Eczema

Eczema: Overview

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.

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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.

Incidence; Causes and Development

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 10% of infants and 3% of the U.S.  population overall.  The skin rash is very itchy and sometimes disfiguring.

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.

Signs and Symptoms

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.

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.

Diagnosis and Tests

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.

Treatment and Prevention

Proper, early and regular treatment by a dermatologist can bring relief and also may reduce the severity and duration of the disease.

The historic use of arctium lappa and other inulin-containing herbs for eczema has scientific validity.

Prognosis

The condition often improves during childhood, and almost always before age 25.  About 60% of patients have some degree of dermatitis and some suffer throughout life.

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.

Signs, symptoms & indicators of Eczema:

Lab Values - Cells

(Somewhat/highly) elevated basophil count

Various chronic forms of dermatitis can increase basophil levels.

Symptoms - Nails

Symptoms - Skin - Conditions

Itchy/scaly nipples

Itchy, scaly and cracked nipples are a sign of eczema.  The itching can make this an embarrassing condition.  It occurs mainly in women in their late teens, and usually affects both nipples.  It may be only on the nipple, or may affect the flatter area surrounding the nipple (the areola).  Scabies should also be ruled out.

Conditions that suggest Eczema:

Symptoms - Skin - Conditions

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Risk factors for Eczema:

Infections

Bacterial Dysbiosis

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 suggests the following may be present:

Infections

Bacterial Dysbiosis

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.

Recommendations for Eczema:

Botanical

Grapefruit 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.

Diet

Not recommended
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.

Digestion

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.

Drug

Antihistamines

Antihistamines can relieve itching and break the 'itch-scratch-itch' cycle which many eczema sufferers say is the worst symptom.  Although scratching relieves an itch, it also worsens inflammation and itching by causing more inflammatory substances to be released in the skin.

Environmental

Change In Clothing Habits

Wear loose-fitting clothes to help reduce sweating, and avoid rough-textured clothing.  Wash clothing with mild soaps only and rinse thoroughly.

Chemical Avoidance

Avoid exposure to chemical irritants and any other agent that might cause skin irritation.

Lab Tests/Rule-Outs

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.

Test Thyroid Function

Hypothyroid patients with eczema respond well to thyroid medication.

Mineral

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.

Nutrient

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.

Physical Medicine

Topical Applications

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.

Vitamins

Vitamin A

Vitamin A can be useful in any skin healing process.  Levels of 10-15,000 IUs are usually sufficient.

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