Skin Disorders: When the Barrier Fails

Thoughts on the Rational Treatment of Atopic Dermatitis

This is the 4th in our series of updates on atopic dermatitis. In the preceding articles we considered why so many more children nowadays are developing eczema, what we know about the genetic underpinings of the disease, and how defects in the skin barrier and loss of the acidic pH on the skin surface are key to understanding how the dermatitis develops. In this post we consider how this information provides the basis for new, rational paradigms for treatment.


Migration back to life on the farm is probably not an option for many, but there are steps that people with atopic dermatitis can take to address their skin’s vulnerability.  For a start, they can practice ‘gentle skin care’ and avoid extracting the natural oils from their skin that are essential for its barrier function by modifying their bathing routines. [Read more…]

Atopic Dermatitis: Is It All About pH?

lemons crop

In two earlier posts we discussed why atopic dermatitis is becoming more prevalent and what is known about the genetic underpinings of this common disorder. In this installment, we look at how the most common gene associated with atopic dermatitis acts to produce the skin condition.

It has known for decades that the skin has a “sour surface”. The pH of the skin surface is acidic (~5), while our cells and blood have a nearly neutral (~7.4) pH. This low surface pH is assumed to be critical to discourage the growth of bacteria and other microorganisms. Indeed, the microbes that normally inhabit our skin (our so-called ‘normal skin flora’) thrive in an acidic environment, while the pathogens that cause serious infections,  such as Staphylococcus aureus and the streptococci, do not. [Read more…]

Atopic Dermatitis: Its In the Genes


In an earlier post, we examined two current concepts about the increased prevalence of the allergic skin disease, atopic dermatitis.  The allergic diseases – atopic dermatitis, asthma, and allergic rhinitis – have long been known to run in families. But the inheritance of these ‘atopic’ diseases is complex and involves more than one gene, like many other common conditions, such as diabetes, high blood pressure, or psoriasis. To date, variations , called ‘polymorphisms’, in over 100 genes have been linked to the risk of developing one of these allergic disorders. [Read more…]

Atopic Dermatitis: A Modern Epidemic Because We’re Too Clean?


The prevalence of atopic dermatitis (or eczema) is soaring, as are its related allergic disorders, asthma and hay fever (or allergic rhinitis). No one knows exactly why, but a popular theory blames our too healthy urban life style – the so-called ‘hygiene hypothesis.’ We no longer live on farms. No longer are we exposed early in life to pathogen-enriched rural soils. Our babies have less contact with animals, and, with our smaller families, fewer siblings. The immunizations and antibiotics they receive protect them from many of the more severe childhood illnesses. [Read more…]

Scaly Skin and Ichthyosis (Nothing To Do with Fish Skin)

fish scales 480w pixels

Scaly or flaky skin is what we see when the process of discarding the outermost cells of our skin is no longer invisible – as it should be. The shedding process has gone from being normal, that is, orderly and invisible, to being disorderly or ‘pathological’, and highly visible. The process of discarding these spent cells or ‘squames’ from the outermost layer of skin, the stratum corneum, is called ‘desquamation’. Normal desquamation is accomplished cell by cell and is imperceptible to the naked eye. The normal shedding of skin cells is aided by friction during our daily activities and is further helped  by bathing. [Read more…]

Aging Skin: Beyond Wrinkles

elephant skin

Wrinkles come with age – and for most of us they are unwelcome guests.  Sunlight is a well-recognized cause of wrinkles. Slowly adding up over time. we pay the price of our past hours in the sun, as year by year our skin accumulates wrinkles. And just as nothing is fairly distributed in life, so, too, sun-induced wrinkles come sooner and with more intensity to some of us.

The unpleasant discovery of new wrinkles can begin quite early in life for those of us with lightly pigmented skin, and especially for those who are red-heads. The cautionary tales we hear about sun exposure and wrinkles are true, of course, as are the far more serious concerns about sun-induced skin cancers. But we should not equate sun-damaged or ‘photoaged’ skin – the aging that is produced by ultraviolet light – with chronologically or ‘intrinsically-aged’ skin – the aging that comes to all with the passage of time. Age itself does take its toll on skin, but it does so in a manner less obvious to the eye than the wrinkles that are formed by a life in the sun. [Read more…]