Well in your skin

Treating the intestine as a therapy for the skin: the team around dermatologist Charlotte Brüggen is researching a new therapeutic approach for neurodermatitis. Until now the main relief for those affected has been ointment and more ointment.

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In the middle of a meeting it started again. The itch in her neck was all too familiar to Rita Stalder*, and she could feel a new bout coming on. Now a 36-year-old professional, since childhood Rita has suffered from neurodermatitis causing the skin of her neck, throat and hands to become inflamed. This chronic skin condition plagues her day and night. The eczema itches terribly, preventing her from sleeping. In Switzerland the condition affects more than one in ten people, from infants to adults.

“Neurodermatitis develops through a complex interplay of genes, environmental factors, and the immune system,” explains Charlotte Brüggen, attending physician at the Department of Dermatology at University Hospital Zurich (USZ). The structure of the skin is changed, and its protective function is weakened. This means that unwanted bacteria can penetrate the skin, causing it to become inflamed. Not only that, but the inflammation is exacerbated because the response of certain immune cells is more violent than usual. Rita Stalder tries to keep the disease in check with moisturizing creams. “In severe episodes the overreaction of the immune system has to be subdued, for example with cortisone in ointments or tablets,” says Brüggen. There is no cure so far.

Together with her research group, the dermatologist is looking for new paths to a therapy – via the intestine. In people with neurodermatitis, the intestinal mucosa is also impaired and permeable, allowing parts of bacteria to get through the intestinal wall into the blood, and then into the skin. There they further aggravate the eczema.

What has not been researched is whether fungi that live in the intestine also promote inflammation via this intestine/skin route. This is what Charlotte Brüggen wants to find out, with the support of the Novartis Research Foundation’s FreeNovation program. She is investigating what fungi settle in the intestines of people with the disease, and whether components of these fungi seep into the blood and trigger inflammation of the skin.

Charlotte Brüggen hopes that “if this connection exists, in the future we could try modifying the fungal flora in the intestine to treat inflammation in the body and skin,” similar to the way probiotics – beneficial bacteria – are already used to treat inflammatory bowel diseases. Then Rita Stalder’s skin could also experience some relief, allowing her to sleep more peacefully.

* anonymized/symbolic image

100% financed

Novartis Research Foundation’s FreeNovation program