eczema, my journey, skin biome, skin care

the skin biome part 2

autumn decoration fall field
Photo by Pixabay on Pexels.com

It’s my favorite time of year and I just received my Chuckling Goat package (but more on that in a bit).

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A few months back I wrote a post about the skin biome and how I was excited by the small movement of companies creating products geared towards helping it. Since then there have been developments about different companies creating products to help either work with the natural skin biome or to help reintroduce micro-diversity to create an appropriate balance for healthy skin.

I didn’t know it previously, but Johnson and Johnson had a movement a while back to create products that didn’t mess up the skin microbiome of babies’ skin. Such products, like Aveeno Eczema Therapy Moisturizing Cream have some studies showing that they actually help to increase the microbiome diversity of the skin with use over time.

The company has become skin microbiome-focused in a multitude of ways, including offering use of their JLINX incubator under the JLABS. S-Biomedic has joined JLINX and is working to create products that remove the bad bacteria and replace it with good ones to balance out the diversity of the skin back to a healthy level. This idea of balance is becoming more and more accepted as it is found that overuse of antibiotics is causing more harm than good for conditions like eczema. Studies are showing that balanced diversity is what we need for our skin biome, rather than sterility (noting that antibiotics still have their place, including when surgery or infection is involved). Microbiome transplants are now no longer a thing of the future but are instead potentially the next big medical treatment protocol!

More recently, I read a book called The Good Skin Solution by Shann Nix Jones, that talked about the gut and skin microbiome and Jones’ personal experience as to how she came to develop a treatment to help manage her young son’s eczema. The goal was to help increase the diversity of both microbiome using the probiotics in kefir made from their goats’ milk. When it was a success with their son, her and her husband decided to sell their products and hence the Chuckling Goat business was born.

Jones reintroduced me the theory that you need to fix your gut microbiome to have any really lasting effect on your skin, but she added the idea that it’s best to treat both at the same time, (hence her her program that includes probiotics for both the skin and the gut). Needless to say I was intrigued so I looked into her products and went on to order some (but unfortunately I can’t get the kefir drinks because I live in the states and they don’t ship that outside of the UK).

Today the soaps and lotions arrived and I am beyond excited to receive them (happy as a clam… or a ceramic jack-o-lantern!). See my spoils below:

2018-10-02 13.40.42

I’ll have to figure out what to do to increase my gut flora diversity in lieu of kefir, as I was advised to avoid dairy while breastfeeding to see if that helped with Fi’s digestive woes. I’m not sure if goat milk would be okay since it is supposed to have less allergenic components than milk. I may just wait until Fi is done breastfeeding.

 

REFERENCES

Myles IA, Earland, NJ, Anderson ED, Moore IN, Kieh MD, Williams KW, Saleem A, Fontecilla NM, Welch PA, Darnell DA, Barnhart LA, Sun AA, Uzel G, Datta SK. First-in-human topical microbiome transplantation with Roseomonas mucosa for atopic dermatitis. JCI Insight. 2018 May 3;3(9):e120608.

Parikh-Das A, Ganopolsky I, Nunez C, Moreira L. A clinical trial to evaluate the efficacy of a OTC colloidal oatmeal skin protectant cream in the management of mild to moderate atopic dermatitis in infants and toddlers. JAAD. 2017 Jun 76(6);AB10.

Puniewska, Madgalena. “How the Microbiome Could Transform Your Skin in Surprising Ways.” Johnson&Johnson Innovation, 12 Oct. 2017, https://www.jnj.com/innovation/how-the-microbiome-could-transform-your-skin-in-surprising-ways.

 

Note: Some of the above links are affiliate links. This means that if you click on one and purchase an item, I will receive a small affiliate commission (at no cost to you).

eczema, my journey, pregnancy, skin biome, skin care, women's health, wounds and infections

breast milk for wound healing

agriculture animal blue sky breakfast
Photo by Pixabay on Pexels.com

As some of you may know I am currently nursing my 3 month old baby girl, and in doing so as she is my first, I’ve learned that leaking is a thing (sometimes it occurs when she’s nursing on one side- the other side will start to drip milk, and other times they seem to leak for no apparently reason at all). As I wear nursing pads in my shirts during the day, the problem begins at night when I’m in bed trying to sleep. The leakage then can be really annoying. So my most recent solution has been spreading the milk on my skin, because why not- it’s already leaking all over it anyway.

My less impulsive logic for trying this experiment came from some research I had been doing a few weeks ago about breastmilk and its health benefits for the baby. Fi got sick and I wanted to know how her immature immune system could handle sickness when she only intakes breastmilk as her food source. This search led me to an internet viral photo showing how a mom’s breast milk changed when her infant got sick. The 2013 study mentioned in that post talks about breast milk’s immunological function and explains how when the mom or baby get sick, the number of leukocytes (aka white blood cells) in the breast milk drastically increases to help protect them, because leukocytes help fight disease (which I found to be such a cool example of symbiosis. I personally have also noticed that breastfeeding seems to keep both me and the baby from getting too severe of sicknesses. In fact, my mom, mother-in-law, and husband each got sick after the baby was born yet Fi and I were fine!).

I also read an article by NPR addressing the breastfeeding versus formula debate for poor countries.  A point it stated made me more curious about breast milk; it said formula can cause increased risks of diarrhea and respiratory infections. I assumed this is so because it requires using water to make (and clean sources are not always available in impoverished countries) but maybe it’s also because formula doesn’t have the same chemical and bacterial composition to allow it to be readily accepted by the baby’s developing digestive and immune systems? By extension I supposed that breast milk had to have some component in it that generally allows it to not irritate the digestive and immune systems*… which is my big sign to think “MICROBIOME” (* this of course is excluding when the baby has allergies or sensitivities to something the mom is eating that is going into her breast milk). The article also talked about how it’s weird that we are constantly trying to research the benefits of breastfeeding when it’s as natural as “breathing, chewing, hearing, passing stool”. But we live in a society where we need evidence and so I decided to play the game of informal (and badly controlled) science to see if I could test my own theory, that breast milk may help with (eczema) healing.

I did not participate in the rigors of the scientific process because I am lazy and I doubt Fi would be content amusing herself long enough for me to do it, but instead I just dabbed some breast milk on my shallow cuts every now and then instead of using neosporin or leaving the cut alone. My observations: it would seem as though breast milk can help with reducing the pain of shallow cuts (I tried it on the cracks on my knuckles and outer ears, cuts on my ankles and hands), and helps to speed up the healing of said cuts. It does not moisturize (the spots I put it on tended to be drier the next day… though that could be because when cuts heal on me, they start skin flaking…) but overall, the spots I put it on did seem to heal up and achieve a cleaner scab and softer skin around it.

Apparent cons of this experiment? The milk can sometimes burn (but again, everything burns when it touches my inflamed skin spots… even water) and it’s also a little sticky but it dries sticky-free. Fun fact, I have a pet peeve about being sticky. I hate it. So much.

After this self experiment, I was more curious to support why I might be seeing the results I saw so I did some low level cursory research. Also speaking of research, I received my diploma the other day. I officially have a Master of Science in Health Sciences from MGH Institute of Health Professions. I am now a MASTER of science. The academic title of master seems somewhat archaic; I envision myself similar in status to an entry-level alchemist or and mage, as I have established myself in a trade, but it will still take years to perfect my craft. Anyway…

There’s not a lot of recent research being done (or at least it’s not readily available yet) but I did come across two recent ones. This first paper, of which I could only access the abstract, tested wound healing of the cornea (yes, of the eye) in mice using human breast milk, milk from mice, artificial tears, and the control group. The results were that the human breast milk caused the fastest healing, followed by the mouse milk. The other two groups (artifucial tears and the control) were still not healed by the end of day two. The other study I found was published in 2015 in Nature, and it was titled, “Human milk proresolving mediators stimulate resolution of accuse inflammation”. It came to the conclusion that the lipid mediator-specializing proresolving mediator profile (a ratio of sorts between lipid mediators and specialized proresolving mediators) in human milk helped the macrophages (or cells that engulf bad bacteria) to contain pathogens and remove dead cells (in a process called efferocytosis- my word of the day). It is important to note that this was seen in vivo (in mice), and that breast milk was not applied topically to the skin. If the results are applicable to humans, I see this study as being useful because people with eczema suffer high levels of inflammation internally not just on their skin, and because turning off the inflammatory phase is also important in wound healing (more on this in a later post).

After that article I backtracked and wanted to know more about what breast milk is, which led me to this document that included the various components of breast milk (though I can not find the professor or the molecular virology lab anywhere else on the web…). Also note that the tables say the various factors are tested “in vitro” meaning not in the organism (for example, secretory IgA from breast milk was probably removed from breast milk and tested in a petri dish against E. coli). Even so, the breadth of potential abilities of breast milk, due to its staggering list of factors alone was interesting in its own right.

In conclusion, though I don’t think breast milk applied externally heals the mother’s eczema or TSW, I do think it can help me with superficial wounds, especially when it’s the middle of the night and I am otherwise unmotivated to leave the bed even if I’ve been scratching.

 

REFERENCES

Arnardottir H, Orr SK, Dalli J, Serhan CN. Human milk proresolving mediators stimulate resolution of acute inflammation. Mucosal Immunology. 2016, May 9;9(3):757-766.

Asena L, Suveren EH, Karabay G, Durson Altinors D. Human Breast Milk Drops Promote Coreanl Epithelial Wound Healing. Curr Eye Res. 2017 Apr;43(4):506-512.

alternative/holistic medicine, eczema, exercise and activity, flare-up, food and nutrition, my journey, NEA, pregnancy, relationships, skin biome, skin care, sugar, topical steroid withdrawal, topical steroids, topicals, women's health, wounds and infections

my deviation from the beaten path

gray pathway surrounded by green tress
Photo by Skitterphoto on Pexels.com

Today’s post is all about trying to convey what life with eczema is like for me. The first thing I need to stress is that my condition was not always this severe. I can remember a “before”, as my condition didn’t start affecting my skin globally until I was 21 or 22.

So how has eczema affected me?

  • insomnia – Some nights I was unable to sleep until 6am. More recently off and on I have difficulty sleeping from midnight to about 6am.
  • food paranoia – Given that I have legitimate food allergies to peanuts, pistachios and cashews, I know how to deal with food allergies that cause anaphylaxis. What I don’t know how to deal with is the thought that some common food might have developed into being the cause for the severity of my skin issues. Also sometimes I’ll eat something that is usually fine for consumption, and I’ll break out in hives in my mouth inexplicably and the next time I consume said food, it won’t happen.
  • many different diets – I have tried the gambit of elimination diets, auto-immune diets, vegetarianism, paleo diets, sugar-free diets, low-carb diets, detox diets, etc).
  • food-related social repercussion – You have no idea how frustrating it is to have people think I am “just being picky” when I am avoiding certain foods or diets. It’s usually when I’m avoiding gluten, dairy, or soy or other common American-diet staples. What I don’t understand is why people think I enjoy avoiding these foods… do they not know my undying love for pizza and ice cream?
  • intimacy issues – picture not being able to cuddle on the couch while watching a scary movie without covering myself in a blanket to make sure my skin doesn’t touch my husbands. Long drawn out hugs? Nope.
  • skin-to-skin with baby issues – I have adapted to the lifestyle of needing to put a barrier between me and my baby’s skin. When I feed her, I throw a cloth on or wear long sleeves before I put her head on my arms. When I have her in a carrier, I try to put a layer between her face and my chest, or else I know I’ll have to take her out earlier as my chest will start turning red, flushing, and itching.
  • exercise limitations – Up until my junior year of college I was doing many different sports and activities including soccer, track and field, long runs on my own, ultimate frisbee, generically running around like an idiot, etc. Post-eczema life, unless I can get a flare to calm down for months, cardio is a nightmare. Hell, at this point in time, just going for a long walk in the summer induces itching everywhere that takes at least 10 minutes in an air-conditioned building to relieve.
  • summer nightmare – See what I mentioned about walking above and now just add that to general life in the summer. I do well if I don’t move, and if I avoid direct sunlight. Though I also need sunlight for vitamin D (and in my previous life I loved the sun) so I’ll pop outside for a few minutes to bask in the sun’s warm embrace and then I’ll overheat and have to come inside. At least the itching only starts if I sweat.
  • pain (cracked skin) – During certain stages of a flare I dry out (especially at night or after washing my hands or other random times) and my skin will crack. The worst areas are my hands (which will fissure all over) and my ears, as well as sometimes under my eyes.
  • obsession – I spend so much time thinking about my skin and worrying over if I am doing something to make it worse, or not doing enough. It gets exhausting really.
  • career switching – I dropped out of my physical therapy doctorate program because I just couldn’t deal with my skin. I wasn’t sleeping, I was uncomfortable sitting (more on that in a bit), and I couldn’t stand being in an air-conditioned room (see below), or being touched or coming in contact with another’s skin, which made it incredibly difficult to practice the hands on aspects of PT. I am now still in a stage of making my own career, which while exciting, is stressful when I have to talk about it because it’s not a clear cut “oh, yeah, I do X” anymore.
  • fear of infections – As my skin barrier is compromised so often, the risk of infections, primarily Staph, is high. I spend a lot of time wondering if I am infected and worrying when I catch a cold or something that I have contracted Staph (again).
  • hand washing (pain/itching) – Imagine how many times you have to wash your hands or use hand sani when you are a PT student working in a clinic. Doing dishes is irritating enough. Sometimes even just taking a shower will irritate my skin.
  • cleaning frequency – Given that I shed skin faster than the average human, I spend a lot of time cleaning to try to not live in my own skin dust filth.
  • social situation aversion – When I am flaring, I have no desire to go out, not only because I worry about the stares I get for physical appearances, but also because it takes so much energy to deal with varying temperatures, varying foods, varying stressors, usually a lot of sitting, the inability to play/dance without itching, etc.
  • general discomfort (pain, itch, smell) – Eczema this severe is uncomfortable. The obvious is that it itches, and not like a “I have a random little itch” but more on the level of if a swam of mosquitoes bite you all over your body but instead of having angry welt-y bite marks externally, they are all inside your body and not visible to anyone. The pain comes from the cracking I mentioned above, as well as the pain of the self-inflicted wounds from scratching too hard. When I have a bad flare, I develop this scent that I call the burning rubber skin that I loathe.
  • depression and anxiety – It’s no surprise that aggressive and long lasting flares take an emotional toll. As I spend time in pain, itching, paranoid about foods I eat, avoiding people, and unable to exercise and play as I normally would, sometimes my moods take a nose dive.
  • money spent – From skin care lotions and moisturizers, general soaps, bath products (bleach, epsom salt, apple cider vinegar), natural house cleaning products, dry brushes, the rebounder, to the doctors’ visits, etc, this condition isn’t cheap.
  • doctor visits (dermatologists, endocrinologists, neurologists) – There is something very frustrating about seeing many doctors and still getting no relief. I have moved a few times in the last past 4 years and as a result have an even larger number of individual doctor visits under my belt. The general consensus? I am fine (as in no underlying crazy cause of my skin issues like cancer), but I have eczema. Oh and have I tried using steroids creams? -.-
  • hormone imbalances – Since I spent so much time inflamed, I usually have a highly elevated level of immune stuff, like my white blood cell count. When my skin first started going haywire, I also have high cortisol level, which made doctors think I had a hormonal imbalance and first order an MRI of my brain.
  • forever fielding questions – “Have you tried X??” “What’s wrong with your skin?” “Do you use lotion?”
  • excoriation disorder (dermatillomania) – Due to very often having flaky skin, I have developed a picking disorder where I spend inordinate amounts of time trying to remove dead skin from my body. It’s become partially therapeutic and partially me trying to exert control over my uncontrollable presentation.
  • scratching OCD – I scratch all the time. In my sleep, when I’m stressed, when I’m relaxing. I don’t even notice I’m doing it sometimes.
  • scarring – Go figure from all that scratching I’d have scars.
  • ring wearing/jewelry/piercings – I no longer wear my wedding band on my left hand because the ring finger on that side is usually swollen. I wear it on my right now. I also had to take out my belly button piercing, my nose piercing, and all ear piercings except tragus one because the skin started itching so badly around them all.
  • hot inflamed skin with cold chills/shivering – One of the worst stages of a flare is when my skin is constantly wet and weeping and heated, but I’m losing so much heat that I am internal freezing and will shiver uncontrollably.
  • winter is bad – It’s hard enough to regulate my body temperature without the weather outside being frigid.
  • sensitivity to pressure contact (sitting/laying down) – This made PT school very trying. Hell, going to a doctors office and laying on the table, or sitting on a chair for too long made my skin feel terrible and heat up and start itching. This is even through wearing long sleeves and pants.
  • nervousness = flares – Some nervousness is good for keeping our brains alert. Unfortunately, any little bit of social nervousness (like before a practical or talking to new people) would cause me to start to flare and itch.
  • wrinkly, swollen skin – Still not sure why this happens (maybe it’s a product of topical steroid withdrawal) but the skin around my joints especially, on the extensor side, starts to look like that of an elephant.
  • discoloration – From redness to drying out gray/white, I am a veritable human mood ring.

And since people love me and will forever want to help, here is a list of what I have already tried:

  • topical steroids (for a good 20 years as this was the main accepted solution to eczema for decades)
  • topical medicines that are not steroids (Elidel/protopic, etc)
  • oral steroids
  • lotions/moisturizers (cetaphil, cera ve, aquaphor, dove eczema line, exederm, burt’s bees, obscurely-named-other-ones, etc)
  • going moisturizer free (actually does help with the red/weeping stage)
  • ocean water
  • chlorinated pools
  • naturopathy
  • acupuncture (including herbs, cupping, and massage)
  • diet (gluten free, soy free, dairy free, vegetarian, sugar free)
  • phototherapy (clinically done in light boxes, and just being in the sun)
  • antihistamines
  • sleep aid pills
  • yoga, meditation, and deep breathing
  • coconut and sunflower oil
  • bleach, epsom, and apple cider vinegar baths
  • antibiotics
  • collagen powder (edible)
  • collagen cream
  • wound care
  • probiotics

Update: I have not tried any biologics because I have been pregnant and am now nursing.

Despite all the shit that comes with eczema, there have been some silver linings in my experience including:

  • Having to deal with eczema year round has made me live much more seasonally. In the warmer months I try to take advantage of being able to walk outside for hours and garden to get vitamin D and get exposed to bacteria in the soil (and as stress relievers). In the colder months I turn to herbal teas and nourishing soups, and bundle up well to go on walks to get fresh air. I pay a lot more attention to what can grow when, and try to eat accordingly (like lighter foods in the summertime).
  • Having dealt with the difficulties of eczema for so long, in juxtaposition pregnancy wasn’t half bad (though to be fair my belly was small and I didn’t have morning sickness… but discomfort with sleeping? Aversions to certain foods? Tired randomly? Feeling generally uncomfortable? Yep, I was used to that all already).
  • In effort to control my flares, I am constantly open to trying new things (though my wallet isn’t!).
  • When I first came up to visit Jake, before we were dating, we had an honest conversation about eczema and I told him how bad it gets for me, and he still wanted to be with me. To this day, I’ve never had insecurity about my skin around him.
  • I have learned to really appreciate the good days. As a result, I’m generally even happier of a person.
distraction, eczema, exercise and activity, skin biome, storytime

digging down deep

pexels-photo-309724.jpeg

Here’s little bit of writing for fun that I came up with during a bout of insomnia this week.


My mama always said you need to dig deep to really find yourself. What I didn’t realize was that she meant it literally.

The first warm weekend in New England, I found myself at Home Depot, my eyes scanning along the garden shelves looking for that perfect plant to take home with me. I had finally coaxed myself out into the sunlight and had witnessed what the winter had done to my yard, and knew it was time to help it heal. It didn’t take long for some hardy flower types to catch my eye and I quickly placed a bunch in my cart and wheeled them to the register. On the way I paused to think if I should buy gardening gloves, but then decided again it.

Soon I was at home, kneeling on the lawn scraping away layers of rock and gravel and old stiff mulch from my beds. As I gardened bare-handed I realized the dirt was getting everywhere, in my tiny cuts, stuck along the dry skin flakes, immersing my hands in their loamy fertileness. Though it was nothing like soaking in a warm bath, I felt comforted by the sun beaming down and the dirt encasing my hands. It felt natural and right, even though my hands were no less dry than any other day.

Later that afternoon as I washed the dirt off with soap, I realized my hands were cracking less and less itchy post-wash, unlike my usual discomfort from water and soap encounters. Though I still applied moisturizer, the effects of my gardening had already reduced some of the more persistent symptoms of my stagnant eczema, and I felt good. Obviously it was no cure, but the benefits of getting down and dirty with the dirt seemed to be somewhat relieving from the usual eczema grind.

It was nice to know that my non-flares hands were still down in their under the scrapes and wrinkles and redness and flakes, even if I had to dig down in the dirt to get to re-meet them.

 

AOBiome, books, eczema, skin biome

the skin biome part 1

pexels-photo-216692.jpeg

A few years back I read a book called Farmacology by Daphne Miller. Miller is a physician who travelled around the United States to study farm practices and connect what she learned to how our bodies work as well as how the farming practices affect our health.

From that book I was inspired to learn more about sustainable habits and understand the complicated relationship between us and our land/food. I thought more about dirt and how we as humans wash and bathe excessively nowadays to kill all the germs, when some are not germs at all, but friendly non-harmful bacteria.

In 2013 I had a bad flare of eczema, and also got a staph infection. From thinking about the book again I realized that all systems have ecosystems of their own, including our skin, and that maybe the reason I had gotten a skin infection may have been because my natural skin cultures were not balanced (or in other words I had more of the bad kind of bacterias than the good). Studies are saying now, when you have a healthy mix of bacteria, they balance one another out and keep the “bad” bacteria in check, and as a result you get a strong skin barrier. When you lack the bacterial diversity, that’s when things go bad, and usually you’ll have an excess of Staphyloccocus aureus, which makes you more likely to have a skin flare. A study in 2013 showed that Staph a. makes a toxin that cause a release of other molecules we know are involved in the dysfunction of the skin in people with atopic dermatitis. It has become clear that unbalanced skin microflora can have particularly devastating consequences.

I’m going to briefly go into a little bit more about the skin and the skin biome. My information is coming from various articles including this one by NIH.

The job of our skin is to keep foreign organisms, dirt, etc out of our bodies. It has its own ecology with millions of diverse micro-organisms, some of which help the immune system learn which similar organisms are detrimental. As I said before, in healthy skin there is a balance of micro-organisms but when that balance gets disrupted it can result in infections or other skin issues.

Healthy skin is usually acidic and dry, and a cool temperature. Areas like the arms and the legs tend to be drier than other skin areas (like the groin, armpits, etc) and so they experience more temperature fluctuations. The acidity prevents certain bacteria, like Staphylococcus aureus, from colonizing the skin.  Other ways the skin fends off bacteria like Staph a. include using the hair follicles. The follicles have sebaceous glands that make sebum, a fatty substance that helps protect the skin by coating it with an acidic and antibacterial shield. Interestingly enough, in my experience, when my flares have gotten bad, I notice my hair (specifically on my arms and legs) falls out.

The skin is made up of multiple layers including the epidermis, which has a top layer called the stratum corneum that’s made of something called squames. Squames are the bits that are shed from the skin after about 4 weeks. I’d bet that the rate of squame shedding is what increases when someone has eczema, and the reason we shed so much when flaring/coming out of a flare.

Everything from clothing, antibiotic use, soaps, moisturizers, age, sex, exposure to environmental bacterias (like dirt and animals), and more can affect the micro biome.

A company that came up on my radar was Mother Dirt with their research partner AOBiome (I have no affiliation to either but I do think they are interesting!). AOBiome study chemicals in our modern skin/hair products and how they mess up our skin bacteria diversity. In particular, they look at a bacteria called Nitrosomonas that was on our skin before we used soap and detergents that messed up the bacteria’s ability to survive on us. AOBiome correlates that the decrease in this nonharmful bacteria is related to the increase in inflammatory skin issues.

Therefore, the goal of AOBiome is to create products that allow Nitrosomonas to live on our skin again, and at the same time help reduce skin inflammation. They are also researching eczema and how their products may be able to help (though according to their website they are still between phase I and phase II of 3 phases of product development). They are definitely a company to keep tabs on for the future.

 

REFERENCES

“AOB, Inflammatory Conditions, and Systenic Effects.” AOBiomeTherapeutics, https://aobiome.com/aob-inflammatory-conditions-and-systemic-effects/. Accessed 27 Sept 2018.

Grice E & Segre J. The skin microbiome. Nat Rev Microbiol. 2011 Apr;9(4): 244-253.

Kong HH, Oh J, Deming C, Conlan S, Grice EA, Beatson MA, Nomicos E, Pollet EC, Komarow HD, Murray PR, Turner ML, Segre JA. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 2012 May;22(5):850-890.

Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Muñoz-Planillo R, Hasegawa M, Villaruz AE, Cheung GY, McGavin MJ, Travers JB, Otto M, Inohara N, Núñez G. Staphylococus delta-toxin induces allergic skin disease by activating mast cells. Nature. 2013 Nov 21;503(7476):397-401.

 

Note: Some of the above links are affiliate links. This means that if you click on one and purchase an item, I will receive a small affiliate commission (at no cost to you).