Nutrition for Eczema: Diet, Supplements and Topical Support
By James P. Meschino, DC, MS
The term eczema encompasses a number of red, itchy skin conditions. Eczema may appear as a dry, scaly rash or weepy, oozing blisters. It is a type of dermatitis that literally means "inflamed skin." Chronic eczema causes dry, red, flaky patches on the skin, most frequently involving the face, neck, scalp, arms, elbows, wrists, and knees. Overall, eczema is estimated to affect up 20 percent of Americans.
Eczema is divided into two main types. The first is contact dermatitis (contact eczema), which occurs when an irritating substance comes into contact with the skin. The offending irritant may be a chemical, cosmetics, wool, lanolin, or rubber shoes. Nickel in jewelry is a common cause. Poison ivy is a form of contact eczema.
Atopic eczema, the second type of eczema, is usually caused by inhaled or ingested allergens, such as foods, pollen, dust, or animal dander. Some experts indicate that intestinal dysbiosis (disruption of the normal bacterial flora of the gut with a disproportionately high concentration of unfriendly bacteria) can promote atopic eczema, as supplementation with probiotics has been shown to improve this condition in some cases. Thus, the approach to eczema needs to be personalized to the unique circumstance of the individual.
There are three main objectives in the treatment of eczema: reducing inflammation, relieving itching of the skin, and moisturizing dry patches. As most alternative health practitioners know, certain dietary practices and various supplements can help to accomplish these objectives in many cases of eczema that seem to be resistant to standard medical treatment. The most evidence-based lifestyle, dietary and supplementation strategies shown to improve cases of eczema are as follows:
Dietary and Lifestyle Considerations void any known dietary or environmental irritants or allergens.
Reduce the build-up of arachidonic acid within skin cells, as arachidonic acid, a polyunsaturated fat, is the direct building block of inflammatory prostaglandin hormones.
To accomplish this, reduce the intake of the following foods: high-fat meat and dairy products; corn oil, sunflower seed oil, safflower seed oil, and mixed vegetable oils; alcohol, hydrogenated fats (e.g., margarine, commercial peanut butter, shortenings).
Replace the above foods with the following: chicken, turkey, fish, Cornish hen, 1 percent milk or yogurt, low-fat cheese (3 percent or less milk fat), olive oil, canola oil, or peanut oil (for salad dressings, to saute vegetables or stir fry only).
Omega-3 fats provide the building block for the production of prostaglandin hormones that reduce inflammatory activity of skin cells. They also reduce the build-up of arachidonic acid in skin cells by blocking the enzyme that converts linoleic acid and gamma-linolenic acid to arachidonic acid. Examples of omega-3 fats of importance to skin health include EPA (eicosapentaenoic acid) and ALA (alpha-linolenic acid). EPA is found in fish and fish oils, and ALA is found primarily in flaxseed oil. Clinical trials have shown that omega-3 fats can be effective in the treatment of eczema.
Gamma-linolenic acid (GLA) has been shown to help in cases of eczema. Studies reveal that many patients with eczema lack the enzyme to convert linoleic acid to gamma-linolenic acid. As gamma-linolenic acid is the building block of an important anti-inflammatory prostaglandin hormone, supplementation with an oil that is high in gamma-linolenic acid, such as borage, black currant or evening primrose oil, has been shown to favorably affect cases of eczema. As such, I recommend a supplement that contains 400 mg each of fish oil, flaxseed oil and borage seed oil (borage seed oil is 22 percent GL, whereas evening primrose oil is only 9 percent GLA).
B Vitamins - A number of B vitamins (especially B6 and niacin) are necessary co-factors to speed up the enzymes that produce anti-inflammatory prostaglandins in the skin.
Antioxidants - Vitamin C, vitamin E, selenium and zinc are also required to support various enzymes within skin cells that promote the formation of prostaglandins, which reduce skin inflammatory conditions, including eczema. I recommend a high-potency multvitamin/mineral supplement that contains a B-50 complex along with boosted levels of antioxidants.
Detoxification nutrients and immune regulators - Milk thistle and indole-3-carbinol work in the liver to enhance detoxification and purify the blood of toxins and various allergens that can aggravate eczema. Prebiotics (FOS and inulin) and digestive enzymes act in concert to detoxify bowel toxins, regulate immune function and prevent partially digested proteins form entering the bloodstream, where they may otherwise induce immune inflammatory reactions that aggravate eczema. Prebiotics help to increase the concentrations of the friendly gut bacteria at the expense of the unfriendly gut bacteria. Prebiotics such as fructo-oligosaccharide (FOS) and inulin are food sources for the friendly bacteria, allowing the friendly gut bacteria to proliferate rapidly, crowding out the unfriendly bacteria. As such, in stubborn cases I recommend a supplement that contains milk thistle and indole-3 carbinol, along with a supplement that contains digestive enzymes and prebiotics.
Recent Studies Suggest Efficacy of Topical Vitamin B12
Most recently, we have seen that another natural agent can be very effective in the treatment of childhood and adult eczema. In this case, treatment of eczema lesions involved the topical application of vitamin B12 (a solution applied to the skin), which was first shown to improve eczema in adults to a significant degree. In April 2009, publishing in the Journal of Alternative and Complementary Medicine, R. Januchowski reported results of a study using topical vitamin B12 to treat eczema in individuals between 6 months and 18 years old. This was the first study to test topical vitamin B12 in infants, children and young adults. The study by Januchowski showed that topical vitamin B12 treatment produced significant improvement in eczema lesions compared to the group given the placebo treatment. These results were seen at two weeks and four weeks post-treatment.
In many cases, once specific allergies have been ruled out, the medical profession is often at a loss to provide eczema sufferers with any meaningful treatment options. For this subgroup of patients, the specific dietary and supplementation practices outlined in this article can provide significant improvement of their condition in many cases. Most recently, we have seen that the addition of topical vitamin B12 to a naturally-based treatment regime may provide even further benefit in these cases.