The prevalence of atopic eczema is increasing in the Western world is increasing dramatically, affecting 11-20% of children and 5-10% of adults.
The underlying aetiology of atopic eczema is attributed to skin barrier dysfunction, with mutations in gene coding for filaggrin, and an altered inflammatory response. Food triggers might be mentioned in a 10-minute GP appointment. Standard allopathic treatment is oral steroids, steroid and emollient creams, and sometimes phototherapy is offered but many of my patients are told that they just have to live with it, and use steroids when they need to.
Any sort of barrier compromise points to structural integrity issues which need to be addressed in order to achieve resolution and there are clear links between epithelial health and the gut microbiome.
Steroids compromise immune function and microbiome health due to their immunosuppressive action. This means that microbes are able to colonise more easily on the skin and mucosal layers, which encompass the digestive system from mouth to anus, respiratory tract, and the genitourinary tract. I don’t tell patients to stop using steroids as it’s not within my remit to do that, but what they find is that their skin calms down as we commence their naturopathic strategy, and they end up not needing to use them anymore as the flares subside.
When I work with eczema patients, we look at things from the very beginning, everything from maternal microbiome health, whether the patient was born naturally or by c-section, food introduction and what early diet was like, childhood home and school environment, if they had pets growing up, immune health, to history of antibiotic use, all the way to the present day, including stressors, trauma, personal care and household products, use of medications, including vaccines, sleep habits, even who the patient might be sharing a house with and how they might be impacting microbiome health. Patients are well informed about dander allergies, but they don’t often consider that their recent eczema flares correlate with a new relationship or a new apparently allergen-free detergent. Mould exposure in the home, office or school or dust mites, even plants are often an issue, and an air filter can make a huge difference in reducing airborne exposures.
Most atopic patients will benefit from removing food triggers, and reviewing histamine load not just in their environment, but also within the diet and there are many variations of a lower histamine diet, including reducing pesticide exposures by switching over to an organic diet. This is why an individualised approach is so important, as you need to find the variation that will work best for the patient, particularly in my clinic as I work with many patients with a history of disordered eating.
There are lots of useful functional tests that I use in clinic to assess underlying factors and current state of health, including comprehensive blood panels, organic acids testing, mycotoxin panels, stool test, skin and nasal swabs. MARCoNS (multiple resistant coagulase-negative staphylococcus) testing is very useful and I have correlated colonisation in some patients with species linked with early development of atopic eczema.
Herbs are an integral part of my approach, particularly aromatic water topical blends, nasal sprays where relevant, creams, teas, bath blends, and powders. Topical use of aromatic waters have been amazing in clearing antibiotic-resistant species without much disruption. Supplements, including digestive enzymes, essential fatty acids, fat-soluble vitamins and zinc help.
Natural ceramide and squalene creams are a better option than petroleum-based emollients to reduce transepidermal water loss, as well as wearing natural fibres to reduce skin irritation. Stress management and encouraging proper sleep and sleep hygiene really expedite the healing process.
Cork, M. J., Danby, S. G., & Ogg, G. S. (2020). Atopic dermatitis epidemiology and unmet need in the United Kingdom. The Journal of dermatological treatment, 31(8), 801–809. https://doi.org/10.1080/09546634.2019.1655137