ECZEMA (DERMATITIS) What Is It? What Causes It? Skin Conditions

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1 Skin Conditions ECZEMA (DERMATITIS) What Is It? Eczema is a general term describing skin inflammation, also known as dermatitis. There are many different forms of eczema, the most common being atopic eczema (atopic dermatitis). Contact eczema (contact dermatitis) and seborrheic eczema (seborrheic dermatitis) are two other forms that occur commonly and will be discussed here. Atopic eczema is a chronic skin disease that causes itchy inflamed skin, and is thought to be the result of an abnormal immune response. In about two-thirds of those who develop atopic dermatitis, it begins during infancy. It is often associated with the other allergic (atopic) diseases - hay fever (allergic rhinitis or nasal allergies) and asthma. In infants, atopic eczema is also known as infantile eczema. Contact eczema develops in direct response to an irritant or allergen that has come in contact with the skin. Due to the many possibly irritants and allergens, it may be difficult to determine what is causing the reaction. Seborrheic eczema is a form of skin inflammation that involves oily, scaly patches of skin that commonly occur on the scalp and face. Dandruff and cradle cap (in infants) are the most common conditions caused by this type of eczema. In contrast to most types of eczema, this type does not necessarily itch. What Causes It? The causes of eczema are not always known, but the following factors play a role in its development or progression: Atopic eczema affects up to 30 percent of the U.S. population. 1 Its prevalence has doubled or tripled in developed countries in the past few decades. 2 Skin with eczema Immune dysfunction Dry, irritated skin Irritant exposure Allergen exposure Antibiotic overuse Dysbiosis Leaky gut Food allergy Gluten sensitivity H. pylori infection Yeast overgrowth Candida overgrowth Genetics At the basis of atopic eczema is a combination of immune dysfunction and a disturbance of the outer layer of skin. 3 The outer layer, called the epidermal barrier (because it functions as a protective layer), weakens. This epidermal barrier weakening causes thinning of the skin and a loss of moisture, producing the characteristic dry skin that is seen in eczema. The immune dysfunction results in an excessive inflammation of the skin the hallmark redness, swelling and pain of eczema. Eczema may be triggered by an irritant that comes in contact with the skin, that is inhaled, or that is consumed. These irritants may also be considered allergens if the skin reacts by producing allergic compounds. In some people, allergic reactions take years to develop, so that only after repeated exposure to an allergen will a reaction occur that 507

2 produces eczema symptoms. Irritants or allergens that may cause an eczema reaction include: Soap Cosmetics Deodorants Fragrances Lotions Medications Cleaning products Insecticides House dust Pollen Molds Pet dander Rubber or latex Metals Costume jewelry Perfume Hair dye Plants like poison ivy Foods Did You Know In healthy infants who are delivered vaginally, and breastfed from a mother eating a healthy diet, levels of Bifodobacteria and Lactobacilli develop to healthy levels in the gut. This is decreasing in developing countries where many infants are delivered by cesarean, and are fed a processed formula instead of breast milk. 10 In these infants, by the age of 2, a distinct difference is seen in their gut flora (bacteria) which persists into adulthood, and may alter the function of the immune system. 11 The use of neutral, or slightly acidic soaps (as opposed to alkaline soaps which are most common) may help people with eczema. The natural ph of the skin ranges between 4.5 and This is slightly acidic, which helps to repel bacterial growth. When alkaline soaps are used, this changes the ph of the skin and can create a more hospitable environment for pathogenic bacteria. Soaps and shampoos that are at a slightly acidic ph are recommended. The overuse and repeated use of antibiotics, especially in infants and children, can interfere with the healthy population of beneficial bacteria in the gut that is so essential in developing proper immune response. Indeed, early use of antibiotics in children and even antibiotic use by the mother during pregnancy, has been associated with the development of eczema in children. 5,6 ECZEMA Dysbiosis, an imbalance in the ratio of good to bad bacteria in the gut, has been associated with the development of eczema. 7 Dysbiosis is thought to negatively affect the proper development of immunity in infants. Dysbiosis may occur for a number of reasons. Antibiotic use, infection, lack or inadequacy of breastfeeding, Candida overgrowth, parasites and poor diet can all lead to dysbiosis. Dysbiosis creates an unfavorable environment in the gut that promotes the development of leaky gut, or increased intestinal permeability, through which larger than normal particles can pass through into the bloodstream. These particles include undigested food, environmental toxins and microbial toxins (this includes bacterial, viral, fungal and parasitic). When these enter the blood stream, the immune system responds by creating inflammatory compounds that travel throughout the body. In people 508

3 Skin Conditions Candida overgrowth is also found in people with eczema, especially severe eczema. 14 Candida is a yeast that is present in and on the bodies of many people. Normally it exists in a small concentration, kept in balance by other bacteria. But when Candida growth increases, it can create many problems, and may be involved in the development or worsening of eczema in some people. An underlying Candida overgrowth can interfere with the healing of eczema and should be ruled out. Seborrheic eczema (cradle cap) with eczema, this inflammation is experienced in the skin. Indeed, leaky gut is found in children with atopic eczema involving an immune system response to larger particles that pass through the intestine. 8,9 (See the Leaky Gut Syndrome section for more information on this condition.) Food allergy is one result of the passage of undigested food particles through the leaky gut. The food remains undigested when there is an insufficient amount of stomach acid, digestive enzymes, or both. High amounts of food allergy antibodies are found in people with eczema. 12 Antibodies are what the immune system produces in response to an allergen. Many people have found relief from eczema by following an elimination diet. Gluten sensitivity is one particular food allergy that is seen in people with eczema. Patients with celiac disease, the most severe form of gluten sensitivity, were found to have atopic eczema three times more frequently than those without celiac disease. 13 The best way to determine if a person has a gluten sensitivity is to follow a glutenfree diet for at least four weeks to see if allergic symptoms decrease. (See the Gluten Sensitivity section for more information on this condition.) With seborrheic eczema, like dandruff or cradle cap (in infants), an overgrowth of the yeast Malassezia is common. This yeast is normally present on humans in oily areas of the skin. In seborrheic eczema, this yeast is found in higher concentrations. It feeds on the fatty oils found in these areas of the skin and proliferates creating the flaking and oily scales that are characteristic of this type of eczema. Atopic eczema often occurs in families in which the other allergic diseases (hay fever and asthma) occur. Additionally, it is common for a person with eczema to also have another allergic disease. There is a 35 percent chance that an individual with eczema will also have hay fever, and a 30 percent chance of having asthma. 15 Factors that may worsen eczema include: 16 Long baths or showers Stress Sweating Cigarette smoke Wool or synthetic fabrics Chemical irritants Allergens Certain foods What Are the Signs and Symptoms? Atopic eczema is an itchy inflammation of the skin. It can affect any part of the skin, but most commonly appears in large skin folds like the inner elbow crease and behind the knees. Symptoms of atopic eczema include: 17 Discolored skin patches Severe itching, especially at night More than 90 percent of people with atopic eczema have Staphylococcus aureus bacteria growing on their skin. 18 If these bacteria multiply, they can cause an infection which can worsen the eczema. There have even been cases reported of MRSA infections (methyllicin-resistant Staphylococcus aureus) in children with eczema

4 Small raised bumps which may drain fluid and/or crust Thick, cracked or scaly skin Raw, sensitive skin Contact eczema appears on any area of the skin that has come into contact with an irritant or allergen. Symptoms of contact eczema include: 20 Rash or bumps Itching Dry red patches Blisters or draining fluid Rash limited to exposed area Pain or tenderness Healing HOPE Testimonial My 3-year-old daughter has been on probiotics for nearly a year. This, along with a lot of prayer, has completely eliminated her eczema and improved her breathing issues. For months Abby suffered with red rings around her eyes and itching around her ankles. Now all symptoms are gone. I am so happy with her progress and wish there was a way to tell other parents about this wonderful natural remedy. Suzanne ECZEMA Seborrheic eczema mainly affects the scalp, but may also affect other oily areas of the body such as the face. Symptoms of seborrheic eczema include: 21 Scales or thick crusts on the scalp that may attach to the hair shaft Red oily skin covered with flakes or scales Itching or soreness Flakes or dandruff How Is It Diagnosed? In the diagnosis of eczema, a thorough medical history and physical exam will be performed. The diagnosis will be based on examination of the skin as well as information about recent contact with any possible irritants or allergens. Family history will also be taken into account. In some cases, a skin biopsy may be performed to rule out other skin diseases. 22 If an allergy is suspected, allergy tests may also be performed. Natural health practitioners may also suggest a comprehensive stool analysis (CSA) that may be helpful to determine causes of eczema, such as bacterial imbalance, or a fungal or yeast infection. Other tests that may be helpful to determine contributing factors to eczema include a food sensitivity test and intestinal permeability test. (See the Appendix.) What Is the Standard Medical Treatment? The standard treatment for eczema largely addresses alleviating the symptoms of the disease inflammation and itching. This involves both over-the-counter and prescription medications. 510

5 Skin Conditions Healing HOPE Testimonial After I finished two weeks of the Candida Cleanse, the raw patches of eczema on my arms and legs nearly healed! The bloating and gas were gone and I am sleeping better. Thanks! Sheri people with eczema harbor Staphylococcus aureus bacteria on their skin, staph infections are common. Oral antihistamines like diphenhydramine (Benadryl) or hydroxyzine (Atarax) may be recommended for severe itching. These are usually used at night since they cause drowsiness. 25 Oral corticosteroids, like prednisone, may be prescribed temporarily for severe cases when other treatment methods fail. These cannot be used long-term, however, due to their adverse effects. 26 Corticosteroid creams are the most common medications used for eczema. Low potency creams can be found overthe-counter while higher potency creams are available by prescription. These creams work to decrease skin inflammation. Side effects include skin irritation or discoloration, thinning of the skin, infections or scarring. 23 Emollient creams or ointments are often recommended to maintain moisture of the skin. These are usually applied immediately after bathing. 24 If the skin becomes infected as a result of excessive scratching, antibiotics may be prescribed. Because most One class of drugs called immunomodulators tacrolimus (Protopic) and pimecrolimus (Elidel) may be used when other treatments have failed. These medications come with a black-box warning, however, which means they carry a risk of serious adverse effects. 27 For seborrheic eczema, antifungals may be used, sometimes in shampoo form, to combat the yeast overgrowth which is found in the oily areas of the skin like the scalp and face. Phototherapy, or light therapy, is another treatment method for eczema that involves the controlled exposure to either natural or artificial UVA or UVB light. 28 Due to the risk of skin cancer and premature aging, this therapy should be used for people with less skin cancer risk. 511

6 Dr. Smith s Comments ECZEMA Like all skin conditions, the gut-skin connection can be seen. Anytime there is an intestinal imbalance of the microbial flora (consisting mostly of bacteria and fungi), a dysregulated immune response often occurs leading to systemic effects which can include many areas of the body, and certainly includes the skin. Eczema (also known as atopic dermatitis) can be seen in association with other atopic conditions, such as hay fever, asthma or hives, but is generally not triggered by pollen or other airborne irritants. The frequent use of antibiotics, the promotion of a germ-free environment, too many vaccines, and a high-sugar diet, which promotes Candida overgrowth and dysbiosis, can all cause a shift toward the T helper lymphocyte 2 (known as Th2) cellular immune response (which can cause antibody-induced allergies) and a deficiency of the T helper 1 lymphocytes (known as Th1) cellular immune response which helps maintain gut bacterial balance. What s more, there are data to support the fact that children in mostly Western industrialized countries are too clean. These children generally do not play in the dirt, may not be exposed to pets, are often not breastfed, and receive about 40 vaccinations before attending school at age 5. The vaccines begin right at birth, with the hepatits B vaccine, at a time when the immune system is still underdeveloped. (Because of serious immune issues, France has stopped this practice of giving hepatitis B immunization at birth.) What happens with the too-clean and over-vaccinated kids is their immune systems become hyperactive and imbalanced with Th2 response greater than Th1 response. In addition, there are low levels of the balancing helper lymphocytes (known as Th3). An article in Science magazine showed that children from Brazil had very strong immune systems with high levels of both Th1 and Th2, but they had no Children raised in a less-than-sterile environment actually develop more balanced immune systems. atopic diseases, and they also had high levels of the Th3 balancing cytokines. What s more, these children had measurable levels of parasites in their bowel movements. They were treated with anti-parasite medicine, and then many of the children developed allergies for the first time in their lives! I am not suggesting that we feed our kids parasites, but playing outdoors in the dirt and grass, and in close contact with pets, especially dogs, may help to balance immunity. There is scientific data showing that kids growing up with dogs have a more balanced immunity. In further support for treating the too-clean kids with animal exposure, 29 it was shown that childhood exposure to animal buildings resulted in a significantly reduced risk of nasal allergies. The greatest reduction in risk was seen for respondents starting regular visits to animal stables during the first year of life, or between ages 3 and 5. Participants remained at a lower risk for nasal allergies which continued even into adulthood. 512

7 Skin Conditions Brenda s Bottom Line If your skin, which is the outer protective coating of your body, has eczema, then your intestinal lining, which is the inner protective coating of your body, is also inflamed in a similar way. When the digestive tract is out of balance, it sends an increased amount of toxins to the liver. The liver can become overburdened, dumping toxins that it is unable to process back into the body. The other organs of elimination must then eliminate these toxins. The skin is one major secondary route of this elimination. Addressing gut imbalance should be the first step for people with eczema. Because Candida overgrowth and gluten sensitivity are common in people with eczema, following the Candida Diet (see the Appendix) while avoiding gluten is a good idea. A minimum of three months is needed to allow the diet the time it needs to heal the body from the inside out. Replacing the beneficial gut bacteria with probiotics is an important part of managing this condition. Follow the recommendations below and on the next page for a whole-body approach to treating eczema. If gluten sensitivity is an issue, follow the Fiber 35 Eating Plan, but also eliminate gluten-containing foods. If none of these are an issue, still follow the Fiber 35 Eating Plan. Lifestyle Taking fewer showers and baths, or limiting time spent bathing can be helpful for those with eczema. Avoid cosmetics that contain harsh ingredients that may irritate the skin. Complementary Mind/Body Therapies Colon hydrotherapy is helpful to aid detoxification. Stress can be a major component of this disease, so find ways to reduce it with therapies such as meditation, yoga, deep breathing, massage, biofeedback, or music therapy. Hypnosis may be helpful for people with eczema. Rule Out: Candida overgrowth (See the Candidiasis section.) Gluten sensitivity (See the Gluten Sensitivity Section.) H. pylori infection (See the Gastritis and Peptic Ulcer sections.) Recommended Testing Comprehensive stool analysis (CSA) (See the Appendix.) Gluten sensitivity test (See the Appendix.) Diet If Candida overgrowth is an issue, follow the Candida diet until the skin clears up. Then follow the Fiber 35 Eating Plan for maintaining skin health. (See the Appendix.) Harsh ingredients in cosmetics can irritate the skin. 513

8 Recommended Nutraceuticals Critical Phase Dosage Benefit Comments Daily maintenance recommendations should also be taken during this phase unless otherwise indicated. ECZEMA Steps of Cleansing See Appendix Complete program that supports the body s seven channels of elimination Three-step program includes a Total Body Cleanse, microbial cleanse, and a targeted cleanse. Probiotics 200 billion daily for two weeks Balances intestinal flora, reducing outbreaks. Look for a formula that is high in bifidobacteria, the main beneficial bacteria in the colon. Helpful Vitamin A 5,000 10,000 iu daily Important nutrient for maintaining skin health. Look for a formula that also contains mixed carotenoids. Vitamin D 3 1,000-2,000 iu daily Aids tissue healing. Research is showing many health complications as a result of low vitamin D levels. Daily Maintenance Omega Oils 2g daily Provides anti-inflammatory GLA and other EFAs to repair skin and unblock pores. Look for a mix of fish oil, pomegranate oil, borage oil, and sea buckthorne oil (omega 3,5,6,7,9). Probiotics billion culture count daily after critical phase Balances intestinal flora, reducing outbreaks. Look for a formula that is high in bifidobacteria, the main beneficial bacteria in the colon. Skin Support Formula Use as directed To support liver function and cleanse blood, which feeds the skin. Look for a formula with burdock, red clover, silymarin (from milk thistle), zinc, and vitamin C. Digestive Enzymes Take with meals Helps digest and absorb nutrients from food, reducing inflammation. Find a formula that contains hydrochloric acid (HCl), as many people with eczmea are low in stomach acid. Fiber 4-5 grams twice daily Promotes regular bowel movement. Look for a soluble/insoluble fiber blend. Use in conjunction with high-fiber diet to reach 35 grams daily. See further explanation of supplements in the Appendix 514