Eczema: The Itch that Rashes
Dr. Bowen discusses the surrounding causes, symptoms, and skincare treatments of Eczema.
Featured Speaker:
After an internship in Internal Medicine at LSU-Shreveport, he served a three years tour as flight surgeon at Little Rock Air Force Base. There he was imbedded with a C-130 flying squadron and deployed twice to Iraq.
He completed his Dermatology Residency at Wilford Hall Medical Center in San Antonio, Texas. He stayed on as faculty for two more years before accepting the position of Chief of Dermatology at Offutt AFB in 2017. He has remained active in the academic community with more than a dozen peer-reviewed journal articles and National presentations. He has been the presenter twice at UNMC Grand Rounds.
He and his wife, Dr. Rebecca Bowen, an Otolaryngologist at ENT Specialties P.C., have three young daughters whom they keep well lathered in sunscreen. Dr. Bowen remains an avid triathlete and open water swimmer; he has completed multiple Ironman races and swam solo across the English Channel!
Dr. Bowen is board certified by the American Board of Dermatology and is Fellow of the American Academy of Dermatology, the American Contact Dermatitis Society, and the association of Military Dermatologists. Feel free to pick his brain on how to enjoy the great outdoors without getting too much sun! He sees all types of dermatology patients but particularly enjoys treating skin cancer, scars, and dermatitis.
Dr. Bowen’s publications have been cited by over 170 other authors, his seminal work on allergy to skin adhesives has been referenced in 16 separate journal articles. His work on Atopic Dermatitis earned him the 2020 Association of Military Dermatologist’s top research award.
Casey Bowen, MD
Dr. Bowen grew up in Omaha, NE and attended Millard West High School where he was a two-time swimming state champion. He then swam for four years at the US Air Force Academy and graduated with a B.S. in Biology as the top student in biomechanics. He then attended medical school at the Nebraska Medical Center and graduated in 2008.After an internship in Internal Medicine at LSU-Shreveport, he served a three years tour as flight surgeon at Little Rock Air Force Base. There he was imbedded with a C-130 flying squadron and deployed twice to Iraq.
He completed his Dermatology Residency at Wilford Hall Medical Center in San Antonio, Texas. He stayed on as faculty for two more years before accepting the position of Chief of Dermatology at Offutt AFB in 2017. He has remained active in the academic community with more than a dozen peer-reviewed journal articles and National presentations. He has been the presenter twice at UNMC Grand Rounds.
He and his wife, Dr. Rebecca Bowen, an Otolaryngologist at ENT Specialties P.C., have three young daughters whom they keep well lathered in sunscreen. Dr. Bowen remains an avid triathlete and open water swimmer; he has completed multiple Ironman races and swam solo across the English Channel!
Dr. Bowen is board certified by the American Board of Dermatology and is Fellow of the American Academy of Dermatology, the American Contact Dermatitis Society, and the association of Military Dermatologists. Feel free to pick his brain on how to enjoy the great outdoors without getting too much sun! He sees all types of dermatology patients but particularly enjoys treating skin cancer, scars, and dermatitis.
Dr. Bowen’s publications have been cited by over 170 other authors, his seminal work on allergy to skin adhesives has been referenced in 16 separate journal articles. His work on Atopic Dermatitis earned him the 2020 Association of Military Dermatologist’s top research award.
Transcription:
Eczema: The Itch that Rashes
Melanie Cole (Host): Welcome to Bryan Health podcast. I’m Melanie Cole and today, we’re discussing eczema. Joining me is Dr. Casey Bowen. He’s a dermatologist at Dermatology Associates of Lincoln. Dr. Bowen, it’s a pleasure to have you join us today. First, tell the listeners a little working definition. What exactly is eczema?
Casey Bowen, MD (Guest): Eczema is more specifically called atopic dermatitis, but eczema is how it’s generally known and that’s an itchy skin condition often related to allergies and asthma. The term comes from the Greek ekzein which means effervescent or to boil forth and in its acute phase, that’s kind of how it presents as an eruption often with little tiny blisters or a wet rash. It affects up to 10% of children in the US and some of them can grow out of it and develop it later on adulthood and every once in a while, it presents only in adulthood. It is just kind of an itchy, dry rash.
Host: So, then what age does it typically present itself and how do parents if it’s a child, know the difference between sometimes rashes that we see, we see all kinds of rashes on our kids and something that is eczema and that can become really chronic?
Dr. Bowen: We don’t typically see it present before two months of age. It certainly can especially in families where there’s a strong history of eczema. And fortunately, the pediatricians in town are very good at picking this up and are good at differentiating often between cradle cap which we see earlier on in eczema. The parents should look for kids being kind of dry, red, itchy and rashy. Before the kids are real good at scratching, the rash doesn’t have very obvious presentation. Once they get a little bit more coordinated, then they can start scratching were it itches, and we do refer to this as the “itch that rashes” meaning that most of what we see is self-induced.
Host: Do we know what causes it Dr. Bowen? You mentioned family history a little while ago. Is there any autoimmune cause? Is there anything we know about this?
Dr. Bowen: So, this is a very well-studied disease. It turns out the primary culprit is a gene called filaggrin. And we’re supposed to get copies from each of our parents and the fewer copies of this gene we get, the worse our disease tends to be. And it is often associated with what we call the atopic triad which is allergies and asthma. And it’s not in the autoimmune family as we think of those conditions, but it is kind of an overreactive immune system in the portion of allergies that has historically been to fight parasites and then instead of fighting parasites in developed countries, it fights detergents, and perfumes and wool and things like that.
Host: So, then what’s the management? What do you do for children for whom this is diagnosed? And how do you help parents to manage that itching and the kids really, frustration and it’s very uncomfortable?
Dr. Bowen: Oh it is absolutely uncomfortable. I think that a lot of patients and parents self-treat. So, we only see probably half of the patients with eczema or true atopic dermatitis. Because a lot of them are mild and they learn that they can’t use harsh soaps or strong fragrances and they need to use a regular moisturizer. For the ones that don’t, that’s who we tend to see in our clinic or are referred over by our great pediatricians in town. Those need to be managed by a regimen of topical steroids to reduce inflammation and then also a pretty strict regimen of mild soaps and kind of cautious bathing and then aggressive use of topical emollients.
Host: So, now, let’s talk about either some of the myths or things that surround it. You mentioned environment, detergents, things like that. Tell us if diet affects eczema, the environment, the things around our house that could exacerbate an eczema outbreak. Tell us a little bit about some of those.
Dr. Bowen: We often get that question and the short answer is yes. So, there are many foods that can aggravate atopic dermatitis or eczema. But the avoidance diets that have been kind of recommended in the past, are not recommended. We don’t say stop all grains and dairy and fruits and all that. We say if a particular food makes the eczema flare, then that’s one to cut out. So, if every time that they have strawberries, they get a rash on their face; well that’s one to kind of cut back on. There are some things in the diet which can actually help eczema. And so, yogurts with live cultures have been shown to improve the balance of kind of good bacteria on the skin. And then there’s some other kind of supplements that can help to increase the expression of that filaggrin gene and one is called l-histidine. That’s a vitamin you can get kind of online or at the local pharmacy. And then there’s a plant-based product called phytoceramides which you can kind of supplement into the foods and help the body make its own moisture. You can also supplement that through the skin with moisturizers like CeraVe. CeraVe is a – it stands for ceramide vehicle and putting that on the skin can actually be absorbed and help the body make its own moisture.
We do recommend in families that have a peanut allergy that they are very careful of that if there is any family history of anaphylaxis but in general, we recommend kind of advancing foods one at a time and just watching for symptoms of allergy, rash, diarrhea, wheeze.
Host: So, we’ve been hearing over the years, about eczema and any predisposition. You’ve mentioned allergies and asthma. Are there any of the true autoimmune diseases that now maybe this child is at risk? Do we know what that risk is? Or how they are all linked together?
Dr. Bowen: We’re learning more and more. Prior to a few years ago, there was no good medications for this. everything that we did for really, really bad eczema after topical steroids was a mild form of poison. We’d use chemotherapy drugs like methotrexate, and we’d use transplant drugs like CellCept and things that would really, really suppress the immune system. As we learn more about the particular chemicals that are involved in the inflammation of atopic dermatitis, the drugs have gotten much more advanced and much more targeted to the specific type of inflammation.
The lifelong risk of eczema – we see studies come out like this from time to time that there may be an increased risk of heart disease, there may be increased risk of ADHD, attention deficit disorder and hyperactivity disorder. And that may just be that kids in the classroom who are itchy all the time have a hard time paying attention. But anything with chronic inflammation can predispose to other kind of inflammatory things down the line. We see increased risk of vitiligo, increased risk of alopecia areata which is like a circular hair loss and sometimes we see increased risk of thyroid disease. And these are all just kind of linked in these kind of proinflammatory states.
Host: Wow. It’s so interesting and as you said, it’s being studied and has been studied. As we wrap up, please tell us what you want parents to know about children with eczema, are outdoor activities okay? Give us a little summary of your best advice for good skincare for children with eczema and when you really want parents to take their kids to a dermatologist.
Dr. Bowen: I’ll start with kind of summer and go to winter. So, in the summer, kids with eczema absolutely encourage some UV. UV light suppresses inflammation. Obviously, as a dermatologist, I don’t advocate carefree UV exposure as it can lead to skin cancer. But a little bit of controlled sunlight especially outside the hours of ten to two when the UV is most intense can actually make eczema better as long as they don’t get sunburned. We want to use physical blockers, mineral sunscreens containing zinc and titanium because those are less irritating to the skin. And we want to make sure that the outdoor activities – if grass is making their allergies flare, that can make their eczema flare and that can be counterproductive. But getting in a swimming pool is fine as long as we shower off afterwards and apply a moisturizer. And then as we get into the winter months, the things that tend to make eczema flare are stress, dry air, cold temperatures, wool type clothing, all the things that you would expect to find in Nebraska in the winter.
And so then we really want to be focusing on using a moisturizer, not stripping the oil from our skin with harsh soaps, things like that. So, if we have parents that are doing these kinds of best practices using the good skincare and they are not able to stay on top of it, first line of defense is the pediatrician’s office, an over the counter topical steroid and if those don’t seem to be cutting it, then absolutely make an appointment and let’s see if there’s something that we can do to help or if there’s an allergy that has developed on the skin that we need to eliminate from that child or even adults daily exposures.
Host: What great information. So, important for parents to hear when the right time is to see a dermatologist and how to help their child with eczema. Thank you so much Dr. Bowen for joining us today and thanks to our Bryan Foundation partner, Union Bank and Trust. That concludes this episode of Bryan Health podcast. Please visit our website at www.bryanhealth.org for more information and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Bryan Health podcasts. I’m Melanie Cole.
Eczema: The Itch that Rashes
Melanie Cole (Host): Welcome to Bryan Health podcast. I’m Melanie Cole and today, we’re discussing eczema. Joining me is Dr. Casey Bowen. He’s a dermatologist at Dermatology Associates of Lincoln. Dr. Bowen, it’s a pleasure to have you join us today. First, tell the listeners a little working definition. What exactly is eczema?
Casey Bowen, MD (Guest): Eczema is more specifically called atopic dermatitis, but eczema is how it’s generally known and that’s an itchy skin condition often related to allergies and asthma. The term comes from the Greek ekzein which means effervescent or to boil forth and in its acute phase, that’s kind of how it presents as an eruption often with little tiny blisters or a wet rash. It affects up to 10% of children in the US and some of them can grow out of it and develop it later on adulthood and every once in a while, it presents only in adulthood. It is just kind of an itchy, dry rash.
Host: So, then what age does it typically present itself and how do parents if it’s a child, know the difference between sometimes rashes that we see, we see all kinds of rashes on our kids and something that is eczema and that can become really chronic?
Dr. Bowen: We don’t typically see it present before two months of age. It certainly can especially in families where there’s a strong history of eczema. And fortunately, the pediatricians in town are very good at picking this up and are good at differentiating often between cradle cap which we see earlier on in eczema. The parents should look for kids being kind of dry, red, itchy and rashy. Before the kids are real good at scratching, the rash doesn’t have very obvious presentation. Once they get a little bit more coordinated, then they can start scratching were it itches, and we do refer to this as the “itch that rashes” meaning that most of what we see is self-induced.
Host: Do we know what causes it Dr. Bowen? You mentioned family history a little while ago. Is there any autoimmune cause? Is there anything we know about this?
Dr. Bowen: So, this is a very well-studied disease. It turns out the primary culprit is a gene called filaggrin. And we’re supposed to get copies from each of our parents and the fewer copies of this gene we get, the worse our disease tends to be. And it is often associated with what we call the atopic triad which is allergies and asthma. And it’s not in the autoimmune family as we think of those conditions, but it is kind of an overreactive immune system in the portion of allergies that has historically been to fight parasites and then instead of fighting parasites in developed countries, it fights detergents, and perfumes and wool and things like that.
Host: So, then what’s the management? What do you do for children for whom this is diagnosed? And how do you help parents to manage that itching and the kids really, frustration and it’s very uncomfortable?
Dr. Bowen: Oh it is absolutely uncomfortable. I think that a lot of patients and parents self-treat. So, we only see probably half of the patients with eczema or true atopic dermatitis. Because a lot of them are mild and they learn that they can’t use harsh soaps or strong fragrances and they need to use a regular moisturizer. For the ones that don’t, that’s who we tend to see in our clinic or are referred over by our great pediatricians in town. Those need to be managed by a regimen of topical steroids to reduce inflammation and then also a pretty strict regimen of mild soaps and kind of cautious bathing and then aggressive use of topical emollients.
Host: So, now, let’s talk about either some of the myths or things that surround it. You mentioned environment, detergents, things like that. Tell us if diet affects eczema, the environment, the things around our house that could exacerbate an eczema outbreak. Tell us a little bit about some of those.
Dr. Bowen: We often get that question and the short answer is yes. So, there are many foods that can aggravate atopic dermatitis or eczema. But the avoidance diets that have been kind of recommended in the past, are not recommended. We don’t say stop all grains and dairy and fruits and all that. We say if a particular food makes the eczema flare, then that’s one to cut out. So, if every time that they have strawberries, they get a rash on their face; well that’s one to kind of cut back on. There are some things in the diet which can actually help eczema. And so, yogurts with live cultures have been shown to improve the balance of kind of good bacteria on the skin. And then there’s some other kind of supplements that can help to increase the expression of that filaggrin gene and one is called l-histidine. That’s a vitamin you can get kind of online or at the local pharmacy. And then there’s a plant-based product called phytoceramides which you can kind of supplement into the foods and help the body make its own moisture. You can also supplement that through the skin with moisturizers like CeraVe. CeraVe is a – it stands for ceramide vehicle and putting that on the skin can actually be absorbed and help the body make its own moisture.
We do recommend in families that have a peanut allergy that they are very careful of that if there is any family history of anaphylaxis but in general, we recommend kind of advancing foods one at a time and just watching for symptoms of allergy, rash, diarrhea, wheeze.
Host: So, we’ve been hearing over the years, about eczema and any predisposition. You’ve mentioned allergies and asthma. Are there any of the true autoimmune diseases that now maybe this child is at risk? Do we know what that risk is? Or how they are all linked together?
Dr. Bowen: We’re learning more and more. Prior to a few years ago, there was no good medications for this. everything that we did for really, really bad eczema after topical steroids was a mild form of poison. We’d use chemotherapy drugs like methotrexate, and we’d use transplant drugs like CellCept and things that would really, really suppress the immune system. As we learn more about the particular chemicals that are involved in the inflammation of atopic dermatitis, the drugs have gotten much more advanced and much more targeted to the specific type of inflammation.
The lifelong risk of eczema – we see studies come out like this from time to time that there may be an increased risk of heart disease, there may be increased risk of ADHD, attention deficit disorder and hyperactivity disorder. And that may just be that kids in the classroom who are itchy all the time have a hard time paying attention. But anything with chronic inflammation can predispose to other kind of inflammatory things down the line. We see increased risk of vitiligo, increased risk of alopecia areata which is like a circular hair loss and sometimes we see increased risk of thyroid disease. And these are all just kind of linked in these kind of proinflammatory states.
Host: Wow. It’s so interesting and as you said, it’s being studied and has been studied. As we wrap up, please tell us what you want parents to know about children with eczema, are outdoor activities okay? Give us a little summary of your best advice for good skincare for children with eczema and when you really want parents to take their kids to a dermatologist.
Dr. Bowen: I’ll start with kind of summer and go to winter. So, in the summer, kids with eczema absolutely encourage some UV. UV light suppresses inflammation. Obviously, as a dermatologist, I don’t advocate carefree UV exposure as it can lead to skin cancer. But a little bit of controlled sunlight especially outside the hours of ten to two when the UV is most intense can actually make eczema better as long as they don’t get sunburned. We want to use physical blockers, mineral sunscreens containing zinc and titanium because those are less irritating to the skin. And we want to make sure that the outdoor activities – if grass is making their allergies flare, that can make their eczema flare and that can be counterproductive. But getting in a swimming pool is fine as long as we shower off afterwards and apply a moisturizer. And then as we get into the winter months, the things that tend to make eczema flare are stress, dry air, cold temperatures, wool type clothing, all the things that you would expect to find in Nebraska in the winter.
And so then we really want to be focusing on using a moisturizer, not stripping the oil from our skin with harsh soaps, things like that. So, if we have parents that are doing these kinds of best practices using the good skincare and they are not able to stay on top of it, first line of defense is the pediatrician’s office, an over the counter topical steroid and if those don’t seem to be cutting it, then absolutely make an appointment and let’s see if there’s something that we can do to help or if there’s an allergy that has developed on the skin that we need to eliminate from that child or even adults daily exposures.
Host: What great information. So, important for parents to hear when the right time is to see a dermatologist and how to help their child with eczema. Thank you so much Dr. Bowen for joining us today and thanks to our Bryan Foundation partner, Union Bank and Trust. That concludes this episode of Bryan Health podcast. Please visit our website at www.bryanhealth.org for more information and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Bryan Health podcasts. I’m Melanie Cole.