Eczema and Dermatitis

Dematitis & Eczema treatment.

There are numerous different types and causes of dermatitis with the most chronic being Eczema. There are many forms of eczema treatment depending on the causes. People may also suffer contact dermatitis, a skin irritation resulting directly from contact with an allergenic substance:

Dermatitis literally means ‘inflammation of the skin’, which may be acute, subacute and chronic. It results in a red, scaly rash which is often itchy.

Dermatitis affects approximately 10% of children and 7-24% of adults.  

Eczema is the chronic form of dermatitis and is synonymous with gut dysbiosis, immune dysregulation, infections (viral, bacterial, fungal) and elevated IgE antibodies.

Atopic dermatitis (eczema):

• Most frequently diagnosed in infancy and may subside in adulthood, although flare-ups can occur throughout life with various stressors.
• Genetic predisposition to high circulating IgEs and epidermal barrier defects
• Often triggered by ingestion of allergenic foods (e.g. cow’s milk, wheat, egg white, peanut, nuts and fish) or contact with allergens (dust mite, animal saliva, grasses, wool, fragrance, nickel, sodium laurel sulphate, etc).
• Environmental factors such as very dry sleeping environments, harsh soaps and detergents, excess sweating, rubber gloves, solvents and over washing of the skin all can trigger eczema
• Frequently occurs with hay fever and/or asthma (underlying atopy)
• Causes red, scaly, dry, itchy skin which may ooze
• Tends to occur on flexor surfaces of elbows or knees, hands, feet, torso and face.
• Easily becomes infected with bacteria, especially Staphylococcus aureus
• Exacerbated by stress, illness and infections, scratching, change in climate, and contact with irritants such as wool, detergents and soaps
• Strongly associated with dysbiosis and increased intestinal permeability (maternal probiotic supplementation during pregnancy and breastfeeding reduces the risk of eczema)

Contact dermatitis:

• Caused by contact with allergen or irritant (e.g. soaps, detergents, chemicals, plants, fragrance, latex, nickel, sunlight)
• Irritant contact dermatitis accounts for 80% of all contact dermatitis
• Causes localised rash or irritation with burning and itching
• Can take anywhere from several days to several weeks to heal, as long as contactant has been removed

Signs and symptoms of Eczema

The signs and symptoms will depend on the type of dermatitis. Signs and symptoms common to all types including eczema are:

• Skin rash with redness, swelling and itching of skin
• May be characterised by fluid-filled vesicles and blisters

Differential diagnosis

• Psoriasis
• Fungal or viral infection
• Scabies
• Drug eruptions
• Cutaneous T-cell lymphoma

TREATMENT STRATEGY FOR ECZEMA

• Investigate gut microbiome imbalances, gut dysbiosis, intestinal permeability, parasites etc.   Skin conditions and particularly eczema have a strong affiliation with the gut.  Balancing the gut microbiome and resolving dysbiosis is always the first step in managing eczema.   Comprehensive investigative testing is required to identify pathogens and potential insufficiency dysbiosis
• Identify / address underlying cause: essential in the successful treatment of eczema
• Reduce histamine release – often methylation is contributing to poor histamine processing through to Methyl Transferase dependent DAO enzyme
• Relieve symptoms / prevent ‘itch-scratch’ cycle
• Avoid / remove allergenic foods or contact allergens
• Promote skin healing / tissue repair
• Support nervous system
• Support digestive function
• Promote lymphatic clearance

Diet plan guidelines for Eczema

• Identify / eliminate any food allergens: in nursing infants, the mother will need to avoid ingesting allergenic foods.
• Most common allergenic foods include dairy, wheat, soy, eggs, peanuts, tree nuts, seafood, citrus, tomatoes, corn, strawberries
• Children often react to foods that they eat frequently or crave
• IgE testing may be done to ascertain true food allergies
• IgG or IgA blood testing or food elimination diet may need to be done to identify food sensitivities
• Minimise pro-inflammatory foods: sugar, refined carbohydrates, trans fats, omega-6 fatty acids, caffeine and alcohol
• High fibre diet to support bowel function and growth of beneficial gut flora
• Probiotic foods to support healthy immune response and reduce intestinal permeability
• Include bitter foods, lemon juice and/or apple cider vinegar to support digestion of food

Supplements that support Eczema

• Omega 3 EFA’s – to reduce inflammation
• Evening primrose oil – effective in reducing skin inflammation, especially in combination with omega-3 EFA’s
• Vitamin C – reduces inflammation and histamine response; promotes tissue repair
• Probiotics: Spore forming probiotics along with L. plantarum, L. rhamnosus GG, Bifidobacterium longum BL999, L. reuteri and S. boulardii
• Zinc – to support skin healing and tissue repair
• Vitamin A – to promote tissue repair
• Selenium – antioxidant, immune modulation0
• Biotin 3 mg bid: deficiency linked to seborrhoea, especially in infants (if infant is breastfeeding, treat mother with biotin)

Herbal medicine treatment that supports Eczema

• Relieve symptoms: topical application of herbal creams (vitamin E base): calendula, myrrh, echinacea, goldenseal, chamomile, chickweed, comfrey, licorice, EPO, essential oils
• Reduce inflammation: turmeric, ginger, licorice, gotu kola, bupleurum
• Immune system support: echinacea, astragalus, Siberian ginseng, withania
• Anti-allergic: albizzia, baical skullcap
• Bitters for digestion: gentian, andrographis, dandelion, globe artichoke
• Detoxification/lymphatic clearance: burdock, nettle, blue flag, cleavers, red clover, yellow dock, sarsaparilla, Oregon grape
• Improve circulation: yarrow, prickly ash, gingko
• Skin / tissue repair: gotu kola, gingko

Lifestyle / Physical measures that improve Eczema

• Encourage breastfeeding for infants with eczema
• Identify / avoid contact with allergenic or irritant substances: wool, soaps, detergents, chemicals, fragrances, SLS, nickel, latex, dust mite, animal dander, etc.
• Frequent topical applications of oil-based moisturisers to soothe and protect skin barrier: fragrance-free and natural skin products only should be used. Examples include coconut oil, evening primrose oil, vitamin E cream or oil, rosehip oil

Topical applications to reduce skin inflammation include:

• Calendula, goldenseal, echinacea and/or chamomile in a vitamin E cream base
• Oat baths
• Cool peppermint tea sprayed onto skin may relieve itching and burning
• Cool wet compresses to decrease vasodilation, reduce inflammation and serum production

FUNCTIONAL MEDICINE TREATMENT OF ECZEMA

Eczema is a common condition affecting both adults and children. 

Identifying the underlying causes, triggers and contributing factors are vital is overcoming eczema.  Comprehensive gut analysis is required as a baseline for this disease as well as identifying other body system imbalances such as methylation and HPA axis dysregulation.  There are often key nutrient deficiencies and disruption to various biochemical pathways including sulphur metabolism.

Food intolerances and other contact irritation sources should also be investigated.

At our Perth clinic of Advanced Functional Medicine we successfully treat a wide range of patients with eczema from children to adults. 

Using a functional medicine approach and thorough investigative testing, we can uncover major contributing factors of the disease.  This allows our treatments to balance major body systems, rebuild the gut microbiome and addressing immune system dysregulation.

If you or a family member are suffering from eczema or other skin disorder we would love to hear from you.  How long have you suffered eczema for?  What are you main triggers?  What treatments helped the most for you?   Please write a comment below.

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