A Holistic approach to childhood eczema

I struggled with my first baby who had terrible eczema. Unfortunately, back in 1998, I had not studied nutrition and integrated medicine. If I knew then what I know now, I would have made some changes to my own diet and my baby’s diet. I know how frustrating eczema can be and I know a functional approach can be helpful in some situations. I firmly believe the gut and skin are very related and you cannot consider a skin condition without considering the gut and what goes into it.

Childhood eczema is a very common condition that I see every day as a GP. Here are a few common questions that I get asked. Bear in mind this is a generalised Q&A- and that individual cases vary.

It is always good to book into see your own health care provider and get a proper 1 to 1 consultation to see what is right for you and your child and make sure you are getting the right help.

What is atopic eczema?

Eczema comes from the Greek world meaning to ‘boil over”. It is a skin condition, which usually starts at 3 months of age in childhood. In two thirds of cases it resolves by 5 years but can continue into adulthood. My own baby’s eczema got a lot better when she was 7 years old- but even now, when she gets stressed, the eczema flares up. The UK has one of the highest rates of childhood eczema. The main symptoms are itching and dry skin more at risk of getting infected. It typically starts in the creases of the elbows and behind the knees but can also appear on the face and elsewhere. It commonly flares up intermittently.

Why has my child got eczema?

The current understanding is that the cause of eczema starts off from a mixture of genetics and skin barrier structure dysfunction. Then, once the susceptible skin is exposed to a particular individual trigger the disease erupts. Risk factors include: family history of allergy, formula feeding, early antibiotic use, cigarette smoke exposure and poor maternal essential fatty acid intake. The exposure of the child and mum to normal good bacteria has also been shown to have an effect on the development of eczema. (The Hygiene Hypothesis). About half of children with eczema have been shown to have a food allergy.

Why doesn’t the cream I get from my GP make it go away?

Conventional medical treatments for eczema are mainly aimed at the level of the skin, with emollients to moisturise, steroids to reduce inflammation and immune modulators to reduce the inflammatory response. Oral antihistamines can be used to stop the itching and wet wraps to prevent scratching. These treatments can help suppress the symptoms but the aim of them is not to target the underlying trigger of the problem. The creams are not a cure. Personally, I found I had to put creams onto my daughter every few hours and a lot of the time her skin did not get better. It was so frustrating at times.

What can I do with my child’s diet if it is an allergy?

To successfully treat eczema, it is essential to identify the triggers. The easiest way to identify food allergies and sensitivities is to either get tested or to do an elimination and challenge diet. A little detective work is needed to find out if there is an allergy or not. The major offenders in eczema are cows’ milk, eggs, milk, peanuts, soy, fish, and gluten. It is estimated that 25 percent of children who avoid a known trigger from this list for one year will outgrow the allergy (Kulig et al, 1999). Elimination diets can be time consuming and often need to be carried out with professional supervision to guide the client and provide education in maintaining nutritional balance, especially in the case of children.

What other triggers are there apart from food?

Other triggers may be animal dander, temperature variation, cosmetics and skin products, dust, mould and infections too. The environment is very important place to start doing detective work.

What about food additives and processed foods?

As a functional GP, I would be super keen to see a whole food diet on offer to my patients with avoidance of junk and processed foods. Food additive elimination has been studied in adult patients with eczema, and results showed that it was helpful in some types of patient. (Worm et al 2000). Avoiding fast food is also shown to be of help in reducing eczema. (Ellwood et al, 2013) and I have never actually seen junk food to be of any help in eczema cases.

Is there any natural topical remedy I can try?

Applying topical Coconut oil twice a week for 8 weeks has been found to improve eczema in children in a case controlled trial. (Evangelista et al, 2014). Bathing in Dead Sea salts has also been proven to be of benefit. It can enhance hydration and reduce inflammation when used daily for 15 minutes. (Proksch et al, 2005).

What about probiotics?

There is a lot of exciting emerging evidence about the role of good bacteria in the gut having a role in eczema. The use of probiotics has a lot of good supportive evidence. Perinatal administration of the probiotic Lactobacillus Rhamnosus GG has been shown to reduce atopic dermatitis in newborn children with Cow’s milk protein allergy (CMPA) or eczema, (Majamaa and Isolauri,1997). Take advice on use of probiotics for your child before you go ahead and try though.

Do a lack of vitamins make eczema worse?

There has also been a lot of work looking into low vitamin D as a driver of food allergy and eczema. (Rudders and Camargo, 2016). Individual differences in the genes responsible for vitamin D receptors may have an important role to play too. (Koplin et al 2016). Ensuring vitamin D levels are optimal is a good idea.

What can I do to reduce the risk of my baby getting eczema?

Part of a naturopathic or functional medicine approach is to identify babies at risk when still in utero or better still, prenatally. That means if a woman has a family history of eczema, her baby may be at risk of developing the condition. This gives the practitioner the opportunity to work with mum to educate and support her diet and lifestyle factors even before birth. It is also important to understanding potential drivers and try to avoid them with a preventative approach.

References

Ellwood P, Innes Asher M, García-Marcos L, et al. (The ISAAC Phase III Study Group). (2013). “Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three”. Thorax. 68(4) 351-60.

Evangelista MT, Abad-Casintahan F, Lopez-Villafuerte L. (2014). “The effect of topical virgin coconut oil on SCORAD index, transepidermal water loss, and skin capacitance in mild to moderate pediatric atopic dermatitis: a randomized, double-blind, clinical trial”. International Journal of Dermatology. 53(1):100-8

Koplin J.J, Suaini N.H, Vuillermin P, Ellis J.A, Panjari, M, Ponsonby A.L. et al. (2016) “Polymorphisms affecting vitamin D-binding protein modify the relationship between serum vitamin D (25[OH]D3) and food allergy”. Journal of Allergy and Clinical Immunoogy 137: 500–506 9-15

Kulig M, Bergmann R, Klettke U. (1999) “Natural course of sensitization to food and inhalant allergens during the first 6 years of life”. Journal of Allergy and Clinical Immunology.103:1173–1179

Majamaa, H, Isolauri E, (1997). “Probiotics: a novel approach in the management of food allergy”. Journal of Allergy and Clinical Immunology. 99, 17 Proksch E, Nissen H, Bremgartner M, Urquhart C. (2005). “Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin”. International Journal of dermatology 44(2) 151-157.

Rudders, S.A. and Camargo, C.A. (2015) “Sunlight, vitamin D and food allergy”. Current Opinion in Allergy ad Clinical Immunology. 15: 350–357

Worm M, Ehlers I, Sterry W, et al. (2000) “Clinical relevance of food additives in adult patients with atopic dermatitis”. Clinical Experimental Allergy. 30(3):407-14.

Laura Quinton