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Integrative Approach to Eczema

Eczema aka Dermatitis is, on its own, a useless term. It just means inflammation of the skin. There are many different kinds of eczema:

-Contact dermatitis: The classic is poison ivy, but can be from contact with anything

-Irritant dermatitis: Like hand eczema you get after washing dishes without gloves

-Nummular eczema: Eczema that is round

-Atopic dermatitis: This is the kind of eczema people get as a child and is associated with a family history, asthma and/or seasonal allergies

In this blog, I will be predominantly speaking about Atopic Dermatitis, but many of the recommendations I make will pertain to any eczema condition. For atopic eczema, hand eczema, and irritant eczema, the chain of events leading to misery can be summed up as follows:

Impaired skin barrier function -> -> penetration of irritants and allergens -> -> itch -> -> scratch -> -> rash

So, in order to treat eczema, you MUST make sure the skin barrier is intact and working properly.  How do we do this?


Repairing skin Barrier

1.      The right moisturizers:
-Look for the following Ingredients: Shea butter, coconut oil, glycerin, ceramides.  Some of my favorite products include Neals Yard Orange & Geranium Body Balm (This is the line I sell through my website – I am obsessed with this product and use it on hands and feet every night), Neals Yard Wild Rose Body Elixir (This is aromatherapy – happy and relaxed feeling ensue when I use it), and Alba Very Emollient Moisture Lotion Maximum (What woman does not love a product she can get her husband to use?  And it comes in big 32 ounce pump)
-Put it on after the shower when skin slightly damp
-Water at beginning of ingredient list means moisturizer will be less effective

2.      Wear Gloves while doing dishes or housework! Water and Chemical Irritants are your enemy! I like the True Blues Brand, which I bought on Amazon for about $12.  They are lined with cotton, are sturdier,  and feel a million times better than the Playtex ones.  And yes, this may sound nuts, but moisturize your hands every single time after you wash them.

3.      New York apartments are so dry, and coupled with the low humidity outside, your skin is thirsting for moisture.  So drink a lot of water, and consider getting a humidifier.  Make sure it has a HEPA filter.  I like the Venta Airwasher because it is a humidifier, an air purifier, and is very easy to maintain.

4.      Ingredients to stay away from because they have the highest rate of skin allergy in eczema-prone patients (This list from January 2014 Journal of the American Academy of Dermatology, pg 104)

  • Formaldehyde
  • Quaternium 15
  • Imidazolidinyl urea
  • Diazolidinyl urea
  • DMDM Hydantoin
  • 2-Bromo-2-Nitropropane-1, 3-diol

Do any of those sound like you would want them on your body anyway?

I also avoid parabens in my personal products, but when it is unavoidable, methylparaben and ethylparaben are not as bad as the others.

5. Lastly, do not wash your skin with harsh soaps.  I think people are too aggressive in their hygiene, and their skin pays the price. Look for soaps or body washes that have no Sodium Lauryl Sulfate, which is drying.  Look for the same ingredients as suggested above - shea butter, glycerin, and coconut oil.  Avocado oil and nut oils are good too. If your arms and legs are not dirty, plain old water is fine to wash.

Supplements for Eczema

1.      Vitamin D3 2000 units daily:

  • I like my eczema patients to be on the high side in vitamin D levels. I used the following studies to back up my recommendation for supplementation with Vitamin D3 if you are low:

A recent metanalysis which looks at many studies and collates their data found an inverse relationship between the severity of atopic dermatitis and vitamin D levels, i.e. lower vitamin D meant worse eczema, and higher vitamin D more mild eczema. Furthermore, studies have shown that, in individuals with AD who are deficient in vitamin D, repletion of vitamin D results in decreased severity of disease. i And a randomized controlled trial (the best kind) showed some benefit in supplementing with vitamin D in eczema.ii

One of the treatments for severe eczema is Ultra-Violet B light, and I was taught that this is due to the suppression of the cells that lead to inflammation in eczema, but I wonder if part of the reason people get better with light treatment is because of the increase in Vitamin D.

If a patient has eczema predominantly on the face, hands, or feet, I like to check a Zinc level as Zinc deficiency can manifest as eczema in these areas.

I am still unsure about the role of gluten in eczema. I do not routinely check for gluten sensitivity although I have patients that swear that a low to no gluten diet helps them.
2. Zinc gluconate 20-30mg daily only if you are low in zinc.

  • A zinc deficiency leads to an eczema-like rash called acrodermatitis enteropathica, so I like to make sure my patients are not low. I recommend zinc gluconate as it is the easiest to absorb and digest.

3.      The omega 3 EPA (eicosapentaenoic acid):  EPA is an essential fatty acid, meaning your body cannot make it; you have to ingest it.  About 20% of the outer layer of skin, the stratum corneum, which is responsible for the intat skin barrier, is made of essential fatty acids.  So a deficiency in these acids

  • I recommend at least 650 mg, but more is better with this one.  The best source is fish oil, and I personally take and offer my patients the Nordic Naturals ProEFA which has 850 mg of EPA, and also concentrated GLA (see #4), so you only have to take one thing.  Some of the brands are contaminated with mercury, so I think a reputable company is very important. For my vegetarians, I recommend flax seed oil.

4.      The Omega 6 GLA (Gamma-linolenic acid):  Most Americans get too much Omega 6 in our diet (from hydrogenated oils) and not enough Omega 3.  GLA is the exception to the rule of don’t eat too much Omega 6’s.  GLA is an essential fatty acid most abundant in Black Currant Seed oil, followed by Borage oil, and then Evening Primrose oil.  Most Omega 6 fatty acids increase inflammation, but GLA reduces it.  It reduces water loss from the skin, thur reducing scaliness and itchiness, and increasing skin’s feeling of suppleness. Take 500 mg a day.  You should NOT take evening primrose oil if you have seizures, and should NOT take Borage oil if you are pregnant as can induce pre-term labor.

This is a great link to learn more about GLA

Stress reduction

i Mutgi K, Koo J. Update on the role of systemic vitamin d in atopic dermatitis. Pediatr Dermatol. 2013 May- Jun;30(3):303-7.
ii Hata TR, Audish D, Kotol P, et al. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. J Eur Acad Dermatol Venereol. 2013

 Stress and Eczema

You already know this if you have eczema.  Stress and Eczema are best friends.  Eczema is an inflammatory condition, and stress increases inflammation in the body.  You need to find something that works for you tpo reduce stress, whether it is yoga, meditation, prayer, hanging out with friends and family, exercise- Stress reduction is different for everybody, and it is challenging! I use this Neals Yard Remedies to Roll aromatherapy roller.  If I have a crazy day at the office, I rub it on my wrists, and Presto, new and improved Dr. Fishman.  A glass of Red Burgundy does wonders for me too

Sorry this was such a long one - Complex topic. Be well, CF