Theo, a sweet 10 year old, came to see me with her mom this week. When I asked what she was looking for help with, she pulled down her sock and showed me a half dollar sized red and raw rash just next to her ankle bone. She told me she'd had this rash for about 2 years. New rash patches had been showing up, on her vulva, in her ear and under her arm. They were itchy, and her mom told me her daughter was feeling embarrassed about them, she always made sure to wear socks so no one would see the rash on her ankle.
Mom was, of course, concerned. She had been to see a conventional medical doctor, who prescribed a potent triple combination of a topical anti-fungal, steroid cream and topical antibacterial. She probably would've conceded to doing all three of these, except that something about putting this near her daughters vaginal and rectal opening felt against her better judgment.
In going over Theo's medical history several things were significant.
1) Theo's dad has had similar rashes most of his life.
2) Theo has had recurrent strep throat that has always been treated with antibiotics.
3) Two years ago she was having recurrent fevers and was finally diagnosed with mononucleosis, an illness caused by a virus we call Epstein Barr.
4) One year ago, Theo was treated with a 10 day course of Ciprofloxacin for a insect sting that had caused her eye to swell.
Less significant but still important was a history of thrush and moderate to severe cradle cap as a breast-fed baby.
What naturopathic physicians know, and conventional medicine is beginning to understand, is that antibiotic use causes dysbiosis in the gut. Think about it. Antibiotics are given to kill bacteria that are causing an infection somewhere in the body. The antibiotics do not differentiate between good bacteria and the bacteria believed to be causing the infection. All bacteria is the same and all bacteria is, in essence, wiped out.
It can take a full year for the gut biome to recover after a single round of antibiotics.
Our gut health is dependent on a healthy and properly functioning gut biome. Each and every small intestine cell, the microvilli of the gut AND the absorption of certain nutrients are completely dependent on the healthy bacterial populations of the digestive system. Wipe out the gut flora and each part of this interdependent and complex living system suffers.
One of the most common aftermaths of recurrent antibiotic use is a condition called leaky gut syndrome. When antibiotics kill off the bacterial gut population, this damages the microvilli of the small intestine. The microvilli look a lot like the coral in the sea, they need certain environmental conditions in the gut in order to thrive. As the microvilli get damaged (something that can be seen on an intestinal biopsy), this begins to affect the small intestine cells that sit just beneath the microvilli. In a normal, healthy and functional digestive tract, these small intestine epithelial cells are packed in, one right up to the next, creating tight gap junctions. Nutrients that have been broken down by the digestive process get actively transported across the wall of the intestine cell. Nothing gets through that isn't supposed to get through.
In a damaged, or leaky gut situation, the gap junctions between the small intestine epithelial cells become loose. Now larger particles, such as larger proteins, are able to passively slip through the gaps and get into the lymphoid tissue (GALT) or immune system tissue that sits just below the small intestine wall. In this tissue, the immune system check everything out, and if it doesn't recognize something, it tags it and makes an antibody to it. This will eventually lead to an autoimmune process over many years.
How is this all related to the skin and specifically to skin rashes?
During embryonic development, the outer layer of the developing tissue (what eventually becomes the skin) involutes or turns in upon itself, creating the digestive tract. The digestive tract is really a tube that separates the inside of the body from the outside. Skin health is intimately linked with gut health, they both derive from the same tissue and the same things that support the digestive system also support the skin. Poor diets, diets high in sugar and fried foods, are often the culprit of acne and pimples. Rosacea, a facial rash, worsens with alcohol.
In the case of Theo, my working diagnosis is that she has atopic dermatitis, another name for eczema. The strongest risk factor for the development of atopic disease is a positive family history. A child with an allergic parent has a 20-40% greater chance of developing an atopic disease.
What I discussed with Theo's mom was the need to repair Theo's gut over 3 months as a critical piece in her treatment plan. A key piece of this is the removal of any potential allergenic foods. My recommendation was for Theo and her family to follow an elimination of wheat, dairy, sugar and soy from the diet for three weeks. At the same time, I recommended a multi-strain, high parts per billion probiotic, a supplement to heal the gut, gamma-linoleic acid to help repair the skin and a topical herbal cream to soothe the rashes as they healed.
The following is the treatment plan I gave. I told Theo and her mom that I would expect her to see a decrease in the rashes over the month.
Borage Oil: 1 tsp daily, can put in smoothie
HMF Super powder: 1 tsp daily (this is my go-to probiotic)
GI Repair Powder: 1 tsp 2x/day (a combination of supplements and herbs to heal and repair the gut)
Diet Suggestions: Bone Broth, rice, quinoa, vegetables, mackerel salad, sardines.....anything with fish oils, avocado, coconut oil. Total avoidance of gluten, dairy, sugar and soy for 3 weeks. Anti-Inflammatory Diet.
Nat Mur 30c: 3 pellets 3x/day for 3 days (a homeopathic I often use for skin issues
Vitamin D liquid: 2,000 IU daily
A-Mulsion: 10,000 IU daily
TOPICAL CREAMS TO USE: Calendula Tea/Cream, Chamomile Cream, Borage Oil topically
It's possible that there will be other recommendations I offer to Theo as we continue our work together. This treatment plan is a solid beginning.
If you or someone you know has a skin condition, there's a high likelihood that the digestion is involved. Feel free to share this blog post, or to book an appointment with me or another naturopathic physician who has been highly recommended. Sharing is the best kind of caring.
In health, happiness and well-being,
Dr Kelly Jennings