Eczema is a debilitating skin condition, having implications for the patients’ quality of life such as physical sufferings, issues of mental and social wellbeing, and sleep deprivation. A treatment strategy incorporating use of natural eczema remedies, and precautions and preventions can help alleviate its distressing symptoms.
Eczema, also known as atopic dermatitis, is the most common form of skin inflammation. Genetic as well as environmental factors are thought to play a part in the development of this condition. Those with eczema usually have dry, scaly and itchy skin that is prone to infection. In some chronic cases, excessive scratching may induce the thickening and scarring of skin.
Intense itching is the predominant symptom of eczema, which can be quite discomforting and distressing. Repeated scratching triggers a self-perpetuating itch-scratch cycle, which can have a significant impact on the patient's quality of life.
Atopic eczema is caused due to a compromised barrier function of the outer most layer of skin, making it susceptible to the penetration of irritants and microbes.
The lifetime prevalence of eczema is about 12% in children and 7% in adults. About 60% of cases develop within the first year of life. The personal and family history of allergies such as asthma, hay fever and rhinitis is closely related to eczema.
How to Prevent Eczema
Skin hygiene is at the core of eczema management. Therefore, bathing and showering are encouraged to keep the skin clean. However, it is advised to keep baths and showers to under 10 minutes because prolonged exposure to water may wash away the protective oils that keep our skin moist.
The use of lukewarm water as opposed to hot water is recommended for bathing. A study found that the temperature of hot water in bathing/showering should be set at about 38–40 °C because the itching response is induced at a skin temperature of 42 °C or higher.
Soap substitute that is free of sodium laurel sulphate (SLS) is recommended for bathing. This chemical is a skin irritant and may act as a trigger for eczema patients. SLS free formulations of aqueous cream or emulsifying ointment are good substitutes of soap that can be purchased from the pharmacy.
After bathing, use heavy cream-based moisturiser to guard the skin against dryness. Petroleum jelly works well as an after-bath moisturiser. Avoid water based lotions, scented lotions and even baby lotions, which have a high water content, and other chemicals.
Common physical irritants that can exacerbate eczema include carpets, harsh fabrics, woollen cloths, dust mites, and chemicals found in detergents, antiseptics, chlorine and some plants and grass. Even water can be a mild irritant for sensitive skin. Avoidance of these will help to keep the eczema in
Disturbances in perspiration and excess sweat retained on the body may worsen eczema symptoms. To protect the skin surface from having excessive sweat, undergarments made of breathable and low hygroscopic fabric should be worn and warm temperatures and humidity should be avoided.
Food intolerance is another factor that can cause a relapse of eczema; hence it is important to be aware of whether any such intolerances exist. There is no formal test to assess food intolerance and so patients will need to ascertain whether they have any through trial and error. Foods that can trigger eczema include cow’s milk, tomatoes, strawberries, citrus fruits, eggs, peanuts and artificial colours, flavours and preservatives.
Any stimulation of the immune system can temporarily induce an eczema flare-up. This can be caused by a viral infection, a hidden bacterial infection (eg urinary tract infection) or emotional stress. Antihistamine therapy may be helpful in patients with a suspected stimulation of the immune system.
Sometimes intolerable itching is the most distressing symptom of eczema, and it is not an easy symptom to manage. People may scratch their skin in their sleep and wake up with skin lesions induced by scratching. In such cases thin cotton gloves can be used at night. Keeping the nails of infants short would also be good practice.
How to Treat Eczema
The treatment of eczema is aimed at maintaining a state of remission without the need for active drug therapy. The main management of eczema includes hydration and topical anti-inflammatory medications for flare-ups. The priority in treatment is focusing on a daily skin moisturising regimen with a fragrance-free ointment that has minimal preservatives.
The use of ointments improves the moisture content in the outer most layer of skin and leads to the prevention of allergen invasion and relapses, as well as suppression of itching by recovering and maintaining skin barrier functions. Hydrophilic ointments with moisture retaining properties have been used with significant benefits in managing eczema.
Studies have shown that the use of full body emollient therapy in newborns at a high risk of developing eczema, once per day starting from 3 weeks of age, had relative risk reduction of 50% as compared to those where such emollients were not used.
Several cohort studies have reported that increased Omega-3 long-chain polyunsaturated fatty acids intake during pregnancy may reduce the risk of atopic eczema and asthma. The use of omega-3 in the form of fish oil during pregnancy and the early life of newborns has been proposed as a prevention for various allergies. Omega-3 influences the cell membrane, and potentially modulates inflammatory responses.
Low levels of vitamin D have been reported in children and adults with eczema. Vitamin D regulates immune functions, and as such its deficiency exacerbates bacterial infections in the skin leading to eczema. Vitamin D has been found to improve eczema in a subset of patients who had recurrent bacterial infections.
Similarly, a double-blind randomised control trial showed a significant improvement in the active group being administered vitamin D, regardless of the initial severity of their atopic eczema. Supplementation of vitamin D is a safe health service endorsed route to prevent the deficiency of this vital vitamin for the rest of the body, particularly during the winter months.
Some studies have reported the protective effect of breastfeeding against the development of atopic eczema. Breastmilk supports diverse colonisation of microbiome besides nurturing the immune system of the newborn. There is some scientific evidence to suggest that exclusive breastfeeding until the age of four months reduces the risk of developing eczema at four years of age regardless of presence of family history of allergies and asthma.
For high-risk infants unable to be completely breastfed, hydrolysed formula milk may be used in preference of cow’s milk for reduced infant and childhood allergies. The general consensus amongst reviews is that hydrolysed milk formula in at-risk infants offers some protection against allergic diseases, in particular, eczema.
Several studies examining the role of prebiotics and probiotics in allergies have shown that alteration in gut microbiota composition can precede the occurrence of atopic eczema. The use of prebiotics for the prevention of allergy in infants reported some reduction in atopic eczema. Similarly, some specific strains of probiotics modulate gut bacteria, which influence skin inflammation and protect against developing eczema.
Kefir, tempeh and sauerkraut are probiotics packed with good bacteria. These and several other probiotics can be cultured at home using easy to follow recipes with the added benefit of cutting the cost. On the other hand specific strains of probiotics such as Lactobacillus and Bifidobacterium can be purchased from health stores. Fruits, vegetables and legumes are good sources of prebiotics due to their high fibre content.
Colloidal oatmeal has hydrating and anti-inflammatory properties that substantiate its benefit in treating eczema symptoms. Colloidal oatmeal is water attracting and helps the skin retain water. Similarly, symptoms associated with eczema dry skin, such as itching, skin irritation and increased skin sensitivity can be managed well with colloidal oatmeal.
Oatmeal containing body cream has shown to significantly improve skin hydration and reduce skin desquamation. Therefore, oatmeal cream is a valuable alternative to prescription creams with promising treatment benefits of eczema.
Colloidal oatmeal is also beneficial for eczema patients as a bath additive. Anecdotally, patients with wounds and sensitive lesions prefer oatmeal baths over bleach baths because of their tolerability and lack of irritation to the skin.
Herbs for Eczema
Herbs offer a range of actions that directly impact the skin and can be applied directly. Chickweed (Stellaria Media), for example is an extremely effective remedy for relieving the itching of eczema. It is most effective in a non-greasy form, such as poultice, lotion or cream. Alternatively, treating the bath water with a tablespoon of Chickweed oil is effective in helping sooth the skin that is itching from eczema.
The herb Gotu Kola (Centella asiatica) has been traditionally used for inflammatory skin conditions such as eczema and the research has been supportive for these claims. More prominent relieving of eczema symptoms has been observed with the gel product. Alternatively, poultice soaked in the tea made from 1 to 2 teaspoons of dried herb in a cup of very hot water has been used with benefit.
Aloe Vera is anti-inflammatory, and it is applied externally in the form of gel for wound healing and soothing inflamed skin. Because of its moisturising effect, the skin becomes softer, and wounds heal rapidly. Many eczema patients reported a decrease of eczema symptoms such as skin dryness and scaling and improved skin quality, after using aloe vera gel topically.
Chamomile cream has been used with considerable benefit in inflammatory skin conditions. Chamomile helps in skin cell regeneration and works as an antioxidant, fighting free radical damage on the skin. It is also believed to be hypoallergenic with the ability to neutralise skin irritants.
Calendula officinalis is credited with reducing inflammation and preventing infection due to eczema. The prevention of infection is associated with the antimicrobial properties of this herb which has a healing effect on skin lesions, abrasions and minor wounds caused by excessive itching. Its beneficial effects have been experienced by using it in the form of ointment which can be purchased from health stores.
Evening Primrose oil has shown promising results to ease eczema symptoms, when taken orally as a supplement. It supplies gamma-linolenic acid (GLA), an essential fatty acid that people with eczema sometimes lack. 1000 mg capsule three times a day may be taken for three to four months, for noticeable benefit.
Homeopathy for Eczema
Homeopathy has an impressive track record of successfully treating skin conditions. It is the second most common form of complementary and alternative medicine used by outpatient dermatology patients. A recent case series has shown promising results of homeopathic intervention for eczema patients and reported a sustained relieving of eczema symptoms.
Homeopathic remedies are safe and gentle in stimulating the body’s internal healing capacity, which make them equally beneficial for children and adults. Some common homeopathic remedies that have been used in treating the following types of eczema are as follows: -
Sulphur is a very important remedy for treating eczema that feels extremely good whilst scratching. After scratching, however, the skin will become sore and there is more burning. The eczema tends to ooze if scratched too much, otherwise the skin tends to be dry, red, and rough looking. Contact with water aggravates the eczema and causes great burning.
Graphites have been used with success for eczema, where skin tends to be dry and rough and secretes a very thin, sticky, gluey substance. Cracks that bleed easily may be seen. This remedy is particularly helpful for eczema on the eyelids, behind ears, around the mouth and chin, in the bends of elbow, and behind knees. This eczema oozes a fluid that is usually watery, transparent, and sticky.
Arsenicum album is useful for dry, scaly eczema that resembles fish scales. The affected area itches excessively and burns. The burning is relieved with the application of hot water or warm cloth. Varying levels of mental restlessness is often seen in patients.
Rhus tox is useful for acute outbreaks of eczema, especially if the entire body is affected. The eczema has small, fluid filled eruptions. All symptoms are worse at night, in cold, damp weather, and during winter. Scratching causes an even greater need for scratching. The eczema tends to burn and can form a thick crust that oozes an offensive substance.
Mezereum is useful for eczema that is characterised by intolerable itching, great chilliness, and sensitivity to cold air. Itching with this type of eczema is made worse at night by the warmth of the bed. This remedy is also useful for treating eczema that occurs at the site of vaccination. It has been used with encouraging results for cradle cap of children.
Eczema is a complex condition requiring a multifactorial treatment strategy to manage it. The management of eczema rash and associated itching is fundamental in improving the quality of life for the eczema patient. A combination of precautions, elimination of certain dietary items, and healthy lifestyle form the basis to treat eczema. Similarly, skin hygiene and moisturising with a suitable ointment, emollient or cream help to tame eczema symptoms. Identification of food intolerances and other triggers such as environmental allergens may be helpful in determining a precaution regime. Therefore, general awareness and knowledge of the condition by the patient, including foods to avoid with eczema, assume equal significance. Likewise, alternative and complementary health approaches and the use of some micronutrients in the form of supplements may be used with beneficial effect. In case of chronic eczema, which may well be a lifelong condition, achieving a lengthy period of remission is the core treatment strategy.
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