AbstractCareful observation while problem solving an individual case of pediatric eczema using the engineering method led to a framework by which others could carry out similar environmental problem solving to alleviate their own individual cases of eczema and related allergy problems. The resulting heuristic, published on a web site in 2004, has been updated with community- and web-based user experiences to form a reliable resource. Understanding the effect of modern syndets on skin-barrier function under normal household conditions was crucial to developing the heuristic and may explain the increasing prevalence of eczema in the industrialized world.
Since Strachan’s 1989 ”hygiene hypothesis” letter in the BMJ , much subsequent research has supported and refined the notion that continually increasing prevalence of eczema, atopy, and associated allergic diseases suggests ”widespread environmental factors originating from the industrialized world are operating in genetically susceptible persons” . Yet a unifying explanation and solution remain elusive. While some aspect of cleanliness seemed potentially related, trends in the use of domestic cleaning products themselves lacked correlation with atopic diseases over the last 100 years, especially given widespread adoption of mass-produced personal hygiene products in the early 20th century that resulted in major public health benefits without a commensurate rise in allergic diseases .
Practical studies of personal care products highlight the need to ”mirror the use conditions of the product as closely as possible” since even direct testing doesn’t predict the result of actual, long-term usage . The history of surfactant use in the last 200 years is varied but can be roughly summed in the industrialized world as: rare use of often harsh surfactants mostly made at home under poorly-controlled conditions gave way to widely used mass-produced traditional alkaline soaps in the early part of the 20th century , gave way to increasingly hydrophilic syndets in step with the rise in allergic disease. When modern cleaning products are differentiated by molecular properties and associated impact on membrane barrier function, in addition to novel patterns and increasing ubiquity of domestic exposures, a correlation, both ecological and practical, emerges.
Based on rigorous personal, empirical problem-solving in an individual case, and generalizing over time through incorporating additional cases and open source information, we developed a ”citizen science” website heuristic for environmental problem-solving of eczema . Both authors have training as engineers so we chose to apply the engineering method . A major aspect of the solution is managing household exposure to overly hydrophilic modern surfactants, which appear to abnormally increase membrane permeability. From experiential feedback, the website is structured to best engage site users to overcome common misconceptions, avoid common practical pitfalls, and to understand and most effectively solve the problem in their own environments.
The underlying basis for the heuristic represents a potentially unifying revision of previous explanations proposed by Strachan , Rook , and others, incorporating and reconciling relevant and otherwise seemingly contradictory research related to birth order, microbial exposures, probiotic usage, antibiotic usage, infections, washing habits, rural versus urban environments, GNP, prevalence of parental allergic diseases, increasing prevalence of eczema and allergy in pets, household pet exposures (to humans), water hardness, breastfeeding, skin dryness, food-related outbreaks (especially to certain protein foods), and even traditional ”triggers” like weather. It also suggests a new view of the role of allergy in human evolution.
RESULTS OF APPLYING HEURISTIC
Website-user-reported results are consistent with pre-launch community-based results and are anecdotal but still useful. Historical medical writings about atopic dermatitis are equally non-optimal but some patterns of information are distinct and unmistakable . So, too, can some site user experiences help validate and refine the heuristic. The majority of site traffic arrives by bookmark or direct link rather than search engine, and appears to be predominantly by word of mouth. Statistics from 2014: 73,765 unique users, with 234,058 page views.
Typical results of users understanding and properly applying heuristic:
• Alleviated eczema.
• Not a mere removal of triggers. Cause and effect become clear. Breakouts no longer seem random, even before the problem is solved.
• Control - possible to prevent or reverse subsequent breakouts quickly without treatment.
• Healthy, normal skin without treatment or moisturizing. Repaired skin barrier approximately 2 months after alleviated eczema if environmental improvements are maintained.
• Reduced allergic diseases, including asthma, among all members of a household.
• Normal life with heightened environmental awareness by site users.
ANALYSIS AND OBSERVATIONS
* Eczema outbreaks seemed reliably proportional to exogenous and endogenous impacts on skin permeability. Most modern syndets and many personal care products enhance the permeability and penetration of skin in unprecedented ways.
* Small amounts of water (such as sweat in flexural areas, but external sources of wetting as well) in combination with detergents and other penetration enhancers appear to substantially increase permeability at those locations during wetting.
* Tiny traces of detergents remaining on the skin have an appreciable impact on the permeability and skin quality over time, especially in the presence of later wetting. Even substantial rinsing efforts with water are not enough to remove traces to a low-enough level to avoid abnormal water loss over time.
* The major mechanism of skin dryness in atopic and non-atopic individuals related to washing appears to be the result of residues of extremely hydrophilic substances like detergents and moisturizers on the skin, and the resultant increase in skin permeability, water loss over time, and impairment of the dynamic process of skin repair. Residues on the skin can come from contact with surfaces, dusts, and other household washing, in addition to direct exposure from the washing of the skin, detergents in fabrics, or the application of products (e.g. certain types of moisturizers). Ingested syndets appear also to affect skin.
* The membranes of all living beings, not just those with eczema, appear subject to these environmental influences. Over time, impairment of the dynamic skin repair process results in thinner, dryer, less supple skin and other membranes than in the absence of such influences. Removing these new environmental influences entirely reverses not only eczematous symptoms and dry skin, but also in ensuing months, largely attenuates atopy, allergies, and asthma, and improves and normalizes skin quality. The atopic person or the person with chronic, seemingly inherited dry skin, can go on to be entirely normal with no intervention at all. A cause-and-effect relationship can be observed by reintroduction of these environmental influences.
* Removal of very hydrophilic surfactants and other skin penetration enhancers using less hydrophilic surfactants for washing is a far more effective strategy for reversing these environmental influences than refraining from surfactant use altogether or using only water for washing.
By this interpretation, the modern eczema and allergy epidemic appears to be the result of abnormal amplification of what we propose is a normal biological signal, allergy. Eczema is more readily expressed in the presence of unhealthy but normal environmental exposures such as increased indoor dampness and mold, for example, and atopic individuals are more susceptible under the circumstances . Both eczema and atopy are described in medical literature prior to the 20th century, at fairly low prevalence . Additionally, in less-industrialized nations with very low rates of eczema today, atopy rates are similarly low . Viewing allergy and eczema as feedback or signals to the conscious brain by the immune system, conceptually similar to pain for the nervous system, and the modern allergy epidemic as an abnormal environmental amplification of those signals, among other things, reconciles the precipitous worldwide increase and significant modern prevalence of atopy with basic biological principles.
When underlying environmental influences cause disease, heuristics that allow each individual in their unique circumstances to best solve the problem can result in the most optimal outcome overall and must be validated along with a proposed solution. Such a validation study might be appropriately achieved through a large-scale, open-source, citizen science effort.
Insights from T. Berry Brazelton’s clinical experience from his book Touchpoints proved invaluable to initial problem solving. The authors would like to acknowledge with gratitude the support of family and friends and site users of SolveEczema.org. NASA had no technical or fiscal role in the work.
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Showing 2 Reviews
REAL ECZEMA RESEARCHAs someone who went to a university, who participated and conducted many studies along with a career involving research, I am excited to find someone who has correlated the use of detergents to the worsening of allergies and atopic dermatitis. After countless appointments, doctor/naturopath visits, and allergy testing, I happened upon the story online of someone who rid their home of all detergents and it helped their son get his eczema under control. This led me to A.J's Lumsdaine comprehensive website and hypothesis.
Inspired, I spent all day reading through the diligent research this individual had compiled. I enjoy science and logical thinking so it was imperative to have so many people and valid research backing this correlation. This data supports this theory and in my opinion should be shared with parents and especially the medical world. Although some doctors are aware of this research, there are many who still need to be informed of this possible reaction with some children.
After allergy testing showed no allergies, the doctors really did not know what to tell us about our son's eczema. We repeatedly were told the same song and dance of
- "Keep putting on those steroids.
- "We need a higher dose of steroids it doesn't seem to be helping. You may need to try oral steroids as the eczema has come back worse this time."
- "Eczema is an inflammatory disease."
- "We do not know what is causing this. Try a bleach bath."
- "Are you moisturizing after the bath?"
- "Try not bathing."
- "Hmmm.. he has no allergies, but his blood panel shows elevated white blood cells that are related to allergies. Just do the steroids it should go away."
- "We need to try antibiotics in conjunction with steroids and possibly Elidel cream even though insurance does not cover it because your son is under the 2 year old mark. The reason is because they did a test with monkeys doubled the amount and they developed lymphoma cancers, but do not worry we have not seen that in humans yet."
I know my personal story does not make her research completely valid. However, no one else has provided any true scientific answers for the rise and systemic cause of eczema. I hope she will be able to conduct research on this topic. I would love if there could be a controlled study conducted. If she ever needs a participant or someone to help aid in the process by spreading the word, count me in.
Thank you! Words will never be enough to describe how thankful I am for the painstaking work of collecting/shifting through the science of detergent/eczema and conducting your own research.
The most important and helpful workWe as family found the solveeczema.org web site by A.J. Lumsdaine when desperately searching for any help with the allergies and eczema of our baby grandson in 2014-2015. All the advice the doctors, including dermatologists and allergists was pretty much useless. A.J. Lumsdaine offered not only practical advise that worked, but also understanding of the problem, which is a great psychological relief. Our 2-year old grandson is now eczema free and our two households are as much free of any detergents as possible. The authors of this article and solveeczema.org web site deserve the highest prize and our eternal gratitude. I wish them continued success and support of the community around their publications, and hope that the proposed theory of eczema prevalence and its remedies will became a subject of scientific study with peer-review process and lead to even more practical advise and improved home hygiene products that avoid damaging skin membranes.
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