Many dermatologists manage eczema with steroid creams. But is a steroid deficiency really the cause of dry, itchy skin?
Eczema – or, as we doctor-types like to call it, Atopic Dermatitis – has been on the rise in the western world, with an estimated 7 to 15 percent of the population affected (Lancet 2006 Aug 26;368(9537):733).
The main symptom of eczema is itchiness, particularly on the backs of the knees, in the elbow creases, and on the face, neck, forehead, backs of the hands, and toes.
Most cases are managed (note that I don’t say “cured”) with steroid creams like hydrocortisone and triamcinolone. These creams essentially work by telling the inflammatory chemicals in the skin to calm down, thus providing significant symptom relief in the short run. When used long term, however, these creams can thin the skin and break it down. Plus the unpleasant symptoms come right back once the tube of cream runs out.
Understanding the causes of eczema can help us find more natural – and much more effective – ways to reduce the frequency and severity of its symptoms, and maybe cure it permanently.
So… Where does it come from, you may ask?
There is a clear genetic predisposition to eczema within affected families. Although many patients think there’s nothing you can do about your genes, I prefer to think of it this way: what you inherent from your parents is a greater or lesser need for a certain set of nutrients.
So keep reading: just because your family members suffer from eczema doesn’t mean that you have to.
Eczema + Asthma + Allergies
Eczema tends to run in families, particularly in families where other member have eczema, asthma, and/or allergies. These conditions all share a common root cause, and indeed, many people are affected by all 3 conditions. Nearly 80 percent of children with eczema develop allergic rhinitis, and 30 to 50 percent develop asthma.
The underlying imbalance behind eczema, asthma, and allergies – collectively referred to as the atopic triad – is a tendency to be “hyper-allergenic” or “atopic.” (This is why eczema is called atopic dermatitis.)
Although everybody’s allergies are different, most people with eczema are irritated by skin contact with wool, lanolin, and sweat, and almost all (60 to 80 percent!) have food intolerances.
Food Allergies & Intolerances
It’s estimated that 60 to 80 percent of all cases of eczema are associated with food allergies and/or food intolerances (Clin Exp Allergy 2004 May;34(5):817).
To successfully treat eczema, it is essential to identify the triggers. In medicine we refer to allergies and other triggers “obstacles to cure,” because while the trigger foods are still in the diet, full resolution of the condition is near impossible.
The easiest way to identify food allergies and sensitivities is to either get tested (available at Natura Integrative Medicine) or to do an elimination and challenge diet on your own to watch for reactions to common trigger foods (I’m happy to coach you through this process during a private visit).
The major offenders in eczema are eggs, milk, peanuts, soy, fish, and gluten. In babies with infantile eczema, I recommend avoiding these foods entirely until 18 months of age. It’s estimated that 26 percent of children who avoid a known trigger from this list for one year will outgrow the allergy! (J.Ped 1989)
Less common (but still worth mentioning) food triggers include citrus, tomatoes, strawberries, corn, chocolate, food preservatives, and artificial coloring. One study (J.Ped 1989) showed that if a child was triggered by one of these “minor” allergens and avoided that food for a year, there was a 66% chance of outgrowing the allergy altogether. That’s amazing! That’s a better success rate than with allergy shots!
Respiratory allergens – such as animal dander, smoke, and dust mites – are also a problem for many with eczema.
Babies at high risk for atopic conditions (those with a first-degree relative with eczema, asthma, or allergies) are less likely to develop these ailments themselves if they are exclusively breast-fed for at least 4 months. That means giving the baby no other food besides breast milk – not even formula – for the first 4 months of life.
Eating trigger foods and/or taking too many antibiotics can over time create inflammation in the gut, affect the integrity of the cells lining the intestine. The spaces between these cells (known as “tight junctions”) begin to break down in the presence of this inflammation, creating a condition known as leaky gut.
When the gut becomes “leaky,” pieces of protein and harmful bacteria can start passing through the spaces between the cells, wrecking inflammatory havoc. These proteins and bacteria stimulate the immune system to react, resulting in a myriad of symptoms from autoimmune disease to irritable bowel syndrome (IBS) to food intolerances to eczema.
Therapies that treat leaky gut invariably improve eczema symptoms.
Regardless of the patient’s age, probiotics have been shown to help a staggering number of those living with eczema. One study even found that babies given probiotics from birth onward were half as likely to develop eczema by age two when compared to babies who didn’t get probiotics (Lancet 2001). Likewise, glutamine has likewise been shown to reduce the risk (Arch Pediatr Adolesc Med, 2007; 161 (11): 1095-101).
For more information about leaky gut, check out this great blog post by one of my heroes, Dr. Aviva Romm (http://avivaromm.com/10-signs-leaky-gut)
Patients with eczema often have low levels of a chemical called cyclic adenosine monophosphate, or cAMP. cAMP is an important signaling messenger that regulates the production of many important substances within the body. Patients low in cAMP tend to have higher levels of histamine. (If you’ve ever had a rash or hayfever, then you’ve likely become acquainted with the unpleasant, itchy effects of histamine.)
I therefore often strive to increase cAMP levels in patients with eczema to reduce the itching and inflammation. One of the best ways to increase cAMP and lower histamine is through exercise, which is yet another compelling reason to start moving your body on a regular basis.
Brightly-colored foods like blueberries, raspberries, parsley, green tea, and oranges are rich in flavonoids, a nutritional compound that increases cAMP.
Some cAMP-increasing herbs include licorice, borage, black currant, evening primrose oil, and ginkgo – herbs that I often blend into custom formulations for my patients.
You’ve probably heard that inflammation is bad, and that anti-inflammatory foods and supplements can help a myriad of health conditions. This is particularly true for patients with atopic conditions like eczema.
It’s been found that patients with eczema are deficient in an enzyme that helps convert healthy foods and even supplements into anti-inflammatory chemicals in the body.
This enzyme, known as delta-6-desaturase, is essential for turning vegetarian health foods (such as nuts, seeds, and vegetables) and even supplements (like flax oil) into forms that can be used to fight inflammation. Without this enzyme, patients with eczema and other atopic conditions end up having higher inflammation than others.
Fortunately, nutrients such as vitamin B3 and zinc can support the function of delta-6-desaturase, strengthening its function in affected patients over time.
Fish oil supplements, which are rich in the anti-inflammatory chemicals EPA and DHA, do not rely on delta-6-desaturase to work in the body, and therefore help effectively fight inflammation in patients with eczema. This is why the patients with eczema in my practice are almost always put on a fish oil supplement and encouraged to eat fish rich in EPA (wild salmon, halibut, mackerel, herring, sardines) at least twice a week. (Assuming there is no fish allergy.)
Because patients with eczema have poor delta-6-desaturase activity and therefore possess higher levels of inflammation than others, it is further important to avoid inflammation-causing foods and substances. I strongly encourage my patients with eczema to eliminate poor quality fats from the diet, as these are known to promote inflammation in the body: grain fed meats, fried foods, and hydrogenated oils. Anti-inflammatory diets low in gluten, sugar, alcohol, and nightshade vegetables also yield incredible results. (Check out the Anti-Inflammation Diet and Cookbook by Dr. Jessica Black for more information.)
In adults and older children, the importance of stress management cannot be overstated, as stress rather dramatically increases inflammatory cytokines in the body. Indeed, emotional health and stress management is all too often the missing piece in patient care.
Weaker Skin Defenses
The above-explained imbalances in the immune response lead to downstream imbalances in the skin. Although successful treatment lies in treating the deeper causes of eczema – namely through balancing the allergic response, strengthening the immune system, healing the leaky gut, and fighting inflammation – it’s also important to care for the skin directly to alleviate symptoms when they arise.
There tends to be a hyper-vigilance among North Americans when it comes to personal hygiene. Although frequent bathing and hand washing does indeed prevent the risk of transmitting bacteria and viruses, these practices tend to dry out the skin. I often recommend that patients bathe as infrequently as they can (while still maintaining social and hygienic standards), so that the oils naturally secreted by the skin can help keep it supple and strong. I also discourage patients from using anti-bacterial soaps, as these disrupt the normal and healthy bacterial balance on the skin’s surface.
It’s also important to moisturize the skin frequently with emollients like Eucerin, calendula oil, coconut oil, olive oil, almond oil and Lycrogel. Be sure to read labels and avoid any ingredients you’re allergic to (eg: if you’re allergic to nuts, don’t use almond oil!). I also recommend adding calendula oil or calendula succus (juice) to a store bought moisturizer to help facilitate skin healing.
Raw, unpasteurized honey (manuka is best) can also be rubbed into the raw and itchy areas, and has been shown to be quite helpful in relieving and resolving symptoms (Complement Ther Med. 2003 Dec;11(4):226-34). (Please note that honey is contraindicated in babies.)
Nourish the Body, Treat the Cause
The skin is where the body expresses deeper-seated imbalances. It’s clear that the conventional approach of treating eczema at the level of the skin alone is not working, as topical creams and steroids do little if anything to address the cause of this condition.
To effectively treat eczema, it’s essential that we start nourishing the body on a deeper level, namely through balancing the allergic response, supporting the immune system, strengthening the integrity of the gut, and fighting inflammation. This approach takes more work than the conventional model, but is also more effective in the long term. Your health is worth it, and I’m here to help you along the way.