- Lindsey Dalton
- January 17, 2024
Exploring Eczema Treatment Through a Functional Medicine Lens
Eczema is a prevalent skin condition affecting millions worldwide that presents a complex challenge for those seeking effective treatment. This article delves into understanding eczema from the perspective of functional medicine, exploring innovative approaches while comparing them to conventional treatment methods.
Understanding Eczema
Eczema (aka atopic dermatitis) is defined as an inflammatory skin condition that causes dry, itchy skin, rashes, scaly patches, blisters and skin infections.1 It develops due to a defective skin barrier and is associated with the development of food and environmental allergies. Children of parents who have allergies or asthma are at higher risk for developing eczema.² The exact cause of eczema is unknown. According to the American Academy of Dermatology (AAD) it is caused by an interaction of environmental and genetic factors.
There are no specific laboratory biomarkers for diagnosis of eczema. Usually the skin is examined and a biopsy can be performed. Elevation of IgE levels in serum may also be seen. Most cases of eczema are considered mild but 10% are more serious. Regardless of the severity, the itch from eczema can greatly affect the quality of life of those affected.
Conventional Treatment of Eczema
Medications such as steroids, emollients, and antihistamines are commonly prescribed to treat eczema. Topical steroids are the most widely prescribed treatment for eczema as they can relieve symptoms of itching, redness and swelling because they suppress the activity of some immune cells. Other topical treatments include calcineurin inhibitors and PDE4 inhibitors. 7
Other therapies for eczema include immunosuppressants, phototherapy and wet wraps. Immunosuppressants slow down the immune system and reduce eczema symptoms. Phototherapy uses different wavelengths of UV light to reduce itch and inflammation. It is generally used when topical medications are not effective. Wet wraps can rehydrate and help topical medications penetrate the skin when severe itch and pain are present. They are dressings made from cloth soaked in warm water with a dry layer applied on top. Wet wraps should be used only when necessary, under the supervision of a skilled medical professional.8
There are limitations and potential side effects that may arise when treating eczema. Some treatments may provide symptomatic relief rather than a cure and it may require ongoing care. Treatments also vary among different patients, so what works well for one may not for another. Prolonged use of topical steroids may lead to a rebound effect where the eczema can worsen once discontinued. Some people may develop a tolerance or resistance to certain medications over time. The underlying cause of eczema such as gut dysbiosis or food sensitivities may not be addressed.
Triggers and Contributing Factors
Functional medicine addresses the root cause of eczema by considering various body systems. Individualized treatment plans may involve dietary modifications, lifestyle changes, and targeted interventions to promote overall well-being and alleviate eczema symptoms. Eczema triggers include a weakened immune system, stress, environmental allergens(dust mites, pet fur, mold) food allergens (dairy, peanuts, soy, wheat), certain fabrics, makeup, skin care products, soaps, smoke, hay fever, and damp or dry weather. These risk factors can contribute to the severity and frequency of an eczema flare if a person is genetically predisposed.
Gut dysbiosis and leaky gut can be a major contributor to the development of eczema. Once a person has a leaky gut, food particles can enter into the body and the immune system identifies them as foreign. This causes the immune system to react as if fighting off a pathogen and inflammation throughout the body increases. This systemic inflammation can present on the skin as eczema. You can learn more about leaky gut here.
Functional Medicine Approaches to Managing Eczema
Foods with anti-inflammatory properties such as veggies, fish, turmeric and ginger can help reduce inflammation and improve flares. Limiting inflammatory foods like dairy, whole grains, gluten, ultra-processed foods, nightshades (pepper, tomatoes, eggplant), flour, red meat, and sugar may also improve symptoms. There are certain diets that may be beneficial in reducing flares and symptoms. The Mediterranean diet is highly ranked since it eliminates foods linked to inflammation. The diet includes whole foods, plant-based foods and lean proteins while avoiding processed foods and limiting red meat and alcohol. An elimination diet may also help since it removes potential food triggers from the diet and adds them back in slowly one at a time. This diet helps patients determine their eczema triggers and may lower severity. 4 Food sensitivity testing can have a major impact on identifying food triggers and can help to reduce flares quickly. If you’re interested in testing, we have a kit available in our store.
There are several lifestyle modifications that may also help. Eczema patients usually have less diverse microbiomes so creating a more diverse microbiome can be beneficial. Eating high fiber, fermented foods and limiting alcohol and stress can help diversify the microbiome.5 Taking a high-quality probiotic with multiple strains of beneficial bacteria is a good way to promote a balanced microbiome as well. We love this option. We also have a blog post all about eczema and probiotics you can read here. Lifestyle modifications such as hydration, regular exercise, rest, relaxation, sufficient sleep, and maintaining proper nutrition will also help decrease stress and inflammation in the body. Identifying and addressing underlying causes with allergy testing and the elimination diet may help determine the root cause of eczema.
Bridging the Gap: Integrating Functional Medicine and Conventional Treatment
Complementary practices can be considered alongside conventional treatments for a more holistic approach to managing eczema. Proper skin care such as using fragrance-free, hypoallergenic products, mild soaps, taking lukewarm baths, and patting skin dry may help alleviate symptoms. Moisturizing skin with ointments or creams and making dietary adjustments may also help. Patients should identify potential food triggers such as dairy, gluten and preservatives while adding anti-inflammatory foods rich in omega-3 fatty acids such as fish, flaxseed and walnuts. Probiotics found in yogurts and supplements can help improve gut health, reducing inflammation. Stress management techniques such as meditation, yoga or deep breathing can limit stress related eczema flares. Collaborative care for eczema is essential for providing comprehensive, individualized, and effective management that addresses the various dimensions of this complex skin condition. It promotes teamwork, communication, and patient engagement, ultimately contributing to improved outcomes and quality of life for individuals with eczema.
Studies have found that psychotherapeutic interventions alongside standard medical care were more effective than conventional treatments alone, both for eczema and for eczema-associated psychological symptoms. The interventions included meditation and mindfulness, stress-reduction, habit-reversal training, hypnotherapy, music therapy, massage therapy, and standard psychological treatments such as cognitive behavioral therapy.10
Conclusion: A Holistic Perspective on Eczema Treatment
In conclusion, emphasizing patient-centered care and individualized approaches in eczema treatment acknowledges the diverse nature of the condition and the unique needs of each patient. This approach not only improves treatment outcomes but also enhances the overall experience of care for individuals living with eczema.
Written by Heather Sullivan, PharmD Candidate
Edited by Lindsey Dalton, PharmD
References
- Eczema | Causes, symptoms & Treatment | ACAAI Public Website. (2022, September 12). ACAAI Public Website. https://acaai.org/allergies/allergic-conditions/skin-allergy/eczema/
- National Eczema Association. (2022, November 14). Eczema (atopic dermatitis) causes, symptoms and treatment. https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/
- National Eczema Association. (2023, September 22). 7 Types of eczema: Symptoms, causes & treatment. https://nationaleczema.org/eczema/types-of-eczema/
- Whelan, C. (2023, October 18). How to create an Eczema-Friendly Diet. Healthline. https://www.healthline.com/health/skin-disorders/eczema-diet#Foods-to-avoid
- How does the ‘Gut-Skin axis’ affect eczema? (2021, September 10). Healthline. https://www.healthline.com/health/eczema/how-does-the-gut-skin-axis-affect-eczema#recommendations
- Medication for eczema & dermatitis. (n.d.). NYU Langone Health. https://nyulangone.org/conditions/eczema-dermatitis/treatments/medication-for-eczema-dermatitis#:~:text=Corticosteroids%20are%20anti%2Dinflammatory%20medications,itching%2C%20redness%2C%20and%20swelling.
- National Eczema Association. (2023a, February 22). Eczema Treatment | National Eczema Association. https://nationaleczema.org/eczema/treatment/
- Jones, K. (2022, September 26). Wet wraps: What they are and How to use them. National Eczema Association. https://nationaleczema.org/blog/get-the-facts-wet-wraps/
- D, D. J. P. (2022, December 8). Types of medication for eczema: common list & side effects. RxList. https://www.rxlist.com/types_of_medication_for_eczema/drugs-condition.htm
- Oska C, Nakamura M. Alternative Psychotherapeutic Approaches to the Treatment of Eczema. Clin Cosmet Investig Dermatol. 2022;15:2721-2735. Published 2022 Dec 14. doi:10.2147/CCID.S393290
Dr. Dalton’s areas of focus include disease state management, medication therapy management, and health/wellness coaching. She is a Whole30 Certified Coach, and is passionate about helping people improve their lives through lifestyle modifications. She has seen first hand how changing food alone can vastly improve your health.
