Eczema – going skin deep

The itch of eczema can be mildly irritating but it can also be so maddening as to drive you to desperation.

But do not despair as there are many natural ways to manage eczema and bring that itch under control.

Eczema is an inflammatory condition of the skin, which may present with red, blotchy and itchy skin, with scaling and cracking and a rough and scaly appearance. Blisters may form, oozing fluid and leading to crusted and hard skin. Itching may become so severe to cause sleep disturbance, agitation and depression.

ATOPIC DERMATITIS

There are many types of eczema, of which atopic dermatitis (AD) is the most common. AD affects up to 20% of children and up to 3% of adults. AD occurs as early as infancy or childhood (teething), and presents most often on the face, hands, feet, back of the knees and inner elbows. Recent data indicates that its prevalence is still increasing, especially in low-income countries.¹ In South Africa some studies done among children of different age groups show one-year prevalence rates of 1 to 13.3%. Sixty percent of cases show spontaneous clearing by puberty; however, the condition may recur in adults.² In a population-based study in the US, the chronicity of AD highlights that only 50% of children below the ages of seven years, and 60% in adulthood, had complete resolution.³

CAUSES

Genes and the environment

Although the causes remain unclear, AD appears to occur as a result of predisposing genes, in combination with environmental stimuli. Recent studies suggest that there is a deficiency of a protein in the epidermis, the filaggrin gene, which offers a protective barrier,⁴ and keeps the outer layer of the epidermis (stratum corneum) hydrated. This deficiency breaks the skin barrier, causing loss of water and exposure to potential allergens. This results in dry and scaly skin, as well as inflammatory and allergic immune responses.⁵

Further studies suggest that there is a higher risk of children aged two to four years developing asthma and allergic rhinitis who have AD, due to sensitisation of IgE antibodies to common environmental allergens.³ 

Diet

Many studies have shown the link between diet and eczema, in which certain foods may either cause or exacerbate the condition. However most food allergies have found to resolve in early childhood, or from dietary elimination, except for peanuts and tree nuts, which is likely to continue.⁶

ROOT CAUSES

Genetic predisposition makes a person more vulnerable to developing eczema. Stress is a contributing factor, which causes repeated flare-ups if this is not well controlled. Hormonal changes in woman occur post menopause, when there is a decrease in production of oestrogen. Amongst other actions, oestrogen is responsible for the production of collagen and skin oils, without which the result is dry and itchy skin.

Poor lifestyle choices, occupational hazards, as well as poor compliance to the prevention and management of eczema, will also affect the outcome of skin health. Vitamin and mineral deficiencies contribute to a weakened immune system, which further predisposes a person to developing eczematous skin reactions.

Triggers

These may include: harsh chemicals, detergents, disinfectants, soaps, perfumes or preservatives, found in cosmetics or toiletries; nickel found in jewellery, watch straps or zips; wool/synthetic clothing, dust, pollen, smoke, pollution, mould, pet dander, dust mites and dandruff; skin infections, sweating, teething, and extreme changes in temperature and humidity.

Allergens

Testing for allergies is recommended, so that the root cause can be identified early and avoided/treated.

Allergens are substances which cause an allergic reaction. The antigens cause an abnormally vigorous immune response, in which the immune system fights off a perceived threat that would otherwise be harmless to the body.

Food allergies are especially common, such as gluten (wheat, oats, rye and barley), peanuts, fish, cow’s milk, eggs and soy. An acute immune reaction occurs from a few minutes to three hours of ingesting the agent to which a person is allergic. The body responds by making the antibody, IgE, which releases chemicals that create inflammation, which can lead to tissue damage. Examples of an acute food allergic response includes: eczema, hives, bronchitis, asthma, sneezing, coughing and excessive spitting up.

A food allergy involves an immune system response, whereas food intolerance occurs as a result of an inability to properly digest a substance in certain foods, which may be from an enzyme deficiency. When a person has gluten intolerance, there is a greater production of Zonulin (a protein that dismantles junctions). Zonulin breaks down the lining of the gut, thereby also contributing to a leaky gut syndrome, which is a contributory factor for eczema.

MANAGING ECZEMA

There is no known cure for eczema, but management of symptoms include creams to moisturise the skin, ultraviolet light, or medication to control the immune response. Topical antiseptic, antifungal, antibiotic or steroidal creams may be prescribed, and/or immunosuppressant drugs, such as antihistamines to control the itch. Studies suggest that certain types of nutrient supplementation with probiotics, prebiotics, fatty acids, or formula, may prevent or reduce the severity of eczema.⁷

Skin care

Use a non-soap cleanser or dermatological bar, and wash your skin with your hands instead of a facecloth, as this is not only harsh on the skin, but it also harbours bacteria. Pat the skin dry, instead of rubbing, to protect the skin. If you are allergic to pollen, wash your hair at night to get rid of pollen on the hair, and use a mild dermatological shampoo.

Moisturise the skin immediately after hand washing or showering to keep it moist and supple. Shower with warm water at about 32°C (heat dries out the skin), and not for too long, as this will further dry out the skin. Rinse off the body immediately after swimming, and avoid prolonged exposure to the sun, and use a high factor sun protective, waterproof lotion.

Calendula oil promotes skin healing, eliminates bacteria, and reduces inflammation. Coconut oil contains lauric acid, a rare type of fat found only in coconut oil and mother’s breast milk. Lauric acid is converted into monolaurin, a compound that is highly toxic to viruses, bacteria, fungus and other microorganisms. It also deeply penetrates and moisturises the skin, while protecting it from environmental and free radical damage.

Environment, air and breathing

Get plenty of fresh air and avoid polluted areas (car fumes, industrial exposure and tobacco smoke). Exercise the judicious use of air conditioners by not making the air too cold, which will dry out the skin. A humidifier adds moisture to the air, preventing dryness of the skin.

Reduce stress

Take time out to relax. Do deep breathing exercises, get fresh air, do yoga, socialise with your friends, join a club, have a hobby, do not overwork, and get emotional support.

Elimination

Keep the bowels functioning regularly, gentle massages, and cupping. Drink plenty of fresh water, at least one and a half litres for children and two litres for adults.

Exercise

Moderate exercise stimulates circulation and strengthens the immune system. Do not overdo exercising as increased sweating dries out the skin.

Rest and sleep

Listen to gentle music before going to bed, while sipping on a cup of warm camomile tea. Get sufficient rest and sleep to recuperate the body, and to facilitate healing. Avoid heavy meals before retiring, as well as stimulants, such as alcohol or coffee. Avoid watching TV or working at the computer before sleeping, as this will keep the mind stimulated.

Diet

Avoid a diet high in processed foods, with preservatives, added colourants and favouring, as this causes inflammatory reactions in the body.

Anti-inflammatory foods

Particular attention needs to be paid to diet, by substituting pro-inflammatory foods for anti-inflammatory ones instead. Eat plenty of raw and organic food, and avoid processed foods, caffeine, dairy, gluten, meat, sugar and alcohol, as much as is possible. Dark leafy green and cruciferous vegetables, such as spinach, kale and broccoli, have higher concentrations of vitamins and minerals, such as calcium, iron, and disease-fighting phytochemicals, than those with lighter-coloured leaves.

Fatty fish, such as salmon, mackerel, tuna and sardines, are high in omega-3 fatty acids, which have been shown to help reduce inflammation. Nuts contain antioxidants, which assist the body to fight off and repair the damage caused by inflammation. Almonds are a good source of inflammation-fighting healthy fats, which are rich in fibre, calcium, and vitamin E. Walnuts have high amounts of alpha-linolenic acid, a type of omega-3 fat.

Top seven eczema-healthy foods

In her book The Eczema Diet: Discover How to Stop and Prevent the Itch of Eczema through Diet and Nutrition, author Karen Fischer describes the top seven eczema-healthy foods:

1. Bananas are rich in potassium, and contain histamine-lowering nutrients, magnesium and vitamin C.
2. Beef or chicken broth provides skin-repairing amino acid glycine.
3. Potatoes are rich in fibre, potassium, vitamin C, and are alkalising.
4. Green onions contain histamine-lowering, anti-inflammatory quercetin, and are a rich source of vitamin K, which is beneficial for a healthy skin.
5. Buckwheat is gluten-free, contains quercetin to lower histamine, and has strong anti-inflammatory effects.
6. Rice milk is a low-allergy food and is low in chemicals.
7. Mung bean sprouts are strong alkalising foods.

Supplements

A probiotic supplement and cultured probiotic foods, such as sauerkraut, kefir, natto, tempeh, kimchi and miso, assist the body to restore friendly bacteria in the gut and fight against bad bacteria that cause inflammation.

Supplementation with essential fatty acids (omega-3 and -6), vitamin D³, vitamin B¹², magnesium and zinc, promotes a healthy immune system. Vitamins C and E help protect intestinal cells from oxidative and free radical stress, and vitamin C has anti-inflammatory effects, antioxidant activity and antibiotic qualities. Flax seeds, chia seeds, cod liver and fish oils, evening primrose oil, black currant seed oil, borage oil and hemp oil, are all also great sources.

CONCLUSION

Although eczema is physically, emotionally and socially discomforting, do not despair. Making healthy lifestyle choices and being aware of contributing factors, can ensure in a goof quality of life.

Editor's note: Here are two other excellent articles on the Natural Management of Eczema and how to Stop the Itch – tips for eczema sufferers.

References

1. Nutten S. Atopic Dermatitis: Global Epidemiology and Risk Factors. Ann Nutr Metab. 2015; 66(1):8-16.
2. Todd, Epidemiology of atopic dermatitis. SAMJ, S. Afr. Med. Journ. 2014; 104(10).
3. Bantz, S.K., et al. The Atopic March: Progression from Atopic Dermatitis to Allergic Rhinitis and Asthma. Journ Clin Cell Immunol. 2014; 5(2): 202.
4. Brown, J. Atopic eczema and the filaggrin story. Semin Cutan Med Surg.2008; 27(2):128-37.
5. McLean, W.H. The allergy gene: how a mutation in a skin protein revealed a link between eczema and asthma. F1000 Med Rep. 2011; 3: 2.
6. Katta, R., and Schlichte, M. Diet and Dermatitis: Food Triggers. J Clin Aesthet Dermatol. 2014; 7(3): 30-36.
7. Foolad, N., et al. Effect of Nutrient Supplementation on Atopic Dermatitis in Children. A Systematic Review of Probiotics, Prebiotics, Formula, and Fatty Acids. JAMA Dermatol.2013; 149(3):350-55.