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Dermview: Eczema : Episode 1

Environmental Factors that Effect Eczema


In this episode of DermView, Adelaide Hebert, MD, explains how eczema can lead to growth issues in pediatric patients, how environmental factors may play a role in flare ups, and more.

Adelaide Hebert, MD, chief of pediatric dermatology at the McGovern Medical School at UTHealth Houston, Texas drilled down into the intricate details of eczema, sharing her experience of the disease in pediatric patients.

To listen to what she had to say, watch the video below.

Morgan Petronelli, Associate Editor: Well thank you so much for joining me today. My name is Morgan Petrelli, Associate Editor with dermatology times and today I'm joined by Dr. Adelaide Hebert, Dr. Hebert if you want to introduce yourself and any of the research that you're currently conducting.

Adelaide Hebert, MD: I'm Dr. Adelaide Hebert. I work at the University of Texas Medical School in Houston, Texas. I've been chief of pediatric dermatology here for 37 years, and have been actively engaged in clinical research for the past 36 years. The research interests that I have include atopic dermatitis, psoriasis, hyperhydrosis, acne, rosacea, skin, soft tissue infections, and diaper dermatitis. We really will study almost anything that deals with skin in both pediatric and adult realms. I don't typically do IV antibiotics studies, but we're very interested in biologic therapy and the new Janus kinase (JAK) inhibitors. We do the full scope we feel of research within the adult and pediatric realm.

Petronelli: How does the prevalence of eczema differ based on age, gender, and race and or ethnicity?

Hebert: We see a vast difference in atopic dermatitis (AD) in different groups. One of the examples that I often use is that if the parents have eczema, asthma, or hay fever, the child is more prone to developing this skin condition. We do see a trend in families, but we do see children who have no family history who can develop severe eczema as well.

We certainly see different characteristics [in different demographic groups]. Asian people tend to have very severe eczema; they really suffer with this disease state. In the Black population, we may or may not have the genetic basis influencing the skin findings and the barrier effect, but we can still see profound AD.

Asthma is often associated with eczema. In the state of Texas, the number 1 drug written for children is an asthma drug. We also see eczema in patients if, for example, 1 or both parents have been born overseas and they immigrated to the United States. That child can have worse eczema. It's not just immigrating to the United States. This is known in other countries as well. It's about immigrating to a country where the skin has not been accommodated to, and then the eczema can be more profound. 

That’s something I make parents aware of. I don’t suggest that they go home to their country of origin, but they will often relay to me that, if they go home for a holiday and come back, the eczema goes away magically. That's not something they observed while in the United States. 

So, we do see very variations in the amount of eczema across the different ethnicities, but also against the against the different Fitzpatrick skin types.

Petronelli: What is eczema’s impact on quality of life? What about its effect on comorbidities?

Hebert: We feel that eczema is 1 of the most impactful disease dates in terms of quality of life [QoL]. It impacts not just the child but also the family. One of the impacts in terms of QoL is itching. These patients don't sleep well, and their parents don't sleep well. There's co-sleeping where the child gets in bed with the parent and the parent’s sleep is disrupted by the child's itching. 

The concern we have with this is aging status. Not only do the children disrupt the skin barrier by scratching, they also disrupt their deep sleep so their growth hormone is not secreted, and their linear growth can be impacted unfavorably. There are many arenas in QoL that are affected.

These children have a difficult time going out during very hot summers as the protein and sweat serves as a trigger for furthering the condition. Also, dust mites can play a role. Unfortunately, because we have a very moist environment, they can survive even in the cleanest of homes. There can be associated conditions such as metabolic syndrome. There also may be a slight increase of cardiovascular events in our more aged patients. All these things impact QoL.

The QoL is greatly impacted because we have difficulties in controlling this ongoing relapsing disorder that is visible for patients with psychosocial development, even when they are adults. We know because it's such a visible disorder, and the patients have concurrent scratching, it can be extremely problematic. Another factor that we should consider is these patients get more cutaneous infections, both bacterial and viral. 

There's not a realm of the patient’s life that AD doesn't touch upon. This is 1 of the discussions we often have with patients and their parents when they come in for their initial or ongoing evaluations for this disease.

Make sure to stay tuned for the other 2 parts in this 3 part series.

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