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Healthnotes

Eczema

Also indexed as: Atopic Dermatitis

Soothe your eczema irritation. This common skin condition is characterized by dry, itchy skin. According to research or other evidence, the following self-care steps may be helpful:

Avoid allergens and irritants
Work with a qualified professional to identify airborne allergens, chemicals, foods, and irritants that make your condition worse

Take fatty acids
Supply anti-inflammatory fatty acids missing in many people with eczema by taking 500 to 1,000 mg a day of GLA (gamma-linolenic acid) from evening primrose oil or borage oil, or 1,800 mg a day of EPA (eicosapentaenoic acid) from fish oils; children should take amounts proportionately less according to body weight

Help children avoid allergies with beneficial bacteria
Pregnant women and newborns should get probiotic supplements that contain 10 billion colony-forming units a day of lactobacillus-type bacteria to reduce risk of eczema in early life

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full eczema article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About eczema

Eczema is a common inflammatory condition of the skin.

Many skin diseases cause symptoms similar to those of eczema, so it is important to have the disease properly diagnosed before it is treated.

Product ratings for eczema

Science Ratings	Nutritional Supplements	Herbs
	Borage oil Evening primrose oil Fish oil (EPA/DHA) Galacto-oligosaccharides and fructo-oligosaccharides (for prevention) Probiotics	Calendula (for radiation-induced dermatitis) Chamomile St. John’s wort Witch hazel Zemaphyte® Chinese herbal formula
	Vitamin C	Calendula Chickweed Licorice Oak Oats Onion Red clover Sarsaparilla Shelled hemp seed Shiunko (topical)
See also: Homeopathic Remedies for Eczema
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Eczema is characterized by scaling, thickened patches of skin that can become red and fissured. It may also appear as tiny blisters (called vesicles) that rupture, weep, and crust over. The most troublesome and prevalent symptom of eczema is itching, which may be constant.

Dietary changes that may be helpful

Eczema can be triggered by allergies.¹ ² Most children with eczema have food allergies, according to data from double-blind research.³ A doctor should be consulted to determine whether allergies are a factor. Once the trigger for the allergy has been identified, avoidance of the allergen can lead to significant improvement.⁴ However, “classical” food allergens (e.g., cows’ milk, egg, wheat, soy, and nuts) 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 has similarly been shown to improve the eczema. Triggers included food additives, histamine, salicylates, benzoates, and other compounds (such as aromatic compounds) found in fruits, vegetables, and spices.⁵ 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.

It has been reported that when heavy coffee drinkers with eczema avoided coffee, eczema symptoms improved.⁶ In this study, the reaction was to coffee, not caffeine, indicating that some people with eczema may be allergic to coffee. People with eczema who are using a hypoallergenic diet to investigate food allergies should avoid coffee as part of this trial.

Other therapies

Avoidance of known allergens, as well as known irritants such as soap and hot water, is also recommended.

Vitamins that may be helpful

Researchers have reported that people with eczema do not have the normal ability to process fatty acids, which can result in a deficiency of gamma-linolenic acid (GLA).⁷ GLA is found in evening primrose oil (EPO), borage oil, and black currant seed oil. Some,⁸ ⁹ ¹⁰ but not all,¹¹ ¹² ¹³ ¹⁴ double-blind trials have shown that EPO is useful in the treatment of eczema. An analysis of nine trials reported that the effects for reduced itching were most striking.¹⁵ Much of the research uses 12 pills per day; each pill contains 500 mg of EPO, of which 45 mg is GLA. Smaller amounts have been shown to lack efficacy.¹⁶

Supplementation with borage oil, another source of GLA, has led to reductions in skin inflammation, dryness, scaliness, and itch in eczema patients in some,¹⁷ but not all, preliminary¹⁸ or double-blind trials.¹⁹

Many years ago, use of large amounts of vegetable oil (containing precursors to GLA) was reported to help treat people with eczema,²⁰ ²¹ but these studies were not controlled and do not meet modern standards of research.

Ten grams of fish oil providing 1.8 grams of EPA (eicosapentaenoic acid) per day were given to a group of eczema sufferers in a double-blind trial. After 12 weeks, those using the fish oil experienced significant improvement.²² ²³ According to the researchers, fish oil may be effective because it reduces levels of leukotriene B4, a substance that has been linked to eczema.²⁴ The eczema-relieving effects of fish oil may require taking ten pills per day for at least 12 weeks. Smaller amounts of fish oil have been shown to lack efficacy.²⁵

One trial using vegetable oil as the placebo reported that fish oil was barely more effective than the placebo (30% vs. 24% improvement).²⁶ As vegetable oil had previously been reported to have potential therapeutic activity, the apparent negative outcome of this trial should not dissuade people with eczema from considering fish oil.

In a double-blind trial, the addition of a mixture of 90% galacto-oligosaccharides and 10% fructo-oligosaccharides to infant formula prevented the development of eczema in infants who were at high risk of developing eczema. The incidence of eczema in the first six months of life was 9.8% in the group receiving oligosaccharides, compared with 23.1% in the placebo group, a statistically significant difference. The product used in this study was designed to mimic the oligosaccharide content of human milk, and was added at a concentration of 0.8 grams per 100 ml.²⁷

Although supplementation with 400 IU of vitamin E per day has been reported in anecdotal accounts to alleviate eczema,²⁸ research has not supported this effect.²⁹ Moreover, rare cases of topical vitamin E potentially causing eczema have appeared.³⁰ People with eczema should not expect vitamin E to be helpful with their condition.

A double-blind trial reported that use of a hypoallergenic infant formula plus probiotics (500 million organisms of Lactobacillus GG bacteria per gram of formula, taken for one month) initially led to improvement in eczema symptoms in infants with suspected allergy to cow's milk.³¹ However, by the end of two months, both the group receiving Lactobacillus GG and the placebo group had improved approximately the same amount. In the same report, a preliminary trial giving 20 billion lactobacilli twice per day to breast-feeding mothers led to significant improvement of their allergic infants’ eczema after one month. However, another double-blind trial found that Lactobacillus GG was no more effective than a placebo in infants with mild to moderate eczema.³² In another double-blind trial, a different probiotic preparation (1 billion organisms of Lactobacillus fermentum VRI-033 PCC taken twice a day) reduced the severity of eczema in a group of young children with moderate or severe eczema.³³ Probiotics may reduce allergic reactions by improving digestion, by helping the intestinal tract control the absorption of food allergens, and/or by changing immune system responses.

In 1989, Medical World News reported that researchers from the University of Texas found that vitamin C, at 50–75 mg per 2.2 pounds of body weight, reduced symptoms of eczema in a double-blind trial.³⁴ In theory, vitamin C might be beneficial in treating eczema by affecting the immune system, but further research has yet to investigate any role for this vitamin in people with eczema.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

The table below summarizes the three categories of herbs used for people with eczema: anti-inflammatories and herbs that affect the immune system (immunomodulators), astringents (herbs that bind fluids and exudates), and herbs that affect the liver (also called alteratives). Alterative herbs are poorly researched. Astringents are only helpful if applied topically when weeping eczema is present; they will not help people with dry eczema.

Mechanism of Action	Examples
Anti-inflammatory and/or immunomodulator	Allium cepa, Calendula, chamomile, chickweed, licorice, onion, Zemaphyte® Chinese herbal formula
Astringent (helps dry up weeping lesions)	Oak, witch hazel (also anti-inflammatory)
Alterative (liver-supportive)	Burdock, red clover, sarsaparilla, wild oats

Zemaphyte®, a traditional Chinese herbal preparation that includes licorice as well as nine other herbs, has been successful in treating childhood and adult eczema in double-blind trials.³⁵ ³⁶ ³⁷ One or two packets of the combination is mixed in hot water and taken once per day. Because one study included the same amount of licorice in both the placebo and the active medicine, it is unlikely that licorice is the main active component of Zemaphyte®.³⁸

Several Chinese herbal creams for eczema have been found to be adulterated with steroids. The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions.³⁹

A cream prepared with witch hazel and phosphatidylcholine has been reported to be as effective as 1% hydrocortisone in the topical management of eczema, according to one double-blind trial.⁴⁰

Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema.⁴¹ ⁴² One trial found it to be about 60% as effective as 0.25% hydrocortisone cream.⁴³

In a double-blind trial, people with eczema applied a cream containing an extract of St. John’s wort to the affected areas on one side of the body, and a placebo (the same cream without the St. John’s wort) to the other side. The treatment was administered twice a day for four weeks. The severity of the eczema improved to a significantly greater extent on the side treated with St. John’s wort than on the side treated with placebo.⁴⁴ Although the mechanism by which St. John’s wort relieves eczema is not known, it might be due to the anti-inflammatory and antibacterial effects of hyperforin, one of its constituents. The cream used in this study contained 5% of an extract of St. John’s wort (standardized to 1.5% hyperforin). As topical application of St. John’s wort can cause sensitivity to the sun, care should be taken to avoid excessive sun exposure when using this treatment.

Onion injections into the skin and topical onion applications have been shown to inhibit skin inflammation in people with eczema, according to one double-blind trial.⁴⁵ The quantity or form of onion that might be most effective is unknown.

A Japanese topical ointment called Shiunko has been reported to help improve symptoms of eczema, according to preliminary research.⁴⁶ The ointment contains sesame oil and four herbs (Lithospermum radix, Angelica radix, Cera alba and Adeps suillus) and was applied twice daily along with petrolatum and 3.5% salt water for three weeks. Clinical improvement was seen in four of the seven people using Shiunko.

Topical preparations containing calendula, chickweed, or oak bark⁴⁷ have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.

Radiation therapy for breast cancer frequently causes painful dermatitis at the radiation site. In a study of women undergoing radiation therapy for breast cancer, those who topically applied Calendula officinalis had significantly fewer cases of severe dermatitis, compared with those who used a standard medication.⁴⁸ Calendula treatment was begun after the first radiation session and was applied twice a day or more, depending on whether dermatitis or pain occurred.

Burdock, sarsaparilla, red clover, and wild oats have been used historically to treat people with eczema, but without scientific investigation.

Though it has not been studied, theoretically shelled hemp seed or its oil may be useful for people with eczema due to its content of essential fatty acids.⁴⁹

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Holistic approaches that may be helpful

Numerous trials have reported that hypnosis improves eczema in children and adults.⁵⁰ A preliminary trial emphasizing relaxation, stress management, and direct suggestion in hypnosis showed reduced itching, scratching, and sleep disturbance, as well as reduced requirements for topical corticosteroids. All of the patients studied had been resistant to conventional treatment.⁵¹

References
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3. Niggemann B, Sielaff B, Beyer K, et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999;29:91–6.

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7. Manku MS, Horrobin DF, Morse NL, et al. Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 1984;110:643–8.

8. Schalin-Karrila M, Mattila L, Jansen CT, et al. Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Br J Dermatol 1987;117:11–9.

9. Lovell CR, Burton JL, Horrobin DF. Treatment of atopic eczema with evening primrose oil. Lancet 1981;I:278 [letter].

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50. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

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