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Overcoming Inflammation

Overcoming Inflammation

Flu vaccines and autoimmune diseases

September 19, 2017
Should people with autoimmune diseases get a flu vaccine? If so which ones?

Have you received your annual flu vaccine?  Flu season is just getting started.  People who suffer from autoimmune diseases, like rheumatoid arthritis, lupus, and Sjogren’s syndrome, often have a weakened immune system, either from the disease itself or from the medications used to treat their disease.  Today I’d like talk about the flu also known as influenza, and discuss what steps you can take to protect yourself this season.

What is the flu or influenza?

The medical word for the flu is influenza.  Influenza is a type of virus that mainly attacks the respiratory system.  There are two general types of influenza: influenza A viruses and influenza B viruses.  Different components make up the flu virus: one hemagglutinin (H1, H2, H3) and one neuraminidase (N1, N2). There are many different strains of influenza and to make matters worse, it tends to mutate.

The stomach flu is NOT caused by influenza.  The stomach flu is a general word used to describe a gastrointestinal infection caused by other types of viruses like Norovirus, the most common cause of gastroenteritis in the United States.

What are some of the signs and symptoms of the flu?

The signs and symptoms of the flu vary widely and are rather nonspecific.  They can include:

  • High fever
  • Muscle pain
  • Rigors, uncontrollable shaking
  • Headache
  • Malaise
  • Sore throat
  • Nonproductive cough
  • Runny nose

Complicated cases

Sometimes the flu can morph into a much more serious illness.  It can cause viral pneumonia and then can lead into a secondary bacterial pneumonia, sinusitis, and/or an ear infection.  This tends to happen in people who have a weakened immune system like children and older adults.  People with autoimmune conditions and especially people taking medications that weaken the immune system also are at high risk.

How is the flu transmitted?

The flu spreads from person-to-person by large particle droplets.

  • Airborne droplets: Coughing and sneezing
  • Skin-to-skin: handshakes and hugs
  • Saliva: Shared drinks and kissing
  • Touching contaminated surfaces: Keyboard, doorknob

What are the best ways to prevent the flu?

The best ways to prevent the flu are first, by washing your hands and second, by getting vaccinated for the flu at the beginning of each flu season.  Choosing healthy lifestyle practices, like eating clean, exercising, and getting a good night’s sleep, are also important.

What are the most convincing reasons for getting vaccinated against the flu?

  • During the 2016 – 2017 flu season, it caused 5.1% of outpatient visits.
  • Pneumonia and the flu caused 2% of reported deaths.
  • There were at least 18,000 confirmed flu related hospitalizations, 60% of cases occurred in people aged 65 years and above.
  • There were 98 confirmed flu related pediatric deaths.[1]
  • Risks of complications, hospitalizations, and deaths from the flu are the highest among people age 65 and above, young children and people who have medical conditions that weaken the immune system.
  • If you end up getting the flu, the flu vaccination may make your flu illness milder
  • By getting the flu vaccine, you decrease the risk of passing it on to the people you love

Who should get a flu vaccine?

Everyone six months and older.  This is especially important for people who have a high risk of getting flu-related complications.  These include:

  • Children younger than five
  • Adults 65 years of age and older
  • Pregnant women, up to two weeks postpartum
  • People that live in a nursing home or another type of long-term care facility
  • People that have a medical condition that weakens the immune system, this includes almost everyone with an autoimmune disease

Medical conditions

  • People with weakened immune systems (autoimmune diseases, cancer, HIV or AIDS, people on chronic steroids and biologic medications)
  • Asthma
  • Neurological and neurodevelopmental conditions
  • COPD and cystic fibrosis
  • Coronary artery disease and heart failure
  • Diabetes mellitus
  • Blood diseases like sickle-cell anemia
  • Kidney disease
  • Liver disease
  • People with an extremely high body mass index (BMI) > 40

When is flu season and when should I get my flu vaccine?

In the United States, flu season occurs during the months of October into May.  Historically, the greatest number of cases occur during the month of February.  The CDC recommends that people get a flu vaccine by the end of October.  If you’ve missed the deadline, no worries, better late than never!

What viruses will the 2017 – 2018 flu vaccines protect against?

Every year, manufacturers must change the structure of the flu vaccine, because the virus is constantly changing.  Scientists use data from the previous year to try to guess which strains will be more problematic in the upcoming season.  Flu vaccines typically have 3 to 4 specific strains of influenza.  This year, the vaccinations that have three types of virus should contain the following:

  • A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • A/Hong Kong/4801/2014 (H3N2)-like virus
  • B/Brisbane/60/2008-like (B/Victoria lineage) virus

Vaccines that contain four strains should contain the above as well as the following:

  • B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Where can I get a flu vaccine?

Most doctor’s offices carry the flu shot.  Call your primary care provider or specialist to see whether they can give you your flu shot this year.  If not, most pharmacies also give this service as well.

Still unsure, please follow this link to find a flu shot near you.

Which flu vaccine should I get?

According to the CDC’s of published guidelines for the 2017 – 2018 season, they recommend the use of the inactivated influenza vaccine or IIV, or the recombinant influenza vaccine (RIV).  These come as injections.  They recommend against vaccination with the nasal spray flu vaccine.  The latter is a live attenuated vaccine.  People who take biologic medications should not receive live attenuated vaccines.

Can I get a flu vaccine if I’m allergic to eggs?

The following are the CDC recommendations regarding egg allergies and the flu vaccine.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.

  • People who have symptoms other than hives after exposure to eggs, such as angioedema, respiratory distress, lightheadedness, or recurrent vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a healthcare provider is able to recognize and manage severe allergic conditions. (Settings include hospitals, clinics, health departments, and physician offices). People with egg allergies no longer have to wait 30 minutes after receiving their vaccine.[2]

Disclaimer: I have some safety concerns about the latter.  I’m simply stating what the CDC has issued.  When in doubt, talk to your doctor.

Why does the flu vaccine sometimes cause flu-like symptoms?

Here are a few reasons.

You have the flu

The incubation period is between one and four days.  It also takes about two weeks for your body to build immunity after receiving the vaccine.  Therefore, you can get the flu after a flu shot if your body hasn’t had time to build immunity yet.

You have a cold

Rhinoviruses are a common culprit.  These are the viruses responsible for the common cold.  In severe cases, the common cold can feel like the flu and you can catch it the same way.

The vaccine failed

Last year, the vaccine was only 34% effective at protecting against influenza A (H3N2) and 56% against influenza B viruses.  Unfortunately, over the past six seasons, vaccines have been less and less effective.[3]  However, any immunity is better than no immunity.

The flu vaccine gave you the infection

This can occur if you’ve received a particular type of flu vaccine that uses a live attenuated virus.  This is the vaccine that comes as a nasal spray.  Live attenuated vaccines are vaccines that contain a less potent form of the real virus.  The immune system reacts to the virus and develops antibodies without causing the infection.  Sometimes the virus is stronger than the immune system.  The real infection can occur when this happens.

The CDC advised against the use of this particular type of vaccine.

Most common cause, your immune system is reacting to the vaccine

Scientists make injectable flu vaccines with inactivated virus or without any virus at all.  Therefore, by definition, these are not infectious.  You cannot get the real infection from them.

Some people may experience some soreness, redness or tenderness from the shot itself.  Some people actually develop a low-grade fever, headache, and muscle aches (i.e., flu-like symptoms).  These typically last about 2 days and resolve without any intervention.  This is your body’s way of telling you that it’s mounting an immune response to the vaccine.  This means your body is responding to the vaccine and making antibodies to protect you from the real infection, which is MUCH more severe.

Final thoughts

I know vaccines have received a bad reputation over the past few years.  However, when you look at the data, vaccination particularly for the flu, ultimately saves lives.  Let’s take example.

During the 1918 – 1919 flu season (i.e., the Spanish Flu), 1/3 of the world population experienced a terrible flu pandemic. About 50 to 100 million died.  Now this was a particularly bad season, “the mother of all flu seasons”, and the reason it was so deadly has to do with many factors that we have yet to confirm. The CDC has experimented with an influenza virus that has the genetic material from the 1918 virus.  Their results suggest that our modern-day vaccines and FDA-approved antiinfluenza medications like Tamiflu, would have worked against the 1918 virus.[4]

Bottom line, flu vaccines save lives.

If you want to learn more about the flu, please follow this link.

References

Fingers smiling against flu shot message image by wavebreakmedia via Shutterstock

[1] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[2] https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm

[3] http://www.mdedge.com/jfponline/article/145540/vaccines/latest-recommendations-2017-2018-flu-season

[4] https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Overcoming Inflammation

How to travel with medications

August 16, 2017
Airplane in the sunset: How to travel with medications

The other day, someone asked me how to travel with medications.  In this particular instance, it had to do with a medication that comes as a prefilled syringe.  I figured I’d write down some tips on how to travel with rheumatology medications.

Before you travel

Before traveling, ask your doctor for a letter describing your medical condition and the medication(s) that you are taking for that particular condition.  The TSA officer may not ask you to produce such a document, but if they do you’re covered.  This isn’t really an issue for oral medications but more for liquid medications.  Read on to learn more about liquid medications.

Medications

The TSA allows travel with your medication in both your carry-on and your checked baggage.  However, I suggest that you always carry it with your carry-on.  First, you never know when you’ll need your medication.  Second, you don’t want anyone tampering with your medications.  As you already probably know, some medications are very expensive.  E.g., 1 etanercept pen costs about $1 000.  Would you put $1 000 in cash in your checked bag?  Call me paranoid but I wouldn’t.

Oral medications

When it comes to medications that come in pill form, you do NOT need to tell the TSA that you are carrying medications.  You can carry as much medication as you will need for your trip.  However, like any other carry-on baggage, the TSA needs to screen your medications through their x-ray machine.  The TSA does not mandate that you carry your medications in the original prescription bottle, however, every state has their own set of laws regarding the labeling of prescription medications. You absolutely need to verify and comply with your own state’s laws.

Subcutaneous medications

First, you must tell the TSA officer that you are carrying liquid medications.  These include medications that come in pens, prefilled syringes, and vials like subcutaneous methotrexate.  Prescribed creams and eye drops are also considered liquid medications.  Some examples of subcutaneous medications include etanercept, adalimumab, abatacept, golimumab, and belimumab, etc.

Unlike your usual liquids like shampoo or perfume, liquid medications are exempt from the 3-1-1 liquids rule.  This means that you ARE allowed to bring more than 3.4 ounces or 100 mL of liquid medication in your carry-on bag.  Moreover, you are NOT required to place the medication in a plastic zip-top bag.  Like oral medications, the TSA does not require that you carry medications in their original labeling, however, it is highly suggested.  Remember, you must comply with your state’s laws.

Liquid medications also go through x-ray screening.  If you don’t want your medication screened by x-ray, you must tell the TSA officer.  Your medication will need to undergo additional screening procedures like visual screening.

Used syringes

You had a great trip, but now it’s time to go back home.  During your trip, you may have used a syringe/pen or two.  It’s important to note that you can bring used syringes or pens but you must transport them in a sharps disposal container.  You can put your container in your checked bag and you can also bring it on your carry-on bag.

Accessories

Some medications need to be kept cold at all times until you actually need them.  Some accessories include ice packs, freezer packs, gel packs, or syringes.  The TSA will screen these items.  If the officer is unable to use the x-ray to clear any of your items, they also will need more screening.

Aids

These items include walkers, crutches, and canes.  Like any other item, these items undergo x-ray screening.  If the item does not fit into the machine, the TSA officer will do a visual screening.

Wheelchairs and scooters

Obviously, these items don’t fit through the x-ray machine.  When traveling with these items, the TSA officer will screen your device, including the seat cushion.

What if you can’t walk or stand?

The TSA officer will help you sit down in a chair and you will undergo a pat-down screening.

Have a fun trip!

Now you’re ready for your big trip!  If you need more information please visit the transportation security administration website.  When in doubt, please contact them directly before your trip.

Safe travels!

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Diseases and Conditions Overcoming Inflammation

Can UV light trigger lupus flares?

July 12, 2017
Can UV light trigger lupus flares?

Now that summer is finally in full swing, I’d like to remind everyone to use broad spectrum sunscreen while enjoying the sun!  This is especially important for people living with systemic lupus erythematosus (SLE). Ultraviolet (UV) light is a known trigger of SLE flares BOTH involving the skin and major organs.  Many people also report joint pain, weakness, and headaches.  These flares can be very serious.

Although we know UV light is a trigger for SLE flares, we still don’t fully know how it happens.  This is what we do know.

  • UV light directly damages the DNA of skin cells.
  • The cells release inflammatory cytokines, most notably interleukin-1α and tumor necrosis factor-α.
  • UV light also increases interferon-α signaling. People with high levels of interferon-α signaling often develop fevers, fatigue, and low white cell count (leukopenia).  Interferon-α signaling is thought to be an important part in the development of SLE.

Take home points

So while you’re enjoying the sun remember to:

  1. Avoid the sun when UV light is strongest, between 10 AM and 3 PM. If you use IFTTT, check out this app.  You will get a notification on your phone when the UV index is high… and it’s free!
  2. Use broad spectrum UVA/UVB sunscreen.  Try to aim for a SPF higher than 30.
  3. Try wearing clothing that have vivid colors and a tight weave. The Skin Cancer Foundation has a great article regarding this topic: “What is Sun-Safe Clothing?”
  4. Wear a broad-brimmed hat when spending time in the sun.

Be safe and please leave your comments below!

References

 Fernandez D, Kirou KA. What causes lupus flares?  2016 Mar;18(3):14. doi: 10.1007/s11926-016-0562-3.

Medical Disclaimer

This information is offered to educate the general public. The information posted on this website does not replace professional medical advice, but for general information purposes only. There is no Doctor – Patient relationship established. We strongly advised you to speak with your medical professional if you have questions concerning your symptoms, diagnosis and treatment.

Featured Overcoming Inflammation

What is the best diet for autoimmune diseases

June 21, 2017
What are some foods have anti-inflammatory properties?

In recent years there’s been a lot of talk about the autoimmune diet. But what exactly is an autoimmune diet and which foods have anti-inflammatory properties?  These are some of the most common questions my patients ask me in clinic.  Essentially, what foods help autoimmune diseases?  In certain cases, it’s pretty cut and dry.  If you have celiac disease, avoid gluten.  If you have ankylosing spondylitis, Crohn’s disease, or ulcerative colitis, try to follow the FODMAP diet.  There already exists evidence-based research that supports these interventions.

But what about other autoimmune diseases like rheumatoid arthritis, lupus, Sjogren’s syndrome?  What should you be eating if you have any of these?  Do they have their own autoimmune diet?  Should you avoid nightshades, dairy, gluten, eggs, etc.  In recent rears a myriad of “anti-inflammatory diets” have surfaced on the web.  For the most part, they are supported by little if any evidence-based research.  This is unsurprising.  Good quality research requires money.  Lot’s of money… pharma money.  It simply does not make any business sense for these companies to fund large and expensive studies that have no commercial potential.  Believe me, I am not defending big pharma, I’m simply stating reality.

What is epigenetics?

Even though we do not have great scientific evidence supporting a particular autoimmune diet or foods to prevent, cure, or lessen autoimmune diseases, it’s kind of obvious that some lifestyle practices lead to better health outcomes.  Take smoking.  People that smoke tend to get lung cancer and develop heart disease compared to those that don’t smoke.  But how does that work exactly?

Everyone is born with genes.  Some of these genes are active and some remain dormant.  Your genotype is the entire makeup of your genes.  Your phenotype is the result of how your genetic material is expressed.  For example, you may have the genes for blue eyes and brown eyes.  If the genetic material for brown eyes is dominant, you’ll have brown eyes.

This is where it gets really interesting.  Over the course of your lifetime, some of your genes are turned on and off.  This is influenced by factors like aging, the environment, and lifestyle.  Epigenetics is the study of how genes are turned on and off based on external influences.

Epigenetic changes can be good but can also cause harm.  We think that some of these changes can result in autoimmune diseases.  It’s important to remember that epigenetics is in its infancy.  Researchers still are not 100% sure how this happens, let alone, how to specifically manipulate the environment to cause favorable epigenetic change.

Autoimmune diet: what foods should I eat?

This simple answer to this question is, “I don’t know”.  One day, when researchers crack the epigenetic code, I may be able to answer this questions more accurately.  I may be able to tell you, if you follow the rheumatoid arthritis autoimmune diet, this should help control your inflammation.  Unfortunately, I am unable to say that yet.

But like I was saying at the beginning of this post, some people who adhere to certain lifestyle practices tend to be healthier.  Given we don’t really have actionable epigenetic data to guide lifestyle choices, the goal when it comes to nutrition and lifestyle is to adopt habits that have a tendency to result in overall general health to live happier, healthier, and longer.

The Blue Zones®

The Blue Zones® are 5 regions in the world where people statistically people tend to live to 100 years AND who tend to reach this age in health.  The project spawned from the National Geographic Society.  The goal was to find “hot spots of longevity” around the world.  The researchers identified 5 zones and circled them in blue ink.  These regions are as follows:

  • Ikaria, Greece
  • Okinawa, Japan
  • Ogliastra region, Sardinia
  • Loma Linda, California
  • Nicoya Peninsula, Costa Rica

One would think that there are no similarities between people living in Japan versus people in Greece.  What the researchers identified was a core list of lifestyle practices and environmental factors that shared between all the different regions.

The Power 9®

Move Naturally

People that live to 100 years don’t necessarily run marathons or go the gym.  They are always on the go and they move naturally.  For example, they tend a garden, they walk to the market, they use stairs instead of the elevator.

Purpose

People that live in the Blue Zones live with purpose.  They wake up every morning, and they know “why I wake up in the morning”.  Having a clear purpose in life can add an extra 7 years of life expectancy.

Down Shift

We all know that stress can cause inflammation.  I often see people in my clinic who’s rheumatoid arthritis was in perfect control until something really bad happened, like a divorce, job loss, or a death in the family.  Chronic stress leads to chronic inflammation.  People in the Blue Zones develop daily habits to help reduce stress.

80% Rule

The Japanese have a saying “Hara hachi bu”.  This is a mantra that Okinawans say before every meal, reminding them to stop eating when they feel about 80% full.  There is a delay between feeling full and actually being full.  When you feel 80% full, you are actually full.  So if you stop eating when you feel full, you are overeating.  People living in the Blue Zones tend to eat their largest meal at breakfast and their smallest meal at dinner.

Plant Slant

Although not all regions of the Blue Zones eat meat, their diets all mainly consists of fresh veg and beans.  Lot’s of beans: fava, soy, lentils, etc.  They eat meat very sparingly and servings are small, “about the size of a deck of cards”.

Wine @ 5

Thank goodness for this one!  People in the Blue Zones, expect for Adventists, drink alcohol moderately and regularly.  Typically, they drink 1-2 glasses of wine per day with friends and family at the end of the work day.  They found that people who drink regularly and moderately tend to live longer than those who don’t.

Belong

Almost all people who live until 100 tend to belong to some sort of faith-based community.  They found that attending a service 4 times a month can add up to 4 – 14 years of life expectancy.

Loved Ones First

People living in Blue Zones tend to live close to their families.  It’s common to have children, parents, and grandparents living under the same roof.  They also tend to commit to a life partner.

Right Tribe

People in the Blue Zones keep strong social networks.  Not only are these social strong, but they also foster healthy behaviors.  Women in Okinawa create “moais” early on in life.  These are groups of 5 friends that are completely committed to each other for life.


The true beauty in the Blue Zones Project® is that you don’t need to live in a Blue Zone to reap the benefits.  By living the Power 9® you can set yourself up to live with vitality to a ripe old age.

Conclusion

Medications certainly have made a huge difference in the prognosis of many autoimmune diseases like rheumatoid arthritis and lupus but it’s not enough.  By integrating healthy habits we can potentially turn on an and off genes that contribute to ongoing autoimmunity and inflammation.  Although we still don’t know exactly what the perfect autoimmune diet is, by adopting healthy habits set forth by the Power 9®, you can increase your odds to live a long, happy and healthy life.

Overcoming Inflammation

Tips for family and friends for people living with rheumatoid arthritis

March 15, 2017

Last week I was listening to one of my patients describe their condition in a deeply emotional and revealing way.  He honestly caught me off guard.

He said, that he woke up one day, and felt like a blob.  Like a being without joints, without tendons, ligaments or structure.  He could not walk or move.  He did not feel human anymore.

He was describing Part I of Franz Kafka’s seminal work, The Metamorphosis.  For those who have not read this novella, The Metamorphosis is the story of Gregor, a travelling salesman, who wakes one morning to discover that he has transformed into an insect-like being.  There is no rhyme or reason for his transformation.  It did not happen because he was a bad person or because of something he did.  It simply just happened.  The story deals with his attempts to adjust to his new physical state and his attempts to cling onto his humanity.  It also deals with the transforming relationships he has with various members of his family.  First how some show empathy but then quickly this empathy transforms into a sense burden and then repulsion.

Sound familiar?

When you think about it, it’s kind of depressing, especially for those who suffer from chronic diseases such as rheumatoid arthritis.  In certain cases, it’s a reflection of reality.  One wakes up one day and learns that their body will not let them to do what they used to do.  In the case of rheumatoid arthritis, you didn’t do anything to cause it.  It just happened.  It’s not like you were smoking 3 packs of cigarettes a day for 20 years and then you get diagnosed with emphysema.  That’s called playing with fire.  With RA, it just happens.

So now you find yourself not being able to do what you used to do: do your job, support your family, play with your kids.  It’s not because of a lack of will, your body simply won’t let you… not that you should give up:)  Now you become a burden to your family.  Your relationships change.

Unlike Kafka, I personally refuse to believe that these relationships will inevitably sour.  Healthy relationships with your loved ones can you grow healthier physically, emotionally, and psychologically.

The following are 8 tips to help metamorphose relationships into healthy and supportive ones.  Please share with family and friends!

 

Learn as much as you can about your loved ones disease

Knowledge is power.  It’s easier to have empathy when you have a sense of what’s going on and also what to expect.

But don’t assume you know everything.  You don’t.

No one likes a know-it all.  Don’t assume that you know what your loved one is going through or how they feel.  You can’t learn that in a textbook or from an article.  Be supportive.

Be a good listener

Sometimes people simply need vent.  Listen for cues.

Be adaptable

Life is going to change whether you like it or not.  There’s going to be good days and there’s going to be bad days.  Being rigid about your expectations is not going to get you anywhere.  Be flexible.

Don’t be overprotective

Find balance.  Although you want to help your loved one as much as you can, you also don’t want to strip them of their independence and by being overprotective.

Open communication

Be open about your emotions and thoughts.  A healthy relationship is one free of passive aggressiveness.

Join a support group

There are many support groups out there.  Let me tell you, I’ve been there.  Not for RA though.  All of a sudden the person you love and depend on, gets diagnosed with this terrible disease.  And EVERYTHING changes.  There’s nothing worse than the deep sense of loneliness that comes along.  Support groups can help overcome the isolation.  Find a support group near you!

Unconditional love

Whatever life throws at us, we will deal with it together.  I promise not to scream at you because I’m having a bad day.  I promise not to blame you for the money problems we have now.  I love you, I will support, and advocate for you no matter what conditions.  This is unconditional love.

 

I hope this has been helpful. Please leave any comments below.  I’m interested in hearing your thoughts and experiences.

 

Diseases and Conditions Overcoming Inflammation

Simple and easy ways to hydrate your skin

January 23, 2017

This past Christmas, I received probably one of the most bizarre gifts I have ever received.  A full adult-sized onesie! Let me tell you, it hasn’t really brought out the most flattering bit of my anatomy.  Last year I had lamented that my house was kind of cold in the winter and mentioned that babies had it made with their one-piece pajamas.  That being said, I decided to use my family’s superhuman memory to my advantage.  This year it was all about my dry skin and how wonderful it would be to have a paraffin wax machine.

I have to admit it though, that onesie does keep me nice and toasty at night!

While waiting for the paraffin wax machine that hopefully will be making its apparition Christmas 2017, hint-hint, I thought I’d do a little research about the topic of dry skin: anatomy, immunology, and basically how to keep it as moist as possible without that oily feeling.  People who suffer from autoimmune diseases tend to suffer from dry skin.  This really isn’t surprising.  This skin is the largest organ in the human body.  Because of its large surface area, it needs a large complex immune system.  Autoimmune diseases = inflammation and inflammation involving the skin = dryness, irritation, and itchiness.

Anatomy and immunology

The medical term for dry skin is xerosis and the term dermatitis signifies inflammation of the skin.  The skin is made up of the epidermis which is the most superficial layer followed by the dermis and then the subcutis.  These layers are made up of blood vessels, hair follicles, as well as glands.  One of the main functions of the skin is to protect your body from the outside world.  That being said, the skin contains many immune cells such as Langerhans cells, neutrophils, eosinophils, and lymphocytes.  When skin is irritated by bacteria, viruses, chemicals, the immune system kicks in to fight off the foreign invader.  With autoimmune diseases, it’s the immune system that starts to attack the skin itself.  In either case, when the immune system is activated it causes inflammation which = irritation + dryness.

There are many autoimmune diseases that affect the skin.  Some of these include scleroderma, Sjögren’s syndrome, rheumatoid arthritis, lupus, sarcoidosis, and psoriasis.

So what can you do to keep your skin moist and healthy? Drink plenty of water, limit the amount of exposure of your skin to water, protect your skin from the sun, avoid allergens, and moisturize regularly.

Avoiding irritation and dehydration

You would think that more water equals more hydration.  That may be true for ingested water, but it’s the opposite for water that makes direct contact with your skin.  For example, every healthcare worker soon learns that there is a positive correlation between the dryness of their hands with the amount of times they wash their hands per day.  Don’t get me wrong washing your hands is very important to prevent the spread of infection, but it certainly does a number to your skin.  Some things simply cannot be avoided.  That being said, if you suffer from dry skin, try to limit the amount of time you spend washing in the shower.  Make it a quick 5 min instead of a long 30 min shower.  Another tip is to use lukewarm water instead of hot water.

For people who shave, try to shave immediately after you shower.  The hair will be much more malleable at this time.  Always use a sharp razor and always shave with the line the hair grows.  These will lessen the amount of irritation caused by shaving.

This may sound obvious, but it’s really important to prevent your skin from burning.  Burnt skin = dehydration.  If you plan on being in the sun, try to stay in the shade between 11 AM and 3 PM.  The UV is at its highest during these hours.  Aim to cover up with clothing made of light-colored cotton.  Light colored clothing adds a few extra SPF points.  Broad-brimmed hats and sunglasses are your friends.  Use sunscreen liberally.  At least 15 SPF.  For people suffering from lupus, plan for a much high SPF as UV can actually trigger a full-fledged systemic flare.

What I mean by avoiding allergens means, try to avoid anything that may cause some form of allergic reaction.  Again allergic reaction = inflammation = deterioration of skin barrier function = dehydration.  Obviously, it’s impossible to avoid everything but it may be a good idea to swap perfumed household products for hypoallergenic ones: laundry detergent, softener, soap, shampoo, moisturizer etc.  Anything that directly or indirectly makes contact with your skin.  It’s important to note that even, “all natural” products can potentially contain allergens.  For example, most people aren’t allergic to Shea butter, but some are.  Learn to know your skin.

Hydrate you skin

Are you as confused as I am when it comes to moisturizers?  Which ones are good?  Which ones are bad?  What’s the difference between a lotion, cream, and an ointment?  What goes where?  How much should I apply?  How often?

It’s essential to moisturize daily particularly those suffering from dry skin conditions.  Simply put, dry skin is determined by the amount of transepidermal water loss and this in term is determined on the integrity of the skin barrier function.  The composition of the moisturizer determines whether the treatment helps skin barrier function or not.  I can’t tell you which moisturizer is better than the other, because I haven’t found any blinded head-to-head evidence-based studies addressing this topic.  If you do find one, let me know.  I’m all ears!

Moisturizers come in various forms: lotions, creams, and ointments.  Lotions are the least greasy and ointments are the greasiest.  Typically, the greasier the moisturizer, the longer it lasts.  The questions what goes where and how often and how much to apply, may actually be over-complicating the matter.  The goal is to keep the skin nice and hydrated.  When you really think about it, consistency is key.  Would you wear a thick greasy ointment on your hands all day long?  I wouldn’t because it’s uncomfortable and quite frankly not practical.  Due to my job description, I wash my hands nearing 100 times a day.  I’d rather use a cream or lotion and simply apply it more often.  The ointment might be better tolerated at night before going to bed?  If I’m comfortable, I’m more likely to wear the moisturize regularly.  How much to apply?  Apply enough so that the skin feels moist.

Like I said, there’s no need to complicate things.

One word of advice, when applying a moisturizer, try to stoke it onto the skin in the direction that the hair naturally falls.  This can prevent folliculitis.

Caution

A little bit about miracle cures.  They don’t exist.  Any product marketing itself to be a “cure for psoriasis”, is probably a product to be avoided.   A lot of these products have high doses of corticosteroids, which may initially make the skin look more hydrated and look “healthier”.  If you suffer from psoriasis, it may even clear it up.  But in the long run, regular application will cause permanent skin thinning, aging, and atrophy.  Just like food, read the ingredients on the packaging of your moisturizer.

When it comes to diet, in general beware of any diet advocating cutting out lists of foods.  For the most part, these are not founded in evidence and you actually may be doing more harm than good.  Nothing beats a clean diet and plenty of water.  What that actually means, is a matter up for debate.  For more information regarding clean eating, I recommend visiting the Blue Zone Project by Healthways.  The Blue Zone principles were derived from a National Geographic study identifying practices in cultures where people tend to live longer, i.e., greater than 100 years of age, and healthier as compared to the normal population.  When you have entire populations of people living longer and healthier over  thousands upon thousands of patient years, it makes me think they’re onto something.

Parting words

I hope you’ve found this information useful.  If you would like more information, please contact your local physician.  Love your skin, keep it nice and hydrated!

References

Dermatology Secrets Plus, 5th edition copyright 2016 by Elsevier

American Academy of Dermatology

Loden M. Effect on moisturizers on epidermal barrier function. Clin Dermatol. 2012 May-Jun;30(3):286-96.

Penzer R. Providing patients with information on caring for skin. Nurs Stand. 2008 Nov 5;23(9):49-56.

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