It’s always the gluten
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, November 1, 2020
Gluten is to dermatitis as brown recluse spider bites are to ulcers. Often blamed, but rarely the cause. I run a contact dermatitis clinic, and without fail, at least one of my patients every week is absolutely certain that gluten is the cause of their dermatitis. With all due respect to my patients and friends who do suffer from true gluten sensitivity, I spend a lot of time convincing my patients that gluten is NOT making them itch. These cases are usually pretty simple, particularly when patch testing offers us a coherent alternative explanation. However, over the years, I have had — as I am sure many of you have had — other patients in whom the potential role of diet in their skin condition is less clear. Do certain foods cause their problem, and can dietary changes heal their skin? In the past, I did not feel I had much science to offer them and, in fact, some of what we thought we knew about this subject has changed significantly over the years. Nineteen years ago, I refused to feed my infant son peanuts, as we then believed that avoiding ingestion before age three minimized the risk of developing peanut allergy. Fortunately for us, I suspect our sweet nanny totally ignored my advice and fed him peanut butter anyway. Many years later, he is not allergic to peanuts, and we now know that early ingestion of peanuts actually helps prevent development of allergy.
There appears to be a growing interest in the scientific community about the possible contribution of diet to illness and health, resulting in, at the very least, a good start on the topic in many areas, including skin diseases. Assistant Editor Emily Margosian will help bring you up to date on our understanding of the role diet may play in some of our more classic skin conditions. I think you will be impressed by the expertise some of our colleagues have in this field and, hopefully, the next time your patient wants to know if gluten is the problem, perhaps you will feel better prepared to answer them! Now if I just had a better answer for their next question, which is often “but what about stress…?” (Stay tuned for next month’s DermWorld.)
Another great read this month, which I cannot recommend highly enough, is our Clinical Applications column, in which I had the privilege of interviewing our colleague Dr. Craig Burkhart. If you are not a pediatric dermatologist, you may have missed the work he and his co-authors recently published in Pediatric Dermatology on structural racism and its influence on the severity of atopic dermatitis in African American children. It’s a great study, so, by all means, go back and read it if you haven’t. However, first read the thoughtful comments Dr. Burkhart offers us about this difficult, but critically important topic. If we are ever to provide equitable health care to all our patients in this country, we need to consider not only the individual context in which health and disease occur, but also the societal ones. This study is an excellent way to begin that discussion, and I hope it spurs more such studies in other diseases.
My final accolade this month has to go to Dr. Marta Van Beek, with my sincere thanks to her for making me laugh. Anyone who can bring humor to a financial statement is a goddess in my book, and Marta hit the target perfectly with her pajama sentiments for this year. I’m sure many of you will agree!
Happy Thanksgiving to all and take heart: only one more month ‘til 2021!
