Eczema
There are different types of eczema. This leaflet is mainly concerned with atopic eczema. This commonly affects children and often affects several areas of the body. To treat eczema you need to eliminate the allergies and environmental triggers that cause it and to supply the key nutrients needed to heal it.
ALLERGIES FROM FOOD OR DIRECT CONTACT
Food
Some foods are particularly likely to cause problems. Top of the list are milk, eggs,additives and preservatives,especially azo dyes (common cause in children) and wheat (more in adults). The following cause eczema slightly less often: sugar, chicken, chocolate, tomatoes, orange, apple, blackcurrant, yeast. Less frequent causes are fish/shellfish, beef, nuts, banana and soya. Fairly safe foods are: most vegetables, lamb, pork, venison, duck, buckwheat and other fruit. (A study in 2018 found 50% of toddlers with eczema had food allergies).
To find out if you have a food allergy you may need to do an exclusion diet. Our food intolerance leaflet may help. Stop the suspected foods for two weeks. If this is a the trigger the eczema will stop erupting and the itching will stop though it may take 3 to 4 weeks to clear completely once you stopped. For severe eczema stop all the underlined foods. For moderate eczema stop the top two groups. For mild eczema stop some or all of the first group. After two weeks (or after the eczema has cleared) add in the foods one by one to test them as explained on the sheet. (If you have no response after two weeks stop fruit as well for a further week).
Remember any food can sometimes cause eczema. In Jennifer Worth’s book Eczema and Food Allergy: The Hidden Cause, (author of Call the Midwife), she describes how her very severe eczema improved only slightly after using a standard exclusion diet and she only got better after going on a diet of lamb, cabbage and carrots for eight weeks. She was reacting to rice and onions (normally rare causes of allergy).
Once you have found the offending foods you will need to avoid them or use some form of desensitisation. Desensitisation is unfortunately not usually available on the NHS.
Contact Allergens
In addition to foods, many other substances can trigger eczema. These include bubble bath, washing powders (especially low temperature ones), some creams, pets, house dust mite and chemicals. Beware on biological washing powders. Sometimes it can help to put all clothes through the washing machine without washing powder until smell-free. Cotton sheets (ideally 100% organic as cotton is typically contaminated with pesticides) may help.
Nearly all children with eczema are allergic to house dust mite. Measures for house dust mite avoidance are effective (see asthma leaflet for more details) but can take months to work.
A useful rule of thumb is: if you can’t put it in your mouth don’t put it on your skin so substances like simple vegetable soaps are useful. If you suspect any substance put it on your forearm under a plaster for 48 hours and see if it causes a reaction.
Beware of the following substances: Sodium lauryl sulphate (in shampoos, toothpaste, conditioners) which is a strong detergent, Propylene Glycol(PG), Polyethylene Glycol (PEG), Isopropyl (the last 3 are solvents), Petrolatum, Imidazolidinyl urea, DMDM hydrantoin, DEA, MEA, TEA (hormone-disrupting chemicals and irritants – often found in bubble baths and beauty products) PVP/VA copolymer, Padimate O, Methyl, Propyl, Butyl and Ethyl Paraben, Synthetic Colours (often labelled FD&C or D&C), Talc, Fragrances (more than 500). Watch out especially for methylisothiazolinone (also known as Kathon CG). A single exposure can cause cracking, soreness and peeling of the skin on the hands especially the fingertips. It is found in many liquid soaps but also in cosmetics, moisturisers, shampoos, baby wipes, inks, detergents, polishes and paints, although it is being removed from many products now. Read labels and avoid these products. A good rule is if it smells then avoid it.
Note some moisturising creams contain potent allergens. For instance, aqueous cream contains sodium lauryl sulphate a powerful detergent.
Nutrients
One of the most important nutrients for the skin is essential fats. The majority of people are deficient in these and the skin is last in the body’s queue for these important nutrients. Deficiency results in dry skin and often thirst. There are two essential fats Omega 3 and Omega 6 and both are often deficient. However, Omega 6 fats are always deficient in eczema. Frequent baths, showers and regular shampoo use will deplete the level of these.
To get these from the diet you need to eat oily fish (herring, mackerel, anchovies, sardines, pilchards and wild salmon) or seeds (particularly linseed) or nuts (almonds or walnuts). For many people with eczema it helpful to supplement with oils. Unfortunately these are cannot be prescribed. Omega 3 fats include EPA fish oils and flaxseed oil. Omega 6 include cold-pressed sunflower and safflower oil (not the standardised heated versions of these oils as heating destroys the essential fats). Hempseed oil contains both in the ideal Omega 6:3 ratio of 4:1. These oils can be taken by mouth or absorbed directly through the skin. For babies you can add to drops of oil to their milk or drink. These fats can also be applied directly to eczematous skin.
Lecithin contains Omega 3 and Omega 6 fats plus other nutrients and often helps eczema and dermatitis. Try the granules. Although they won’t dissolve they can be taken with drinks or added to foods such as yoghurts.
It is also important to cut down on hydrogenated fats which compete with the essential fats. Too much of these can add to your problems. These occur when you heat fats such as in frying and in making processed foods such as margarines and all supermarket oils (except olive oil). Look on labels for hydrogenated fat, also called trans fatty acids, vegetable oil, vegetable fat, shortening, hydrolysed fat, hydrolysed vegetable protein. Children’s diets are often high in these.
Other nutrients are also important. These include Zinc (white spots on the nail are a clue to zinc deficiency), Vitamin C and sometimes B Vitamins, especially B6. There are cases of eczema that are low in Vitamin D and have responded to high doses of this.
Vitamin E deserves a special mention. When applied topically it helps dry chapped skin. This can be done by puncturing a Vitamin E capsule and applying directly to the skin (use d alpha or mixed tocopherol rather than dl alpha tocopherol). It has been used successfully as a treatment for burns. Vitamin E is also excellent for the skin if taken by mouth.
The lotion Skin Salvation (by PurePotions) is a natural remedy developed after a mother who experimented with natural remedies after her daughter developed severe eczema that failed to respond to all standard remedies. It is available on-line and some Holland and Barrett stores. However the original company has changed hands so time will tell if the quality of the product is maintained.
Antibiotics
One course of antibiotics in the first year of life was found to increase the risk of eczema by 46% in one study. Multiple courses have a greater effect. These are best avoided if possible but local antibiotics such as Fucidin cream are often needed.
