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8 Evidence-Based, Holistic Approaches to Eczema

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More than 30 million Americans suffer from eczema according to the National Eczema Association. If you or a loved one are among these millions of people, then you probably want to find a way to get rid of the itchy, scaly patches on your skin associated with this disorder. While your health professional may prescribe some creams or medication, you may also wish to explore with them more natural alternatives.

When you ask around or look online, you will find several possible natural or at-home alternatives to help. Many people find relief through these natural products. A recent review supports this, finding that using complementary and alternative medicine (CAM) either alone or along with conventional medicine led to at least minimal improvement, including reducing symptoms and reducing the relapse rate, in children with eczema. The review showed a greater benefit using CAM alongside conventional medicine.

However, it can be hard to know exactly which of the acclaimed natural remedies actually work, making them worth your time and money. Let’s see which claims hold up to the scientific evidence. Keep in mind that all of these approaches need to be evaluated for you specifically together with the help of your health professional.

Definition of Eczema

Before diving into remedies, let’s first talk a bit about the basics of eczema, including the symptoms. If you suspect you suffer from eczema, be sure to have your doctor assess your symptoms to verify that it is this disease and not another skin condition.

There are actually seven types of eczema:

  • Asteatotic eczema
  • Atopic dermatitis (aka atopic eczema)
  • Contact dermatitis
  • Discoid eczema
  • Dyshidrotic eczema
  • Seborrheic dermatitis
  • Varicose eczema

Atopic dermatitis, the most common form of eczema, often begins in childhood, although it is possible to develop it at any age. Worldwide, it is estimated that about 10% of adults and 16% of children have atopic dermatitis. Children may grow out of their eczema, but it is estimated that about half of children with atopic dermatitis still present with it as adults. Because of the prevalence in children, many of the studies on solutions are performed on children and infants rather than adults.

Although some may overcome this disease, it is typically a chronic disease that persists throughout life. In one large cross-sectional and cohort study on children who developed eczema before age 2, more than 80% of the subjects had eczema symptoms or were trying to relieve their eczema every year from 2 to 26 years old, and half of the subjects continued to have at least one symptom to deal with per six-month period at age 20.

Each type of eczema has its own unique symptoms, but the general symptoms include:

  • Dry skin
  • Increased risk of skin infections
  • Inflammation in the skin
  • Itching
  • Skin barrier problems

Mutations in the gene that encode filaggrin in the skin barrier play a role in the development of eczema, and those with this mutation have a different presentation and outcomes of the disease. Skin barrier dysfunctions beyond filaggrin mutations also play a role in the development of the disease, as do dysbiosis and inflammation. Additionally, there is a strong correlation between asthma and eczema, especially atopic dermatitis, in both children and adults.

Although the symptoms may seem minor or related to skin problems, eczema has a significant negative effect on quality of life due to issues with sleep disturbances and psychological impact. In adults, eczema has been found to negatively impact social life among other aspects of life.

The economic burden of the disease is estimated at $5.297 billion, based on data from 2015. This includes direct and indirect costs of the disease. Thus, the actual impact of eczema is quite significant, making it much more than just a simple skin disorder.

The Connection Between Inflammation and Eczema

As you will see, many of the natural remedies, as well as the conventional ones, target inflammation. This is likely due to a strong connection found between inflammation and eczema.

For example, in a cross-sectional population-based study in Finland, eczema was found to be associated with low-grade inflammation. Those with atopic eczema were more than twice as likely to have elevated hs-CRP (an inflammatory marker) levels than those without the disease even after adjusting for certain confounding characteristics, such as BMI, smoking, and others. In a mouse study, researchers found a link between dysbiosis and inflammation contributing to eczema, particularly an increase in certain bacterial species (Staphylococcus aureus and Corynebacterium bovis).

Natural Remedies

The standard conventional approach is a combination of topical corticosteroids and emollients or moisturizers. However, many patients and parents of children suffering from eczema have started to look for natural remedies to replace or complement conventional treatments. Because of the popularity of finding more natural approaches, studies have begun to review the efficacy and safety of many of these complementary and alternative medicine approaches. Let’s see which ones may pass the test.

Cardiospermum 

Many natural skin care creams for eczema contain Cardiospermum, a genus of plants commonly found in tropical areas of the Americas, Africa, and India. The research supporting its use is slim but positive. One non-randomized study reviewing outcomes after two years found that using plant-based ointments, including those with mahonia or Cardiospermum, was as effective or better than usual care, demonstrating at least a therapeutic equivalence.

A mouse study used Cardiospermum cream as one of five groups in a study looking at Sanpao herbs, a traditional Chinese remedy. Cardiospermum did not work as well as the Chinese herbs nor the prednisolone and was only slightly better than the positive control group.

More research is probably necessary to determine the efficacy of Cardiospermum creams, but the research out there shows it may be a promising potential natural alternative.

Chinese Herbs

Another common suggestion on lists for natural solutions for eczema is Chinese herbs. However, the efficacy for these remains in contention. There have been some positive results. For example, in the mouse study mentioned above, the use of traditional Chinese herbs (Sanpao herbs) was found to be effective in inhibiting eczema from developing. Another study, this one on children, found that those who used Chinese medicinal herbs did better than those who took the placebo. Additionally, the participants who continued the herbs for 12 months continued to see benefits. At the end of the study monitoring, 18 of the 37 who continued on the trial had at least a 90% reduction in their eczema activity and an additional 5 also improved to a lesser degree.

However, a systematic review found a few randomized controlled trials demonstrating some efficacy of Chinese herbs but determined larger trials were warranted to continue to determine their potential. A Cochrane review likewise found that more research is warranted and pointed out that the effective outcomes generally came from studies using the herbal mixture Zemaphyte.

Chinese herbs are another potentially effective natural remedy that has yet to have conclusive evidence showing the efficacy but which may be worth trying if you have eczema.

Colloidal Oatmeal

One of the best studied natural ways to deal with eczema is colloidal oatmeal. Studies have found it relatively safe and effective to use, although some children may have or develop a sensitivity to oats. Most likely, its efficacy is due to its impact on the body’s response to inflammation.

In one study on infants in the UK that focused on healthcare costs, using a colloidal oatmeal emollient (Aveeno) either first or after using a different type of emollient (a non-cosmetic moisturizer) led to a reduction in the number of visits to the doctor and lowered the odds of needing a prescription for antimicrobials or topical corticosteroids versus those who never used the colloidal oatmeal.

Another study found a moisturizer containing 2% colloidal oatmeal and 7% sweet almond oil was safe and effective for those with moderate to severe hand dermatitis. Another small study found a 1% colloidal oatmeal cream effective during the 14-day trial on both children and adults. Another study found that colloidal oatmeal cream was equally effective to a prescription-based cream for helping relieve mild to moderate eczema in children.

With this evidence, you may likely find lotions or soaps with colloidal oatmeal to be beneficial, unless you have an oat or gluten allergy or sensitivity or are at risk of one.

Essential Fatty Acids and Oils

Many people turn to different fatty acids and oils to help relieve eczema. Mechanistically, this makes sense. Some studies point to the lipid to protein ratio potentially playing a role in the skin barrier function inadequacies in eczema. Eczema development may also be due to an abnormality of essential fatty acid metabolism.

When searching for a natural oil to use topically, you may want to avoid olive oil. Some studies suggest the potential for olive oil to actually exacerbate, rather than improve, symptoms of eczema.

The most popular fatty acid oral supplements to help with eczema are evening primrose oil and borage oil. However, studies have yet to back this up. No studies have found borage oil to be effective. Studies on evening primrose oil have been more promising, although some controlled trials find nonsignificant results. The studies thus far are small and not always well constructed, so more research is necessary before fully dismissing these options.

There is some preliminary evidence supporting the use of evening primrose oil, especially orally. One study found a potential dose-dependent response to using evening primrose oil. In this small study of 40 children and adolescents, one group received 160 mg of evening primrose oil daily (two 40-mg capsules twice daily) for 8 weeks and the other took 320 mg (four 40-mg capsules twice daily). The 320-mg group found improved serum fatty acid levels and greater improvement in EASI scores (a scoring system for eczema severity) than the other group, although there was a non-statistically significant improvement in the 160-mg group.

The researchers also found a significant negative correlation between serum fatty acid levels of linolenic acid and the EASI scores, showing that as the serum fatty acid levels improved, so did the eczema symptoms. However, a Cochrane review found no evidence for the use of evening primrose oil or borage oil for help relieving eczema.

Another essential fatty acid supplement connected with eczema is fish oil. Some small studies have found promising results for its use in eczema, with a Cochrane review suggesting larger studies are required.

Therefore, if you want to increase your essential fatty acid intake, fish oil may be the best option. Evening primrose oil may also provide some benefit, but borage oil likely will not. I always think it’s best to have a health professional run a fatty acid profile to see which fatty acids, if any, are deficient, in excess, or out of balance to know exactly what needs supplementation.

L-Histidine

Another supplement currently touted for eczema relief is the amino acid L-histidine, and there are some promising studies backing up its use.

One study found that supplementation with L-histidine helped relieve symptoms of eczema. The proposed method of function is that histidine is required for the epidermal barrier protein profilaggrin. As discussed, the loss of function in the gene for this protein is highly associated with the development of eczema, as are diets deficient in histidine. In a pilot study, taking 4 g of L-histidine for a period of eight weeks led to a significant reduction in the scores in the questionnaires filled out by the patients and by the clinicians, demonstrating improvement compared to the placebo. Those who began with the placebo and then crossed over to the supplement also found benefit.

Thus, L-histidine supplementation may provide benefit, especially for those who have mutations in the profilaggrin gene, but more studies are needed to fully substantiate the use of L-histidine supplementation.

Phototherapy 

Phototherapy (the use of UV light or other non-ionizing radiation) is frequently used, especially as a secondary form of treatment or a complement to lotions or other topicals. Because it already has a place in conventional treatment, it is well-studied. One current hypothesis behind its efficacy is that it helps modulate the immune system, including inactivating the antigen-presenting cells and targeting Th2 cells, which may play a role in the inflammation-triggering eczema.

Typically, narrowband UVB light is used due to its relative safety and efficacy for eczema. One review study found that NB-UVB light is most effective for chronic use while UVA1 may be equally effective in moderate to severe cases. A small study found that using a UV-free blue light was safe and effective. They found that both the light-exposed and control lesions on the skin improved during the trial, but it was a small group with just 20 patients.

This type of option is effective and easy to find, but it does come with some risks, as you are using small levels of radiation to treat the skin. It’s best to work with a practitioner to assess whether this is a good method for you specifically.

Probiotics

Probiotics are promising but the evidence thus far is mixed. Several studies over the past few decades have looked at the use of probiotics in preventing and/or helping relieve eczema. One study found that there was a difference in the microbiota composition of infants with eczema compared to those without. Another study found that taking probiotics improved infantile eczema.

One systematic review looking at CAM options in children with eczema found an improvement in those taking probiotics compared with a placebo in five studies. Another systematic review and meta-analysis found there are promising results for taking probiotics in those who are under age two. In the latest  Cochrane Review (published 2018), which is considered the gold standard of systematic reviews, the researchers looked at 39 randomized control trials with a total of 2,599 participants from infants to 55 years old with a variety of ranges. Only six of the studies were on adults. Because the studies found little to no difference in the quality of life of the patients or the symptoms, the Cochrane review concluded that there is no evidence for the use of probiotics.

Vitamin D 

Another promising natural alternative with some evidence to back it up is vitamin D, although there is yet to be a consensus on its efficacy. A meta-analysis and systematic review found that in those with atopic dermatitis, there was a lower level of serum 25(OH)D compared to those without, which was statistically significant in children but not in adults (although there was a small sample size for adults compared to the children included in the study). After supplementing with vitamin D, there was an improvement in the disease presentation based on scores.

Additionally, one study on children in Hong Kong found an inverse association between vitamin D deficiency and atopic dermatitis and with the severity of the disease. Another study found an inverse relationship between serum vitamin D and eczema in children and adolescents in Germany. Lower maternal vitamin D levels during pregnancy have also been associated with an increased risk of children developing eczema. In one randomized, double-blinded, placebo-controlled trial, taking 1,000 IU vitamin D supplements daily during the winter months improved eczema for children in Mongolia.

As with many of these natural solutions, more research is necessary, but there are many promising studies pointing toward a potentially helpful impact.

Additional Therapies

In addition to taking the supplements or using the creams listed above, there are some extra actions and behaviors you can do to help eczema symptoms.

Combat Dry Skin

Dry skin plays a role in the development, triggering, and exacerbation of eczema. Therefore, you want to do what you can to combat dry skin, especially during the winter months. A few tips I like include:

  • Use a humidifier
  • Take lukewarm showers and avoid using soap and instead use a replacement made for dry skin
  • Use lotions or other emollients (moisturizers)
    • A Cochrane systematic review on emollients and moisturizers for eczema found that most moisturizers provided benefit to patients with eczema, and this relief was greater when it was used as an adjunct to other solutions. They did not find any significant difference between the various types of moisturizers.

Food Allergies and Eczema

Food allergies and intolerances can manifest in many different ways, including as skin problems such as eczema. One study using a web-based survey found an association between diagnosed food allergy and diagnosed hand eczema, especially in occupational kitchen workers (chefs and other food handlers). Another study found an association between IgE sensitization to both food allergies and aeroallergens and preschool eczema up to 16 years old.

Therefore, if you have any known food allergies, then you may find that avoiding them helps to reduce your eczema symptoms and severity. If you are unsure if you have any food allergies or intolerances, then there is testing you can do, or you can undergo an elimination diet and reintroduction to identify problematic foods. Talk to your doctor, nutritionist, or another healthcare practitioner to learn more.

Stress Relief and Psychodermatology

As with many chronic diseases, there is a correlation between stress and eczema. In one study on hand eczema, those with high-stress levels were more likely to have hand eczema, and there was also a positive dose-response relationship.  Studies have also found a correlation between maternal stress and the development of eczema in their children.

Therefore, stress relief activities and therapies may also help reduce your eczema, especially if you find you have a flare up around the times that you have increased stress. Studies have found a benefit from many stress-reducing therapies, such as acupuncture and massage, in treating eczema.

Some of my favorite stress relief techniques that have at least preliminary evidence demonstrating benefits for eczema include:

Some of these can also be used to help you reduce the urge to itch during active flares, especially hypnosis and cognitive behavioral therapy. This may help reduce the time of an active flare, allowing you to work on getting it under control.

Remove Irritants

In addition to using conventional treatments, natural solutions, or reducing stress, you can also remove irritants to reduce eczema, including:

  • Perfumed soaps, laundry detergent, body wash, etc.
  • Dyes in soaps and detergent
  • Clothing that exacerbates your condition, especially wool or tight items

Studies have found that the type of soap may exacerbate eczema, especially with repeated hand washing in hand eczema cases. A milder soap may help prevent or reduce eczema conditions. It may take some trial and error to find one that best suits you, but it is best to start with varieties made with natural ingredients and for sensitive skin. You may discover other irritants through trial and error.

Although the eczema options we have discussed fall under the natural heading, it is possible to have an adverse reaction to them. Therefore, always discuss any therapy you plan to do with your doctor, dermatologist, or another healthcare practitioner to ensure it is the right course for your unique situation.

Do you have any approaches you swear by? I’d love to hear about other potential options for relief from you.

 

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1 Comment

  1. Terry

    I was very interested to read your article and always appreciate your insights Deanna. I have had a mild case on my torso (don’t know what kind) that I’ve been trying to get rid of for years after I had to do a round of antibiotics when I broke my arm at age 50 and it appeared about 2 years after. I’ve done various gut protocols thinking I had candida which helped a bit but now I am doing a high probiotic gut microbiome reset for 6 weeks and along with cutting out many offenders like sugar, and other inflammatory foods…I only eat real foods generally, I have added in Kefirs that I make both dairy and beet, etc., sauerkrauts, probiotic foods of any kind along with super healthy eating and hydrating and only one week into this program my rash has receded. Oh and I had begun this program after I had done a 30 day round of the super high quality Bio-K probiotic you get in the refrigerated section. So I believe I have finally begun to eradicate the rash and get my health fully back…hurray. I have worked hard and deserve this relief.

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