Eczema

eczema

What is Eczema?

The term eczema is a word which comes from the Greek language and
when translated essentially means “to boil out.” A long time ago health-care practitioners literally believed that if a person had eczema their skin was boiling, and that this outward manifestation was due to heat being produced in the body and eczema was the skin literally boiling out of the body.

About 1%-2% of adults have a skin rash which is due to eczema, and this skin condition is even more common in children. Most of those who are affected with eczema as adults will have their first episode before 5 years of age. For most eczema sufferers, this annoying skin disease will improve with time, but unfortunately for an unlucky few, eczema can be a chronic and recurrent disorder.

What I find interesting is that many practitioners get confused with skin diagnoses, and various cases of psoriasis I have seen were diagnosed as eczema, and cases of dermatitis were diagnosed as eczema or psoriasis. It can get very confusing indeed, but once you have seen countless skin cases you soon get a feel for what represents eczema and what is psoriasis or dermatitis. The term “dermatitis” is often given to skin cases which are inflammatory by nature, and hence eczema is sometimes called dermatitis for that reason. Here’s a good tip to remember in medicine, anything ending in “itis” generally refers to an inflammatory condition.

dermatitis_1What is the difference between dermatitis and eczema?

The difference between dermatitis & eczema is not always that easy to determine both of these skin conditions are very similar. Dermatitis tends to be a more localised allergic reaction to a specific substance like a chemical in soaps or makeup, that comes in contact with the skin. Eczema differs from dermatitis in that it is often the result of an allergy, asthma or hay fever.

Dermatitis can be either acute or chronic, and in the acute skin lesions of dermatitis you will generally find small fluid-filled structures called vesicles that are usually found on red and swollen skin (see the image on the left). Dermatitis lesions can even resemble the vesicles of herpes at times and I have know this to confuse some practitioners! When these little vesicles break open (and they can they can be so very itchy), fluid leaks out which will generally cause weeping and oozing to occur. When this fluid dries out, it produces a thin crust. In more chronic cases of dermatitis, you will find older lesions, and these vesicles may be harder to diagnose because they won’t have the characteristic fluid filled vesicles. A skin specialist can do an examination of the skin tissue under the microscope which will usually confirm the diagnosis.

The more common forms of dermatitis include allergic contact dermatitis (an allergy to a common substance like poison oak, stinging nettle or the metal nickel), irritant dermatitis (from excessive contact with a chemical substance – I have seen this in sheet metal workers, boilermakers, coach builders, fitters and turners and those who use lubricants and various hand cleaners), fungal infections (candida patients are more prone to dermatitis), scabies infestations, and seborrheic dermatitis (the scalp or inside the ear, also called cradle cap in infants).

I find that eczema differs from dermatitis in that it tends to run more in families and can be a chronic ongoing condition. The eczematous lesions can (and more likely with young children) become infected due to scratching, and like dermatitis, the eczema can crack, causing oozing and weeping of the area.

Unfortunately, the doctor with any infection will prescribe an antibiotic, further undermining the immune system and particularly the digestive system, causing leaky gut syndrome to develop. And unfortunately that’s when the fun starts, because leaky gut syndrome is linked to food allergies, which only further exacerbate the eczema. My recommendations? Use Tea Tree oil neat on the skin with any infections, that will solve the problem quickly in most all cases. I’ve given up counting how many children I’ve seen who have developed recurring eczema after antibiotics. Ask any naturopath and they will be quick to tell you of the relationship of eczema and antibiotics and a child.

What is psoriasis?

If you want to know a lot more about psoriasis, the signs and symptoms and causes and my treatment recommendations for psoriasis then please go to our psoriasis page. Psoriasis is known as an auto-immune condition, meaning that it is caused by the immune system itself attacking the skin cells and causing certain cells to grow and multiply too quickly. It is quite different from eczema and dermatitis, and it is truely amazing how practitioners get skin conditions mixed up.

Atopy

Atopy refers to a lifelong and inherited (genetic) predisposition to inhalant allergies such as asthma and allergic rhinitis (hay fever). While atopic eczema is not in itself an allergic disease, atopic patients are much more likely to have asthma, hay fever, and even various forms of dermatitis. Atopy is not as common as eczema itself, and can affect all races and ages, and particularly including young infants.


Atopic Eczema Case History

Here is a case of a 5 month old boy brought to our rooms with eczema and many other chronic health complaints, Anna, the boy’s mother, wrote a nice email which I have included below.

“The biggest hurdle I have found in the dealing with my child’s allergies is the resistance of the medical system with anything “natural” – doctors were of absolutely no help at all”.  Anna Reeves

“My name is Anna Reeves, and I don’t know if you remember, but I came to see you in August 2006 with my 5-month-old son Hamlin, who was exclusively breastfed and suffering from eczema, runny stools, excessive wind, sinus/breathing/ear problems, and reflux.

I saw you for an initial consultation, and you gave me dietary tips and a diet plan to follow (you suggested the most likely foods to be, etc). I also bought some children’s nutritional supplements from you. I started the diet that day and within literally two weeks the reflux/vomiting after feeding had stopped. The eczema got worse and worse, though I knew I was doing the right thing (you said this may happen and explained why, which I found really helpful) and I persevered with the dietary changes you suggested. I didn’t use any steroid doctor-prescribed creams (only natural products to help soothe the skin) Within  6 months we were ONE HUNDRED PERCENT symptom-free. It was truly unbelievable. Hamlin is now a healthy, happy, still completely symptom-free 17 month old. I am still breastfeeding and neither of us eat the allergenic foods you pointed out.

He is way off the Plunket charts for his age in weight, and eats like a horse – meat, fish, seafood, veges, fruit and some gluten-free bread/pasta. I have learnt to cook and enjoy food around his allergies and realised that I was highly allergic to these foods myself, I can not tolerate them whatsoever. My own health and vitality has improved ten-fold.
Hamlin has had no immunisations (you advised me to think carefully about my choices in view of his allergies and poor immune function) I did further research and made a definite (informed choice as you pointed out) decision to NOT immunise. And my son has never EVER been sick since I made the changes you suggested, nor needed to see any doctor or have any type of drug based allopathic medicine.

To be honest, he biggest hurdle I have found, in the dealing with Hamlin’s allergy journey, is the resistance of the medical system – I truely found that the doctors were absolutely no help at all. Most practitioner’s attitudes in general too – everyone I talked to about eczema could only offer me info/experiences with “interventions” – formulas, herbs, steroid creams, etc etc. There was little support or understanding out there for “self-management” or “alternative” ways of dealing with allergies and actually getting to the bottom of the cause.

So, I am emailing you to share my story’s conclusion. I never thanked you and want to do so wholeheartedly. The consultations I had with you really gave me the tools to educate myself and free my son (and myself) from our own personal hell due to the symptoms he (and I, unknowingly) were suffering. I am so grateful that “on a desperate whim” decided to see you and you were there to share your knowledge. You were understanding, easy to talk to and explained everything so well. I hope my story helps other parents seek help – like the information you gave me.

               Hamlin (below) at 5 months
Hamlin (right) at 16 months

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Hamlin2

I have emailed you a photo of him at 5 months (to be honest I didn’t take any pictures when it got worse – I couldn’t bare to) –  you can see the eczema on his cheeks, head and stomach. And another at 16 months. Please feel free to share these pictures with other mums so that they can see that there IS life beyond drugs and steroids.
Sorry this has been so long and please feel free to use any of it, in any way you see fit as a testimonial.
Thanks again Eric, for all your help”. Anna Reeves  New Zealand


Eczema Causes – Genetic

It is generally agreed that the tendency towards atopy is a genetically inherited condition. I have found quite often that when a parent brings their child into our clinic with eczema, there is often a close relation such as the mother or father who also had eczema, or hay-fever or asthma as a child. People with eczema have been found to have a wide variety of abnormal immunologic findings which are probably related to one or more genetic defect. For example, such individuals tend to have elevated IgE antibody (immunoglobulin E) levels and may have issues in fighting off certain viral, bacterial, and fungal infections. Others will have a more exaggerated response towards certain triggers such as house dust or dust mites. People with eczema however may have elevated IgE and IgG levels, immediate or delayed immunoglobulins.
There is little doubt, like most other non-infectious diseases, eczema can be triggered by various environmental factors. One of the biggest finding I have seen with most all cases of eczema is excessive skin dryness, which seems to be due a lack of certain skin proteins. Any factor that promotes dryness is likely to exacerbate eczema.

Non Atopy Eczema Causes

The priority of the naturopath is to uncover the likely cause/s of any chronic or acute condition. Sometimes the cause is not always that apparent though. What if a child presents with eczema, and no parents, relations or any distant relatives have immune problems? Why would a child develop eczema? Surely there must be one or more causes why a child develops a skin condition such as eczema. There sure is, and in my opinion there are several likely reasons and here are a few likely causes which I see time and again in my clinic. One of the biggest reasons? – Antibiotics.

  • The child was only breast fed for a few weeks and then placed onto a (usually milk/whey based) infant formula.
  • The child developed a “mysterious skin rash” not long after antibiotics were given.
  • The child was born premature and was given (heavens forbid) intravenous antibiotics in hospital.
  • The child was given cow’s milk before he/she turned one year old, developed reflux and has been treated with an acid blocker like Omeprazole for colic or reflux.
  • I see cases quite regularly of children with eczema and also chronic digestive complaints, why? try to see if antibotics were prescribed some while ago, they usually were.
  • The child was diagnosed as being as asthmatic and placed on a “preventive” inhaler (inhaled steroid) and a broncho-dilator (Ventolin – Salbutamol), six months or one year later the skin rash developed.
  • The child went from a milk-based formula to a soy-based formula, and the skin became problematic after.
  • The adult had eczema, asthma and hayfever all his/her life. In several cases I have found that these adults had an extensive background of antibiotics.

zovirax_cream

Pharmaceutical Drugs Cause Eczema

Pharmaceutical drugs1 most common for producing eczema include: ALL antibacterial drugs (especially aminoglycosides, antibiotics like amoxycillin, ampicillin, erythromycin, gentamycin, lincomycin, rifamycin, cephalosporins), antimycotic (antifungal)  drugs, anti viral drugs, tromantadine hydrochloride, idoxuridine, acyclovir (Zovirax), antiparasitic drugs, antihistamines, phenothiazines, steroids, non steroidal anti inflammatory drugs, anesthetics, and anticancer drugs.
(1) Drs Ruggero Caputo and Stefano Veraldi, two Italian dermatologists at the University of Milan (Eczema, Ronald Marks, ed., Martin Dunitz Ltd, London)

Environmental Triggers Of Eczema

Eczema has many different causes, and there are several possible environmental causes apart from genetic and iatrogenic (drug-induced) causes I have already listed, here are the most common environmental causes of eczema.

  • Harsh soaps and detergents (additives,   chemicals)
  • Hand cleaners (chemicals)
  • Various solvents (fuel, turpentine, paint thinners)
  • Low humidity
  • Lotions (many contain petroleum derived ingredients)
  • Rough wool clothing
  • Sweating
  • Rubber or plastic gloves
  • Rubbing
  • Staphylococcal bacteria
  • Repeated wetting and drying of the skin

Eczema Symptoms and Signs

Doctors sometimes refer to eczema as “the itch that produces skin rashes.” Eczema can be extremely distressing for some children, and the rash can cause equally as much much distress for the parents because their child may even find it hard to get to sleep. Eczema will often become more more irritable as the skin warms up (in bed) which will make a child itch and scratch her skin until it literally bleeds.

 Here are some of the more typical signs and symptoms of eczema:

  • Intense itching is often the very first symptom.
  • The rash appears sometime later and may appear red, blotchy and bumpy.
  • The eczematous skin rash may itch or burn.
  • If the rash is scratched, it may ooze and become crusty.
  • Chronic rubbing of the skin may produce thickened plaques of skin.
  • Painful cracks can develop over time.
  • Although the rash can be located anywhere on the body, it is most often found around the neck, flexures of the arms (behind the elbow) and the flexures of legs (behind the knee).
  • Infants may commonly exhibit the rash on the torso and face.
  • As the child begins to crawl, the rash may involve the skin of the elbows and knees.
  • The itching may be so intense that it interferes with sleep causing insomnia (for both the parents and the child!)

Conventional Eczema Treatment – Steroids

steroid_cream_1_1Your medical practitioner will generally prescribe a hydrocortisone cream which is generally regarded a “sufficient” to control the rash. Once your doctor has diagnosed eczema, the mainstay of therapy is generally an anti-inflammatory medication and relief from the itching. Emolients (skin moisturisers ) are recommended to soften and moisten dried skin. What I find interesting is that medical professionals don’t generally consider the diet to be of much concern, and are quick to recommend a steroid cream to “cure” (more likely suppress) the rash of eczema.  Apart from that, it is all about treatment rather than trying to establish any likely cause.

Leaky Gut Syndrome and Eczema

The other interesting point worth raising is that Western medicine has little if any regard for the digestive system’s involvement in terms of a person’s immune system. Natural health and integrative medicine practitioners are well aware of leaky gut syndrome, a condition where the small intestine becomes more permeable to the immune system, allowing certain protein molecules to adversely affect immunity. Antibiotic drugs are linked with destroying the beneficial as well as non-beneficial bowel flora, increasing bowel permeability, thereby facilitating the progress of leaky gut syndrome.
Prescription-strength steroid creams, moisturisers and sometimes antihistamine medications are the basic treatments offered. If your doctor has determined that you have a secondary bacterial infection complicating your eczema rash, then an antibiotic may be prescribed. For severe cases of eczema which do not respond to a high-potency steroid cream, alternate treatments with other aids may be tried, and these include coal tar, PUVA (psoralen + ultraviolet A light), and (heavens forbid!) if the case is particularly resistant to treatment, then chemotherapeutic drugs may even be prescribed – yes, for eczema.

Systemic Infection

In a few rare cases, eczema can become a systemic infection, the skin may become that irritated that it actually begins to breaks down and large areas can become infected. So what do you need to look out for? –  If the rash has become red, hot, and very painful or if a fever develops, an emergency department visit may be necessary if you cannot see your doctor within 24 hours.

Diagnosing Eczema

I can usually identify eczema quite quickly just by looking at the rash and asking the patient (or caregiver) questions about how it appeared.

The four key elements in identifying eczema are:

  1. Characteristic appearance and distribution of a chronic rash, often red in appearance.
  2. Dryness of skin, quite notable in many cases.
  3. Severe itching, can drive the person crazy.
  4. Atopy, or a personal or family tendency toward asthma and hay fever.
eczema_of_leg_1

Eric’s Eczema Treatment Recommendations

  • The first thing you want to get for your child is a great product called Skin Repair. It is a formula we are having really good feedback from and it made from Pure Emu Oil along with calendula.
  • Remove whatever is causing the allergic reaction is the easiest and most effective treatment. You may want to start with your diet first, see my Hypo-Allergenic Diet Sheet.
  • I invariably find that many cases flare-up on day two to three after following my Hypo-Allergenic Diet. This is normal in some cases, and occurs due to a heightened response from the remaining antibody/antigen complexes. Once you stop eating the foods or drinks which stimulate the immune system, you will invariably find that an immune system (not having to contend with the continual ingestion of antibodies) will do a little “housekeeping”. Flare ups can be helped significantly with a good multi-probiotic and an Omega 3, a superb anti-inflammatory.
  • Another good tip is to change your laundry detergent to a more natural product, as your health-food shop.
  • A change may be necessary. Sometimes in really chronic cases, a change to a new climate or even changing jobs may give the breakthrough.
  • Take a good probiotic to help repair any underlying leaky gut. The most successful cases of eczema are the ones that remained on a top quality Omega for a few months. I recommend supplementing from three to twelve months.
  • Do not take hot showers, take warm showers or baths. Hot showers only irritate and dry the skin out more easily.
  • Use a mild soap (a glycerin soap, one you can see through) or a liquid natural body cleanser.
  • Use an emollient. Before drying off, apply an effective emollient to the wet skin. Emollients are substances that prevent the evaporation of water. They do not flow and will leave a slightly greasy feel on the skin. Commercial emollients contain petroleum jelly (stay away from those petro-chemical products please) Again, ask your health-food shop for a good product here, you wll find that there are several choices. Emu oil for example is superb.
  • Wear natural fibres like merino or pure cotton undergarments and avoid wearing tight-fitting, rough, or scratchy clothing, especially rough woollen clothing.
  • Try to avoid scratching the rash. If you can’t stop yourself from scratching, cover the worst areas with a dressing. A good tip is to wear gloves at night to minimise skin damage from scratching. Try chickweed ointment, I have found it most effective to stop that incessant night time itching.
  • An ice cube rubbed over the worst areas can give significant relief.
  • Avoid strenuous exercise during a flare. Whenever the skin is in a flared up condition, avoid anything that causes it to flare up, this may be sports, exercise, etc. Find something milder temporarily.
  • Stress is implicated in eczema flare-ups. Avoid physical and mental stress if at all possible. The best way to avoid acute flare-ups is to eating right (The Hypo-Allergenic Diet), do some light activity, and get plenty of sleep. These healthy habits will help you stay healthy, thereby helping to prevent flares.
  • Results take time. Do not expect a quick response, like within a week. Atopic eczema is a controllable condition, but consistency in the right dietary and lifestyle habits, along with the application of treatment products is necessary.

Eczema Long Term

  • Expect slow improvement, but may come in as little as two weeks. This will especially be the case if you follow a strict avoidance diet and take the probiotic and Omega 3 continually. doctor’s drugs are for impatient patients who want results NOW.
  • Eczema often fades away in adulthood, but there is no doubt – people who have eczema can tend to have lifelong problems with skin irritation and related problems. Especially if they drink alcohol and take pharmaceutical drugs.
  • Keep the affected skin areas as clean, dry, and protected to avoid and prevent infection.
  • Avoid steroid creams, they don’t “cure” the condition just because it goes away, they more likely suppress the condition. Steroid creams have many side-effects and are not a good idea long term whatsoever.
  • Do the Hypo-Allergenic Diet for 3 months before deciding it is not working, book in to see me if the case is particularly chronic or non-responsive to treatment.
  • Use Tea Tree Oil soap and products regularly, they will help prevent infections from occurring.
  • Eczema often spontaneously improves in most individuals after puberty. In a few unfortunate individuals, it becomes chronic, resulting in occasional flares of the symptoms, often at times of very low humidity (such as winter time with the heat on).
  • People who have eczema may tend to have more issues with family and social relationships and work difficulties.
  • The role of stress inducing flare ups of eczema is poorly understood by Western medicine, and I find that high cortisol (acute stress) in particular has the ability to really flare-up the skin. Once a person becomes increasing fragile due to to a lack of sleep caused by eczema, the condition can flare more easily and repeatedly, it is therefore a top priority to ensure that the sleep patterns are restored to normal. That way, a more effective healing can take place.
  • Take Omega 3 daily, between one to three capsules each day with foods. Omega 3 is very anti-inflammatory and will help the skin significantly. Children can have a capsule mixed in with their foods.
  • Take a multivitamin daily, this makes good sense. Several trace element deficiencies have been linked with eczema.

 

References:

  • Wasserbauer, N., and M. Ballow. “Atopic Dermatitis.” Am J Med. 122.2 Feb. 2009: 121-125.
  • National Eczema Association for Science and Education
  • Asthma and Allergy Foundation of America. “Atopic Dermatitis (Eczema).”
  • International Eczema-Psoriasis Foundation. “Atopic Dermatitis.”
  • “Food allergies commonly misdiagnosed, especially among eczema patients” (Press release). National Jewish Medical and Research Center. 16 March 2009.
  • “Atopic dermatitis (eczema) – Prevention at Mayoclinic’s website”. Retrieved 2011-10-10.
  • “Daily Skin Care Essential to Control Atopic Dermatitis article at American Academy of Dermatology’s EczemaNet website”. Retrieved 2009-03-24.
  • Bathing and Moisturizing at National Eczema Association’s EASE website”. Retrieved 2008-05-07.
  • Treating Eczema at The Eczema Society of Canada’s website”. Retrieved 2008-05-07.

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