The term eczema is used to describe all kinds of red, blistering, oozing, scaly, brownish, thickened, and itching skin conditions. Examples of eczema include dermatitis, allergic contact eczema, seborrheic eczema, and nummular eczema.
The term atopic describes a group of allergic or associated diseases that often affect several members of a family. These families may have allergies such as hay fever and asthma but also have skin eruptions called atopic dermatitis (AD). While most people with AD have family members with similar problems, 20% may be the only one in their family bothered by this problem. AD is very common in all parts of the world. It affects about ten percent of infants and three percent of the U.S. population overall. The skin rash is very itchy and sometimes disfiguring.
Diagnosis is primarily based on the appearance of the skin and on personal and family history. The health care provider should examine the lesions to rule out other possible causes. A skin lesion biopsy may be performed, but is not always required to make the diagnosis. This disease may result in an increased eosinophil count.
Symptoms can include: intense itching, blisters (vesicle formation) with oozing and crusting, skin redness or inflammation around the blisters, and rash. In children under 2 years old, skin lesions begin on the cheeks in infants and may progress to the scalp, arms, trunk, and legs; they may also exhibit dry, leathery skin areas (lichenification), more or less pigment than their normal skin tone (normally found in the inner elbow or behind the knee). It may spread to the neck, hands, feet, eyelids, or behind the knee. Raw areas of the skin (excoriation) may arise from scratching and ear discharges or bleeding.
The condition usually improves in childhood or sometime before the age of 25. About 60% of patients have some degree of dermatitis and some suffer throughout life. When the disease starts in infancy, it’s sometimes called infantile eczema. This itching, oozing, crusting condition tends to occur mainly on the face and scalp, although spots can appear elsewhere. In attempts to relieve the itching, the child may rub their head and cheeks and other affected areas with a hand, a pillow, or anything within reach. Parents should know that many babies improve before two years of age. Proper treatment can be helpful, sometimes controlling the disease until time solves the problem. One study found the longer a baby was breast-feed from a mother with eczema, the greater the risk of their developing it too.
If the disease continues or occurs beyond infancy, the skin has fewer tendencies to be red, blistering, oozing and crusting. Instead, the lesions become dry, red to brownish-gray, and the skin may be scaly and thickened. An intense, almost unbearable itching can continue, becoming severe at night. Some patients scratch at their skin until it bleeds and crusts. When this occurs, the skin may become infected.
Amongst teens and young adults the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists, and on the face, neck and upper chest. Although these are the most common sites, any body area may be affected. An itching rash as described above, along with a family history of allergies, may indicate atopic dermatitis. Proper, early and regular treatment by a dermatologist can bring relief and also may reduce the severity and duration of the disease.
The disease does not always follow the usual pattern. It can appear on the palms or backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for many years.
Emotional tension can provoke and aggravate itching in patients with AD and, according to a number of studies, AD patients show higher levels of anxiety, hostility and neurosis than matched controls. Neurodermatitis is a form of atopic dermatitis characterized by a self-perpetuating scratch-itch cycle. Although symptoms increase in times of stress, physiological changes in the nerve fibers are also present.
Avoid sweating and rough-textured clothing. Wash clothing with mild soaps only and rinse thoroughly, and avoid exposure to chemical irritants and any other agent that might cause skin irritation. Local application of soothing lotions ameliorates itching (zinc oxide works well), but greasy preparations should not be used for extended periods since they block the sweat ducts. The historic use of arctium lappa and other inulin-containing herbs for eczema has scientific validity.
Hand eczema may improve by wearing white cotton gloves covered with rubber gloves to avoid contact with irritants. Hands should be patted, not rubbed dry after each washing. With all forms of eczema, bathing too frequently can dry the skin and make the problem worse. Scratching tends to worsen the problem. Cold compresses may reduce itching. A larger list of eczema types with a brief description of each can be found at the Eczema Types page.
Scientists at the University of Dundee have taken a step closer to a full understanding of eczema and related allergic diseases with the discovery that people from different ethnic backgrounds have different mutations of the gene that causes the debilitating skin disorder.
Professor Irwin McLean and his team from the College of Medicine, Dentistry and Nursing at the University of Dundee, together with Dr Alan Irvine in Dublin, have used a groundbreaking new method to examine the filaggrin gene. The team made a major breakthrough last year when they reported that defects in the filaggrin gene can cause dry skin, eczema, eczema-associated asthma and other allergies. Their continued work has now shown that within the gene there can be several faults and that eczema sufferers of different ethnic backgrounds will have different faults within the gene. Their findings will be published in Nature magazine.
They have found, so far, 15 different mutations within the gene – if you have a mutation in your gene, you have a 60 per cent chance of having eczema. If you have two mutations in your gene, you have an almost 100 per cent chance of having eczema.
Of the mutations, 5 were prevalent in the European patients examined, who were mainly from the UK and Ireland, and 9 per cent of the population were shown to carry these gene defects. There are two mutations which are the most prevalent in all European people.
There were also two mutations prevalent in the Oriental populations that were tested. Four per cent of people of Chinese descent carry this mutation, meaning it could lead to eczema in more than 50 million people in the Far East alone.
Other mutations in the gene were found in single families and so are very rare or family specific.
The filaggrin gene is one of the hardest to decipher because of its repetitive pattern, but McLean’s laboratory have developed a new method which analyses the gene fully and will allow all defects to be identified.
Based on the results, it is predicted that the filaggrin gene will be found to be a major gene for these diseases in the global sense.
Eczema affects one in five children in the UK alone and is just as common in most parts of the world. In the UK and Irish populations, the Dundee and Dublin groups have shown that the filaggrin gene is involved about half of the severe, difficult-to-treat cases of eczema.
Conditions that suggest Eczema
Risk factors for Eczema
Allergy / Intolerance to Foods (Hidden)
Foods which have commonly been linked to atopic dermatitis include milk, wheat, eggs, soy and peanuts. [J Allerg Clin Immun 1983;71: pp. 473-480] Other studies have found that chocolate, seafood, oranges, celery and yeast may provoke symptoms. [Allergy 1989;44: pp. 47-51]
Thirty-five children with atopic dermatitis were proven to be allergic to various foods by dietary elimination and challenge, radio-allergosorbent test (RAST) and human basophil degranulation test (HBDT). Oral sodium cromoglycate improved skin lesions in these patients and protected them from the effects of challenge with food allergens. This protective effect of oral sodium cromoglycate may be explained by the blocking of the immune response in the gut wall and of antigen entry. [Ann Allergy. 1981 Sep;47(3): pp.173-5] The initial dose was 100mg per day and was progressively raised to 200-600mg per day, depending on the response.
Dysbiosis, Bacterial
Fecal and duodenal flora in patients with atopic eczema have been studied. Evidence of small bowel dysbiosis and subtle malabsorption phenomena was found in the majority of cases.
History of eczema
Foot itching
Eczema suggests the following may be present
Allergy / Intolerance to Foods (Hidden)
Foods which have commonly been linked to atopic dermatitis include milk, wheat, eggs, soy and peanuts. [J Allerg Clin Immun 1983;71: pp. 473-480] Other studies have found that chocolate, seafood, oranges, celery and yeast may provoke symptoms. [Allergy 1989;44: pp. 47-51]
Thirty-five children with atopic dermatitis were proven to be allergic to various foods by dietary elimination and challenge, radio-allergosorbent test (RAST) and human basophil degranulation test (HBDT). Oral sodium cromoglycate improved skin lesions in these patients and protected them from the effects of challenge with food allergens. This protective effect of oral sodium cromoglycate may be explained by the blocking of the immune response in the gut wall and of antigen entry. [Ann Allergy. 1981 Sep;47(3): pp.173-5] The initial dose was 100mg per day and was progressively raised to 200-600mg per day, depending on the response.
Dysbiosis, Bacterial
Fecal and duodenal flora in patients with atopic eczema have been studied. Evidence of small bowel dysbiosis and subtle malabsorption phenomena was found in the majority of cases.
Eczema can lead to
Pruritus Ani
Skin conditions such as psoriasis, eczema and seborrhea can cause symptoms in several different areas of the skin surface, including around the anus.
Recommendations for Eczema
Grapefruit / Citrus Seed Extract
When dysbiosis is present, treatment with antibiotics or with a natural antibiotic derived from grapefruit seeds has produced major improvement in the GI symptoms of eczema patients and moderate improvement in the severity of eczema. One advantage in the use of grapefruit seed extract over conventional antibiotics lies in its antifungal activity. This agent adds a second therapeutic dimension and eliminates the possibility of secondary candidosis. The minimum effective dose of grapefruit seed extract for bacterial dysbiosis is 600mg per day.
Green / Oolong / BlackTea (Camellia sinensis)
In one study, a 10gm bag of Oolong tea was soaked in 1 liter of boiling water, 1/3 of which was consumed after each meal of the day. Reduced itching and inflammation was reported and 54% showed a good or better response after 6 months of use.[Archives of Dermatology (2001;137: pp. 42-3]
Evening Primrose Oil / GLA
Please see the link between Eczema and Essential Fatty Acids.
St John's Wort (Hypericum perforatum)
A St. John’s wort extract cream (1.5% hyperforin) was applied to one side of the body twice daily for 4 weeks in a well-controlled study of 21 patients with mild to moderate atopic dermatitis. The treated side experienced reduced eczematous lesions. St. John’s wort cream did not reduce skin colonization by Staphylococcus aureus. [Hautarzt 2003;54(3): pp.248-53 (German)]
Neem
In the case of eczema, clinical studies demonstrate that even the application of weaker Neem leaf extracts effectively cured acute conditions of eczema. Using a soap or shampoo containing Neem oil can easily relieve the itching and redness of eczema. For specific areas of need on your skin apply Neem cream after bathing and/or shampooing with Neem oil products.
Gluten-free Diet
Restriction of all gluten and casein containing foods and regular exposure to sun provide additional valuable measures in healing this challenging problem. [BMJ (electronic edition) 12 July 2002]
Increased Fruit/Vegetable Consumption
Eczema can be triggered by allergies, and according to data from double-blind research most children with eczema have food allergies. However, classical food allergens are often not the cause of eczema in adults. A variety of substances have been shown, in a controlled trial, to trigger eczema reactions in susceptible individuals; avoidance of these substances, such as aromatic compounds found in fruits, has similarly been shown to improve eczema. These reactions do not represent true food allergies, but are instead a type of food sensitivity reaction. The authors of this study did not identify which substances are the most common triggers of the condition.
Conventional Drugs / Information
Apollo Pharmaceuticals has conducted research to characterize the Pharmacological profile of Relieva, a topical preparation containing Psorberine in Novasome, a proprietary liposome formulation. The in vitro studies to specifically determine the immunoregulatory effects of Psorberine, a natural product, show that: it is a potent anti-inflammatory compound.
Because the clear anti-inflammatory profile of psorberine (in psoriasis) suggests that it might also be effective in atopic dermatitis, we decided to determine the efficacy and tolerability of Relieva in adult patients with Atopic Dermatitis (eczema) and an open label study was conducted in the USA. Forty two patients were enrolled in the 12 week trial carried out by Global Clinicals Inc. Efficacy and safety was assessed using EASI scores and a Subject Reported Questionnaire.
Study results showed significant improvements with respect to EASI scores by comparison to subject’s baseline scores. In addition, subjects responding to a post treatment evaluation questionnaire indicated a substantial benefit when rating effectiveness, itching and appearance as a result of using the study preparation. September 2007.
“Relieva has exceeded our expectations in treating eczema because it was originally formulated to treat psoriasis but the new result for treating eczema and Atopic Dermatitis are amazing. These recent clinical trial and laboratory studies have been a pleasant surprise.” — D.J. Weiland
Chemical Avoidance
Considerably more people than previously believed are allergic to the most common fragrance ingredient used in shampoos, conditioners and soap. A thesis presented at the Sahlgrenska Academy, University of Gothenburg, Sweden found that over 5% of those who underwent patch testing were allergic to the air oxidized form of the fragrance ingredient linalool.
“I would suspect that about 2% of the complete population of Sweden are allergic to air oxidized linalool. That may not sound very much, but it is serious since linalool is so widely used as a fragrance ingredient. Linalool is found in 60-80 % of the perfumed hygiene products, washing up liquids and household cleaning agents that can be bought in the nearest supermarket, and it can be difficult for people who are allergic to avoid these products”, says dermatologist Johanna Bråred Christensson, author of the thesis.
Around one person in five in Sweden has some form of contact allergy. Nickel is by far the most common substance that causes eczema, but the thesis shows that oxidized linalool occupies third place in the list, after nickel and cobalt.
In the study, oxidized linalool was added at patch testing for more than 3,000 patients who wanted to find out what was causing their eczema. Between 5% and 7% proved to be allergic to the oxidized form of the fragrance ingredient.
“Linalool is present in many products around us, and this is probably the reason that contact allergy to this material is so common. Some people can shower with shower cream that contains linalool but never develop contact allergy, but we know that the risk increases as the exposure to the substance increases”, says Johanna Bråred Christensson.
Linalool is a fragrance ingredient found naturally in lavender, mint, and other plants. Linalool breaks down when it comes into contact with oxygen, it becomes oxidized and can cause allergy. Manufacturers do include other substances in the products to delay this oxidation process, but allergenic substances can still be formed from linalool when it is stored.
“One way of trying to minimize exposure to oxidized linalool is to avoid buying large packs of soap and shower cream, and always to replace the top after using a bottle”, says Johanna Bråred Christensson.
Personal Hygiene Changes
Please see the description of a new soap being used to treat facial skin problems under “Personal Hygiene Changes”.
Test for Food Allergies
Food allergy detection and elimination should not be overlooked in searching for the causes of eczema. Many studies have documented the major role that food allergy plays. In cases of atopic dermatitis, eggs, milk, wheat, soy protein and peanuts are the most common offending foods. Inhalant allergens such as house dust mite, pets, pollen and cut grass may also cause an acute flare-up of eczema.
Hydrochloric Acid (Trial)
If improvement isn’t clear when using zinc or essential fatty acids, consider HCl and pancreatic enzymes. The pancreas manufactures picolinate, which is used in zinc absorption. A Dr. Bray, MD, as well as linking asthma to a high rate of HCl deficiency, found that in severe eczema 50% of subjects were hypochlorhydric. Most cases are not this severe, but the possibility of HCl deficiency should be checked.
Test Thyroid Function
Hypothyroid patients with eczema respond well to thyroid medication.
Zinc
One university study found that in subjects suffering from marginal zinc status, an enzyme involved in cell reproduction was uniquely impaired in the skin. Clinical experience has shown zinc supplementation to be particularly valuable in treating eczema, probably due to its being a common deficiency and its importance in delta-6-desaturase. Zinc may provide some benefit either orally or topically.
Essential Fatty Acids
In published studies, a mixture EFAs from safflower, sunflower and flax oil provided benefit. This is a condition where delta-6-desaturase is often impaired. It may be wiser to start with oil that contains GLA and, if improvement occurs, switch to a cheaper oil. GLA can be used in doses up to 1gm (of actual GLA) per day in more serious cases. Add vitamin E at the same time any EFAs are used.
Primarily in children, the first step is a limitation of n-6 fats that are converted to inflammatory arachidonic acid lipoxygenase mediators. N-6 fats are common in nearly all polyunsaturated vegetable oil products (with the exclusion of olive and canola oils, which are relatively high in n-9 and n-3 fats respectively). Bakery products are particularly troublesome, as high percentages of the n -6 fats have been converted to trans isomers that further exacerbate the dermatitis.
The second step would be to increase n-3 fats such as EPA and DHA that are common in fish oils. Cod liver oil is profoundly effective here as it has significant quantities of vitamin D and vitamin A that frequently provide synergistic therapeutic effects. Typical daily therapeutic quantities of n-3 fats are 300 mg per 4 kg of body weight. Supplementation with ALA (i.e. flax) is frequently not sufficient to generate significant quantities of EPA and DHA.
Also consider limiting most grains and fruit juices as they are rapidly converted to simple carbohydrates that increase insulin levels which can disturb EFA metabolism. [BMJ (electronic edition) 28 June 2002]
Vitamin B12 (Cobalamine)
The results of the following study suggest that topical application of vitamin B12 is a safe and effective eczema treatment.
Vitamin B12 inhibits production of inflammatory cytokines and can trap nitric oxide, making it less harmful. A study investigated the effect of a topical application of a vitamin B12 containing cream on eczema severity in 41 people aged 18 to 70 years. The participants were randomly assigned to apply a vitamin B12 cream (containing 0.07% cyanocobalamin, a form of vitamin B12) to affected areas on one side of the body, and a placebo cream to affected areas on the other side of the body two times per day for eight weeks. The severity and extent of eczema was rated at the beginning of the study and at two, four, six, and eight week intervals thereafter. The participants and doctors also assessed each treatment’s effectiveness and how well it was tolerated.
For all participants, the extent and severity of eczema were significantly less on the side of the body treated with the vitamin B12 cream than on the side treated with the placebo cream. Both the doctors and the study participants rated the vitamin B12 cream as superior to the placebo cream in effectiveness and tolerability. Only a few mild adverse reactions (local skin irritation) were associated with use of the vitamin cream. [British Journal of Dermatology 2004;150: pp.977-83]
It does not appear that vitamin B12 cream is readily available at this time. One large United States compounding pharmacy was contacted and they were not producing it as of June 2005. However, they were willing to make a 0.07% cream on a prescription basis (not for resale). If interested, you could have your doctor contact McGuff Compounding Pharmacy and request this item. Apothecure also offers a 200mcg/ml gel on a prescription basis.
Vitamin E
Supplementation with vitamin E for 8 months improved symptoms and reduced serum IgE levels in a placebo-controlled study of 96 patients with atopic dermatitis. [Int J Dermatol 2002;41(3): pp.146-150]
Vitamin A
Vitamin A can be useful in any skin healing process. Levels of 10-15,000 IUs are usually sufficient.
Vitamin Paba
Weeping eczema has been noted in some people with PABA deficiency as well as patchy areas on the skin.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Eczema
Swelling of the outer skin of unknown cause. In the early stage it may be itchy, red, have small blisters, and be swollen, and weeping. Later it becomes crusted, scaly, and thickened.
Dermatitis
A general term used to refer to eruptions or rashes on the skin.
Seborrhea
Skin disease characterized by dry or moist, greasy, yellow crusts or scales.
Atopic
Genetically predisposed toward developing immediate hypersensitivity reactions to common environmental allergens.
Allergy
Hypersensitivity caused by exposure to a particular antigen (allergen), resulting in an increased reactivity to that antigen on subsequent exposure, sometimes with harmful immunologic consequences.
Allergic Rhinitis
Also known as hay fever, this is an inflammation of the nasal mucous membranes that is caused by specific allergen(s). It is an allergy characterized by sneezing, itchy and watery eyes, a runny or stuffy nose, coughing and a burning/scratchy sensation of the palate and throat.
Asthma
A lung disorder marked by attacks of breathing difficulty, wheezing, coughing, and thick mucus coming from the lungs. The episodes may be triggered by breathing foreign substances (allergens) or pollutants, infection, vigorous exercise, or emotional stress.
Biopsy
Excision of tissue from a living being for diagnosis.
Eosinophil
The eosinophils, ordinarily about 2% of the granulocyte count (60 to 75% of the white blood cells), increase in number in the presence of allergic disorders and parasitic infestations.
Vesicle
Small sac.
Anxiety
Apprehension of danger, or dread, accompanied by nervous restlessness, tension, increased heart rate, and shortness of breath unrelated to a clearly identifiable stimulus.
Zinc
An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.
Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with one teaspoon herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Tinctures may be used singly or in combination as noted. The high doses of single herbs suggested may be best taken as dried extracts (in capsules), although tinctures (60 drops four times per day) and teas (4 to 6 cups per day) may also be used.
Yeast
A single-cell organism that may cause infection in the mouth, vagina, gastrointestinal tract, and any or all bodily parts. Common yeast infections include candidiasis and thrush.
Basophil
The basophils account for about 1% of the granulocyte count (60 to 75% of the white blood cells). They release chemicals such as histamine and play a role in the inflammatory response to infection.
Sodium
An essential mineral that our bodies regulate and conserve. Excess sodium retention increases the fluid volume (edema) and low sodium leads to less fluid and relative dehydration. The adult body averages a total content of over 100 grams of sodium, of which a surprising one-third is in bone. A small amount of sodium does get into cell interiors, but this represents only about ten percent of the body content. The remaining 57 percent or so of the body sodium content is in the fluid immediately surrounding the cells, where it is the major cation (positive ion). The role of sodium in the extracellular fluid is maintaining osmotic equilibrium (the proper difference in ions dissolved in the fluids inside and outside the cell) and extracellular fluid volume. Sodium is also involved in nerve impulse transmission, muscle tone and nutrient transport. All of these functions are interrelated with potassium.
Allergen
A substance that is capable of producing an allergic response in the body.
Antigen
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Milligram
(mg): 1/1,000 of a gram by weight.
Duodenum
First portion of the small intestine between the pylorus and jejunum.
Psoriasis
An inherited skin disorder in which there are red patches with thick, dry silvery scales. It is caused by the body making too-many skin cells. Sores may be anywhere on the body but are more common on the arms, scalp, ears, and the pubic area. A swelling of small joints may go along with the skin disease.