inflammatory stimuli on the skin, white blood cells and muscles.
There are various types of lipooxygenase that lead to different products, the most important in the inflammatory process is 5-lipooxygenase, 5-LOX.

Prostaglandins, Thromboxanes, and Leukotrienes

Prostaglandins, Thromboxanes, and Leukotrienes are chemical messengers or mediators, that is, molecules that bring a message to specific cells and activate or deactivate metabolic responses in these cells. They, therefore, have a function similar to hormones, only that, unlike what hormones do, the chemical message is carried only at a short distance, that is, only to the cells that are in the vicinity of the place where the mediators were produced. There are different prostaglandins, different thromboxanes and different leukotrienes that carry specific messages. In many cases these act as mediators of the inflammatory process , therefore they trigger all the events that are involved in inflammation:
– vasodilation with consequent blood supply (redness),
– increased capillary permeability with consequent fluid exudation (swelling or edema),
– stimulation of nociceptive nerve signals (pain),
– on-site recall of immune system cells that attack a possible invader (chemotactic action)
– activation of the biosynthesis of fibrous tissue to strengthen or repair the affected part (even if there is no need)
– generations of free radicals that can chemically destroy an invader (but also damage our tissues, i.e. they just “shoot in the middle”).
Prostaglandins and thromboxanes, however, also play important physiological roles in normal conditions, i.e. in the absence of inflammation. For example, they regulate the secretion of mucus that protects the walls of the stomach, they regulate the biosynthesis of cartilages and synovial fluid in the joints, they regulate vasodilation, hence the correct flow of blood in the various local districts, and more.

Triglycerides

Triglycerides are the main components of most oils and fats. These are heavy, non-volatile and little polar molecules, insoluble in water, made up of glycerol (or glycerin) esterified with three molecules of fatty acids: therefore, it is a tri-ester of glycerin, from which the name derives. Each fatty acid contains 8 to 22 carbon atoms (commonly 16 to 18) and can be saturated, mono-unsaturated or poly-unsaturated. The size of the fatty acids and their saturation determines the physical and sensorial properties of the triglycerides, which can appear as oils (liquids at room temperature) or fats (solid or semi-solid) and can have greater or less greasiness and smoothness on the skin. Unsaturated triglycerides or with shorter fatty acids are more fluid and have greater flowability.

Fatty acids (saturated, mono-unsaturated and poly-unsaturated)

The name fatty acids is commonly used to indicate those organic acids that are found in the composition of lipids, that is, in animal and vegetable oils and fats, both in the free form and in the form of esters with glycerol (e.g. in triglycerides), or they are esterified with “fatty” alcohols, that is, long chain alcohols, to form waxes. Fatty acids are carboxylic acids (formula R-COOH) which have a long carbon chain (R), unlike common organic acids such as acetic acid and propionic acid, which have 2 or 3 carbon atoms in total, respectively. Fatty acids are defined as saturatedif they do not have double carbon-carbon bonds, (called “unsaturations”), they are defined mono-unsaturated if they have only one, they are defined mono-unsaturatedpoly-unsaturated if they have two or more double bonds (see figure). The term omega-3 (ω-3) or omega-6 (ω-3), refers to the position of the first double bond starting from the bottom of the chain of carbon atoms: if the first double bond is encountered after 3 carbon atoms the fatty acid is classified as omega-3 , if after six carbon atoms omega-6 , as shown in the figure. The most common saturated fatty acids are palmitic acid (16 carbon atoms and no double bond, C16: 0) and stearic acid (18 carbon atoms, 18: 0), the most common mono-unsaturated is the oleic acid, typical of olive oil (18 carbon atoms and 1 double bond in position 9, C18: 1; ω-9), while the most common poly-unsaturated are linoleic acid and linolenic acid, progenitors respectively omega-6 and omega-3 (see figure).

Terpenes and terpenoids

Terpenes or terpenoids are a large family of natural molecules, typically containing 10 to 30 carbon atoms, which are biosynthesized from a common “brick”, isopentenyl pyrophosphate (IPP), containing 5 carbon atoms (see figure). The discovery that the repetitive brick consists of 5 carbon atoms is relatively recent, while it was once assumed that the entire family was created by repeating a brick of 10 carbon atoms, which was called “terpene”. Therefore, the molecules with 10 carbon atoms (such as limonene, see figure) were called mono-terpenes, i.e. composed of a single brick, diterpenes those with 20 carbon atoms (e.g. the cafestol that gives the aroma to the coffee), triterpenes those with 30 carbon atoms (e.g. beta-carotene). Since molecules made from 15 carbon atoms were also found (such as bisabolol), it was thought they contained a terpene and a half, and were called sesquiterpenes (from the Latin semis = half + atque = and). Today it is known that the repetitive unit is composed of 5 carbon atoms, therefore it is easy to understand how mono-terpenes contain two (see figure), sesquiterpenes three, diterpenes four, triterpenes six.