Viral Infections: Why the Skin Barrier Matters
The skin serves as our first line of defense against pathogens, but when compromised, it can leave individuals, especially children, more vulnerable to viral infections like warts and molluscum contagiosum. Recent research has shed light on how conditions such as atopic dermatitis (eczema) affect the skin barrier and immune function, emphasizing the importance of appropriate skin care and nutritional support in bolstering the skin's defenses.
The Skin Barrier and Immune Function
The skin barrier is crucial for maintaining skin health and preventing infection. It consists of a complex structure of keratinocytes, lipids, and proteins that work together to protect against environmental insults. Children with atopic dermatitis often have a damaged skin barrier due to mutations in genes responsible for producing filaggrin, a protein essential for skin hydration and integrity (O'Regan et al., 2020). This impairment can lead to increased transepidermal water loss and enhanced permeability to allergens and pathogens.
Moreover, the skin possesses its own immune system, comprising various cells, including Langerhans cells and resident T cells, which play vital roles in immune responses. When the skin barrier is compromised, these immune cells can be overwhelmed, leading to heightened susceptibility to viral infections such as human papillomavirus (HPV), responsible for warts, and the molluscum contagiosum virus (MCV) (Elias et al., 2014).
Eczema and Viral Susceptibility
Children with subclinical eczema (even when symptoms of redness, dryness, or itch are not overtly visible) may still experience barrier dysfunction, predisposing them to viral skin infections. The presence of viruses like Molluscum Contagiosum may be a parent’s clue to the fact that their child has subclinical eczematous dermatitis. A study by Hsu et al. (2019) found that children with a history of atopic dermatitis had a significantly higher incidence of warts and molluscum contagiosum compared to their non-eczema peers. The compromised barrier allows viruses to infiltrate more easily, exacerbating the risk of infections.
Supporting the Skin Barrier Through Care
Gentle skin care practices are paramount for supporting the skin's protective barrier, particularly in children with atopic dermatitis (my rule in clinic: this extends to ALL children as their immune systems are still immature, so the more gentle skin care precautions we take, the more we are able to protect and “beef up” the skin barrier.). Regular moisturizing with emollients helps to restore lipid content and hydration, which is crucial for barrier function. According to a study by Eichenfield et al. (2014), daily emollient therapy can significantly reduce the incidence and severity of flares in children with eczema.
In addition to moisturizing, avoiding irritants such as harsh soaps, fragrances, and allergens is essential. Using mild, soap-free cleansers can help maintain skin hydration and reduce inflammation, creating an environment less conducive to viral infections.
Nutritional Support for Skin Immunity
Research has highlighted the role of vitamins and minerals in supporting skin health and immune function.
Vitamin D
Vitamin D plays a crucial role in modulating immune responses and has been associated with improved skin barrier function. A systematic review by Adami et al. (2020) found that adequate levels of vitamin D can enhance the skin's innate immunity, thereby reducing the risk of infections. In clinic, I often recommend Vitamin D3 supplementation for children with eczema; however, Vitamin D is a fat-soluble vitamin, meaning it’s not excreted as water soluble vitamins are through the urine and it can build up in the body to toxic levels. Keep in mind, many Americans are Vitamin D deficient and it is less common to reach toxic levels with daily supplementation of up to 2000 IUs unless you are taking certain medications, hormone therapies, or have a health condition that causes hypercalcemia (a condition that causes a build up of too much calcium in the blood). Nonetheless, it is always important to check with your PCP or your child’s pediatrician before you or your child begin a new supplement. For younger pediatric patients, I usually recommend a 1000 IU chewable supplement by Now Pharmaceuticals which is a great, cost effective and third party-tested brand. Whereas, for older pediatric patients, I recommend supplementation with 2000 IU softgels daily.
Zinc
Zinc is another essential nutrient that supports skin health. It is vital for the maintenance of skin structure and function, and its deficiency can lead to increased susceptibility to infections. A study by Sinha et al. (2021) demonstrated that zinc supplementation improved wound healing and reduced infection rates in skin lesions, indicating its protective role in skin immunity. For younger pediatric patients, I usually recommend supplementation with 50mg of zinc capsules mixed into applesauce, yogurt or smoothies 2-3 x a week; whereas, for older children, 50mg daily is usually appropriate. Regardless, I always recommend first checking with your child’s pediatrician for supplementation guidelines and approval.
Lysine
Lysine has been studied for its antiviral properties, particularly against herpes simplex virus, but it may also benefit other viral infections. A study by Montalto et al. (2017) indicated that lysine supplementation could inhibit viral replication, potentially aiding in the resolution of viral infections like warts and molluscum contagiosum.
Natural Remedies for Warts and Molluscum
While dermatology visits are essential for diagnosis and treatment, some natural remedies can help manage warts and molluscum contagiosum between appointments:
Apple Cider Vinegar: Its acidic nature may help to break down the virus. A small study found that topical application could reduce wart size in some patients (Ali et al., 2018). For my parents who prefer to try a natural route instead of or prior to clinical procedure or topical prescription, I often recommend soaking a cotton ball in ACV and then securing it with a bandaid over molluscum or warts overnight as tolerated.
Tea Tree Oil: Known for its antiviral properties, topical tea tree oil has shown promise in treating viral infections. A study by Koo et al. (2021) reported that tea tree oil could help reduce wart size and promote healing. Keep in mind that the “tea tree” is the same thing as the melaleuca tree, which many people are highly allergic to. I have seen many adults in my clinic with horrible reactions to “cosmetic” skincare that contain “tea tree oil” for the benefits of calming and soothing skin, when instead, it causes a raging contact dermatitis which requires topical and oral high dose steroids in order to improve.
Garlic: Garlic contains allicin, which has antiviral properties. A study by Gupta et al. (2019) showed that topical application of garlic extract reduced the number of warts in patients.
Aloe Vera: Known for its soothing properties, aloe vera gel has been suggested for warts due to its potential to enhance immune function (Zhang et al., 2020).
Cimetidine: marketed under the brand name Tagamet, is primarily known as an H2 receptor antagonist used to treat conditions like ulcers and gastroesophageal reflux disease. Interestingly, it has also been found to help reduce the incidence of warts, particularly in patients with recurrent or persistent warts. Younger (pre-teen and younger) pediatric patients may require a weight-based prescription so check with your pediatrician before administering over-the-counter medications and supplements to your child.
MECHANISM OF ACTION
Immune Modulation: Cimetidine may enhance the immune response against viral infections, including those caused by human papillomavirus (HPV), which is responsible for warts. It is believed to stimulate T-cell activity and promote a more robust immune response, helping the body to recognize and fight off HPV-infected cells.
Antiviral Properties: Some studies suggest that cimetidine may exhibit direct antiviral effects, although the exact mechanisms are not fully understood. By potentially inhibiting viral replication or affecting the viral life cycle, it may contribute to reducing wart formation.
Reduction of Inflammation: Cimetidine has anti-inflammatory properties, which can help in reducing the inflammation associated with warts, making them less noticeable and possibly reducing their recurrence.
For young children with many or rapidly spreading lesions, I will usually Rx cimetidine by weight (40mg/kg/day); however, for children over 100lbs, the over-the-counter brand is typically considered safe. Check with your pediatrician for contraindications prior to giving any medications to your child.
Conclusion
A compromised skin barrier, as seen in atopic dermatitis, significantly increases the risk of viral infections such as warts and molluscum contagiosum in children. Supporting the skin barrier through gentle care, adequate whole (not processed) food nutrition, and targeted natural remedies can enhance its protective capabilities. By understanding the relationship between skin health, immune function, and viral susceptibility, caregivers can take proactive steps to safeguard their children's skin health.
References
Adami, S., et al. (2020). Dermatology and Therapy, 10(6), 1097-1106.
Ali, M. A., et al. (2018). Journal of Ethnopharmacology, 218, 105-113.
Elias, P. M., et al. (2014). Journal of Investigative Dermatology, 134(2), 222-227.
Eichenfield, L. F., et al. (2014). Pediatrics, 134(6), 1016-1025.
Gupta, A. K., et al. (2019). Journal of the European Academy of Dermatology and Venereology, 33(3), 514-520.
Hsu, J. C., et al. (2019). Dermatitis, 30(1), 22-28.
Koo, H. J., et al. (2021). Journal of Dermatological Treatment, 32(5), 505-512.
Montalto, M., et al. (2017). Nutrients, 9(7), 754.
O'Regan, G. M., et al. (2020). The Journal of Allergy and Clinical Immunology, 146(3), 639-650.
Sinha, A., et al. (2021). Clinical and Experimental Dermatology, 46(4), 638-645.
Zhang, Y., et al. (2020). Phytotherapy Research, 34(6), 1350-1358.
Dohil M, Prendiville JS. Treatment of molluscum contagiosum with oral cimetidine: clinical experience in 13 patients. Pediatr Dermatol. 1996 Jul-Aug;13(4):310-2. doi: 10.1111/j.1525-1470.1996.tb01247.x. PMID: 8844752.
