Eczema

Nearly a quarter of our little ones have eczema, an inflammatory skin condition.

Just as asthma has, eczema and most all other forms of atopic dermatitis have increased in incidence over the last decade, effecting upwards of twenty percent of children and three percent of adults. There is no cure for #eczema with exception of identifying and eliminating known triggers, which is not given near enough effort in conventional medicine.

People with eczema tend to have very dry skin in general because this disease causes defects in the stratum corneum, or the skin barrier, which serves to protect us from irritants, bacteria, viruses, and allergens in our environment. The stratum corneum also works to keep our skin moist. It's a sort of cascading effect then that eczema is a reactive condition to triggers in our environment and then in its response, our protective barrier further breaks down and we become more vulnerable to these triggers.

Depending on the type of eczema and its severity, treatments typically range from over-the-counter remedies to various prescription medications. These aren't without risk - topical steroids, corticosteroids, immunomodulators, and antihistamines - and all require continued use as they do not address the underlying issue.

Essentially all inflammatory conditions have underlying triggers so as a functional and integrative clinician, while we do want to treat the acute discomfort, it is important to communicate that this is a short-term plan. Our larger goal is to identify the trigger causing the immune response, often found in the environment or diet. Skin trauma can also be at the root, so identifying ways in which the skin may endure scratching or rubbing is also important.

Our practice will offer testing to identify foods, chemicals, and dyes that create inflammation in the body, when we identify someone with dermatitis, #allergies, asthma, or a plethora of other inflammatory issues such as migraines, irritable bowel, and anxiety. We can also identify genetics that indicate an underlying issue with gluten. This testing accompanies an individualized diet which helps reduce inflammation significantly and after symptoms resolve, foods are reintroduced one at a time as we monitor for reactions. Sometimes the threat comes from our environment, pollens, dusts, or #molds.

There are a number of approaches for identifying the underlying trigger and many times, it isn't just one offender, but doing this work is imperative to finding your most optimal health. Dry skin will also require moisturizing and support to retain it. As we dig for causes, we can also work to improve the immediate care given to our largest organ - the skin.

Hydrating the Skin

Although there have not been comparative studies to pinpoint the best frequency or duration of bathing, we use to believe that taking baths was drying to the skin, so limited these for those with skin conditions; today however, we believe that the skin benefits from daily baths, even soaking, although without soap or bubbles. Warm, not hot water, for five to ten minutes is recommended and then locking in the moisture by patting the skin with a towel and applying moisturizer.

Try not to scratch and rub the affected skin and limit contact with irritating materials. Liberally apply moisturizer over the body, not just the areas with eczema to lock in that moisture from the bath. Ointments and creams are more effective than lotions for people with dry skin conditions because the water in lotion evaporates quicker. Look for a high oil content moisturizer, but without fragrances. Dispense moisturizer with a pump or clean spoon to avoid contamination, and wait until it is absorbed before dressing. Wear soft, breathable clothing and avoid itchy fabrics like wool that can further irritate your eczema. Moisturize throughout the day, whenever skin starts to itch of feel dry.

Products with the "National Eczema Association Seal of Acceptance" are intended especially for those with eczema or sensitive skin. Be sure to try any new lotion or cream in a small area before rubbing it all over, to assure you haven't sensitivity to any of the ingredients. Baking soda, a quarter-cup to the bath and applying it directly to the skin in the form of a paste can help relieve itching.

Bleach baths are also encouraged by the National Eczema Association to reduce the risk of staph infections as this can help decrease bacteria on the skin and reduce inflammation in both children and adults. Use just a half-cup of household bleach for a full tub of water, one-quarter cup for a half tub and soak for ten minutes, two-to-three times a week, then rinse off. Keep in mind that those with bleach sensitivities or allergic asthma may be aggravated by chlorine fumes, and they are quite horrendous for our environment. There are other options (see below). During more intense eczema flare-ups, wrap therapy can work wonders to rehydrate and calm the skin.

Adding colloidal oatmeal to your bath, or applying it to the skin directly in the form of a paste, is also a common treatment for relieving itching. When the skin stings during those more intense outbreaks, adding a cup of table salt to the bath water can help ease symptoms too. Good old apple cider vinegar (fermented apple juice) may help protect the skin pH and guard against bacterial infections. Add between a cup and a pint to the bath or apply directly to the skin as a wet dressing can offer some antimicrobial effects (and replace the bleach bath recommendation for those seeking an alternative option).

Coconut oil ranks about as high as breastmilk for being the "cure" for about every ailment, and while I am not offering it as the "cure," it really does earn its hype. Coconut oil contains lauric acid, a nutritious fatty acid, or lipid, also found in breastmilk. Lauric acid is used to develop monolaurin, which is an antimicrobial agent which fights bacteria, fungi, yeast, viruses, and other pathogens. It naturally penetrates the skin quickly which boosts hydration, improves skin elasticity, fights itch, and reduces staph bacteria on the skin which ultimately will reduce potential for infection. Choose those which are "virgin" or "cold pressed," as these methods avoid chemicals. Of all the natural approaches, coconut oil has the most scientific research to back up its legitimacy (see below). Sunflower is another option.

Keeping your skin's moisture intact is one of the most important strategies for controlling eczema. It's important to understand how and when to properly moisturize and which products are best to use when you have eczema. High oil content is the goal, but ointments are typically petroleum based, or mineral oil. They aren't always favored by clients either as they leave a greasy feeling on the skin.

Creams would be second to ointments in the amount of oil they contain and their ability to seal in moisture. Many contain stabilizers or preservatives that can irritate the skin though, so be cautious. Lotions contain the least amount of oil, because they are primarily water, so they evaporate quickly. They often contain preservatives too so can burn the skin.

Finally, skin barrier repair creams are an option, available both by prescription and over-the-counter. These are infused with lipids and ceramides, which are naturally occurring substances found in healthy skin barriers that those with eczema often lack. These form a protective layer on the skin to help lock in moisture and keep out invading irritants, allowing the skin to heal and become more resistant to symptoms, including burning, dryness, and itch.

Moisturize at least twice each day, and apply a thick layer of moisturizer all of the skin within three minutes of bathing or showering to lock in the moisture. If it feels tacky on your skin, don't remove the excess. It will be absorbed within a few minutes. Moistures your hands every time you wash them or when they come in contact with water.

Finding the right moisturizer can be a challenge though; what works for one person, may not work well for another and our skin changes so eventually you may find your favorites may not be as effective, or the manufacturer may change the formulation and not even add that to the label.

Honest does have an organic all-purpose balm with sunflower seed, beeswax, olive fruit oil, coconut oil, shea butter, tamanu oil, calendula flower, and chamomile oil. They also have a fragrance free conditioner.

Vitamin, Mineral, & Dietary Nutrients

We can also work to improve our vitamin, mineral and other dietary nutrients. These significantly impact the health of our skin, which is really just a reflection of our body within. Vitamin A is well known to be important in the treatment of inflammatory skin conditions. The synthetic retinoids in vitamin A promote differentiation and cell turnover, and modulate dermal growth factors. When we don't have enough vitamin A, we have more scarring and less mucous production. Rough, dry skin is a common sign of vitamin A deficiency and a characteristic of eczema. While some carotenoids like beta-carotene can be converted to retinol, liver, kidney, pastured egg yolks, and extra-virgin cod liver oil are excellent sources of preformed retinol.

Zinc is another star player in our skin's immune function, protein synthesis, wound healing, DNA synthesis, and cell division. It protects against ultraviolet radiation and has anti-inflammatory effects. Zinc also interacts with vitamin A as a component of retinol-binding protein and significantly increases the level of vitamin A in the blood. It's a little easier for our body to obtain zinc from animal sources, over plant sources, with better sources being organ meats such as kidney and liver, red muscle meats like beef and lamb, and shellfish. Plant foods like pumpkin seeds and nuts have high zinc content, but the zinc in these foods is less bioavailable. Soaking and sprouting can help liberate the zinc in these options.

Collagen maintains the extracellular stability of the skin, and vitamin C is crucial in the production of this antioxidant. When we have high levels of vitamin C in our diet, we have a healthier appearance as our skin is less dry and our wounds and scars heal better and faster. Bell peppers, guava, dark leafy greens, broccoli, Brussels sprouts, citrus fruits, and strawberries are great sources, raw and lightly cooked.

Skin inflammation can also be reduced with supplementation of omega-3 fatty acids, also reducing redness, itching, and scaling of the skin. The best source is cold-water fatty fish, about 12 to 16 ounces each week. Think of sardines, salmn, mackerel, trout, anchovies, black cod, and shellfish when thinking omega-3.

Biotin is an essential cofactor for enzymes which regulate fatty acid metabolism and their job is to protect the skin from damage and water loss. Inadequate intake causes dermatitis. Deficiency is rare unless you consume raw egg whites, as a protein in the egg whites binds with biotin and prevents absorption in the gut. Still, some do benefit from extra supplementation, or the addition of liver, Swiss chard, and romaine lettuce. Biotin is also great for the gut microbiota, so this is a two for one.

Selenium is another big one, and it's harder to come by since our soil is less and less nourishing. Intestinal inflammation can certainly occur with selenium deficiency, as can a plethora of other issues, as selenium supports the function of glutathione. Selenium is best received from the diet as supplementation may pose risk of prostate cancer. Again, organ meats for the win, along with seafood, beef, turkey, and lamb. Brazil nuts are also incredibly potent sources of selenium if you can tolerate nuts - just two offer 200 micrograms of selenium.

Niacin, or vitamin B3, is one that most of us get in sufficient quantity, but those with celiac disease, SIBO, or inflammatory bowel disease may lack. A deficiency results in pellagra, which includes dermatitis. Food sources include meat, poultry, tuna, salmon, seeds, green leafy vegetables, coffee and tea. The liver can also convert tryptophan, a common amino acid, to niacin. Too much of this though, and you may suffer flushing.

A silica-deficient diet has been shown to cause poorly formed connective tissue, including collagen which improves elasticity and firmness. Leeks, strawberries, cucumber, mango, celery, asparagus, and rhubarb are all great sources of silica. It's also found in certain brands of water, such as Fiji water, or trace mineral drops which you can add to drinking water.

Vitamin K2, more for bones and less for its role in blood clotting such as vitamin K1, is also important for skin's elastin. As you may know, functional clinicians will encourage you to supplement K2 along with your vitamin D3 supplement because it helps the integration of vitamin D into your bones. It also helps vitamin A to function optimally within your body. Food sources are high-fat, grass-fed dairy, especially cheese and ghee, as well as egg yolks, liver, natto, and sauerkraut. Some sources may not be well tolerated as many with eczema are also sensitive to dairy, eggs, and soy.

Vitamin E is secreted on the skin's surface through the sebum where it works against free radicals that cause skin damage. It also works with selenium to increase glutathione levels, which is incredibly important in the damage control against oxidative damage to cells. Glutathione also regulates the production of prostaglandins, reducing inflammation. Sulfur is necessary for both collagen and glutathione synthesis and vitamin E is involved in immune function, cell signaling, and gene expression as well as the suppression of inflammatory arachidonic acid, so all of these are important to assure you are maintaining adequate supply in your diet. Sulfur-containing amino acids are found in meat, poultry, fish, garlic, onion, Brussels sprouts, asparagus, kale, broccoli and cabbage. Fermentation makes sulfur more bioavailable, so fermented cruciferous vegetables are particularly good sources of sulfur. Vitamin E is most often obtained from polyunsaturated vegetable oils like soybean, canola and corn oil, but better sources are from spinach, turnip greens, Swiss chard, bell peppers, asparagus, collards, kale, and broccoli. Olive oil and avocado oil contain vitamin E as well. Long term supplementation with vitamin E is not recommended.

Vitamin B5 or pantothenic acid supports wound healing and growth and differentiation of keratinocytes. When applied topically, it helps to regenerate skin cells and connective tissue and significantly increases glutathione levels in the cells, protecting against oxidative damage. Vitamin B5 is found in many foods, including organ meats, egg yolks, fish, shellfish, dairy products, chicken, mushrooms, avocado, sweet potatoes, and broccoli. Cooking at high heat though will destroy this so its important to mix raw and lightly cooked fresh foods to obtain adequate levels of vitamin B5.

Vitamin D3 has been shown to promote T regulatory cell function which has multiple roles in the performance of our immune system. Sun exposure is your best source of vitamin D, but it is also available in cold-water fish, cod liver oil, and pastured chicken and duck eggs. Supplementation is often necessary and typically we encourage our clients to aim towards 60, a much more functional level than what the CDC has determined acceptable at 30, which essentially means we don't tend to see overt disease above this level.

Melatonin, turmeric, primrose oil, and CBD are other alternative options recognized as having benefits for individuals with eczema. Of course, work with your clinician, because some of these may not be appropriate for your individual circumstances or be harmful when taken together with other supplements and prescriptions.

Topical Vitamin B12

A study in 2009 demonstrated topical vitamin B12 to be effective for childhood eczema, but several studies prior have demonstrated effectiveness in adults. The thought is that vitamin B12 helps to reduce the nitric oxide production and really, this is a great option, particularly for children because steroidal creams do need to be administered in a higher dosage for the body surface and there are just so many drawbacks to this approach. The study above was evaluated on children six months to 18 year olds and was a double-blinded, randomized, placebo-controlled study so kinda hot-to-trot, right? We prescribe this for two to four weeks.

Ancient Wellness Approaches

We're a huge fan of whole-body approaches, as an integrative and functional wellness practice, so if we lean towards Traditional Chinese Medicine (TCM) for thoughts on eczema therapy, we would seek to balance the Qi. Acupuncture might allow this, massage, cupping, mind-body practices, or Chinese herbs.

Ayurvedic also seeks to bring the body into balance with similar modalities, such as herbs, oils, dietary changes, massage and mind-body practices such as yoga and meditation. Qigong and Tai Chi are additional examples of ancient mind-body practices that combine breathing with body movement and meditation to attain focus, clarity and relaxation. All are favorites; the yoga and meditation we offer in the clinic several times each week. Yoga is rooted in #Ayurveda and based on a Hindu philosophy that combines deep, slow breathing (pranayama) with a series of poses (asanas) to help achieve balance, focus and inner peace. More information is available to all our active Eden clients in our Yoga & Mindfulness forum.

Work towards a Healthy Gut

Well, if you've stuck around very long, you know I am going to mention working on the gut which is directly correlated to our skin (and brain). Our gut microbiota influences systemic inflammation, oxidative stress, glycemic control, and tissue lipid content. When our gut is inflamed, it allows larger content from the gut, not intended for circulation, to leak through the gut wall. This creates an inflammatory response and even eczema.

When we think about gut health and eczema, we must consider H. pylori, #SIBO, parasites, and intestinal permeability. We also need to rebuild this microbiota through eating a nutrient-dense diet which includes a full rainbow of foods, prebiotics, and probiotics. Sometimes we do need to treat the gut infections, such as SIBO, prior to supplementing with probiotics but when it is appropriate, these can be taken orally or found in fermented food sources. Prebiotics as well, are the non-digestible carbohydrates that feed the beneficial bacteria which have already set up came in your gut. Onions, leeks, garlic, artichokes, and starchy vegetables are good examples. Both probiotics and prebiotics have shown to have significant impact on the health of our skin, in particular improving atopic dermatitis in children.

Stress & Lifestyle

No matter what you call it, adrenal fatigue, nervous system regulation, sympathetic dominance, limbic system healing, vagal nerve healing - none the same but all similar - we can't often achieve complete healing without addressing these far under appreciated aspects of our wellness. This is true too for our little ones. Stress is a known trigger for eczema flares.

Stress has been shown to impair wound healing and atopic dermatitis individuals often have low cortisol, indicating a dysregulation in some way among the hypothalamic-pituitary-adrenal axis. Stress in itself causes inflammation and inflammation causes eczema. Certainly the steroids often offered clients with dermatitis or asthma can aggravate this presentation.

This is such an important part of the puzzle, that I would argue if you aren't seeing the results you want, this is likely the cause. Come here first. Help your body feel safe - your brain, nervous system, and immune system, so it can relax and focus on healing. Many of you are at war 24/7 and your body can't divert the energy required to heal.

Yoga and mindfulness can really make an impact here, which is why we have a #yoga studio in our clinic, front-and-center. Many stress regulation techniques exist though. Maybe try hypnosis or biofeedback. You can #hike with us if a member, get grounded or jump in our limbic healing program and learn a number of ways to bring healing into this area of your life.

Along the same line, but different, is our immune system regulation in that some clients with eczema have what is known as "histamine intolerance." This can be genetically based intolerance or the response of a really maxed nervous and immune system resulting in mast cell activation. Again, another dive we take in our Detoxification & Wellness program, and limbic healing is an important part of that, but if genetic, individuals may have a #DAO enzyme deficiency, histamine n-methyltransferase (HNMT) mutation, or poor methylation of the liver. This is part of our epigenetics evaluation, also within our Detoxification & Wellness program, and yes, all our active clients have access to this program without any additional cost. Amazing, right!?

Environmental Toxins

Again, these pillars of health are all deeply addressed within our Detoxification & Wellness program, available to all our active clients, but sometimes eczema is about undiagnosed heavy metal toxicity. Our skin is our primary toxin elimination organ, so it will clearly demonstrate inflammation if our body burden is high.

If you suspect heavy metal toxicity, we are happy to offer testing. However, detoxing is a complex process and one that if not done properly, can make you very sick and even gain weight. Certainly you can cause eczema flares by doing so. We are happy to guide you here.

Eczema Flares Out of the Blue

In spite of your best efforts, even when you do all the "right" things, eczema can still flare for some individuals. Over the counter medicines are available without a prescription, but these too pose risk. Some interact with other prescriptions and other over-the-counter medications, as well as your supplements, foods, or even beverages. These medications can also be dangerous for those with certain medical conditions, so be sure to speak to your primary care provider prior to use. When using over-the-counter medications, follow directions and don't assume more is better.

Antihistamines & Pain Relievers

Atopic dermatitis is the most common form of eczema and part of what we know of as the atopic triad, eczema, allergies, and asthma. In fact, people with atopic dermatitis have a great chance of developing comorbidities or related health conditions, namely asthma, hay fever, and food allergies.

Antihistamines can help with the itch and inflammation, even sleep. Diphenhydramine (Benadryl, Siladryl, Unisom, Banophen, and Sudafed), Chlorpheniramine (Chlor-Trimeton, Wal-Finate, Aller-Chlor), Cetirizine (Zyrtec, Aller-Tec, Alleroff, Cetiri-D), Loratadine, (Claritin, Alavert, Wal-itin), Fexofenadine (Allegra, Aller-ease, Aller-Fex, Wal-Fex Allergy), and Doxylamine (Unisom, Wal-Som, Ultra Sleep) are examples.

Pain relievers can also be helpful for the pain and inflammation. Motrin, Advil, Aleve or Naprosyn, as well as Tylenol are options; however, Tylenol is falling out of favor for children and may exacerbate allergies.

Topical Hydrocortisone

A low potency steroid such as topical hydrocortisone, which can be obtained over-the-counter, can help to reduce irritation, itching, and inflammation. Over-the-counter steroids come in many forms, including ointments, creams, lotions, and gels. These are used for the temporary relief of itching and rashes caused by most types of eczema. Typically, an over-the-counter hydrocortisone is recommended one to four times each day, for up to seven days. Using them longer poses risk, such as thinning of the skin, stretch marks, acne, and exacerbating infection. Do this only under the care of a clinician.

Medicated Shampoos

These are also available over-the-counter with ingredients such as ketoconazole, selenium sulfide, coal tar, and zinc pyrithione help with symptoms of seborrheic dermatitis on the scalp (dandruff). The active ingredients in shampoos typically work by helping lift the seborrheic dermatitis scale from the scalp and/or provide an anti-fungal treatment to combat the overgrowth of a type of yeast called Malassezia, which is thought to contribute to the development of seborrheic dermatitis.

Prescriptions

Topical treatments for eczema are medications which are applied to the skin to manage symptoms and reduce inflammation. There are a few options here, with the most common being prescription steroids in varying strengths, calcineurin inhibitors, PDE4 inhibitors, and Janus kinase (JAK) inhibitors.

Biologics are other prescription options, which are injected, and for those with moderate to severe eczema, immunosuppressants may be recommended. There are other traditional systemic medications as well, but each of these are beyond the purpose of this post, and can be more thoroughly discussed with your primary care provider.

Phototherapy: Light Therapy

Treatment with different wavelengths of ultraviolet light can be prescribed to treat many forms of eczema in adults and children and helps to reduce itch and inflammation. Generally, this is prescribed for eczema which covers the body, more widespread, or for localized outbreaks which are not improved with topical treatments.

The most common type of #phototherapy used to treat eczema is narrowband ultraviolet B (NB-UVB) light, although other options may be recommended by your clinician, including those with ultraviolet A (UVA) light. Treatment with phototherapy uses a special machine to emit either UVB or UVA light, and may take a month or two to prove effective. Apply a moisturizer prior to entering the cabinet. Sunburn may result, premature skin aging, photosensitive skin eruptions, nonmelanoma skin cancer, and cataracts.

Questions? Leave them in the comment section below or give our office a call: 765-335-2171.

References

Evangelista, M. T. P., Abad-Casintahan, F., & Lopez-Villafuerte, L. (2014). The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial. International Journal of Dermatology, 53(1). DOI: 10.1111/ijd.12339.

Januchowski, R. (2009). Evaluation of topical vitamin B12 for the treatment of childhood eczema. Journal of Alternative Complementary Medicine, 15(4), 387-389.

Varma, S. R., Sivaprakasam, T. O., Arumugam, I., Dilip, N., Raghuraman, D. M., Pavan, K. B., Rafiq, M., & Paramesh, R. (2018). In vitro anti-inflammatory and skip protective properties of virgin coconut oil. Journal of Traditional & Complementary Medicine, 9(1), 5-14.