By Katie Stage, ND
Food adEczema is a chronic skin disorder that causes itchy skin and scaly rashes. Also called atopic dermatitis, it affects 2-5% of the general population and 10-30% of infants and children1 and it frequently runs in families. Part of the family of atopic conditions, eczema often occurs with, and predisposes for, asthma, allergic rhinitis, and food allergy.
Eczema frequently begins in infancy, with 50% of patients experiencing symptoms in the first year of life2. It may resolve on its own as the patient grows older, but does leave that adult with a predisposition for relapse when exposed to triggers.
Eczema usually presents as an itchy rash that is aggravated by a variety of irritating factors such as heat, sweating, soaps, fragrances, lotions, detergents, and the somewhat inevitable scratching of the area. The rashes most frequently occur on the cheeks, chin, scalp, around the mouth and eyes, and on the back of the arms and legs on infants and children, and on the inside of the arms and legs of adults. While an eczematous rash can present differently in different people, it is commonly red, dry, flaking, and may feel rough or slightly swollen. Scratching the rash can lead to additional skin damage and may result in a hyper-pigmented, leathery-looking rash with scarring.
While we do not have a complete understanding of the disease mechanism that causes eczema, genetically predisposed immune dysfunction, environmental stimuli, and skin barrier changes all play a role. The T-cells of the immune system are hyper-responsive, causing an exaggerated response to allergens and microbes in the environment2. This hyper-responsiveness is why people with eczema often also have allergic rhinitis, asthma, and food allergies. Additionally, those with eczema have diminished barriers in their skin. This, coupled with dryness (and partly causing the dryness), causes increased susceptibility to damage from irritants and chemicals, trauma, microbes, and allergens.1 Eczema is diagnosed clinically, although sometimes skin scraping or biopsies are done to rule out other skin conditions such as psoriasis, fungal infection, or bacterial infection.
Eczema is most commonly treated conventionally with corticosteroids. However, while corticosteroids can reduce the symptoms, they do nothing to prevent occurrence of eczema, and when discontinued, the skin symptoms often return or even get worse. Other conventional treatments for eczema, such as antihistamines, tricyclic antidepressants, and antipsoriatic agents (coal tar) can have systemic side effects, and also only treat the symptoms, thus predisposing for relapse when discontinued.
Naturopathic medicine aims to treat the cause of disease, so addresses the factors that contribute to the eczematous and atopic disposition. Since the immune system is hyper-responsive in individuals with eczema, it is important to address allergies and eliminate triggers. Food allergies are common in those predisposed to eczema, and the elimination of trigger foods is often enough to cure the patient of their eczema. In babies, the elimination of the mother’s food allergens, if breast-feeding, is crucial. Environmental allergies such as dust, mites, and pollen should also be addressed. Air and water filters, allergy rinses (available in newer washing machines), nasal irrigation, and anti-allergic bedding may also be helpful.
For those environmental triggers which cannot be completely eliminated, there are naturopathic treatments that help decrease the body’s allergic response. Vitamin C, bioflavonoids, magnesium, and the herbs white oak and ammi visnaga help prevent the release of histamine that triggers the allergic response. So these help not only the eczema, but the associated conditions of allergies and asthma as well. The essential fatty acid EFA, found in fish oil, also decreases the inflammatory response. Avoiding foods which are pro-inflammatory, such as red meat, trans fats, and fried foods, as well as spicy foods and alcohol, is also often helpful in preventing eczema.
Stress is another common trigger for outbreaks. A naturopathic physician would aim to discover the cause of the stress, and prescribe an appropriate natural treatment, which could include acupuncture, homeopathy, mind-body therapies, hydrotherapy, or botanical tinctures. The gut plays a major role in immunity, so treating the gastrointestinal system is also helpful in cases of eczema. Whether a cause or result of the hyperactive immune system, increased permeability of the GI tract predisposes for food intolerances, microbial overgrowth, and imbalance of protective gut flora. Herbs such as marshmallow and deglycyrrhizinated licorice (DGL), as well as the nutrient quercitin and the amino acid glutamine, can help rebuild the gut lining while probiotics can help repopulate good flora and displace harmful flora. The restoration of proper gut flora additionally helps modulate immune response and thus decreases susceptibility to allergens.
Since dryness is a key aspect of eczema, keeping the skin moisturized is also helpful in preventing the rash. Eczematous skin is sensitive to irritants, so a gentle, non-scented moisturizer is best. I prefer oil, salve, or ointment preparations, as these impart more moisture into the skin and are less likely to contain alcohol, common in lotions and drying for the skin. Coconut, sesame, jojoba, and even olive oil may be used. Herbal infusions of calendula, comfrey, plantain, and gotu kola into the oil or salve are soothing and can help decrease itching and increase healing. Washing strips the skin of moisture and should be minimized to 1-2 times a day at most. Gentle and non-scented cleansers, such as olive oil soap, should be used. Avoid scrubbing the skin or using a rough washcloth over the area, as this can further traumatize the skin. Heat (hot water, hot ambient air temperatures) often aggravates eczema and should also be minimized.
Finally, homeopathy can decrease the susceptibility to develop skin and allergic reactions and eczema. Homeopathy is a well-researched medicine that is prescribed by matching the individual symptoms of a person to the symptoms associated with that homeopathic remedy. Homeopathic remedies are effective, safe, and have no interactions or side effects. Since the unique symptoms of each individual are considered, it is best to have a naturopathic physician evaluate the most appropriate remedy, although commonly prescribed remedies for eczema include sulphur, Rhus tox, and graphites.
Eczema is a common skin condition, but it is effectively, safely, and naturally treatable. Addressing the factors that cause eczema when it first occurs, in childhood, can additionally help avoid the common progression to asthma and allergic rhinitis.
1 Ring J., Huss-Marp J.: Atopic eczema. Karger Gazette . 7-9.2004
2 Kliegman: Nelson Textbook of Pediatrics, 19th ed.