Eczema (also known as ‘atopic dermatitis’) is a non-contagious condition of the skin that results in dry, red and itchy skin. The skin tends to flare up and settle down and is commonly seen in infants and young children, although for some it continues into adulthood.
(To keep it simple from here on, I’ll refer to it as simply ‘eczema’. )
Eczema also can affect sleep and therefore energy and quality of life.
“I don’t know what is triggering it exactly.
“Terrible sleeper… bloody torture.”
Sound familiar? I hear it from exhausted and frustrated parents all the time.
The itch and discomfort affects your child’s sleep, which often flows on to the rest of the family. This cycle of itch/lack of sleep/fatigue can contribute to overwhelm, stress and feeling like there is no other way, potentially affecting relationships too.
Much of the blame for eczema points to genetics. Yes, researchers have found over 80 genetic variations associated with eczema .
But having the genetic variation(s) that predisposes you eczema doesn’t mean you’ll necessarily have the condition. This has been shown in twin studies, with identical twins (who share the same genes) may have one twin with eczema and the other without . It is clear that other factors must play a part in the development of eczema.
The danger of not looking past genetics leads to a failure to address the bigger picture, including the known triggers.
Blaming genetics alone does not give parents hope for improvement other than ‘growing out of it’, even though it is clear that eczema is a condition that has a complex relationship between genetics and environmental factors .
While we cannot change the genes we are born with, we can influence the way that our genes are expressed.
This exciting field of science is known as Epigenetics. It means that even if your child has the genes associated with eczema – and they do have eczema – positive steps can be taken to enhance gene expression and cellular function -i .e. for better skin.
Epigenetics means that our gene expression is influenced by lifestyle, stress, environment and diet/nutrition. These are areas that can be assessed and addressed.
Furthermore, these factors as well as indoor air pollution, antibiotic use and low levels of vitamin D are also associated with eczema .
“The prevalence of eczema has been increasing too rapidly to be accounted for by shifts in genetic variation” , which encourages sufferers of eczema that there are other ways to address eczema than just the ‘old approach’.
Many parents are finding that the old approach to eczema is no longer working for their family and they are looking for a new way to help their child.
Many parents have done everything they’ve been told to do, they feel like they’re not being listened to and are realising that they want a safe and new way forward for their family.
So… what does all of this mean?
It means that more can be done for eczema, beyond the old approach.
1. DIET AFFECTS THE SKIN
Yes, this is a controversial one!
Despite the controversy, a group of doctors (allergists and dermatologists) lead by Guibas published a review in 2013 reporting on the disparity in eczema research published in dermatology compared with immunology (allergy) journals . They reported that there were 10 times the number of research papers on the relationship between eczema and food in the immunology (allergy) journals than the dermatology (skin) journals.
Research papers in immunology journals tended to report improvement in skin with the removal of certain foods. On the other hand, research in the dermatology journals were of lesser quality evidence – being case studies, opinions and only a small percentage of research papers on eczema and food. These tended to discourage the removal of foods from the diet as an approach to managing eczema.
While there were appropriate cautions against removing foods without professional advice due to the potential for malnutrition, many research studies have demonstrated that food can be a potential trigger for eczema.
2. GUT HEALTH IS IMPAIRED IN PEOPLE WITH ECZEMA
So what is this ‘gut health’ that many people are talking about?
Many people relate ‘gut health’ with having symptoms in the gut – e.g. reflux, constipation, and bloating. While impaired gut health may be associated with these conditions, it is also implicated in eczema too, even without these gastrointestinal symptoms.
Our gastrointestinal tract contains many trillions of micro-organisms that play a significant role in our immune system. These micro-organisms are involved in many different functions in our body and are vital to health.
Children with eczema have a different gut microbiota profile than those without eczema. Improving gut health may improve eczema – it is certainly been our personal experience and those of many others.
3. PROBIOTICS AREN’T THE FULL PICTURE
Some probiotic research shows an improvement with eczema, however this is not consistent across the board. A recent Cochrane Systematic Review pooled all of the research on probiotics and eczema and found that there was no overall improvement in taking probiotics alone for eczema .
While this conclusion may be disappointing, it isn’t the full picture. As eczema is a complex condition of genetics, gut health and environmental triggers etc., it is unsurprising that it requires more than just a probiotic.
Stool microbiota testing can help provide more information on the likely picture of gut health. While stool microbiota testing is not 100% accurate, it is currently the best and most cost effective option that consumers and health professionals have to guide a more informed and individualised approach than simply guessing. Gut health may also be improved by adding in other nourishing support like gelatin and a wide variety of colourful vegetables, fruits, nuts, seeds and grains.
4. ‘GUT HEALING’ FOODS MAY MAKE IT WORSE…
Fermented foods such as sauerkraut, kefir and yoghurts are food that may be beneficial for our gut health. They contain billions of beneficial bacteria, however they are also high in a naturally occurring food chemical called histamine.
Histamine may also be a trigger for those with eczema and may be a sign of a gut health issues. If you’re starting out with these foods, start slow (i.e. small amount), one at a time, and monitor for symptoms. There are some genetic variations that affect the body’s ability to break down histamine and may require additional nutritional support to do so.
5. THERE’S NO MAGIC MOISTURISER
Moisturisers are an important part of eczema management. They aim to minimise moisture loss from the skin and maintain an intact skin barrier. They can also help soothe the skin, however since they are often the main recommendation along with a prescription, there is a lot of focus on the perfect moisturiser that will fix it all.
I was on a forum the other day and this is what I came across:
“We’ve tried sooo many brands…. We are still trying to work it out…”
“So far I’ve used 1kg tub of cream with not much effect.
What else can I try?”
It always breaks my heart. Unfortunately, that moisturiser that’s made of unicorn tears (yes, someone wrote that on a forum recently as well!)… the one that will cure all – doesn’t exist.
So you can stop the search party. What works for one person doesn’t necessarily work for all, either. Sorry to be the bearer of this news! (You may have already discovered this anyway after trialling a dozen different creams….)
Yes, moisturisers are a very good place to get right first as they are typically applied several times a day to most of the body. It is therefore important to ensure that the moisturiser itself isn’t a trigger.
Moisturiser being a trigger? Yes. Sometimes it can make the eczema worse. This was a lesson for us early on – buyer beware! Even though a product is on the shelf in the shop, doesn’t mean it is safe.
Surprising, I know.
Some products contain known skin irritants – and that isn’t even the worst of it – but it is a crucial step to cross-check the ingredients on EWG.org for their safety and the presence of skin irritants.
Although many of us are looking for something that is ‘natural’, avoid food-based products as this may lead to the development of an oral allergy.
AND…. as you’re probably realising, the moisturiser isn’t the whole picture.
So once you’ve found a moisturiser, move on to spending more time on addressing gut health, nutrition and the other triggers that you can do something about.
6. OUR HOME ENVIRONMENT CONTAINS MANY TRIGGERS
Indoor air is reported to be more polluted than our outdoor environment, with many invisible triggers indoors than just the house dustmites. Some other considerations include:
- Candles, soy melts, reed diffusers, synthetic room sprays and wall plug ins
- Chemicals in the water including chlorine – (think drinking and bathing water)
- Mould and mycotoxins – bathrooms, roof leaks. This needs to be addressed ASAP
- Cleaning chemicals
- Personal Care Products
- Skin Care Products
7. HAVING ECZEMA SAVES WATER
Well, it should! 😉 Tap water contains chlorine and other chemicals which may irritate the skin. Water also is more alkaline than your skin (which is naturally acidic). Our skin microbiota – the protective microorganisms on our skin – like a more acidic environment. Increase the pH of our skin may affect our skin microbiota, allowing more pathogenic (aka “bad”) bacteria to thrive.
Reduce the frequency and duration of the bath/shower may help to minimise this, as well as having the water at a cooler temperature (this means shorter time to heat up, right?).
8. STRESS CAN WORSEN ECZEMA
Stress is a commonly reported trigger for eczema and therefore managing or reducing stress can be helpful for soothing the skin.
Good quality sleep/rest, connection, nutrition and support can be helpful in reducing and managing stress. Audit for areas in your life that can increase stress for you or your child and brainstorm ways to reduce it. This might include daily meditation, exercise, grounding, singing/dancing, use of essential oils, getting out in nature.
9. WEATHER CAN SOOTHE OR FLARE UP SKIN
Do you ever worry about the weather and its effect on eczema skin? Are you worried about the Summer coming up, or the winter and the drying heating, or even whether going on holidays may mean a flare up?
The heat, the cool weather, heating, cooling, humidity and dry air can all be triggers for eczema. Some people find their eczema is worse in Winter and others find it worse in Summer. The key here is to recognise the weather trigger and be prepared.
Whatever the case, if you are travelling to a different area, ensure that you are prepared for a flare up and bring whatever tools that you require to manage it. Even though our son no longer deals with eczema any more, we do find that being in a different environment and eating different food sometimes results in drier skin.
Changes in skin associated with travelling may be the result of sleeping on different bed sheets washed in commercial cleaning detergents, or the increase in gelati / fish and chips in the diet (!), sunscreens or the daily swimming in chlorine. So we bring our soothing essential oils, moisturisers, and barrier creams (for pre-swimming) just in case.
We CAN Be Proactive With Eczema and Regain Control
Although eczema is a complex condition, identifying triggers and minimising or removing them, and addressing eczema at the underlying causes allows us to regain control of a challenging condition.
Making changes one step at a time reduces the overwhelm, and multiple tweaks over a few weeks and months can add up to make a significant difference to the lives of those with eczema.
If the old approach is no longer working for you and you are wanting to regain control of your life with a safe and supported way forward for a healthier future, then: