Children With Eczema Have Same Impaired Quality of Life as Those With Kidney Disease

Children with serious skin conditions feel their quality of life is impaired to the same extent as those with chronic illnesses such as epilepsy, renal disease and diabetes, according to research published in the July issue of British Journal of Dermatology.

A team of Scottish researchers surveyed 379 5- to 16 year-olds, who had been suffering from skin diseases like acne, eczema and psoriasis for more than six months, together with their parents.

They asked the children and their parents how much the condition impaired the child's quality of life when it came to factors such as pain, loss of sleep, dietary restrictions, interference with school and play, friendships, teasing and bullying and medical treatment.

They then compared the quality of life scores given by the parents of 161 children with chronic diseases in the same age group.

Only six of the 546 parents approached by staff at Ninewells Hospital in Dundee and Perth Royal Infirmary preferred not to take part in the research. All the children included were attending outpatient clinics at the two hospitals.

Key findings included:

· The children in the study said that psoriasis (red scaly patches) and eczema were the two skin conditions that caused them the greatest distress. Both resulted in a 31% impairment in their quality of life score. This was followed by urticaria (itchy allergic skin rash) at 20% impairment and acne at 18% impairment.
· From the parent's perspective, eczema was the biggest skin problem at 33%, followed by urticaria at 28%, psoriasis at 27% and hair loss at 19%.
· When they compared the overall results for the children with skin diseases and chronic illnesses, the researchers found that the condition that had the worst affect on quality of life was cerebral palsy at 38%. Generalised eczema and kidney disease both scored 33%.
· Cystic fibrosis also made the top five (32%), followed by urticaria and asthma (28%), psoriasis (27%), epilepsy and bed wetting (24%), diabetes, hair loss and localised eczema (19%) and acne (16%).
· When children with psoriasis, and their parents, were asked to chose the factors that affected the child's quality of life most, parents rated bullying third and children rated bullying fourth.
· Teasing or bullying was also a key concern for the 11 children with hair loss, with six of the children and nine of the parents putting it first on their list.
· The biggest concerns for children with eczema, psoriasis and uticaria was itching or pain, while children with acne or warts said that embarrassment was their main worry.

"Our study shows that children with chronic skin diseases – and their parents – reported the same level of quality of life impairment as the parents of children with many other chronic illnesses" says lead author Dr Paula Beattie from the Royal Hospital for Sick Children in Glasgow.

"Skin diseases are often more obvious to other children than chronic diseases such as asthma or diabetes and are more likely to lead to alienation, name calling, teasing and bullying.

"Some skin conditions can also disturb children's sleep and cause lack of self-confidence, embarrassment and poor self-esteem, especially as they get older.

"Although skin diseases may not shorten life in the same way as serious conditions like cystic fibrosis, they can cause children as much, if not more, distress in their everyday lives."

"Measuring quality of life can be a powerful political tool as it provides the patient's perspective on the health impact of different diseases" adds co-author Dr Sue Lewis-Jones from Ninewells Hospital, Dundee.

"This is particularly important when arguing for vital resources, especially in dermatology, as skin diseases are not considered to have as much of an impact on people's lives as other illnesses.

"Our study clearly shows the profound effect skin diseases can have on children's quality of life and we hope that our findings will raise awareness of the problems they face and encourage greater sensitivity towards them."

SOURCE: Blackwell Publishing Ltd.

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Education Program Reduces Severity of Eczema

Age-related educational programs for the long-term control of atopic dermatitis in children and adolescents were significantly more effective than conventional treatment, according to a randomized controlled trial of 823 parents and affected patients in Germany.

Atopic dermatitis affects up to one-fifth of schoolchildren. Management of this chronic disease may be suboptimal due to lack of information and lack of confidence in medical treatment. While several educational interventions have been developed for adults with eczema, programs for children are sparse.

In this study, an interdisciplinary team presented standardized educational programs for the management of atopic dermatitis. Those in the intervention group participated in six weekly group sessions lasting two hours each. Participants were grouped by age: parents of children ages 3 months to 7 years; parents of 8- to 12-year-olds; and adolescents ages 13 to 18 years.

Topics included basic medical information; stress reduction, dealing with itching and scratching, and sleep disturbance; recognition and avoidance of trigger factors, daily skin care; stage-related treatment of symptoms, unconventional therapies; general child nutrition, food allergies in atopic dermatitis; and issues of coping, self-management plan.

Parents and affected adolescents completed questionnaires before the intervention began and 12 months later that assessed subjective severity of eczema, itching behavior and quality of life for parents of children younger than 13. The study also assessed clinical severity of eczema.

Significant improvements in clinical severity of eczema and subjective severity were seen in all intervention groups compared with the control group. In addition, parents of children younger than 7 years of age experienced significantly better improvement in all five quality of life subscales (psychosomatic well-being, effects on social life, confidence in medical treatment, emotional coping and acceptance of disease) compared with the control group. Parents of children ages 8 to 12 years experienced significantly better improvement in confidence in medical treatment, emotional coping and acceptance of the disease.

The authors concluded that integrating educational programs for the control of atopic dermatitis with routine care should be considered.

Source: http://aapnews.aappublications.org

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Watching a Weepy Film May be a New Way to Reduce the Symptoms of Eczema

Eczema Club note: This really unique eczema treatment should also pose a question: Does being sensitive actually helps eczema suffers? I think it does. What do you think? Leave your comment about it on this post.

Research based on 60 patients with atopic eczema who had an allergy to latex, shows that those who cried while watching Kramer Vs Kramer had a reduced allergic response immediately afterwards.

The patients viewed a weather information video and the sad movie, and after each viewing various tests — including allergic response to latex — were carried out by researchers at Satou Hospital, in Osaka, Japan.

The results show that after watching the film about the weather, there was no change.

But in 44 out of the 60 patients who cried after watching Kramer Vs Kramer, there were significant changes.

They had reduced allergic responses, including skin wheals, and lower levels of antibodies to latex.

One theory is that the emotional effect of crying has some beneficial impact on the immune system, although exactly how is unclear.

A special type of silk material may be as good as some drug-based treatment for eczema.

Research by dermatologists at the University of Zurich shows that the antimicrobial material was as effective as steroid creams.

Atopic dermatitis or eczema can be aggravated by irritation and bacteria, and in the research the doctors compared the antimicrobial silk fabric — DermaSilk — with a rub-on corticosteroid.

Fifteen girls wore a dress where the left side was made of DermaSilk and the right side was made of cotton.

The right arm and leg were treated daily with a corticosteroid, mometasone, for seven days.

Results show that for both treatments, there was a significant decrease of eczema after seven days.

"No significant difference between DermaSilk-treated and corticosteroid-treated skin could be observed.

"DermaSilk showed potential to become an effective treatment of atopic dermatitis," say the researchers.

Reference: http://dailymail.co.uk, ©2008 Associated Newspapers Ltd

Bacterial Toxin in the Home May Protect Infants from Eczema

New findings support the controversial ''hygiene hypothesis''

Children whose homes contain high levels of endotoxin, a bacterial compound that collects in house dust, may be less likely to develop eczema during their first year of life, according to a study led by Dr. Wanda Phipatanakul, a pediatric allergist and immunologist at Children's Hospital Boston and assistant professor of Pediatrics at Harvard Medical School.

The study corroborates other recent work that supports the ''hygiene hypothesis'' -- speculation that early exposure to infectious or inflammatory agents causes changes in babies' immune systems that reduce their risk of developing allergy-related conditions later in life.

Various studies have looked at the relationship between endotoxin and allergies, but this is the first U.S. study to look at the effects of endotoxin exposure on eczema, one of the most common allergic diseases of infancy.

As part of the ongoing, Boston-based Home Allergens and Asthma Study, the researchers followed nearly 500 infants living in the Boston metro area beginning at 2 to 3 months of age. They collected dust samples from the living rooms of 400 of them and analyzed the samples for endotoxin, a component of the cell walls of various bacteria. All the babies had a parent with allergies or asthma.

The more endotoxin in the home, the less likely babies were to be diagnosed with eczema during their first year of life. When endotoxin concentrations were classified into four levels, the risk for eczema was about 25 percent lower with each increase in endotoxin level, after adjustment for other eczema-related variables.

Infants whose homes had a dog also were less likely to develop eczema, but this relationship weakened after adjustment for endotoxin exposure. Eczema risk was increased in infants whose fathers had a history of eczema, or whose mothers were sensitive to at least one allergen.

Cases of eczema have increased two- to three-fold in industrialized countries since World War II, a pattern similar to that seen for asthma and other allergic conditions.

According to the hygiene hypothesis, today's cleaner, more germ-free environments may deprive babies' developing immune systems of chances to practice fighting off microbes; as a result, their immune systems veer toward an allergic type of response, mistakenly attacking harmless substances. Supporters of this still-controversial idea note that children who live on farms, grow up with pets, come from large families, or start day care in early infancy are less prone to allergies and asthma.

Phipatanakul does not advise parents to buy pets, stop cleaning their homes, place their infants in daycare, or do anything else to protect them from eczema.

''We now know that there are things in the environment that may be important in eczema,'' she says. ''But you need lots of studies to be able to come up with recommendations.''

Phipatanakul notes that the mechanisms of allergies are very complicated, and that it's not clear what endotoxin does to the immune system. In fact, a number of studies have linked endotoxin exposure with wheezing and airway inflammation in established asthmatics.

The research was funded by the National Institutes of Health.

Children's Hospital Boston is the nation's premier pediatric medical center. Founded in 1869 as a 20-bed hospital for children, today it is a 300-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. More than 100 outpatient specialty clinics are located at Children's. Children's Hospital Boston is the primary pediatric teaching affiliate of Harvard Medical School, home to the world's leading pediatric research enterprise, and the largest provider of health care to the children of Massachusetts. For more information about the hospital visit: www.childrenshospital.org

Source: http://childrenhospital.org

Eczema Sufferers Test Out Benefits Of Water Softeners

ScienceDaily (Nov. 30, 2007) — In the very first trial of its kind in the world over 300 families are being recruited to find out if water softeners can help in the treatment of childhood eczema.

The independent trial run by clinicians at The University of Nottingham has received funding of nearly £1million from the Department of Health's National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. The study will focus on hard water areas in Nottingham and Leicester, Cambridge, London and the Isle of Wight.

The aim of the Soft Water Eczema Trial (SWET) is to discover whether eczema can be improved by deliberately softening all water used in the home — except at one tap in the kitchen which will supply mains water for drinking.

Families of eczema sufferers and some doctors have said that living in a hard water area may make eczema worse.

Recently a team of researchers at The University of Nottingham found that eczema is more common in primary school children living in hard water areas in the UK compared with children living in soft water areas. No one really knows why, but it could be because hard water contains high levels of calcium and magnesium, leading to increased use of soaps which can act as skin irritants.

Professor Hywel Williams and his research team at the Centre of Evidence Based Dermatology are running the trial. Professor Williams said: “I have wanted to do this study for many years as patients keep telling me that water softeners help their skin, but other people aren't so sure. Carrying out a proper randomised controlled trial will help us find the answer. If ion-exchange water softeners are found to improve the symptoms of eczema, this will be an extremely important finding for both patients and doctors. Many patients worry about the possible side effects of the usual treatments for eczema, so this would be a welcome addition to their treatment options.”

The study is in the process of recruiting 310 children between the ages of 6 months and 16 years who have moderate to severe eczema.

Up to one fifth of all children of school age have eczema, along with about one in twelve of the adult population. The severity of the disease can vary. In mild forms the skin is dry, red and itchy, whist in more severe forms the skin can become broken, raw and bleeding. Eczema is not contagious and with treatment the inflammation of eczema can be reduced, though the skin will always be sensitive to flare-ups and need extra care and protection against dryness.

The water softener industry (through their representative body, the UK Water Treatment Association) – is closely involved in the development of the trial and a generic water softener has been specially produced for the study. The industry is meeting the costs of producing and installing water softener units. The study findings will be quite independent from any industry influence.

The trial will run until the end of next year and the results won't be known until the end of 2009 when all the information has been analysed.

Reference: http://sciencedaily.com
Adapted from materials provided by University of Nottingham. University of Nottingham (2007, November 30). Eczema Sufferers Test Out Benefits Of Water Softeners.

Eczema Club note on hard water:

What is hard water?

Hard water is water containing a high level of calcium, magnesium, and other minerals. Hard water reduces the cleansing power of soap and produces scale in hot water lines and appliances. On contrary, water with a low mineral content is known as soft water.

Source: http://aquatechnologies.com, http://wikipedia.org

Childhood Eczema Treatment with Aromatherapy and Massage

Researchers are continually reviewing treatments which can help help childhood eczema. One solution recently considered by the School of Applied Science, South Bank University, London, UK was Aromatherapy - therapeutic massage incorporating a blend of aromatherapy essential oils.

A group of eight children, all born to professional working mothers, were studied to test the hypothesis that aromatherapy, used as a complementary therapy in conjunction with normal medical treatment, would help to alleviate the symptoms of childhood atopic eczema.

The children were randomly assigned to one of two groups; the first group received aromatherapy (massage with essential oils). The essential oils, chosen by the mothers for their child, from 36 commonly used aromatherapy oils, were: sweet-marjoram, frankinsence, German chamomile, myrrh, thyme, benzoin, spike lavender and Litsea cubeba.

The second group was used as a control and these children received the counselling and massage without essential oils. Both groups received counselling and and a massage by the therapist once a week and the mother every day for a period of 8 weeks.

The treatments were evaluated by daily day-time irritation scores and night time disturbance scores, determined by the mother before and during the treatment. General improvement scores were allocated two weeks after the treatment by the therapist, the general practitioner and the mother.

The results showed a significant improvement in the eczema in both of the groups of children following therapy, but there was no significant difference in improvement shown between the aromatherapy massage and massage only group.

The report therefore concluded that 'there is evidence that tactile contact between mother and child benefits the symptoms of atopic eczema but there is no proof that adding essential oils is more beneficial than massage alone'.

Further studies on the essential oil massage group showed a deterioration in the eczematous condition after two further 8 week periods of therapy, following a period of rest after the initial period of contact. This may have been due to a decline in the novelty of the treatment, or, possibly allergic contact dermatitis provoked by the essential oils themselves. The researchers conclude that prolonged studies with aromatherapy essential oils are needed as short-term beneficial results could be overturned by adverse effects after repeated usage.

Another point that this study highlights is that people who wish to use aromatherapy essential oils should consult a professionally trained aromatherapist rather than self-prescribe, as these oils can cause harm if used incorrectly.

Source:

Phytother Res 2000 Sep;14(6):452-456Evaluation of Aromatherapy to help treat childhood eczema
Anderson C, Lis-Balchin M, Kirk-Smith M

Edited from Internet Health Library (c)

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The Role of Ceramides in Eczema

Skin Lipids that Keep Skin Moisturized

Scientists are uncovering the important role that ceramides play in the barrier function of the skin.

The top layer of the skin is the epidermis, and the top layer of the epidermis is the stratum corneum (SC). Even though the SC is very thin -- 10-30 mm or one-tenth the thickness of a piece of paper -- it is the main barrier of the skin. It keeps chemicals that come in contact with the skin from absorbing into the body, and it keeps water inside the skin from leaching out.

Lipids in the Skin

The SC contains three types of lipids -- ceramides, cholesterol and free fatty acids. These lipids have different chemical compositions and different functions throughout the body. There are nine different types of ceramides in the SC, conveniently named ceramide 1 through ceramide 9, and they account for 40-50% of the lipids in this outermost layer.

Ceramides and Skin Disease

Scientists have learned that people who have eczema have significantly fewer ceramides in their SC. On the other hand, people with psoriasis (another itchy, flaky rash sometimes confused with eczema) have the same number of ceramides compared to people with normal skin. However, the psoriasis-sufferers have less ceramide 1, 3, 4, and a sub-set of 5 and 6; and more ceramide 2 and another sub-set of 5.

Replacing Ceramides Improves Eczema

Recent studies have shown that lipids can be replaced with topical preparations. Interestingly, all three lipids have to be replaced at a certain ratio to restore the barrier function of the skin. If the incorrect balance of lipids is applied, it actually takes longer for the skin to heal.

The healing effect of ceramides has been studied in eczema, but there are no studies yet for psoriasis.

Moisturizers with Ceramides - Not All the Same

There are several moisturizers that claim to have ceramides in their ingredients, but these are just regular moisturizers unless they can show:

• The moisturizer also contains cholesterol and free fatty acids
• The ratio of these three ingredients is correct
  

Sources:

Berardesca E, et al. "Evaluation of efficacy of a skin lipid mixture in patients with irritant contact dermatitis, allergic contact dermatitis or atopic dermatitis: a multicenter study." Contact Dermatitis. 5(2001):280-5.

Chamlin, Sarah, et al. "Ceramide-dominant barrier repair lipids alleviate childhood atopic dermatitis: Changes in barrier function provide a sensitive indicator of disease activity." Journal of the American Academy of Dermatology 47(2002): 198-208.

Choi, Myeong Jun, and Howard Maibach. "Role of Ceramides in Barrier Function of Healthy and Diseased Skin." American Journal of Clinical Dermatology 6(2005): 215-22.

Coderch L, et al. "Efficacy of stratum corneum lipid supplementation on human skin." Contact Dermatitis. 3(2002):139-46.

Kucharekova M, et al. "Effect of a lipid-rich emollient containing ceramide 3 in experimentally induced skin barrier dysfunction." Contact Dermatitis. 6(2002):331-8.

Reference: http://dermatology.about.com

©2007 About.com, Inc., a part of The New York Times Company. All rights reserved.

Probiotics for Eczema Treatment

About Probiotics

What are Probiotics?

Probiotics are live microbial organisms that are naturally present in the digestive tract and vagina. Probiotics are considered beneficial and are sometimes referred to as "friendly" bacteria.

Some of the ways they are thought to promote health include suppressing the growth of potentially harmful bacteria, improving immune function, enhancing the protective barrier of the digestive tract, and helping to produce vitamin K.

There are over 400 species of microorganisms in the human digestive tract, including Lactobacillus and Bifidobacterium.

A number of medical, diet, and lifestyle factors are believed to disturb the balance in the colon. This imbalance is called dysbiosis. Factors include:

• Inadequate dietary fiber
• Oral antibiotic therapy
• Infant formula feeding

Ingestion of environmental toxinsNo longer kept in check, less healthy bacteria and yeast may flourish, which is thought to increase the likelihood of conditions such as infectious diarrhea and vaginal yeast infections.

Sources of Probiotics

Probiotics can be found in capsule, liquid, powder, or tablet form. Acidophilus drinks can be found in health food stores and some grocery stores and Asian grocers.

Probiotics can also be found in cultured dairy products such as yogurt or kefir, however, the number of live organisms varies greatly from product to product due to differences in processing methods. Fermented foods such as sauerkraut also contain probiotics.

Once ingested, probiotics colonize the intestines and other parts of the body and can sustain themselves unless they are destroyed by antibiotics or other factors.

Although they are thought to be essential for health, because they can sustain themselves in the body under normal circumstances, there is no recommended daily intake of probiotics.

Prebiotics

"Prebiotics" are also thought to improve the balance of probiotics in the intestines.

They are non-digestible carbohydrates that stimulate the growth of beneficial bacteria in the intestines. Sources of prebiotics include fructo-oligosaccharides (FOS) and inulin, found in onions, asparagus, chicory, and banana. FOS is also available as a supplement and is sometimes combined with probiotic dietary supplements.

Why Do People Use Probiotics

• Diarrhea Due to Antibiotic Use
• Traveler's Diarrhea
• Side Effects of Radiation Therapy
• Irritable Bowel Syndrome
• Vaginal Yeast Infections
• Ulcerative Colitis
• Crohn's Disease
• Immune Support
• Lactose Intolerance
• Prevention of Colds
• Allergic Rhinitis / Hayfever
• Constipation
• Colon Cancer Prevention
• Pouchitis
• Small Intestine Bacterial Overgrowth
• Canker Sores

What is the Evidence for Probiotics

Diarrhea: A literature review found 185 studies published in what they deemed to be credible journals between 1980 and 2004. The most commonly studied condition was diarrhea (41 or 22% of the 185 studies).

Seven studies looked at probiotic use in adults, focusing on the strains Lactobacillus reuteri, Lactobacillus GG, L casei, L acidophilus, and S boulardi. Although they varied in dose and probiotic strain, in six of the studies, probiotics shortened the course of diarrhea or decreased its severity.

Many studies have looked at probiotic use in children. Once again, there is a wide range of doses and probiotic strains. The most commonly used strains were Lactobacillus acidophilus, L casei, L GG, and Bifidobacteria. In 20 of the studies published between 1980 and 2004, all of the studies found an improvement.

Seven out of 12 controlled trials reported a definite prevention of antibiotic-associated diarrhea. In addition, a meta-analysis looked at 9 randomized, double-blind, placebo controlled trials with a total of 1214 patients. Six of the nine trials showed a significant benefit of probiotics.

More evidence is needed on the effectiveness of probiotics in such conditions as lactose intolerance, constipation, heart disease risk factors, and Crohn's disease.

Safety Concerns of Probiotics
Side effects of probiotics may include mild, temporary digestive complaints, such as gas and bloating.

People who are immunosuppressed should seek medical advice before using probiotics. It is possible that the probiotic itself may cause a serious infection. One death was reportedly linked to probiotic use in a person taking immunosuppressant medication.

Potential Drug Interactions

Probiotics may interact with immunosuppresant medication (see above).

Probiotics are recommended by some health practioners during and/or after antibiotic use.

Research on Probiotics in the Management of Atopic Eczema

The Department of Paediatrics, University of Turku, Finland has commenced a research to explore the potential of probiotics to control allergic inflammation at an early age. The assesment was done in a reandomised double-blind placebo-controlled study.

A total of 27 infants, mean age 4.6 months, who manifested atopic eczema during exclusive breast-feeding and who have had no exposure to any infant or substitute formula were weaned to probiotic-supplemented, Bifidobacterium lactis Bb-12 or Lactobacillus strain GG (ATCC 53103), extensively hydrolysed whey formulas or to the same formula without probiotics.

The extent and severity of atopic eczema, the growth and nutrition of infants, and concentrations of circulating cytokines/chemokines and soluble cell surface adhesion molecules in serum and methyl-histamine and eosinophilic protein X in urine were determined.

RESULTS: The SCORAD score reflecting the extent and severity of atopic eczema was 16 (7-25) during breast-feeding, median (interquartile range).

After 2 months, a significant improvement in skin condition occurred in patients given probiotic-supplemented formulas, as compared to the unsupplemented group; chi(2) = 12.27, P = 0.002.

SCORAD decreased in the Bifidobacterium lactis Bb-12 group to 0 (0-3.8), and in the Lactobacillus GG group to 1 (0.1-8.7), vs unsupplemented 13.4 (4.5-18.2), median (interquartile range), in parallel with a reduction in the concentration of soluble CD4 in serum and eosinophilic protein X in urine.

CONCLUSION: The results provide the first clinical demonstration of specific probiotic strains modifying the changes related to allergic inflammation.

The data further indicate that probiotics may counteract inflammatory responses beyond the intestinal milieu. The combined effects of these probiotic strains will guide infants through the weaning period, when sensitization to newly encountered antigens is initiated.

The probiotics approach may thus offer a new direction in the search for future foods for allergy treatment and prevention strategies.

Other Researches on Probiotics Effects on Eczema

There’s a new study published in the the Journal of Allergy & Clinical Immunology, supporting previous findings that the consumption of pre-and probitics does prevent the onset of atopic dermatitis (also called neurodermatitis, atopic eczema) in children.

Apparently, supplementing a pregnant women’s — and later, their newborns’– diet with probiotics/prebiotics resulted in a reduction of eczema and atopic eczema cases.

Reference:

http://altmedicine.about.com/cs/herbsvitaminsad/a/Acidophilus.htm

http://www.ncbi.nlm.nih.gov/pubmed/11069570

http://www.eatingfabulous.com/probiotic-supplementation-may-prevent-eczema/

Edited and compiled by Eczema Club.

Eczema Treatment and Research Info

Eczema is a common inflammatory condition of the skin. Many skin diseases cause symptoms similar to those of eczema, so it is important to have the disease properly diagnosed before it is treated.

Checklist for Eczema

Rating	Nutritional Supplements	Herbs
	Borage oil Evening primrose oil Fish oil (EPA/DHA) Probiotics	Chamomile Witch hazel Zemaphyte® Chinese herbal formula
	Vitamin C	Calendula Chickweed Licorice Oak Oats Onion Red clover Sarsaparilla Shiunko (topical)
See also: Homeopathic Remedies for Eczema
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of eczema? Eczema is characterized by scaling, thickened patches of skin that can become red and fissured. It may also appear as tiny blisters (called vesicles) that rupture, weep, and crust over. The most troublesome and prevalent symptom of eczema is itching, which may be constant.

Conventional treatment options: White petrolatum, hydrogenated vegetable oil, or other emollients are often recommended to hydrate the excessively dry skin of eczema. The mainstay conventional treatment for eczema is topical corticosteroid cream or ointment (triamcinolone [e.g., Aristocort®, Triacet®, Kenalog®], mometasone [Elocon®], cortisone [e.g., Cortone®] and others). Avoidance of known allergens is also recommended.

Dietary changes that may be helpful: Eczema can be triggered by allergies.^{1 2} Most children with eczema have food allergies, according to data from double-blind research.³ A doctor should be consulted to determine whether allergies are a factor. Once the trigger for the allergy has been identified, avoidance of the allergen can lead to significant improvement.⁴ However, “classical” food allergens (e.g., cows’milk, egg, wheat, soy, and nuts) are often not the cause of eczema in adults.

A variety of substances have been shown, in a controlled trial, to trigger eczema reactions in susceptible individuals; avoidance of these substances has similarly been shown to improve the eczema. Triggers included food additives, histamine, salicylates, benzoates, and other compounds (such as aromatic compounds) found in fruits, vegetables, and spices. ⁵ These reactions do not represent true food allergies but are instead a type of food sensitivity reaction. The authors of this study did not identify which substances are the most common triggers.

It has been reported that when heavy coffee drinkers with eczema avoided coffee, eczema symptoms improved.⁶ In this study, the reaction was to coffee, not caffeine, indicating that some people with eczema may be allergic to coffee. People with eczema who are using a hypoallergenic diet to investigate food allergies should avoid coffee as part of this trial.

Nutritional supplements that may be helpful: Researchers have reported that people with eczema do not have the normal ability to process fatty acids, which can result in a deficiency of gamma-linolenic acid (GLA).⁷ GLA is found in evening primrose oil (EPO), borage oil, and black currant seed oil. Some,^{8 9 10} but not all,^{11 12 13 14} double-blind trials have shown that EPO is useful in the treatment of eczema.

An analysis of nine trials reported that the effects for reduced itching were most striking.¹⁵ Much of the research uses 12 pills per day; each pill contains 500 mg of EPO, of which 45 mg is GLA. Smaller amounts have been shown to lack efficacy.¹⁶

Supplementation with borage oil, another source of GLA, has led to reductions in skin inflammation, dryness, scaliness, and itch in eczema patients in some,¹⁷ but not all, preliminary¹⁸ or double-blind trials.¹⁹

Many years ago, use of large amounts of vegetable oil (containing precursors to GLA) was reported to help treat people with eczema,^{20 21} but these studies were not controlled and do not meet modern standards of research.

Ten grams of fish oil providing 1.8 grams of EPA (eicosapentaenoic acid) per day were given to a group of eczema sufferers in a double-blind trial. After 12 weeks, those using the fish oil experienced significant improvement.^{22 23} According to the researchers, fish oil may be effective because it reduces levels of leukotriene B4, a substance that has been linked to eczema.²⁴ The eczema-relieving effects of fish oil may require taking ten pills per day for at least 12 weeks. Smaller amounts of fish oil have been shown to lack efficacy.²⁵

One trial using vegetable oil as the placebo reported that fish oil was barely more effective than the placebo (30% vs. 24% improvement).²⁶ As vegetable oil had previously been reported to have potential therapeutic activity, the apparent negative outcome of this trial should not dissuade people with eczema from considering fish oil.

Although supplementation with 400 IU of vitamin E per day has been reported in anecdotal accounts to alleviate eczema,²⁷ research has not supported this effect.²⁸ Moreover, rare cases of topical vitamin E potentially causing eczema have appeared.²⁹ People with eczema should not expect vitamin E to be helpful with their condition.

A double-blind trial reported that use of a hypoallergenic infant formula plus probiotics (500 million organisms of Lactobacillus GG bacteria per gram of formula, taken for one month) initially led to improvement in eczema symptoms in infants with suspected allergy to cows’ milk.³⁰

However, by the end of two months, both the group receiving Lactobacillus GG and the placebo group had improved approximately the same amount. In the same report, a preliminary trial giving 20 billion Lactobacilli twice per day to breast-feeding mothers led to significant improvement of their allergic infants’ eczema after one month. Probiotics may reduce allergic reactions by improving digestion, by helping the intestinal tract control the absorption of food allergens, and/or by changing immune system responses.

In 1989, Medical World News reported that researchers from the University of Texas found that vitamin C, at 50–75 mg per 2.2 pounds of body weight, reduced symptoms of eczema in a double-blind trial.³¹ In theory, vitamin C might be beneficial in treating eczema by affecting the immune system, but further research has yet to investigate any role for this vitamin in people with eczema.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: The table below summarizes the three categories of herbs used for people with eczema: anti-inflammatories and herbs that affect the immune system (immunomodulators), astringents (herbs that bind fluids and exudates), and herbs that affect the liver (also called alteratives). Alterative herbs are poorly researched. Astringents are only helpful if applied topically when weeping eczema is present; they will not help people with dry eczema.

Mechanism of Action	Examples
Anti-inflammatory and/or immunomodulator	Allium cepa, Calendula, chamomile, chickweed, licorice, onion, Zemaphyte® Chinese herbal formula
Astringent (helps dry up weeping lesions)	Oak, witch hazel (also anti-inflammatory)
Alterative (liver-supportive)	Burdock, red clover, sarsaparilla, wild oats

Zemaphyte®, a traditional Chinese herbal preparation that includes licorice as well as nine other herbs, has been successful in treating childhood and adult eczema in double-blind trials.^{32 33 34} One or two packets of the combination is mixed in hot water and taken once per day. Because one study included the same amount of licorice in both the placebo and the active medicine, it is unlikely that licorice is the main active component of Zemaphyte®.³⁵

Several Chinese herbal creams for eczema have been found to be adulterated with steroids. The authors of one study found that 8 of 11 Chinese herbal creams purchased without prescription in England contained a powerful steroid drug used to treat inflammatory skin conditions.³⁶

A cream prepared with witch hazel and phosphatidylcholine has been reported to be as effective as 1% hydrocortisone in the topical management of eczema, according to one double-blind trial.³⁷

Topical applications of chamomile have been shown to be moderately effective in the treatment of eczema.^{38 39} One trial found it to be about 60% as effective as 0.25% hydrocortisone cream.⁴⁰

Onion injections into the skin and topical onion applications have been shown to inhibit skin inflammation in people with eczema, according to one double-blind trial.⁴¹ The quantity or form of onion that might be most effective is unknown.

A Japanese topical ointment called Shiunko has been reported to help improve symptoms of eczema, according to preliminary research.⁴² The ointment contains sesame oil and four herbs (Lithospermum radix, Angelica radix, Cera alba and Adeps suillus) and was applied twice daily along with petrolatum and 3.5% salt water for three weeks. Clinical improvement was seen in four of the seven people using Shiunko.

Topical preparations containing calendula, chickweed, or oak bark⁴³ have been used traditionally to treat people with eczema but none of these has been studied in scientific research focusing on people with eczema.

Burdock, red clover, sarsaparilla, and wild oats have been used historically to treat people with eczema, but without scientific investigation.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Numerous trials have reported that hypnosis improves eczema in children and adults.⁴⁴ A preliminary trial emphasizing relaxation, stress management, and direct suggestion in hypnosis showed reduced itching, scratching, and sleep disturbance, as well as reduced requirements for topical corticosteroids. All of the patients studied had been resistant to conventional treatment.⁴⁵

References:

1. Sampson HA, Scanlon SM. Natural history of food hypersensitivity in children with atopic dermatitis. J Pediatr 1989;115:23–7.
2. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity. J Pediatr 1988;113:447–51.
3. Niggemann B, Sielaff B, Beyer K, et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy 1999;29:91–6.
4. Atherton DJ. Diet and atopic eczema. Clin Allerg 1988;18:215–28 [review].
5. Worm M, Ehlers I, Sterry W, Zuberbier T. Clinical relevance of food additives in adult patients with atopic dermatitis. Clin Exp Allergy 2000;30:407–14.
6. Veien NK, Hattel T, Justesen O, et al. Dermatoses in coffee drinkers. Cutis 1987;40:421–2.
7. Manku MS, Horrobin DF, Morse NL, et al. Essential fatty acids in the plasma phospholipids of patients with atopic eczema. Br J Dermatol 1984;110:643–8.
8. Schalin-Karrila M, Mattila L, Jansen CT, et al. Evening primrose oil in the treatment of atopic eczema: effect on clinical status, plasma phospholipid fatty acids and circulating blood prostaglandins. Br J Dermatol 1987;117:11–9.
9. Lovell CR, Burton JL, Horrobin DF. Treatment of atopic eczema with evening primrose oil. Lancet 1981;I:278 [letter].
10. Wright S, Burton JL. Oral evening-primrose oil improves atopic eczema. Lancet 1982;ii:1120–2.
11. Skogh M. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1986;15:114–5.
12. Bamford JTM, Gibson RW, Renier CM. Atopic eczema unresponsive to evening primrose oil (linoleic and gamma-linolenic acids). J Am Acad Dermatol 1985;13:959–65.
13. Hederos CA, Berg A. Epogam evening primrose oil treatment in atopic dermatitis and asthma. Arch Dis Child 1996;75:494–7.
14. Whitaker DK, Cilliers J, de Beer C. Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results. Dermatology 1996;193:115–20.
15. Morse PF, Horrobin DF, Manku MS, et al. Meta-analysis of placebo-controlled studies of the efficacy of Epogam in the treatment of atopic eczema. Relationship between plasma essential fatty acid changes and clinical response. Br J Dermatol 1989;121:75–90.
16. Berth-Jones J, Graham-Brown RAC. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993;341:1557–60.
17. Landi G. Oral administration of borage oil in atopic dermatitis. J Appl Cosmetology 1993;11:115–20.
18. Borreck S, Hildebrandt A, Forster J. Borage seed oil and atopic dermatitis. Klinische Pediatrie 1997;203:100–4.
19. Henz BM, Jablonska S, van de Kerkhof PC, et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatol 1999;140:685–8.
20. Cornbleet T. Use of maize oil (unsaturated fatty acids) in the treatment of eczema. Arch Dermatol Syph 1935;31:224–34.
21. Hansen AE, Knott EM, Wiese HF, et al. Eczema and essential fatty acids. Am J Dis Child 1947;73:1–18.
22. Bjørneboe A, Søyland E, Bjørneboe GE, et al. Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis. Br J Dermatol 1987;117:463–9.
23. Bjørnboe A, Søyland E, Bjørnboe GE, et al. Effect of n-3 fatty acid supplement to patients with atopic dermatitis. J Intern Med Suppl 1989;225:233–6.
24. Søyland E, Rajka G, Bjørneboe A, et al. The effect of eicosapentaenoic acid in the treatment of atopic dermatitis. A clinical Study. Acta Derm Venereol (Stockh) 1989;144(Suppl):139.
25. Berth-Jones J, Graham-Brown RAC. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis. Lancet 1993;341:1557–60.
26. Søyland E, Funk J, Rajka G, et al. Dietary supplementation with very long-chain n-3 fatty acids in patients with atopic dermatitis. A double-blind multicentre study. Br J Dermatol 1994;130:757–64.
27. Olsen PE, Torp EC, Mahon RT, et al. Oral vitamin E for refractory hand dermatitis. Lancet 1994;343:672–3 [letter].
28. Fairris GM, Perkins PJ, Lloyd B, et al. The effect on atopic dermatitis of supplementation with selenium and vitamin E. Acta Derm Vernereol 1989;69:359–62.
29. Manzano D, Aguirre A, Gardeazabal J, et al. Allergic contact dermatitis from tocopheryl acetate (vitamin E) and retinol palmitate (vitamin A) in a moisturizing cream. Contact Dermatitis 1994;31:324.
30. Majamaa H, Isolauri E. Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 1997;99:179–85.
31. Anonymous. Severe atopic dermatitis responds to ascorbic acid. Med World News 1989;April 24:41.
32. Sheehan MP, Atherton DJ. One-year follow up of children treated with Chinese medical herbs for atopic eczema. Br J Dermatol 1994;130:488–93.
33. Sheehan MP, Rustin MH, Atherton DJ, et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992;340:13–7.
34. Sheehan M, Stevens H, Ostlere L, et al. Follow-up of adult patients with atopic eczema treated with Chinese herbal therapy for 1 year. Clin Exp Dermatol 1995;20:136–40.
35. Sheehan MP, Atherton DJ. A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema. Br J Dermatol 1992;126:179–84.
36. Keane FM, Munn SE, du Vivier AWP, et al. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999;318:563–4.
37. Laux P, Oschmann R. Witch hazel –Hamamelis virgincia L. Zeitschrift Phytother 1993;14:155–66.
38. Nissen HP, Blitz H, Kreyel HW. Prolifometrie, eine methode zur beurteilung der therapeutischen wirsamkeit kon Kamillosan®-Salbe. Z Hautkr 1988;63:184–90.
39. Aergeerts P, Albring M, Klaschka F, et al. Vergleichende prüfung von Kamillosan®-creme gegenüber seroidalen (0.25% hydrocortison, 0.75% flucotinbutylester) and nichseroidaseln (5% bufexamac) externa in der erhaltungsterpaie von ekzemerkrankungen. Z Hautkr 1985;60:270–7.
40. Albring M, Albrecht H, Alcorn G, Lüker PW. The measuring of the antiinflammatory effect of a compound on the skin of volunteers. Meth Find Exp Clin Pharmacol 1983;5:75–7.
41. Dorsch W, Ring J. Suppression of immediate and late anti-IgE-induced skin reactions by topically applied alcohol/onion extract. Allergy 1984;39:43–9.
42. Higaki S, Kitagawa T, Morohashi M, Yamagishi T. Efficacy of Shiunko for the treatment of atopic dermatitis. J Int Med Res 1999;27:143–7.
43. Weiss RF. Herbal Medicine. Gothenberg, Sweden: Ab Arcanum and Beaconsfield: Beaconsfield Publishers Ltd, 1988, 328–9.
44. Shenefelt PD. Hypnosis in dermatology. Arch Dermatol 2000;136:393–9.
45. Stewart AC, Thomas SE. Hypnotherapy as a treatment for atopic dermatitis in adults and children. Br J Dermatol 1995;132:778–83.

Article source: http://vitaminlore.com

Blood Chemicals Link to Eczema

Scientists have identified two blood chemicals linked to itchy eczema, offering new treatment possibilities. The Chinese University of Hong Kong devised an "itchometer" that was worn by 24 children and monitored how much they scratched while they slept.

Researchers found that as scratching increased, so did levels of two specific blood chemicals, reported the British Journal of Dermatology.

A British expert said the finding could point to the skin problem's root cause.

Wrist movement

One in 10 babies are affected by the dry, scaly, skin rashes of eczema, and the condition can persist into adulthood.

Sufferers can be treated with steroid creams, but the mechanisms behind the "eczema itch" are complex and poorly understood.

The latest research adds to evidence that two specific chemicals found in the blood - "brain-derived neurotrophic factor" (BDNF) and "substance P" - are somehow connected to itchy sensations.

The scientists recruited 24 children, with an average age of 11, to wear a wrist monitor which recorded wrist movement during the night.

The assumption was that this could record when the child scratched in their sleep - a reliable indicator of the level of itchiness.

Blood tests from the children showed that as night-time scratching increased, so did the levels of the two chemicals in the bloodstream.

Kam-lun Ellis Hon, one of the researchers, said: "As far as we are aware, this is the first report to demonstrate that BDNF and substance P are significantly linked to disease activity, quality of life, as well as the levels of scratching as recorded by the wrist monitor."

Dr Colin Holden, the President of the British Association of Dermatologists, welcomed the report.

He said: "For most eczema sufferers, itching is the worst symptom of the disease. It is known to keep children awake at night, which in turn affects parents and can put pressure on the whole family, and even affect children's performance at school.

"It is by discovering the mechanisms behind the disease and its symptoms that we can develop new therapies that specifically target the root cause of the problem."

Reference: http://www.talkeczema.com

Climate Changes Affect Atopic Eczema

Background
Atopic eczema, to quote the authors of this study, "is a chronic inflammatory skin disease characterized by itching, lesions and lichenification," especially at "the flexure sites of the major joints of the upper and lower extremities." The pain and itching associated with the disease, as they describe it, "may cause depressive symptoms, social isolation and reduced self-perception," negatively influencing the quality of life in both children and their caretakers. They further report that epidemiological studies suggest climate influences the disease's prevalence, noting that "atopic eczema has been reported worldwide to be positively associated with latitude and negatively with temperature (Weiland et al., 2004)."

What was done
Thirty children, 4 to 13 years of age with severe atopic eczema, were transported from their homes in Norway to the Canary Islands, where they stayed for a period of four weeks before returning, while 26 similarly-infected children of the same age group stayed at home in Norway the entire time.

All were evaluated for various disease characteristics (1) at the start of the study, (2) at the conclusion of the group-of-30's four-week period of stay in the Canary Islands, and (3) three months after the 30 children left the islands to return home to Norway. The specific disease parameters employed in the evaluation were the Scoring of Atopic Dermatitis, the Children's Dermatology Life Quality Index, skin colonization by Staphylococcus aureus, and pharmacological skin treatment.

What was learned
Noting that temperatures during the children's stay in the Canary Islands were much higher than they were back in Norway, Byremo et al. report that their time in the warmer climate significantly reduced the severity of atopic eczema, and that the youths improved in (1) severity of eczema, (2) quality of life, and (3) bacterial skin culture, which was reflected in (4) a reduction in the use of topical steroids, antihistamines and topical antibiotics. These positive changes were observed at the conclusion of the 4-week stay in the Canary Islands, as well as back home in Norway three months later. In fact, the researchers state that the four weeks spent in the Canary Islands "led to a lasting improvement for the children," while "the control group did not show similar improvement."

What it means
Although greater exposure to sunlight and the effect of regularly bathing in seawater, such as the children did at the Canary Islands, likely played positive roles in reducing the severity of their atopic eczema, the results of this study once again proved harmonious with the worldwide negative correlation that prevails between eczema and temperature, suggesting that global warming may well prove beneficial to people unfortunate enough to suffer from it.

Reference: Byremo, G., Rod, G. and Carlsen, K.H. 2006. Effect of climatic change in children with atopic eczema. Allergy 61: 1403-1410.

Major gene discovered that causes dry skin and leads to eczema and asthma

Experts, led by the University of Dundee, have discovered the gene which causes genetic skin conditions affecting millions of people.

Experts on genetic skin disorders at the University of Dundee, with collaborators in Dublin, Glasgow, Seattle and Copenhagen, have discovered the gene that causes dry, scaly skin and predisposes individuals to atopic dermatitis (eczema). Some of these individuals also develop a form of asthma that occurs in association with eczema. This work has been published in two consecutive papers in the March and April editions of the top genetics journal, Nature Genetics.

Margaret Cox, Chief Executive of the National Eczema Society, said: “To discover that eczema patients don’t have the gene which should protect the skin by keeping water in and keeping foreign organisms out is a real step forward. Above all, it answers the age-old question asked by most eczema sufferers, “why?”.

“Understanding the genetic basis of skin diseases such as eczema means that in the future, healthcare professionals will be armed with more and better information and we can tackle the cause rather than simply treat the symptoms of a previously ‘incurable’ skin condition.”

Margaret added: “A development of this calibre will bring considerable hope and optimism for eczema patients throughout the world..”

Currently, only symptomatic treatment of ichthyosis vulgaris and eczema is possible, using emollients and ointments to try to prevent the skin drying out or anti-inflammatory drugs to treat the inflamed skin in eczema. Now that the underlying gene defect behind this disorder is known, it will be possible to design new more effective therapies to tackle the root cause of the problem, rather than treating the symptoms. The Dundee group is already working on developing methods to treat and even prevent these diseases.

The gene in question produces a protein called filaggrin which is normally found in large quantities in the outermost layers of the skin. This protein is essential for skin barrier function, helping to form a protective layer at the surface of the skin that keeps water in and keeps foreign organisms out.

Reduction or complete absence of this important protein leads to impaired formation of the skin barrier. As a result, the skin dries out too easily and in addition, the outer layers of the skin are poorly formed and constantly flake off. As well as keeping water in, the skin barrier normally keeps foreign substances out of the skin. In people with filaggrin mutations, foreign substances can easily enter the skin and be seen by the immune system. This explains the development of inflamed skin (eczema). In some people, priming of the immune system through the "leaky" skin appears to lead to asthma when foreign substances later enter the lungs.

The first study, led by geneticists Professor Irwin McLean and Dr Frances Smith in Dundee and their dermatology colleague, Dr Alan Irvine, Our Lady's Hospital for Sick Children, Dublin, discovered that about 10% of European people carry a type of genetic mutation that switches off the filaggrin gene and this causes a very common dry, scaly skin condition, known as ichthyosis vulgaris. About 5 million people in the UK alone make only 50% of the normal amount of filaggrin protein and have a milder form of the disorder where the skin is dry and flaky. About 1 in 500 people, or 120,000 people in the UK, have both copies of the gene knocked out by genetic mutations and have no filaggrin protein whatsoever in the skin. These individuals have a severe and persistent form of the disease, often requiring specialist treatment.

A second study showed that many people with ichthyosis vulgaris also have eczema. Further research then showed a link between ichthyosis vulgaris, eczema and asthma. McLean, Smith and Irvine, in collaboration with Drs Colin Palmer and Somnath Mukhopadhyay of the Dundee BREATHE study, and Professor Hans Bisgaard in Copenhagen, showed in four independent experiments that these common mutations in the filaggrin gene are a major predisposing factor in the development of eczema and the form of asthma associated with eczema.

* A significant association between filaggrin mutations and eczema was shown in families affected by ichthyosis vulgaris.
* About two-thirds of Irish children with eczema examined were found to carry one or more filaggrin mutations.
* In a study of Scottish children with asthma, there was a very strong association between filaggrin mutations in those children who had both eczema and asthma.
* In a study of Danish babies whose medical history was followed for the first years of life, there was again a strong association between filaggrin mutations and eczema.
* The Danish study also showed that more than 60% of the children carrying filaggrin mutations get eczema within the first couple of years of life.

About 5 million people in the UK carry one of the filaggrin mutations and consequently, have dry skin and are predisposed to eczema and to a lesser extent, asthma.

Worldwide, about 60 million people are estimated to carry these particular gene defects and more than 1 million are predicted to have the severe form of the disease as a consequence of these mutations alone.

The Dundee group already have evidence for the presence of different filaggrin mutations in other ethnic populations and it seems that reduction or absence of filaggrin in the skin is likely to be a major cause of dry skin and eczema worldwide.

This work was funded by The Wellcome Trust and the skin disease charities DEBRA, PC Project, British Skin Foundation and National Eczema Society. Biotechnology and Biological Sciences Research Council (award D13460; C.N.A.P.), Scottish Enterprise Tayside and the Gannochy Trust (C.N.A.P. and S.M.). C.N.A.P. is also supported by the Scottish Executive Genetic Health Initiative.

Article source: University of Dundee's Website.

This project is being supported in part by the by a shared research award from the National Eczema Society and the British Skin Foundation. To help support our research programme please donate here.

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