Immune System And Eczema

Overview

I’m sure you have heard about eczema, but what is it exactly? And why does it happen? In this article, you are going to learn about the immune system and eczema, and how they are related. Eczema is a common chronic condition affecting 1 out of 10 people during their lives.¹ This condition is generally caused by genetic and environmental interactions and can have a substantial impact on the quality of life of eczema patients.^2,3

About the immune system

The Immune system can be described as the system responsible for protecting each individual from anything that could possibly lead to an illness. This includes pathogens, like viruses or bacteria, dangerous environmental substances, and body changes like the appearance of cancer cells.⁴

The main functions of the immune system are:

• Identify a possible threat, like a pathogen
• Prepare and organise an attack
• Eliminate the threat
•  “Memorize” the pathogen for future encounters

But how is the immune system composed? By a diverse group of cells, tissues, organs and molecules. The cells that are part of the immune system have different functions and their majority come from the bone marrow and are produced during childhood.^5,6 Before being released to protect the body, they undergo a series of changes resulting in mature immune cells.

The immune cells also called leukocytes, or white blood cells can be divided into two groups, the myeloid cells: Granulocytes, including basophils, eosinophils and neutrophils, Mast cells and Monocytes.⁷ And the lymphocytes cells: Natural Killers (NK Cells), T Cells and B Cells.⁷ Sharing the lineage of both types, myeloid and lymphocytes, we can also mention the Dendritic cells (DC).

The tissues and organs that make up the immune system include the barrier organs and the tissues and organs that belong to the lymphatic system. The barrier organs consist of the skin and mucous membranes. The lymphatic system tissues and organs are bone marrow, thymus, lymph nodes, tonsils and mucous membranes.⁸

Parts of the immune system

The immune system can be divided into two branches, the innate immune system and the adaptive immune system.^4,9,10

The innate immune system is considered the fast response. It is non-specific, meaning that it can distinguish one human cell from an invader, but can’t distinguish between different invaders. This response is inherited, and it’s similar for each pathogen.^4,9,10

On the other hand, the adaptive immune system is highly specific for each invader, thanks to the antigens located in their walls. Because it is so specific and diverse, this response takes longer. This system is constantly evolving and adapting, “memorizing” the pathogens that have previously come in contact with it, which makes it possible to attack in a much more efficient way when needed.^{4 9,10}  

Conditions and disorders that affect the immune system

There is a range of disorders and conditions that affects the proper functioning of the immune system.^11,12

One group is the immune disorders associated with an under activity of the immune system or immunodeficiency.^11,12 Some of the most common examples are

• Primary immunodeficiencies: in these disorders, the immune system doesn’t work correctly, which causes the patients to have a higher risk of developing infections. Example:  Severe combined immunodeficiency (SCID), this disorder causes the deficient production of some white cells.
• Secondary immunodeficiencies or temporary acquired immune deficiencies: It's caused by some therapeutics (chemotherapy), diseases (measles or flu), procedures (organ transplants) or behaviours (smoking), which weaken the immune system.
• Acquired immunodeficiencies: including AIDS, which is a viral infection caused by HIV, which weakens the immune system by destroying some of the white cells.

The second group refers to the conditions associated with an overactive immune system, which includes allergies and autoimmune diseases (in these diseases, the body attacks healthy tissues and cells).^11,12

Allergies:

• Asthma: the overactive response in the lungs leads to constriction of the airways, which makes it hard to breathe.
•  Eczema: the overactive response causes a red, itchy rash in the skin.
•  Allergic Rhinitis: the response causes sneezing and swelling of the nasal passages.
•  Food allergies: the overactive response leads to a dangerous allergic reaction.

Autoimmune diseases:

• Rheumatoid arthritis: causes the deformation and swelling of the joints.
•  Lupus: affects different body tissues like the skin and the lungs.
• Type 1 diabetes: attacks the insulin-producer cells, located in the pancreas. 

About eczema

Eczema is a common chronic inflammatory skin condition. This condition affects people from all around the world, including babies, children and adults of all ages.^13,14 There are several different types of eczema:

•  atopic dermatitis, also known as atopic eczema
•  dyshidrotic eczema
•  seborrheic dermatitis
•  contact dermatitis
•  neurodermatitis
•  nummular eczema
•  stasis dermatitis ^13,14

Several studies indicate that people who have eczema, may also suffer from asthma or allergic rhinitis (also known as hey fever).¹⁵

Causes of eczema

Patients who suffer from eczema usually have an overactive immune reaction to a number of allergens or irritant materials, which leads to inflammation on the skin’s surface.²

According to National Eczema Association, eczema can be caused by several reasons:

• Immune system: even though eczema is not an autoimmune disease, certain immune system conditions can cause eczema exacerbations, which means that the immune system doesn’t cause directly eczema but can worsen the symptoms.
• Genetics: If  your parents suffer from eczema, there is a higher chance of you also having eczema.
• Allergies: even though eczema and allergies aren’t the same conditions, some allergens, as well as, some food allergies, can lead to eczema.
• Irritants: some products or materials can lead to contact dermatitis, like chemicals or dyes for example.
• Environment: the climacteric conditions can also influence eczema flare-ups, in summer there are higher chances of experiencing eczema.
• Mental Health: just like the immune system, mental health problems don’t directly cause eczema, but can also worsen the symptoms.²

Symptoms of eczema

Eczema presents various symptoms, but it doesn’t mean that they are always present, within the same month, the same patient can have his eczema improve and flare up afterwards . Different patients can also have different symptoms depending on the severity of their condition and their age.^15,16

Eczema can be characterized by:

• Red skin
•  Itchy skin
•  Inflamed skin
•  Skin may become dry, cracked and sore
•  May develop blisters ^15,16

Even though eczema can happen all over the body, the areas affected by these symptoms depend on age or from individual to individual. In younger patients, especially in babies, eczema usually appears on the checks and in the outer parts of the legs and arms. On the other hand, older children, teenagers, and adults are affected by eczema on the back of their knees, elbows and neck.¹⁴

Treatment for eczema

Currently, there is no cure available for eczema, nonetheless, as we can find on  the National Eczema Association page, there are some treatments and therapies that can help reduce the symptoms, these go from lifestyle changes, over the counter remedies to prescription medication.¹³

Before diving into the medication available for eczema, there are some behaviours and therapies that can help with eczema management:

• Putting into practice a regular and consistent routine of bathing and moisturizing. Avoiding hot water and scratching the skin. After bathing, is recommended to tap-dry the body and apply a rich-in-oil moisturizer.
• Wet wrap therapy is recommended for intense flare-up periods. This therapy consists of applying soaking wet fabrics on inflamed areas.
• Taking vitamins and supplements. Even though there are not a lot of scientific studies proving the benefits for eczema sufferers, some patients use vitamin D, probiotics, fish oil, turmeric, and others, to try to have better management of their eczema. Always check with your doctor before taking any vitamin and supplement, as it could interfere with your current medication.
• Practice of mindfulness meditation, yoga, acupuncture or other ancient wellness practices. ¹³

As for the medication, the over-the-counter remedies available are:

•  Antihistamines and Pain Relievers
• Topical Hydrocortisone
•  Shampoos¹³

The prescription medications can be divided into topicals, injectables, oral and phototherapy:

Prescription topicals

• Topical JAK inhibitor
• Topical calcineurin inhibitors
• Topical PDE4 inhibitors
• Topical corticosteroids¹³

Prescription Injectables – Biologics:

•  Dupixent (dupilumab)
•  Adbry (tralokinumab-ldrm) ¹³

Prescription Oral

• Immunosuppressants
•  JAK inhibitors¹³

Prescription phototherapy¹³

FAQs

Does eczema mean weak immune system?

No, eczema doesn’t mean your immune system is weak, it does mean that your immune system has an overactive immune reaction to several allergens or irritant materials, which leads to inflammation on the skin’s surface.

How can I boost my immune system to fight eczema?

There are several ways that can help to enhance your immune system, and all of them largely depend on lifestyle: having a balanced diet, practising regular exercise, sleeping enough hours for a good rest, avoiding alcohol and smoking and staying hydrated. 

What is the biggest trigger for eczema?

Everyone is different, which means that the triggers can also vary from person to person. Some of the most common triggers for eczema are: having dry skin, food, environmental or contact allergies and heat.

Summary

The immune system is responsible for protecting our body from threats, coming from outside and inside our bodies. Eczema is a chronic inflammatory condition that causes, red, itchy and inflamed skin. Patients who suffer from eczema usually present  an overactive immune system, that causes the skin’s surface to inflame, when in contact with a number of allergens or irritant materials.