Skin Deep, information on Eczema

By Jan Holman  (Originally written for Growing Today)

Another sleepless night, fighting the urge to scratch – and losing.  It’s enough to drive you crazy and if your eczema wasn’t aggravated by stress to start with, the stress of living with eczema certainly adds to the difficulty of finding relief.

Sound familiar?  Chances are you, or someone you know, suffers from eczema or dermatitis (the terms are interchangeable) as about one in five people are affected at some stage of their life.  I’ve become more and more interested in eczema, it’s possible causes and the variety of remedies available.  We get quite a number of visitors with eczema or more frequently bringing young children who are miserable with their itchy skin.

I empathise strongly with anyone with this kind of skin problem, having developed it myself as a baby and only finding myself free of it at about 25 years old.  My aim in this article is not to offer a cure – if only I could, but to make available a range of options from different healing disciplines, some self help ideas and hopefully a little insight and understanding into this very confusing and frustrating skin complaint.

Before we look at the various types of eczema, let’s have a look at what happens to the skin.  Our skin is made up of two layers; the thin, outer layer or epidermis – which is continually being replenished by new cells forming at its base.  These travel to the surface changing their shape and structure on the way, until at the surface they compose a scaly layer which is mostly made of keratin – the same substance that forms our hair and nails.

Below the epidermis is a thicker layer, the dermis which is tough and elastic, supplied with blood vessels, nerves, sweat and grease glands, hairs also grow from the dermis.

Source: http://www.benjaminreece.com/source_images/ill29_lg.html

Healthy skin performs a number of vital functions for the body including:

• temperature control
• excreting waste products
• a sensory organ
• providing a barrier against infection
• protecting the body from the sun
• manufacturing some of our Vitamin D requirements

In an eczema sufferer there is generally a higher than normal level of white blood cells in the epidermis and dermis – normally they are present mainly in the blood.  These white cells release chemicals which irritate the skin and set up the “scratch-itch-scratch” cycle.  In cases of allergic dermatitis a group of white blood cells known as T lymphocytes act as vigilantes and develop a specific memory for the contact substance.  These cells multiply rapidly triggering a skin reaction, often forming small blisters.

Scratching is the means by  which eczema becomes visible, this can become extreme and damage the skin, creating more irritation, swelling and redness.  Once the skin is broken there is also the risk of secondary infection.  Any form of eczema can be –

Acute where the skin is red, inflamed, moist and swollen, itchy and painful, often tiny blisters appear which burst and weep.  This stage is uncomfortable but short lived.

Or Chronic – this is a long term phase, dominated by itching – which in turn leads to thickening of the skin as a defence mechanism.

On the positive side when the eczema does clear up it generally disappears without a trace.

The following list is a guide to the various shapes and sizes eczema comes in and, of course, there are exceptions to the rules and some people may suffer from several different forms at different times or more miserably, at the same time.

Types of Dermatitis or Eczema

1.         Atopic Dermatitis – Childhood Eczema

Frequently linked with a family history of asthma, eczema or hayfever.  It affects equal numbers of boys and girls, usually occurring in infancy and subsiding at puberty.

Source: http://dermnetnz.org/dermatitis/atopic.html

 Common Sites:

Patches of dry irritable skin on the face, behind the ears, behind the knees and in the folds of the elbows.

Child may alternate bouts of eczema with asthma, may well have brothers or sisters suffering from hayfever or asthma.

2.         Seborrhoeic Eczema

Affects areas where the sebaceous glands are most numerous (around hair follicles).

Source: http://www.primehealthchannel.com/cradle-cap-symptoms-causes-pictures-treatment-and-home-remedies.html

a)  Infantile ‘ “cradle cap”, where baby has a greasy, scaly scalp and some redness and scaling in body folds.  Generally occurs between 3 – 9 months and does not usually bother the child.

b)  Adult – tends to affect men more than women (and more often with fair hair and skin), pink scaly patches form on scalp, eyebrows, ears, face, front of chest and body folds.  Frequently preceded by bouts of dandruff and itchy scalp.

3.         Contact Irritant Dermatitis

http://www.handdermatitis.biz/

Pretty self explanatory – rash develops in response to exposing the skin to an irritant on first contact.  Redness and itching appear on skin involved.  Common triggers include –

• soap
• detergents
• shampoo
• perfumes
• washing powders which contain stain digesters
• bleaches
• caustics
• paraffin

4.         Contact Allergic Dermatitis

Reactions may occur after many years of handling a substance.  Does not develop on first contact, reaction arises after repeated contact.  There may be a delay of up to a week before the skin reacts and possibly the reaction will not appear on the area that was originally in contact with a substance. More commonly occurring in women.  Common allergens include:

• nickel found in jewellery
• animal hair
• colophony found in sticking plasters
• some plants including Primula obconica, Rue, Angelica and Giant Hogweed

 5.         Stasis or Varicose Eczema

This form of eczema is common in middle aged and elderly persons suffering from varicose vein problems.  The sluggish blood supply to the lower legs deprives the skin and tissues of nutrients – leading to thin, reddened skin, often blotchy with a scaly rash.  If skin is damaged in this area it is important not to scratch as this may easily lead to varicose ulcers which are very difficult to heal.

 6.         Neurodermatitis (Lichen Simplex Chronicus)

Often a small area of skin is affected, frequently on the arms, lower legs or back of the neck.  This area is extremely itchy and uncomfortable and the habit of scratching is formed.  This is aggravated by tiredness and stress.  Most commonly found in middle aged people.

 7.         Nummular or Discoid Eczema

Presents as round, red areas, frequently found in young adults, on the lower arms or lower legs.  Looks like ring worm and is very itchy – they frequently become secondarily infected.  Related to seborrhoeic eczema.

 8.         Asteatotic Eczema

Elderly people may develop this eczema, the lower legs become dry and cracked and look like crazy paving.  It responds well to the use of emollients, moisture retaining preparations and the addition of some dietary supplements.

 Ok, we’ve looked at the various forms eczema takes and looked a little at what happens under the skin.  Now, let’s take a look at some different healing disciplines, how the source of eczema is perceived and their approach to it’s remedy.  In writing this I am trying to remain objective, make sense of what I have been told or have read and regurgitate it for you, so that you can look at some of the options and make an informed choice of where to go from here, although as you will realise there are a lot of other choices available.

 At this point I would like to thank a number of people who have willingly provided their time, wisdom and resources to me:

Lizzie Gilbertson, Naturopath
Central Hawkes Bay

Shelley Hickson, Acupuncturist
Havelock North

Dr Jamie Speeden
Waikato

Maxina Schiavi, National Homoeopath
Massey, Auckland

Stephanie Elder, “Food for Thought”
Waipukurau

Linda Dorwood & Meryl Sayers, “Linda’s Health”
Hastings

Pat & Derek Biggs R.S. Hom (UK)
Auckland College of Classical Homoeopathy

Sifting through the screeds of information I have, there are some common themes, and these seem to me, common sense care for those suffering from eczema, or with skin prone to eczema.

• Wear cotton clothing especially next to the skin; this also includes cotton gloves under rubber gloves for cleaning etc if your hands are sensitive.
•  Keep fingernails short and clean.
• Avoid extremes of temperature, this includes baths and showers and exercise that increases the body temperature – going from hot to cold or cold to hot triggers the itching mechanism.
• Don’t use soap on your skin, there are soap free preparations.  A couple of tablespoons of cider vinegar in the bath will act as a deodorant and soothe skin.  Oatmeal bags or flax seed brew will soften and soothe skin.  Pat skin dry and don’t rub.
• Avoid alcohol.
• Check out possible allergy producing substances both contact and internal; some possible food substances are dairy products, citrus, spices, fish and seafood, eggs and wheat products.
• Avoid exposing yourself to people with coldsores, herpes simplex.
• Lanolin plugs the oil glands and vaseline and other greasy ointments aggravate eczema by preventing the evaporation of sweat, so it’s best to avoid these and products including them.
• Stress, tension, tiredness and anxiety can trigger a flare up of eczema or exacerbate an existing condition.
• Application of emollients, moisturisers, bath oils etc help skin to retain moisture and lessen irritation, & are most effective applied to damp skin, straight out of the shower.
• As for asthma sufferers, dust, animal hair and feathers can be serious irritants.  Use synthetic bedding materials and keep drapes and floor coverings to a minimum especially in the sufferer’s bedroom.
• If your families have a history of asthma, hayfever or eczema try to prolong breast feeding and wean onto goat’s milk products.

Orthodox Medicine tends to focus on external remedies, emollients, topical steroids and preparations containing tar.  These are supplemented when necessary with antibiotics and antihistamines internally.  There is much concern over the use of steroid creams and the side effects include thinning of the skin,  development of small visible blood vessels on the skin and stretch marks, like those of pregnancy, in the skin folds.  It is important too, to use the appropriate strength cream on the appropriate area, do not mix them up, for example by putting a strong cream on the face.  Always use sparingly. Occasional use, for example to allow a child a good nights sleep, free of itching can be helpful even if you are dead against steroid creams per se. Another recent development is the awareness of parabens in cream bases. If possible avoid any cream with paraben additives.

Dietary Supplements

Evening Primrose Oil and Borage Seed Oil these are rich in gamma lineolic acid or GLA.  GLA is biologically important as it effects much of the enzyme activity in our bodies, and in prostaglandins. These are hormone like substances that regulate bodily functions, including blood pressure, digestion and inflammation.  Prostaglandins are produced on site in response to stimulus and live for only a few seconds before being broken down, which is why we need a steady supply of GLA.  Incidentally GLA is also found in vegetables especially green leafy kinds, avocados, vegetable oils, seeds and pulses and interestingly enough in breast milk but to my knowledge it is not in formula milks.  Breast feeding mothers could do well to make a point of eating GLA rich foodstuffs while lactating.

Fish Oils are rich in Vitamins D and A – the skin itself synthesises Vitamin D when exposed to sunlight.  Cod liver oil has long been a dietary supplement and was distributed free after WW2 to pregnant and breast feeding women and children under 5 to combat malnutrition.  Vitamin D works with calcium to build bones and teeth and also affects the quality and tone of skin tissues and promotes healing.  More importantly the fish oils also contain a group of polyunsaturated essential fatty acids, called Omega 3 which differ from the essential fatty acids found in vegetables (Omega 6).  The Omega 3 oils are produced from linolic acid and are used in the production of prostaglandins and leukotrienes, the latter regulate inflammatory disorders, both of the skin and joints.  Omega 3 also affects the prostaglandins which regulate immune function and are responsible for reversing the body’s reaction to stress.

Phew … this is pretty technical stuff but I feel its a bit like putting pieces of a jigsaw together – it helps to have an overall picture to look at.  Right, back to work –

Flax Seed Oil, otherwise known as Linseed Oil (Linum  usitatissumum).  This oil is rich in Omega 3, up to 60%, Omega 6 and Omega 9 fatty acids.  If you are vegetarian and don’t like to take fish oils, this may suit you.  Flax seed oil also contains beta carotene, which is a building block of Vitamin A.  Flax seed oil needs to be used fresh, so check its extraction date.    Even when kept cool and tightly sealed it will lose its nutrients after 4 months.  Store in the fridge and use within 6 weeks of opening.  Capsules help to protect the oil from spoilage.  Flax seed oil can be mixed with other food stuffs, cottage cheese is recommended also yoghurt, tofu, salad dressings and butter.  Flax seeds can also be ground up when needed and used in the bath.  See recipes.

Zinc is involved in the enzyme reactions of most of the major biochemical pathways of the body and is essential for the growth and repair of tissues.  Almost all the zinc in the body is bound up chemically, so one’s diet needs to provide regular zinc when it is needed for the synthesis of new cells and to replace losses in sweat.  Foods which are rich in zinc include meat, legumes, wholegrains and milk products.

Vitamins – Vitamin A is an important link in the chain of skin maintenance and development and controls the rate at which skin cells are shed.  A deficiency of A can lead to thickening of skin as is often seen in eczema (hyperkeratosis).  Vitamin A is synthesized in the body from carotene, found in carrots and apricots and dark green leafy vegetables and in some fish and liver as retinol.

Vitamin E is an antioxidant, it has the ability to neutralise free radicals, which are a normal by-product of the body’s metabolism, but in excess they can multiply out of control and damage healthy tissue, also contributing to the aging process by attacking collagen and elastin fibres which keep our skin supple.  Vitamin E is used in a large number of skin care products, but the most effective way to utilise it is to take it internally.  It is found naturally in unsaturated oils, especially safflower, sunflower, cottonseed, walnut and wheatgerm which has the richest supply.  Also some nuts and seeds, green leafy vegetables (they keep cropping up don’t they?) and wild blackberries.

The skin is an excretory organ and when it is under stress other organs come into play, the liver and kidneys, blood system and lungs may all be working overtime.  There are a number of herbal remedies to help cleanse the body and get rid of toxins.

Herbal Remedies

Burdock – Arctium lappa – is one of the first plants mentioned in relation to skin problems; it’s even listed as Niu Bang Zi in the Chinese Herbal section of eczema (one of the few things I recognise).  The roots are used internally, acting as a blood purifier, cleansing and eliminating impurities.  Root tea may be used externally to soothe skin, also used is a tincture made from the seeds.

Nettle – Urtica dioica – is used as a general tonic, it eliminates toxins and purifies the system, regenerates the blood and stimulates the digestive functions.

Other herbs listed for internal use for eczema include Meadowsweet, Dandelion, Kumarahou and Yellow Dock.  Now this list isn’t complete and isn’t intended to send you off into the garden to fill your teapot.  It’s just a starting point.  Go and see a reputable herbalist, get some books from the library, talk to the staff in your local health food shop.  Herbal remedies are often available in tinctures and capsule form, as well as in fresh or dried stock.

Bach Flower Remedies

There are some Bach Flower remedies that are frequently used to ease eczema, “Crabapple” for instance is a cleanser and helps to balance a feeling of being unclean and ashamed.  If you are feeling stressed or anxious there are remedies you can select to suit your temperament.  They can also play an important role in coping with eczema.  One vital but overlooked role would be in helping the parents of a child suffering from eczema, this is an extremely stressful role and if you are treating your child with unorthodox methods, you may need something to keep you feeling confident, positive and to keep frustration to a minimum.

There are practitioners who specialise in using Bach Flowers and most Health Shops carry a set of mother tinctures and a booklet to help you choose appropriate remedies.  I am getting ahead of myself – I should explain – as best I can, the Flower Remedies were devised by Dr Edward Bach.  There are 38 remedies which use the vibrationary essence of each flower to balance negative emotions which lead to, and are, symptoms of disease.  This may not tell you how they work but personally I have found them extremely effective especially with children and even when used on animals and birds.  Rescue Remedy is probably the most well-known Bach flower mix made up of five essences.  If you, or your child, are taking a constitutional homoeopathic remedy, it is best not to confuse the picture by using Bach flowers, your homoeopathic practitioner will need a clear idea of the reaction to the homoeopathic remedy both physical and mental.

Acupuncture & Chinese Herbal Medicine

Acupuncture is an ancient healing art.  It is said that as long ago as 3000 BC the Chinese noted that soldiers wounded with arrows sometimes got relief from diseases which had been troubling them for years.

The basis of acupuncture is a series of twelve meridians, each meridian links a series of acupuncture points.  “Chi” – the body’s life force flows along these lines and disturbances in the body’s organs are registered as blockages and disruptions of the “Chi”.

The needles used are incredibly fine, you hardly feel them go in – honestly!  Disposable needles are mostly used now, and once they are in place you feel some unusual but gentle reactions, a bit like electrical currents buzzing around.  I have never had acupuncture without falling into a deep sleep on the table, no matter how much I try to resist.

It seems that generally speaking Chinese Herbal Medicine is the most effective for eczema itself.  Acupuncture can be used to encourage the body back into a healthy state.  The two primary causes of eczema are seen to be hereditary and poorly regulated diet.  It may also be related to an attack of urticaria which is not properly treated or some other pathogenic factor such as measles or chicken pox or following after immunisation.

The spleen becomes unhealthy and fails to properly transport food, which accumulates and transforms into damp heat, which collects in and obstructs the skin giving rise to eczema.  In both dry and damp types of eczema the spleen is nourished and the itching is attended to by acupuncture.  Use of corticosteriod creams is discouraged as it is seen as increasing the chance of asthma.  Acupuncture treatment may well be supplemented with herbal tablets, blue flag tablets for example which contain Iris versicolor and Phytolacca decondra among other things.

Homoeopathy

“Like treating like” – this is the basis of homoeopathy.  Its founder, Dr Samuel Hahnemann, noted early in the last century that when he took cinchona bark he developed the same symptoms as a malaria sufferer.  At that time cinchona was used as a treatment for malaria.  Hahnemann was curious about this interesting phenomenom and proceeded to explore this connection by dosing himself and other healthy people with small doses of cinchona and noting the effects.

Many people are wary of homoeopathy, seeing it as some weird healing system.  In actual fact modern medicine has some examples of the same.  The use of x-rays and radium, themselves among the causes of cancer, are used to cure cancer.  Many heart drugs are based on digitalis, which if taken excessively causes heart problems.

The sources of homoeopathic medicines are taken from the natural world – plants, minerals, some animals (Bees – Apis mellifera for example), poisons and pathological sources.  The effect of the remedy deepens the more dilutions it undergoes, this is called potentising.

For eczema treatment, a constitutional remedy is usually employed, this will be specifically chosen to suit you, looking at your body type, complexion etc., how the environment affects you, the effects of certain foods and drinks and your mind and emotional state “from the top of your head to the tip of your toes and everything in between”.

You may only be given one small white pill at the end of an hours consultation.  Don’t be fooled by its simple appearance!  Frequently after starting a remedy you condition will worsen – great, this is a good sign, you should be encouraged that all is going as it should.  The difference between homoeopathic and allopathic (traditional medicine) is that homoeopathics work by raising the body’s awareness of its condition therefore sometimes creating aggravation before cure.

There are any number of people prescribing homoeopathics.  Before embarking on a course of treatment, please check out a practitioner’s qualifications, where they studied and for how long and that they have a Diploma.  The usual study time is 4 years part-time, about 900 hours.

The best recommendation of all is word of mouth.

Recipes:

In the Bath –

Bath Bags – Put one or two handfuls of oatmeal in a muslin bag or tied in a square of muslin.  Place under hot tap when filling the bath (my mother used to do this for me when I was a child).

*Infusions of any of the following herbs will help to soothe and heal the skin:

·      Calendula (English Marigold)

·      German Chamomile

·      Sage

·      Chickweed

·      Yarrows

·      Birch Leaves

·      Red Clover Flowers

·      Kumarahou

A few drops of a prepared tincture or an essential oil in a carrier oil, 2 to 3 drops in 2 teaspoons almond oil may also help – essential oils known for their soothing properties include –

·      Lavender

·      Chamomile

·      Neroli

·      Cedarwood

·      Rose

*Cider vinegar in the bath water 2 or 3 tablespoons.

 Flax seed or linseed:  Boil 2 oz (50gm) of freshly ground linseed in 1-3/4 pints/1 litre of water for 2 minutes.  Strain and add liquid to bath, softens skin and acts as a tranquiliser.

 Alternative to Shampoo:  For irritated scalp.

Boil 4 large marigold heads (Calendula officinalis) in 4 cups of water for 2 minutes.  When cool massage solution into scalp thoroughly.  Wash hair with soapwort solution or sunlight soap, rinse well adding a little lemon juice or vinegar to final rinse.

 Soothing Mixes to Put on the Skin:

Aloe vera gel on its own can be soothing on eczema, it seems to be more helpful for wet eczema as it has a drying effect.  There are many skin preparations containing Aloe vera on the market.  Don’t forget to avoid perfumed products.  Aloe vera combined with moisturising products is useful for both wet and dry eczema.

Lavender Oil:  Fill a clean glass jar ¾ full with lavender flowers, pour in virgin olive oil leaving 5cm air space at top of jar.  Put jar in a double boiler and simmer quietly for 2 hours.  Cool in the pan, strain and store in dark bottles in a cool place.

Dry Skin Body Scrub:

2 level tblsp medium ground oatmeal

2 level tblsp ground almonds

1 egg

2 capsules Evening Primrose Oil

Mix all together to form a paste.  Rub gently over entire body.  Rinse off and follow with the dry skin body oil.

Dry Skin Body Oil:

50ml Almond oil

50ml Grape Seed oil

1 tsp Wheatgerm oil

1 tsp Evening Primrose oil

5 drops Sandalwood Essential oil

A nourishing and soothing oil.  Suitable for most sensitive and inflamed skins.

Crocodile Skin Cream:

This is cheap, inexpensive accessible maintenance cream for anyone with dry skin and certainly helps to keep eczema at bay.  I’ve been using it every day for about 10 years now.  The recipe was given to me by Maxina Schiavi.

1 dollop (about half a cup!) – Aqueous Cream ( we make our own Cream Base now, but it’s possible to buy a paraben- free cream base from  a number of online shops.

1 dessertspoon of each – Castor Oil/Almond Oil

1 tbsp. Glycerine

Few drops of  oil of Bergamot (Bergaptene free if possible)

Mix together to a consistency to suit you.  Add a little more of some ingredients if you want.