Does eczema mean you have a weak immune system?

In this article, I examine the role that immune system plays in the development of eczema, whether eczema is an indication of a weak immune system or one that is just over sensitive? I also look at small and easy steps that can support the immune system and that may improve eczema symptoms.

Does eczema mean you have a weak immune system?

If the skin's protective barrier is impaired, immune cells in the skin can become over-sensitised and overreactive. The immune system's response to a would-be threat can result in inflammation that weakens the skin's barrier function. Both scenarios are a type of immune dysregulation that may cause eczema to develop.

The relationship between eczema and the immune system

It is not a weak immune system that is causing eczema but a very busy one. The term 'eczema' is not specific. Rather, it's a broad term to describe several itchy red skin conditions. Two theories attempt to explain the relationship between eczema and the immune system.(1)

One is that it comes from the inside (inside-out hypothesis) and the other that it starts on the outside (outside-in hypothesis).(2)

Half the people who have eczema inherit a family gene that affects their production of a protein called filaggrin, responsible for bunching together other protein fibres in the skin to create a tough protective barrier. When there isn't enough filaggrin present in the skin, it can weaken the skin's protective barrier and moisture in the skin is lost. The skin can get very dry and easily damaged. A weak defense also allows allergens and microscopic invaders (like bacteria) in, which can trigger the immune system to respond with a bombardment of inflammation. Between the overreaction of the immune system and the weakened skin barrier function, oversensitivity to things like wool, dust mites or even pet saliva develop, and eczema presents itself: ta-da! Dry, itchy, red and inflamed skin that can develop even later in life.

The inside out theory suggests that the allergic reaction comes initially from inside the body, perhaps after a viral infection, or with something like a food allergy. The inflammation that this produces causes the protective barrier of the skin to become impaired. The immune cells in the skin react with more inflammation, which weakens the barrier function and so on...

Both scenarios are a type of immune dysregulation, rather than a weakness. It's all very chicken and egg (what starts where?) when determining eczema's true cause. Tremendously frustrating for those that are trying to figure out what makes their eczema worse and how to manage their itchy skin.

What will support the immune system and reduce eczema flare-ups?

1. Get a good night's sleep

Many people find that their eczema gets worse at night and this is another skincare quandary and vicious circle, as a lack of sleep may affect eczema.

One study found that sleep deprivation reduced the skin barrier's ability to recover. It activated natural killer cells' activity (the immune cells used to prowl for would-be threats). A lack of sleep also increased levels of immune-stimulating proteins and inflammatory biomarkers.(3)

Here are a few tips that may help promote sleep for the immune system and eczema:

Having a routine helps to establish a natural sleep cycle. This means going to bed at the same time every night and getting up at the same time in the morning.
It's important that the sleeping environment is comfortable and is at the right temperature (cool).
A warm (not too hot) shower before bed may help to reduce nighttime itching.
Herbal sleep remedies like Dormeasan may help when it is difficult to switch off.

2. Strengthen the skin's protective barrier

Much of the skin's protective barrier is dependant on the natural moisturising factor and sebum (or oil) it can produce, and how much water it can absorb from the atmosphere.

Keeping the moisture in: Skin can dry out in dry, windy weather and when exposed to indoor heating. Long soaks in hot baths can also strip the skin's naturals oils leaving it permeable and undefended.

Here are a few tips that may help strengthen the skin's protective barrier:

Wash in warm, not hot, water and avoid long sessions in the bath or shower.
Consider a humidifier if the air in your home is very dry and cover up in dry, windy weather.
Avoid soaps and detergents that will strip naturals oils from the skin and are likely to irritate sensitive skin. Wear rubber gloves when doing housework and consider hypoallergenic toiletries that will have a gentle action.
Keep the body cool to avoid a loss of fluid through sweating. Salt in sweat can also irritate eczema-prone skin.
Moisturise the skin as often as necessary, and definitely after any water exposure. Applying a moisturiser immediately after washing will trap a layer of water molecules in the skin. Using a rich, active cream will help counter redness and skin flare-ups. Neem is a natural skincare ingredient that is useful for calming and conditioning dry, sore and eczema-prone skin.

3. Relax the mind

Stress triggers the immune system into action and nature intended this as a way of getting the body to respond to injury and infection. We want to fight off infection and repair any damaged tissue. Excess and chronic stress was surely not part of life's original design concept, and can certainly affect the skin.

One fiendish study examined the effects of stress of eczema by perversely inducing eczema flare-ups using a stress test of mobile phones ringing and the video game Street Fighter 2.(4) Who would have thought that phones and video games can make you itchy!

Here are a few tips that may help relax your mind and lessen the effects of stress on eczema:

Practice deep breathing methods that will activate the parasympathetic nervous system. This will work like a switch turning on a calming mechanism in the body.
Even mild dehydration can worsen the effects of stress and anxiety. If you suspect that you are not getting enough fluid, try drinking an extra 500ml of normal tap water a day for one week. You'll be surprised at how effective hydration is; there are all sorts of fringe benefits! The Eatwell Guide recommends at least 6-8 glasses of fluid every day.
Spend some chunk of time outside every day. This can be a 20-minute walk, some pottering in the garden or a trip to visit a friend.