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Eczema

Introduction

What should I know about Eczema?

The child with poison ivy … the operating room nurse who develops scaly skin on her hands from frequent washing with potent antibacterial soaps … the elderly gentleman with crusty-looking, thickened skin on his arms and elbows … the young woman who seems to always get an angry neck rash neck after a cold … these people all have one thing in common: they are suffering from eczema. The term "eczema" encompasses a number of red, itchy skin conditions. Eczema may look like a dry, scaly rash or weepy, oozing blisters. People of any age can get it.

Eczema is a form of "dermatitis," which literally means, "inflamed skin." Chronic eczema causes dry, red flaky patches of skin, usually on the face, neck, scalp, the arms, elbows, wrists, hands, and knees. During acute flare-ups, the patches become itchy, oozing, and inflamed. The terms "dermatitis" and "eczema" are often used interchangeably.

Medical science classifies eczema and dermatitis into two main categories: contact dermatitis and atopic eczema. Contact dermatitis, also called contact eczema, occurs when an irritating substance comes in direct contact with the skin. The offending irritant may be a chemical, cosmetics, wool, lanolin, or rubber shoes. Nickel in jewelry is a common cause. Poison ivy is a form of contact eczema.

Atopic eczema is usually caused by inhaled or ingested allergens, such as foods, pollen, dust, or animal dander. Some medical literature discusses a third classification called "dysregulatory microbial eczema". (1) Bacteria that penetrate and inflame the outer skin layer trigger this type of eczema.

Atopic eczema is a hereditary condition that typically appears in early childhood. (The term "atopic" in general refers to inherited allergy-related conditions.) Children whose parents both have allergies are twice as likely to develop allergies themselves. (2) The prevalence of atopic allergies such as asthma and eczema has risen steadily since the 1960's, possibly, as some scientists believe, due to worsening environmental pollution. (3) Children with atopic eczema have a higher than normal risk of developing asthma and hay fever. (4)

Food allergies appear to play a significant role in atopic eczema. Infants and young children with severe eczema tend to produce antibodies against certain foods. (5) Some experts think infants whose mothers were exposed to allergy-causing substances during pregnancy have and increased chance of developing eczema, although not all agree. This point of view is strengthened by studies showing that breast-fed infants born to mothers who avoid allergic foods during pregnancy have a lower incidence of eczema. (6)

There appears to be a strong link between allergic sensitivity and the type of bacteria that predominate in the intestinal tract. In a healthy gut, the "friendly bacteria" such as acidophilus and bifidus have the upper hand. These good bacteria help prevent allergy-causing substances, known as "allergens," from inflaming the gut wall. If the friendly gut bacteria are absent, the immune system’s response to allergens can set the stage for other allergic conditions. Colonization of the digestive system with the right bacteria needs to begin shortly after birth. If this is disrupted, the child may be prone to allergy-related conditions such as eczema. (7)

Statistic

World Allergy Organization, 2004.

  • Atopic dermatitis prevalence is 2-5% in children and 10% in young adults.

Advance Data 315.

    There are over 33 million office visits to dermatologists annually (1998). Approximately 11.9 million of ambulatory care visits were for skin rash (1998).

Vital and Health Statistics Series 13, No. 134.

    Contact dermatitis and eczema were diagnosed at over 8.5 million office visits to physicians and at 430,000 hospital outpatient visits(1997). Nearly 8.2 million cases of dermatitis were reported in 1996.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Eczema generally consists of patches of red, dry, flaky skin that is extremely itchy. The affected areas may appear moist, inflamed, and oozing.

General

  • Patches of red, dry, flaky skin
  • Affected areas may appear moist, inflamed, and oozing
  • Severe itching

Treatment Options

Conventional

Treating eczema has three main objectives: 1) Reducing inflammation, 2) Relieving the itching skin and 3) Moisturizing the dry skin patches. Your physician may prescribe the following medications:

    Antihistamines Corticosteroid creams Macrolide lactones A topical form of the antidepressant doxepin. Topical antibiotics

Nutritional Suplementation


Gamma Linolenic Acid (GLA)

People with atopic eczema may be deficient in GLA, an important fatty acid that keeps inflammation under control. Supplementing GLA has shown success in improving in skin roughness, and it seems to normalize the blood chemistry associated with inflammation as well. (8) In one study, a group of children with atopic dermatitis took 3 grams of GLA for 28 days. While none were cured, symptoms decreased, and the children required less medication. No side effects occurred, suggesting that GLA is safe in infants and young children. (9) While a number of studies have shown reductions in dryness, redness, scaling, and overall symptom severity with GLA, not all have been favorable. Good sources of GLA, which can be purchased as supplements, include evening primrose oil, borage oil, and black currant oil.


Omega-3 Fatty Acids

These essential fatty acids, best known for their heart health benefits, help fight inflammation. Their anti-inflammatory action was tested against atopic eczema in a 12-week double-blind study. Supplementation with omega-3 fats from fish oil capsules reduced itching, scaling, and other eczema symptoms. (10)

Note: It is important to supplement vitamin E when taking GLA, fish oil, and other sources of unsaturated fatty acids.


Selenium

This essential trace mineral supports the body’s antioxidant defenses against and free radicals. One of the body’s anti-free radical enzymes, "glutathione peroxidase," needs selenium to work. Interestingly, some people with eczema have been found deficient in selenium. This may allow free radicals to build up in the skin, adding to the irritation. In one study, eczema suffers with low glutathione peroxidase levels got relief from taking selenium along with vitamin E. (11) Another similar study, however, reported no benefit from selenium and vitamin E supplementation. (12)


Zinc

This essential mineral may play a role in eczema, but the evidence is conflicting: while some people with eczema show deficiencies, others have normal zinc levels. (13) In a recent clinical trial, zinc supplements had no effect on eczema symptoms. (14) Still, zinc supplementation is probably a good idea, especially for elderly eczema sufferers who could be prone to zinc deficiency.


Lactobacillus acidophilus

The friendly bacteria such as lactobaccillus acidophilus and bifidus, as mentioned earlier, help protect the intestinal tract from the inflammatory effects of food allergies. By promoting intestinal health and reducing GI inflammation, lactobacillus supplementation may benefit other allergy-related conditions like eczema. Evidence of this was seen in a study of 10 babies with atopic eczema. The infants were given lactobacillus supplements in a base of whey twice daily for one month. Compared to a control group who got whey without the bacteria, the treated babies showed significant improvement. (15) According to some estimates, approximately one-third of young children with atopic eczema have food allergies. (16)

Herbal Suplementation


Olive Leaf

Olive trees, widely cultivated throughout Mediterranean countries as a source of olives and olive oil, have been traditionally used as a source of herbal medicine as well as food. The olive leaf has healing properties useful health properties in a variety of conditions including malaria, infections, cardiovascular diseases, and general well being. Olive leaf contains a key antioxidant called "oleuropein" helps the immune system clear foreign substances out of the system, which can help reduce the inflammatory effect of food allergies that contributes to eczema. (17) Olive leaf extracts containing a concentrated amount of oleuropein are available as dietary supplements.


Evening Primrose

Evening primrose oil (EPO) is an excellent source of GLA which, as discussed above, shows promise in relieving skin inflammation. Supplementation with essential fatty acids such as EPO has been reported to prevent zinc deficiency, thereby potentially improving immunity. (18) EPO helps prevent candida yeast from proliferating in the bowel. (19)


Milk Thistle

Historically, milk thistle was used as tonic for the stomach, digestive system, and liver. (20) Milk thistle contains a powerful liver-protecting ingredient called silymarin. Milk thistle supports the liver’s defenses against free radicals and inhibits of histamine and other inflammatory substances. Because the liver is a primary source of histamine in the body, natural treatment for eczema generally includes liver support.


Grapefruit Seed

Grapefruit seed extract effectively checks the spread of Candida yeast and other organisms that disrupt the normal ecology of the intestinal tract. Clinicians find grapefruit seed extract useful for maintaining a healthy population of friendly organisms in the gut. In one telling study, four weeks of therapy with grapefruit seed extract relieved constipation, gas, and abdominal discomfort. (21) Grapefruit seed extract may provide value in cases where eczema symptoms are triggered by imbalances in the gut microflora.


Artichoke

The flower head of the globe artichoke has been used as a food and medicinal agent for centuries. In medicine, the globe artichoke has historically been used treat poor digestion, "sluggish" liver, and skin problems such as eczema. Artichoke leaf is claimed to be a potent antioxidant that protects and regenerates the liver. (22) Like Milk thistle, globe artichoke checks the production of inflammatory substances that contribute to eczema.

Diet & Lifestyle

Support digestion with hydrochloric acid supplements and digestive enzymes. This helps counter food allergies and prevents overgrowth of unfriendly gut bacteria.

Identify allergic foods and eliminate them from the diet.

References

  1. View Abstract: Hornstein OP. Remarks and recommendations on the definition and classification of eczematous diseases. Z Hautkr. Sep1986;61(18):1281-96.
  2. View Abstract: Hara H, et al. Short chain fatty acids suppress cholesterol synthesis in rat liver and intestine. J Nutr. May1999;129(5):559-67.
  3. View Abstract: Hara H, et al. Short chain fatty acids suppress cholesterol synthesis in rat liver and intestine. J Nutr. May1999;129(5):559-67.
  4. View Abstract: Gustafsson D, et al. Development of allergies and asthma in infants and young children with atopic dermatitis—a prospective follow-up to 7 years of age. Allergy. Mar2000;55(3):240-5.
  5. View Abstract: Gustafsson D, et al. Development of allergies and asthma in infants and young children with atopic dermatitis—a prospective follow-up to 7 years of age. Allergy. Mar2000;55(3):240-5.
  6. View Abstract: Chandra RK, et al. Influence of maternal food antigen avoidance during pregnancy and lactation on incidence of atopic eczema in infants. Clin Allergy. Nov1986;16(6):563-9.
  7. View Abstract: Kirjavainen PV, Gibson GR. Healthy gut microflora and allergy: factors influencing the development of the microbiota. Ann Med. Aug1999;31(4):288-92.
  8. View Abstract: Horrobin DF. Essential fatty acid metabolism and its modification in atopic eczema. Am J Clin Nutr. Jan2000;71(1 Suppl):367S-72S.
  9. View Abstract: Fiocchi A, et al. The efficacy and safety of gamma-linolenic acid in the treatment of infantile atopic dermatitis. J Int Med Res. Jan1994;22(1):24-32.
  10. View Abstract: Bjorneboe A, et al. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl. 1989;225(731):233-6.
  11. Bunker VW, et al. Selenium Status in Disease: The Role of Selenium as a Therapeutic Agent. British Journal of Clinical Practice. 1990;44(8):401-404.
  12. View Abstract: Farris GM, et al. The effect on atopic dermatitis of supplementation with selenium and vitamin E. Acta Derm Venereol. 1989;69(4):359-62.
  13. View Abstract: David TJ, et al. Low serum zinc in children with atopic eczema. Br J Dermatol. Nov1984;111(5):597-601.
  14. View Abstract: Ewing CI, et al. Failure of oral zinc supplementation in atopic eczema. Eur J Clin Nutr. Oct1991;45(10):507-10.
  15. View Abstract: Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol. Feb1997;99(2):179-85.
  16. View Abstract: Wahn U, et al. Atopic eczema: how to tackle the most common atopic symptom. Pediatr Allergy Immunol. 1999;10(12 Suppl):19-23.
  17. View Abstract: Visioli F, et al. Oleuropein, the bitter principle of olives, enhances nitric oxide production by mouse macrophages. Life Sci. 1998;62(6):541-6.
  18. View Abstract: Dib A, et al. Effects of Gamma-linolenic Acid Supplementation on Pregnant Rats Fed a Zinc-deficient Diet. Ann Nutr Meta. 1987;31(5):312-19.
  19. View Abstract: Savolainen J, Lammintausta K, Kalimo K, Viander M. Candida albicans and atopic dermatitis. Clin Exp Allergy. Apr1993;23(4):332-9.
  20. Cardui mariae fructus (Milk Thistle fruit). Commission E Monograph. Bundesanzeiger, no 50. Mar1986.
  21. Ionescu G, et al. Oral Citrus seed extract. J Orthomolecula Med. 1990;5(3):72-74.
  22. View Abstract: Adzet T, et al. Hepatoprotective Activity of Polyphenolic Compounds From Cynara scolymus Against CCl4 Toxicity in Isolated Rat Hepatocytes. J Nat Prod. Jul1987;50(4):612-17.