DermView Episode 1: Environmental factors and eczema

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

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

Morgan Petronelli, Deputy Editor: Well, thank you very much for joining me today. My name is Morgan Petrelli, associate editor of dermatology times and today I am joined by Dr Adelaide Hebert, Dr Hebert if you would like to introduce yourself and any of the research you are currently doing.

Adélaïde Hébert, MD: I am Dr Adélaïde Hébert. I work at the University of Texas School of Medicine in Houston, Texas. I have been the head of the pediatric dermatology department here for 37 years and have been actively engaged in clinical research for 36 years. Research interests that I have include atopic dermatitis, psoriasis, hyperhydrosis, acne, rosacea, skin, soft tissue infections, and diaper dermatitis. We are really going to study almost anything related to the skin in the pediatric and adult fields. I don’t usually do studies on IV antibiotics, but we are very interested in biologic therapy and the newer Janus kinase (JAK) inhibitors. We do the full scope that we think of research in the adult and pediatric field.

Petronelli: How does the prevalence of eczema differ by age, sex, race and / or ethnicity?

Hébert: We see a big difference in atopic dermatitis (AD) in different groups. One of the examples I often use is that if the parents have eczema, asthma, or hay fever, the child is more likely to develop this skin condition. We are seeing a trend in families, but we are seeing children who do not have a family history who can also develop severe eczema.

We certainly see different characteristics [in different demographic groups]. Asians tend to have very severe eczema; they really suffer from this pathological condition. In the black population, we may or may not have the genetic basis that influences skin results and the barrier effect, but we can still see deep 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, one or both parents were born overseas and immigrated to the United States. This child may have worse eczema. It’s not just about immigrating to the United States. This is also known in other countries. It’s about immigrating to a country where the skin hasn’t been adapted, and then the eczema can be deeper.

This is something that I make parents aware of. I’m not suggesting that they go home to their home country, but they often tell me that if they go home for a vacation and come back, the eczema will magically go away. It is not something they have observed in the United States.

Thus, we see very large variations in the amount of eczema according to the different ethnicities, but also against the different types of Fitzpatrick skin.

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

Hébert: We believe that eczema is one of the most impactful dates of illness in terms of quality of life [QoL]. This has an impact not only on the child but also on the family. One of the impacts in terms of quality of life is itching. These patients do not sleep well and their parents do not sleep well. There is co-sleep where the child goes to bed with the parent and the parent’s sleep is disturbed by the itching of the child.

What concerns us is the status of aging. Not only do children disrupt the skin barrier by scratching, but they also disrupt their deep sleep so their growth hormone is not secreted, and their linear growth can be adversely affected. Many areas of the quality of life are affected.

These children find it difficult to go out during very hot summers because protein and sweat serve as a trigger for the disease to worsen. In addition, dust mites can play a role. Unfortunately, because we have a very humid environment, they can survive even in the cleanest homes. There may be associated conditions such as metabolic syndrome. There may also be a slight increase in cardiovascular events in our older patients. All of these things have an impact on the quality of life.

The quality of life is strongly impacted because we have difficulty controlling this recurring recurring disorder which is visible in patients with psychosocial development, even when they are adults. We know that because it is such a visible disorder and patients have concomitant scratching, it can be extremely problematic. Another factor to consider is that these patients get more skin infections, both bacterial and viral.

There is not one area of ​​the patient’s life that AD does not address. This is one of the discussions we often have with patients and their parents when they come for their initial or ongoing assessments for this disease.

Be sure to stay tuned for the other 2 parts of this 3 part series.