Itchy skin, dryness, redness and cracking- uncomfortable signs of an eczema flare-up that can range from mild to having a significant impact on quality of life. Corticosteroid creams can do a fine job of targeting symptoms and inflammation associated with eczema, although below are some suggestions to get to the root cause and prevent future flare-ups.
What is Eczema?
Eczema, also called atopic dermatitis, is a common chronic inflammatory disease affecting the skin barrier which affects around 2-3% of adults [1,4]. Eczema presentations can look different depending on the individual, although itchy, dry, red skin is commonly seen on flexural surfaces (ie. Elbow crease) and the head and neck (including around the eyes). Often with eczema, we see related asthma, allergies and constipation. Eczema and its related conditions can be considered a sign of what is going on inside the body (ie. nutritional deficiencies, food sensitivities or imbalances of intestinal bacteria).
Three factors play a role in eczema presentation:
1. A dysfunctional skin barrier
2. An inflammatory response to various allergens
3. Decreased antimicrobial activity of the skin or impaired immune system function
These interact with each other in a chicken-and-the-egg type of scenario. Genetics are also strongly involved in eczema presentations .
Environmental factors are regularly the source of allergens or irritants that cause eczema to flare up. This could include various body care products (ie. soaps, detergents), tight-fitted clothing, irritating clothing fabrics (ie. wool), exposure to smoke, pollution, changes in temperature and certain foods. Common food allergies or sensitivities related to eczema include gluten, dairy, soy, eggs, fish, shellfish and peanuts . It is interesting to note that eczema is more prevalent in industrialized countries, which could suggest that excessive hygiene is a contributing factor in a dysfunctional skin barrier and elevated immune response .
General Naturopathic Treatments:
One way to improve the barrier function of the skin is to promote adequate hydration via lukewarm baths, the use of mild soap (ie. Dove, Aveeno) and the application of moisturizers immediately after bathing when the skin is still wet. Skincare products which are labelled to be within 4.5-5 pH are best because they are closer to the acidic pH of the skin. Improving barrier function is important because this will decrease scratching, which itself contributes to damage to the skin barrier, causing greater dysfunction.
Loose-fitting clothing may also be more comfortable during a flare-up. It is less aggravating to wear cotton, silk or other natural fibres, ensuring to avoid wool which can make itching worse.
Stress management is a key component of preventing eczema recurrence. Periods of stress and anxiety can affect the immune response of the body and increase inflammatory proteins . Psychological stress also directly affects the chronic “itching” pathway of the brain, causing it to become sensitized . Mind-body therapy such as biofeedback and mindfulness can help increase resilience to stressful situations or periods . Biofeedback is a type of therapy in which sensors are attached to your body to keep track of various involuntary mechanisms of the body, such as heart rate or muscle tension. Through this, one is able to learn techniques to control these body functions. Stress management is different for everyone, so it is important to find what works for you, whether it be journaling, exercising, talking to a loved one, cuddling, or unwinding with a nice book.
In terms of nutrition, it is always important to incorporate healthy fats into the diet such as walnuts, avocados, ground flaxseeds, and fish high in omega-3s. This would be the “SMASH” fish- salmon, mackerel, anchovies, sardines and herring. Having healthy fats is important because they fight inflammation in the body. Supplementation with fish oils may also be beneficial if you are not able to incorporate these in a high enough quantity in your diet alone. For adults, between 2-4g of combined EPA and DHA is beneficial . Another type of omega which has been studied for eczema is gamma-linolenic acid, or GLA. GLA is found in high amounts in borage oil and evening primrose oil. Supplementation of 500mg-1g of borage oil or 1-2g of evening primrose oil is suggested dosing .
In general, during eczema flare-ups it is best to follow an anti-inflammatory type diet which is avoidant of simple carbohydrates (ie. white bread and pasta), dairy, nightshade vegetables (ie. tomatoes, peppers), red or processed meat, processed sugars and fried foods. However, in order to determine if there are underlying food sensitivities which are contributing to the recurrence of eczema, the gold standard is to undergo an elimination diet. Every practitioner does this slightly differently in terms of timelines of how long foods should be eliminated and how and when these foods should be reintroduced. The elimination diet involves completely removing gluten products, dairy, certain fruits and vegetables, red and processed meats, all sugars and sweeteners, alcohol and caffeine. In the meantime, gut healing protocols are often done because (fun fact), a lot of the immune system is in the gut!
As “gut healing protocol” was mentioned just above, one of such protocols may include supplementation with a probiotic. Probiotics are live bacteria that are similar to or the same as bacteria that normally live inside the body. In studies of pregnant moms who supplemented with Lactobacillus rhamnosus, their babies were less likely to develop eczema throughout their lifetime . In general, studies have shown that the Lactobacillus species is more beneficial in those with eczema versus Bifidobacterium on its own [4,5,7]. Prebiotics are sources of indigestible fibre which act as food for probiotics, similar to fertilizer for plants. Prebiotics found in high amounts in foods such as leafy green vegetables, garlic, and onions, have also shown promise in the treatment of eczema in both children and adults .
Vitamin D3 is something that everyone in Canada should be supplementing with during winter months with low sun exposure. It has shown to be beneficial in individuals with eczema, and even in those with eczema who have frequent bacterial skin infections [6,7]. A general maintenance dose of Vitamin D3 is 1000 IU per day, but blood testing of 25-hydroxy vitamin D may be best to determine if further supplementation is required.
Additionally, botanicals (both topical and internal) have benefits for treating and preventing the recurrence of eczema. It is up to your naturopathic or botanical medicine practitioner to determine what herbal combination is best to take internally- it could be a combination of herbs which support liver detoxification, and modulate the immune system and stress response. Topically, creams with glycyrrhetinic acid, which is a derivative of licorice root have shown a reduction of eczema symptoms when applied two to three times a day . Other healing herbs include the “4 C’s”- calendula, comfrey, chickweed and chamomile.
***It is important to keep in mind that these are general suggestions which may not be catered to your specific needs. Please consult with your healthcare practitioner if you are looking to start supplementation so they can determine a safe and relevant dosage for you.
What does Traditional Chinese Medicine (TCM) say?
TCM treats eczema as a pattern of deficiency (similar to the way we see it with Western principles). In Chinese medicine, the organ related to skin function is the Lung, which controls the opening and closing of pores. The Lung also regulates our immune system function, which is why it is implicated in allergies. The connected organ of the Lung is the Large Intestine, which is related due to the commonality of constipation being present in individuals with eczema.
Common TCM patterns associated with eczema include Lung qi deficiency, failure of the Lungs to regulate pores, failure of the Lungs to nourish wei qi (defensive qi/immune system) or Large Intestine dryness. Your naturopathic doctor or TCM practitioner will be able to diagnose which one of these may be relevant and treat it with acupuncture, herbs or dietary changes.
1. N.A. 2019. Clinical overview: eczema and atopic dermatitis. Elseiver Point of Care. Retrieved from Clinical Key.
2. Rakel, D. 2018. Atopic dermatitis. Integrative Medicine, 4th ed. Elsevier Inc. Philadelphia, PA.
3. Ellis, S.R., Nguyen, M., Vaughn, A.R., Notay, M., Burney, W., Sandhu, S., & Sivamani R. 2019. The skin and gut microbiome and its role in common dermatologic conditions. Microorganisms, 7(11):550.
4. Suarez, A., Feramisco, J. Koo, J. & Steinhoff, M. 2012. Psychoneuroimmunology of psychological stress and atopic dermatitis: pathophysiologic and therapeutic updates. Acta Dermato Venereologica, 92(1):7-16.
5. Rusu, E., Enache G., Cursaru R. et al. 2019. Prebiotics and probiotics in atopic dermatitis. Experimental and Therapeutic Medicine, 18(2): 926-931.
6. Schlichte, M., Vandersall, A., & Katta, R. 2016. Diet and eczema: a review of dietary supplements for the treatment of atopic dermatitis. Dermatology Practical and Conceptual, 6(3): 23-29.
7. Goddard, A. & Lio P. 2015. Alternative, complimentary, and forgotten remedies for atopic dermatitis. Evidence-based complementary and alternative medicine, 2015: 676897.