Eczema (Atopic Dermatitis) - Naturopathic MedicineNaturopathic Medicine Summary

Naturopathic Medicine

Naturopathic Summary

Eczema, also known as atopic dermatitis, is a common, chronic condition of the skin that affects many children and adults.[1]

Treatment Philosophy

In naturopathic medicine, eczema is understood as the genetically predisposed combination of a defective skin barrier and an increased inflammatory response.[2] Naturopathic treatments aim to decrease the root cause of the inflammation through herbs, nutrition and diet, and stress reduction.

Symptoms

Eczema is characterized by chronically dry, itchy and scaly skin.[2] When scratched and irritated the skin can become red, itchy, and swollen with oozing and weeping.[2] The skin of the cheeks, wrists, inner elbows and knees are most commonly affected in babies and young children.[2] In older children and adults, the skin of the neck, inner elbows and the backside of the knees are affected more commonly.[2]

Causes

Eczema, also known as atopic dermatitis, is a common, chronic condition of the skin that affects many children and adults.[1] The combination of a genetically predisposed defective skin barrier and an increased inflammatory response play a major role in the cause of eczema.[2] 

Risk Factors

Your body

  • Age: Eczema tends to be worse in childhood with improvement in adolescence and adult years. However, in some cases eczema can persist into adulthood.
  • Genetics: Eczema is an inherited disease and is commonly found in families.

Research shows that there is a genetic cause to the development of eczema in some people.[3] Some people with eczema have an abnormal protein in their skin barrier, leading to a disruption in skin function. This protein, known as filaggrin, is normally a part of a healthy skin barrier. Breakdown products of filaggrin form what is known as the natural moisturizing factor, which keeps skin hydrated.[4,5] Studies have estimated that the number of people with eczema that have an abnormal filaggrin protein may be as low as 25% to as high as 50%.[6]

  • Irritants: Allergens that cause a general allergic reaction of the skin can worsen eczema by causing frequent bouts of skin irritation, known as contact dermatitis or irritant dermatitis.
  • Autoimmunity: The immune system plays a role in the development of eczema[7] and frequent bouts of exposure to irritating chemicals can worsen eczema.
  • Smoking: The harmful effects of smoking are well-known, but many who suffer from eczema may not realize that it can worsen their symptoms, and the symptoms of those around them. Smoking can increase the risk of hand eczema,[8] and exposure to environmental tobacco smoke at home can increase the risk of eczema in school children.[9]

Products

  • Moisturizers: The use of a skin cream/moisturizer is important in bolstering the skin barrier and in maintaining hydration. These should be applied daily and after bathing, especially if soap was used. There are many different kinds of moisturizers available and these should be carefully selected. For example, some moisturizers are much heavier due to an ointment base while others may be lighter due to a cream or lotion base.
  • Probiotics: Supplementation with probiotics during and after pregnancy may decrease a baby’s rate of developing childhood eczema.[10] Topical probiotics may also be helpful for eczema[11]. The benefits may be due to an improvement in skin barrier function following the use of probiotics.[12] This is a growing area of research and more studies are needed to better understand how the dose and species of probiotics may make a difference to eczema.

Environment

  • Climate: Cold and dry environments may aggravate eczema. Cold temperatures worsen the function of the skin barrier.[13] An international study found that colder temperatures were associated with a greater incidence of eczema.[14] The same study showed that there was less eczema present as indoor humidity increased.[14]
  • Allergens: Common environmental causes of contact dermatitis include dust mites, cat dander, animal saliva and latex.[15] Particulate air pollution has been shown to worsen the epidermal barrier function.[16]
  • Hard water: Although most of the research on hard water and soft water has been unclear, one study went more in depth and showed that those people with atopic dermatitis AND a genetic defect in the filaggrin protein were sensitive to hard water and having their clothes washed in hard water.[17] Installing water softeners may be helpful in some people although more studies are needed to understand the effect of water softeners. [17]

Naturopathic Therapies

Eczema is manageable, but there is no absolute cure, so it requires frequent evaluation by trained medical professionals to control flares and prevent symptoms from worsening. Eczema is complex and a study has shown that many patients do not realize all of the factors that can affect their condition[22]. Naturopathic medicine follows the belief that patient and/or parent education is a crucial component of any treatment plan. When the patient understands the condition, they can learn to recognize and avoid the individual “triggers” that worsen the symptoms they experience. A naturopathic practitioner will develop a treatment plan that works with natural symptom controls before, or in conjunction with, synthetic/pharmaceutical controls. Prevention is also important to consider because preventing the exposure to irritants will minimize chronic inflammation, which leads to worsening of eczema.

  • Hydrotherapy: Different forms of hydrotherapy with the potential to improve eczema may include wet wraps using vinegar or bleach,[23,24] balneotherapy, mineral baths,[11] or even an extended stay at a specialized hydrotherapy center.[25]

Botanicals and Herbs

  • Oats: Some believe that oats may worsen eczema, due to common reactions that many individuals have to other grains and cereals. Indeed, certain people with eczema may react to using oats.[18] However, one study used various oat-containing products and found no adverse reactions,[19] and other studies have shown the use of oats to be quite beneficial for patients with eczema.[20,21] Therefore, the use of oats must be evaluated individually and carefully.
  • Licorice and feverfew may also reduce inflammation.[20].

Diet and Lifestyle

  • Diet: An elimination diet can be tried in order to identify triggering foods that may be contributing to the eczema symptoms.[26] This diet entails the removal of common food allergens for two to four weeks before carefully adding them back, one at a time, while being aware of symptoms that may occur.[26] Foods that cause adverse symptoms when added back into the diet are deemed problematic.[26] It is important that the elimination diet is completed under the supervision of a trained health professional. The foods commonly shown to worsen eczema are eggs, milk, grains (barley, rye, and wheat), soy, nuts, and meats like beef, pork, seafood and poultry.[15] Food allergies are to be suspected in children less than 5 years of age with a food exposure history and constant itching that does not seem to improve.[27] However, elimination diets should only be considered under close medical supervision.
  • Breastfeeding: Breast milk can boost a child’s immune system, reducing the risk of developing atopic diseases like eczema.[10] Also, breast milk may help select for healthy bacteria to grow in the gut and one theory suggests this can reduce systemic inflammation and the development of eczema.

Supplements

  • Vitamin D: Although vitamin D’s role in the treatment of eczema is debated, patients with a history of atopic dermatitis often have reduced vitamin D levels,[28] while eczema has improved with vitamin D supplementation.[11]
  • Glutamine: In a study of low birth weight infants supplemented with the amino acid glutamine, it was shown that the infants who received glutamine had lower rates of developing eczema.[29] Similar results have been shown in mouse models.[30]

Lifestyle

  • Stress reduction: Recent studies have shown the relationship between stress and inflammation in people with atopic dermatitis(eczema).[31]
  • Clothing: Clothing is an important, often underestimated contributing factor to eczema. Wool and other rough fabrics can worsen eczema[32-34] and itchiness.
  • Smoking cessation: Second-hand smoke can aggravate eczema. Reducing smoking, or smoking cessation altogether, can lead to a decrease in allergic responses of those exposed to second-hand smoke.[35,36]
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  2. Sohn A, Frankel A, Patel RV, et al. Eczema. Mt Sinai J Med. 2011; 78(5):730-739; PMID: 21913202 Link to research.
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  9. Shirinde J, Wichmann J, Voyi K. Environmental tobacco smoke and the risk of eczema symptoms among school children in South Africa: a cross-sectional study. BMJ Open. 2015; 5(8):e008234; PMID: 26310401 Link to research.
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