eczema, exercise and activity, pondering

exercise is medicine for bones, but also for skin?

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A few years ago when I was living in Maryland, I was volunteering with the Montgomery County Bone Builders program. It was a group that offered community classes to adults aged 55+ to help build bone density and reduce osteopenia risk via group weight lifting. Needless to say, I enjoyed it immensely. Well, the other day I came across some notes I took from a continuing education course I took while volunteering, on exercise as medicine. As usual, I started thinking about what I had learned but now with the framework eczema. And thus I will now gift you all with my self ramblings. Not all of the bone building notes are relevant to eczema but whatever random thoughts I did have I’ll put in lavender.

 

2016 – Seminar

“Exercise is Medicine: The explosion of information today” presented by Professor Karen Thomas (a professor of exercise physiology at Montgomery College)

Exercise as Medicine – “Move”

NIH study at Brigham’s and Women’s Hospital stated that done right, there is no higher injury rate than college-aged person even when lifting heavy weight at few reps for people in nursing homes

Strength Training – use it or lose it (every day a person lies flat, as when ill, they lose 4% fitness) – So those days of relative immobilization from large flares are drastically messing up our health! 

–       muscles have 3 types of fibers:

o   ongoing = type I, slow endurance

o   strong = type II, fast

o   fibers that can go either way

–       lose strength fibers with age – body reabsorbs unused fibers and one can never get them back – It would be interesting to see if there are any correlations of increased (or decreased) incidents of eczema with lost muscle strength fibers with age

–       when exercising want to work all major muscles but especially rhomboids for older adults  

o   arms down at side, thumbs pointed out (rhomboids engaged) = can’t slouch – Finding ways to keep optimal “no slouching” positions are important also for allowing a more consistent flow of our fluids (lymph, blood, etc). 

–       some “old age” symptoms are actually just a product of lack of strength

–       need strong core (but also flexible) to protect everything else (e.g. low back) – A strong core is also important for blood flow and healthy digestion, which are crucial parts to helping our skin heal 

–       need to train people how to move in all directions (train to do activities of daily living) – Good to get lymph moving! 

humans gain muscles at same rate no matter age (so long as fibers not lost)

–       large mental component (which ties into a lot of studies in psychology about how ageism affects people’s memories and abilities… in short, if you think you can’t do something, you make it so you can’t do it)  – The mentality behind skin issues has been highly studied. Meditation, distraction, etc are all seen to help with itch sensation reports

low back pain often caused by muscle weakness

–       leg strength – e.g. squats (we also looked at how people can cheat when going to sit or get up from a chair, as by rocking themselves forward to get up or letting themselves just fall onto the chair rather than engaging their leg muscles)

Bone Density (need enough Ca2+, vitamin D and movement) – similar things we need for skin health

(bone replaces entirely every 3 years)  – skin replaces entirely every 30 days for the average person, or so my doctor told me

–       to get Ca2+ into bone, need negative charge in bone

–       bone bending/moving makes static electric charge that pulls Ca2+ into bone if vitamin D enzyme present – it would be interesting to the study the chemical reactions/absorption rates of products on the skin, moisture, etc during exercise. That and if the collagen levels in the skin change with exercise. And also what is happening chemically with the skin cells when they are inflamed and when they die/new ones are created. Looks like I need to get into skin physiology soon.

–       body parts you move, strengthen – if moving the skin helped strengthen it… that could explain why massages tends to be good for us (besides the stress component? I wonder if they have studies on the affects of massage on skin as it ages.

Training – legs further apart during exercise means less likely to fall b/c wider base of support. Want head over base of support

–       Tai Chi and dancing are good for balance – and good low impact activities for people undergoing a flare to present the sweating-to-itching issue

–       Teach people how to get off the floor via balance and motor ability so they can help themselves – mobility is an important factor for skin health too. you can develop a lot of scar tissue (especially if you spend all day scratching the sh*t out of yourself) so setting yourself up for more general body mobility will help your skin. This is also why massage is known to help people with eczema I believe, because you get the blood flow stimulation and help cleanse out irritants/chemicals. Though also I’ve been wondering about the “new” organ that scientists discovered… the interstitium, and where that will come into play with skin health and chronic skin conditions. I’ll do a separate post on the interstitium later on.

–       Challenge self by doing one sided exercises (like one arm pushups, etc) to work core

ROM (range of motion) – need to be able to move joints as far as they are supposed to move that way no compensation in other joints – again mobility. Also with theories like sanomechanics, where when a joint is loaded, the pressure is hydrostatically spread to other joints. The end result is a floating skeleton, or a balance of all the joints allowing for protection from damage. Apparently the concept is novel, but the application of how to achieve it feels a lot like a cross between meditation, yoga/tai chi/other flow types routines, and good postural alignment. But what sanomechanics made me wonder for years, was if we can accept the concept of joints “communicating” (for lack of a better way to describe it), and keeping one another in balance, why isn’t the idea that the skin behaves similarly or in combination with such “communication” not a theory? I’ll work on fleshing out more about what I mean by that later (maybe in the same post I do about interstitium).

–       so need to learn body’s ROM (different for each person)

PSYCHOLOGICAL – effects on nervous system and brain

–       painkillers mimic endorphins (but one can’t OD on self made endorphins)

–       endorphins mask pain (so good for arthritis) – And potentially itching, given some pathways of itching and pain being similar (post coming soon on this too!)

–       moving increase lubrication of joints and produces endorphins but won’t fix arthritis – but creation of endorphins may help also distract from the itchy sensations!

–       exercise wakes up brain (thalamus) – think smarter and faster (cognitive abilities)

o   elderly can think as well as younger kids but as slower rates

o   consistent exercise maintains cognitive speed

o   exercise prevents dementia (or slows it in those already afflicted, b/c more O2 to brain decreases plaque – especially in regular dementia)

The more you exercise, the less likely you will die from anything – exercise is dose related

–       150 minutes physical activity a week for adults at minimum (so 25 minutes 6 days a week, or 5 days minimum) – I’d say this is an important mark to meet in general, especially when you have a skin flare too!

–       more benefits for longer durations of exercise b/c chemical reactions ongoing – I’m curious if that would be the case with eczema flares, or is it more dependent on the activity level (low/high impact, low/high heart rate, perspiration rates, etc)?

–       want to work at intensity hard enough that one can’t have a conversation  – I tend to do body weight/weight lifting rather than pure aerobic type exercises to avoid sweating. though I will take long walks in my hilly neighborhood, which sometimes winds me (though I am 34 weeks pregnant now)

–       want to be a little sore so just exercise until tired – Would being sore help distract from flare symptoms?

eczema, pondering, wounds and infections

wound care treatments

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Back in my physical therapy student life, we had guest speaker Pamela Unger come in to talk to use about the role of wound care in PT. Much of what we talked about I applied (in my head) to eczema and ways to help treat it for myself. I’ll share some of my thoughts below meshed in in italics with things I learned from Pamela, but note: these are ideas I came up with and are in no way necessarily endorsed or supported by research.

To begin, we need to know that wound healing normally has 3 phases: inflammation, proliferation, and remodeling. During all 3 phases there is vasodilation (aka the blood flow increases to help close up the wound).

The inflammation phase: As we with eczema have constant inflammation, this made me think maybe we are having trouble with this phase of wound healing in particularDuring this phase, the wound works to regain balance of its cells, and also fights to prevent infection, the latter which interested me because people with eczema are generally more susceptible to staph and other skin infections. Is it because our systems start attacking our own good cells and not just the infectious bacteria? Cellularly during this phase, inflammatory mediators are released (so do people with eczema lack these mediators?) and various cells like macrophages/neutrophils consume the bacteria, but presumably less successfully if patients with eczema get staph frequently. The intended results of this phase are that the bacteria and other foreign materials are cleaned out of the wound, and that inflammation is controlled.

During the proliferation phase, the wound starts to fill in and close. Cells called fibroblasts start making collagen (collagen is an important building block for skin cells), the extracellular matrix (a molecular substance that supports the structure of cells) is made, and there is new development of blood vessels (called angiogenesis). The intended results of this phase are that new blood vessels are made, the template for new cells is made (call the scaffold), and re-epithelialization occurs (which means epithelial cells move to form a barrier between the environment and the wound).

During the remodeling phase, the scar is developing and maturing. Cellularly, the collagen fibers start to line up and the skin becomes stronger especially to tensile stress (being pulled/stretched). The intended result of this phase is that the collagen fibers cross over one another adding strength to the wound. The only aspect of this phase that I think ties to eczema is when individuals have healed eczema scars that itch more than open or unhealed areas, but that would mean something chemical is happening and I don’t know why scar tissue would itch more than the other parts of the skin. Though I suppose it could also be assumed that if during a topical steroid withdrawal, the skin becomes excessively wrinkly, it could be a problem with collagen production? 

 

Now that we have the basics, we can talk about a chronic wound. I loosely decided that eczema is a chronic wound by this definition: a skin injury that fails to heal through the normal phases, in a normal amount of time.
A chronic wound can have one of two thickness classifications (usually applied to specific types of ulcers). The first is partial thickness, meaning the epidermis (or outer layer of skin) is broken, but the next layer (the dermis) may not be. A full thickness means the dermis is also broken as well as the fascia, and there may be a breakdown into the muscle/tendon/bone level. I believe generally eczema wounds are partial thickness, though I am sure there are some exceptions/particularly bad wounds that occur.

Generally wound healing can be stalled because of 4 main things:
1. a bacterial infection,
2. inadequate electrical potential (for we are beings of electricity! More on this and the idea of E-stim for eczema management in another post),
3. not having enough microcirculation (aka circulation of blood in the smallest vessels), or
4. too much pressure from interstitial edema (or swelling in between cell layers).

Other factors like age, nutrition, and topical/oral steroids also can slow healing. With nutrition, the biochemical aspects doctors check for wound care would be albumin, pre-albumin, hemoglobin, and hematocrit. They would also want to check that a person has enough protein, calories, and fluid in their diet. We know that when you have eczema, it is especially important to drink lots of fluid and have a balanced diet, but I am unsure if the four other biochemical factors have a correlation with eczema sufferers, though I would assume people with eczema would have decreased levels of albumin (because it’s a protein).

 

So how does one really maintain their skin health? Pamela’s big takeaways were to:
1. keep the skin clean and dry (a big reason we need to clean out the wound is because a biofilm (of bacteria) easily grows in a wound and blocks healing by messing up the chemicals needed to heal),
2. use warm water (not hot) on the skin (because hot water can cause us to have more water evaporation from our skin),
3. use daily hygiene techniques, and
4. MOISTURIZE.

For wound control, Dr. Unger broke it down to 4 steps.
1. Protect the wound surface. Think using gauze, bandaids, wet wraps, cotton clothing, etc. Wet wraps would also help keep in moisture. If excessive moisture, collagen can be useful for absorption (maybe that is why I was able to use a collagen night cream to heal my facial eczema when it was raw).
2. Control bacteria. She mentioned silver ions and slow-release iodine. I believe new eczema products are trying silver so another overlap may be indicated.
3. Control odor. Unclear if this is as application to eczema but she mentioned activated charcoal and I believe there are some eczema products that have charcoal (though I could be wrong).
4. Affect cells. She mentioned using collagen (though how it would apply to eczema wounds specifically, like if it should be orally taken or topically applied, I am not sure).

The last things Pamela mentioned in her wound care lecture that I thought tied well to eczema management were:
1. massage (it has been documented that massage can help eczema, though aggressive massage around a wound may impede blood flow and slow healing, rather than help. So if a person suffering from eczema has lots of open wounds, massage may be more detrimental than useful),
2. avoiding excessive pressure (as excessive pressure or friction can cause wounds, it stands to reason that slumping in a seat, or staying in one position for too long doesn’t help the skin of people with eczema. Getting up and moving seems to have more importance than just general health, mood boosts, and circulation!), and
3. keeping the eczema wounds moist rather than letting them dry out (in the past people believed wounds needed to air out and be dry, but Pamela explained this makes it harder for the wound to heal because it needs a level of fluid movement. I believe dermatologists would support this as I have heard /read about them saying that dry skin leads to itching, and scratching the itch is what causes the rashes).