The No Cause, No Cure Paradigm for Eczema is Wrong
I’ve always been a questioner. This is why I believe eczema can be healed and reversed (and new science backs this). When I was a little kid, I asked lots of questions because I wanted to know how and why things worked. Conversations I?d frequently have with my parents would go something like this:
Me: ?Why does my tummy hurt???
Parent: ?Probably because you just swallowed your gum.?
Me: ?Why would gum make my tummy hurt??
Parent: ?When you swallow your gum it can stick to your insides.?
Me: ?Why would it stick to my insides??
Parent (frustrated): ?Oh, I don?t know, it just does!?
At this point I usually stopped the dialogue because I was clearly annoying my parents and I was frustrated that I didn?t get the answers I desired. Even as little kid I couldn?t understand why gum wouldn?t be digested like the rest of my food?? It also didn?t make sense to me that it would stick to my insides. There is always a reason why (even if not everyone know the answer).
Those same feelings of frustration and disbelief came to the surface for me when I was told I had Eczema. I was instantly transported back to my childhood when I heard the words ?there is no known cause or cure.? It was so infuriating and disheartening.
No cause. No cure. Yet, you?re still miserable, with a very real rash that makes you crazy because you want to keep scratching it incessantly and your doctor hasn?t provided you with any help at all. This is exactly how I felt.
The majority of conventional medicine still clings to the old idea that eczema, also known as atopic dermatitis, is purely a topical rash that makes your skin red and itchy, causes lesions, and is related to allergies.
And if you?ve ever had an eczema breakout you know that this isn?t just something to brush off, or something you should have to live with- ?it?s a problem that affects the way you look and feel too.
I?ve never accepted the no cause, no cure paradigm- there?s always a reason why something is happening. Your body just doesn?t start to malfunction- it?s way too smart for that. There are complex physiological processes that occur over time that culminate in conditions like eczema. We?ll get into the details of that later.
Those of us in the functional medicine community, as well as many researchers, are redefining what eczema actually is. In December 2014, this groundbreaking study published in The Journal of Allergy and Clinical Immunology confirmed what many of us suspected all along- that eczema is indeed an autoimmune condition. The study showed that by blocking 2 key proteins involved in the body?s ability to fight off bacteria and viruses, the eczema was reversed. In the process of eczema, these proteins mistakenly target the body?s own tissues, causing an autoimmune reaction which can result in the body attacking the skin. That sounds like a cause to me!
But before we get into the details of how eczema develops as as autoimmune (AI) condition, let?s review what eczema is and briefly discuss the types.
What is Eczema?
As an inquisitive and frustrated kid, I?d reach for the encyclopedia when I got one of those ?it just is? answers from an adult. Encyclopedias helped, but were still limited in information on many topics.
Now we have an overabundance of information coming at us 24/7 thanks to the internet, but it?s hard to digest and make sense of it all. So, let?s break eczema down.
Eczema is more commonly referred to as Atopic Dermatitis (AD) clinically. That term is very telling since atopy or atopic is Greek for ?being out of place? and dermatitis is ?inflammation of the skin?. What?s interesting is that in my graduate training (which was conventional medical clinical pathology) we learned that atopy refers to an allergic reaction or hypersensitivity occurring in a part of the body NOT in contact with the allergen. Based on this definition you?d think that conventional medicine would?ve realized the cause of eczema isn?t occurring on the skin level, but that hasn?t been the case.
Eczema or Atopic Dermatitis (AD) is defined by the Mayo Clinic as ?a condition that makes your skin red and itchy. AD is long lasting (chronic) and tends to flare periodically and then subside.? It?s the most common type of eczema and research suggests that a family history of atopic conditions such as eczema, allergies, asthma, and hay fever is a predisposing factor in developing it. The data compiled from my research analyzing over 7,000 patients shows that 1 in 5 people with a family history of eczema have eczema. 20% is significant.
Typical symptoms include:
- Itching, which may be mild to severe, especially at night
- Raw, sensitive, swollen skin from scratching
- Small, raised bumps, which may leak fluid and crust over when scratched
- Weeping wounds
- Thickened, cracked, dry, scaly skin
- Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees
Eczema symptoms and appearance differs from person to person. A mild form might look like red, irritated, and slightly speckled skin, to more severe forms where the skin is significantly inflamed, with lesions that are bloody and weeping. Discolorations often occur during the outbreaks and as the skin heals.
7 Types of Eczema (Yes, …there?s actually more than one)
There are many different types of eczema according to various sources. You could go a little crazy researching them all on Dr. Google, so we?ll cover the most common ones here.
Most varieties of eczema are named for where they occur or because they look slightly different than your typical atopic dermatitis. Regardless of where it located or how it looks, it?s still eczema.
- Contact Dermatitis occurs when an irritant or allergen contacts the skin causing redness, burning, swelling and sometimes blisters. It can be caused by things such as frequent hand washing, solvents, chemicals, foods, metals, animals, pollen, and plants like poison ivy. For the record,?I don?t believe contact dermatitis should be classified with these other forms of eczema as the cause is external contact and can happen to anyone regardless of health conditions and family history. It doesn?t appear to be AI in nature.
- Dishydrotic Eczema occurs on the palm side of fingers, palms of hands, bottom of toes, and soles of feet. It presents as red spots, bumps, or blisters. Scaly patches, flaking, and deep cracks can form from damage to the skin. This type is 2 times more common in women. I can vouch for that since this one type that I had in a very classic presentation which makes it easier to distinguish from some of the other types.
- Hand Eczema is different from dishydrotic in that it occurs on the back of your hand and fingers, as well as the webbing between fingers. It visually looks more like typical atopic dermatitis.
- Neurodermatitis, also called Lichen Simplex Chronicus, which is similar to AD in that there?s significant itching but differs in that the surrounding skin is healthy. It occurs in isolated patches that look thick, discolored, dry, scaly or flaky and can be mistaken for psoriasis. There can be underlying dysfunction of the nerves in this area.
- Nummular Eczema, also known as Discoid Eczema is characterized by coin or circular shaped lesions that can be raised. Inflammatory reactions occurring in the body and dry skin are thought to play roles in developing this type of eczema. It can look like ringworm which is a fungal infection so it?s worth ruling that out. ??
- Seborrheic Dermatitis, Scalp Eczema, or Cradle Cap typically occurs in areas where there are high concentrations of oil producing sweat glands including the scalp, face, neck, upper back, shoulders, and chest. Individuals with immune system dysfunction are at increased risk for seborrheic dermatitis. It can have an oily or greasy appearance, unlike the other types of eczema, with white to yellow flakes.
- Stasis Eczema/Dermatitis, also called venous stasis dermatitis, is a special type of eczema that occurs in areas where there?s decreased venous blood flow resulting in pressure build up causing fluid leakage from veins. Red, swollen, flaky, itchy skin occurs initially and if not taken care of can progress to ulceration, infection, and/or permanent thickening or scarring of the skin.
What Causes Eczema
If you type in ?causes of eczema? in Google, you?ll get a variety of answers like:
- No true known cause
- Dry or irritable skin
- Genetic variant that affects the skin’s barrier function
- Immune system dysfunction
- Hormone Fluctuations
- Bacterial or viral infections or imbalances
- Environmental conditions such as cold, dry weather or humid, hot weather
Unfortunately, while many of the above are absolutely true, most conventional doctors still treat it like it?s a condition that only occurs on the surface and don?t address most of that list. They?re likely to suggest topical treatments and possibly tell you to avoid a couple of foods, allergens, and hot or cold weather. They neglect the impact of the true root causes beneath the surface.
The worst fact of all is that some doctors are still of the old school thinking that there is no cause or cure for eczema.
Thankfully, research is evolving and know we know otherwise.
Given that eczema is now considered an autoimmune condition, we know the conditions need to be ?just right? for one to manifest.
These are the 3 key factors that come together to initiate autoimmunity:
- A genetic predisposition/family history
- Intestinal permeability (leaky gut)
- Environmental triggers such as stress, infection, gut or skin dysbiosis (imbalance between the good and bad bugs), food sensitivities or allergies, trauma, hormone imbalances, toxins, and nutrient imbalances.
With autoimmunity, the immune system mistakenly targets a body tissue and tries to attack it like it?s a foreign invader. If you have eczema, this means that the autoimmune process is attacking your skin. And to get rid of eczema, you need to address each of your root causes, which are covered in numbers 2 and 3 above.
For me, the perfect storm for eczema flares was high stress levels, hormone imbalances, GI infections and dysbiosis, leaky gut, and food sensitivities. Histamine containing foods, exercise, and hot showers made it even worse. This scenario is very similar for most of my clients as well.
A New Paradigm for Eczema
Just like when I was a kid, I wasn?t satisfied with the explanation of what causes eczema, so I developed my own process to explain the cycle of how it occurs.
Stage 1: Flare Up
You know when a flare up is coming because your body send you little signals in the form of tingle, slight itchiness or a burning sensation. On the inside the panic begins to set in and you?re thinking, ?Oh no, not again!? These are the subtle hints that you?re body is unhappy and it?s trying to tell you. The flames have been stoked and a fire is beginning to burn inside.
From a physiological standpoint, your immune system is activated from one or more triggers like foods, chemicals, toxins, or microorganisms (bacteria, fungi, parasites, viruses) and has begun attacking your body tissues. Having a genetic predisposition toward eczema or autoimmunity, and a leaky gut make this the perfect storm.
At this point, trying to stop or slow the flare is a good idea as it will help begin to reverse the inflammatory process. Start with your diet as many significant triggers for eczema are food related. At a minimum go gluten and dairy free, but likely you?ll find other foods that need to be avoided while you heal.
Getting stress under control right now is key as it?s often what pushes you over the edge into a flare. It?s hard to eliminate it, but try to manage stressors by maintaining boundaries, saying no, or asking for help. If you can completely eliminate a stressor (like avoiding a toxic person or situation) even better! Also, finding an outlet like journaling, deep breathing, meditation, or walks in nature can profoundly reduce the stress response.
Stage 2: Outbreak
Your flare up transitions to a full blown outbreak when the tingle, burn or minor itch escalates to constant itching causing red, inflamed skin with welts, wounds, and/or blisters. At this point it can appear to be treatment resistant since all of the root causes likely haven?t been addressed.
The outbreak occurs when the inflammatory process mediated by the immune system goes unchecked. The inflammatory chemicals have kicked up and are peaking resulting in your extreme discomfort and many symptoms. During this phase eczema can interfere with life, making social gatherings, work, sleep, and sanity difficult due to the incessant itching. There?s a full blown inflammatory fire raging inside.
Getting to the bottom of all of your triggers and root causes is essential now so you can heal. ?Addressing diet and stress may do the trick for some, but others may require deeper digging or testing which is easiest with assistance of a trained professional. Even though I do this for a living, I call upon my friends and colleagues to make sure I?m not missing anything. We can all use some help now and then!
If you haven?t begun dialing in your diet- there isn?t a better time. You need to focus on taming the fire burning within. Anti-inflammatory supplements and foods are super important now. This blog article I wrote provides a recipe, as well as 6 healing foods and supplements to help put out the flames.
Topically, some people may benefit simply from coconut oil, but I personally didn?t and many of my patients echo that sentiment. The same can be said of shea butter. However, by combining these an easy and wonderful healing salve can be made.
Eczema Healing Salve Recipe
- ? cup unrefined, organic coconut oil
- ? cup unrefined, organic shea butter
- 10 drops calendula essential oil
- 10 drops yarrow essential oil
- 10 drops rosemary essential oil
- 5-10 drops frankincense essential oil
Mix these together in a bowl by hand or with a mixer. It will be hard and clumpy at first, but eventually will soften and everything will come together. Note: you can play with the essential oils as some people respond better to certain ones than others. If you can?t some of these, that?s fine too. These all have healing, calming or anti-inflammatory properties.
The most important thing to remember in the outbreak phase is the root causes. If you don?t identify and address them all, your eczema is likely to return at some point.
Stage 3: Healing
Relief is in sight! ?This is when you start to feel better and symptoms are less severe, but still present. You may or may not be itchy. Your skin still shows signs of irritation, but no open wounds and blisters. It may also appear thick, leathery, scaly, dark, or ashy now. The fire within is now just smoldering embers.
Your immune system is now ramping down and under control, but in physiological time things go slow which is why there are still visible signs (think of how long it takes to completely heal a cut or broken bone).
Steering clear of dietary triggers or any other triggers you?ve identified through self investigation or testing is still a must to maintain healing. Continue use of natural topicals to protect the skin and help rebuild integrity. Nutrients like vitamins A,C, D, and E, biotin, zinc, selenium, and collagen support healing and skin structure.
Stage 4: Clear Skin
Hooray!! When you?re suffering through an eczema flare you often don?t think this day will come, but it is possible to completely reverse eczema and have clear skin again. You?re skin is fully healed and looks great again. No more hiding in long sleeves or gloves!
Think of this stage as maintenance or dormancy. You immune system is finally calmed down and balanced so the attack on skin is over. The fire is out completely!
Maintaining a healthy diet, stress levels, and getting adequate sleep will help keep you here in your happy place.
Common Treatments for Eczema
Again, if you look eczema treatments up in Google, you?ll get a list that looks like this:
- Over-the-counter medications such cortisone cream, Benadryl cream, or antihistamines (Benadryl, Claritin, and Allegra)
- Prescription medications topical corticosteroids, oral steroids, and oral antihistamines. ?
- Moisturizers that contain petroleum jelly, mineral oil, or synthetic emollients like lanolin or glycerin
- Special baths with bleach, salt (sea salt or table salt), baking soda, epsoms salts, oatmeal, or apple cider vinegar. ?
- UV Light/Phototherapy
- Wet Dressings
- Stress Reduction
While the medications may be helpful at first for managing symptoms, they don?t address the root causes and the eczema returns. Long term, the topical creams can damage the integrity of the skin and the topical steroids and oral medications shut off the body?s natural inflammatory response which is counterproductive to healing the body.
The moisturizers typically suggested sometimes work and other times cause more irritation due to the ingredients. Unfortunately, if they do work it?s only addressing issues at the skin level and not what?s beneath the surface.
Special baths can definitely be helpful in managing symptoms, but some need to be use with caution. I am personally not a fan of the bleach baths, ever. Sea salt, table salt and apple cider vinegar can be great, however should be tested first since they could irritate open wounds. Oatmeal baths are also very soothing as long as you know you don?t have Celiac or it?s skin variant called Dermatitis Herpetiformis. If you do, you should probably avoid oatmeal completely as it?s often contaminated with gluten.
Phototherapy from the sun is my preferred use. While using phototherapy lamps that emit UV light definitely have benefit, there are a few more risks associated with them due to broader spectrum of the light rays, such a burning, blistering, accelerated aging/breakdown of the skin, and skin cancer. More recently narrow band UVB therapy, which uses a smaller spectrum and thus less radiation, is a better option for artificial light therapy.
Wet dressings can be very helpful in healing eczema when used with natural moisturizers. However, topical corticosteroids are often used and I believe they?re a bad long term strategy for the reasons given above.
My Methodology for Healing Eczema
While some of the commonly used treatments listed above can be helpful at soothing?or even resolving some symptoms, they?re all missing the most important factor: addressing the ROOT CAUSES.
Even if you?re in remission and asymptomatic, you?re still at risk for a flare up because you haven?t addressed the important factors lingering beneath the surface. You?re trigger might be work, family, or financial stress, a stomach virus or infection, passing of a loved one or pet, a divorce or separation, moving to a new town or job, or even injuring yourself exercising.
My major trigger was always work related stress (or not addressing it) as it is for so many that suffer from eczema.
The good news is that I healed my eczema and we, together, can heal yours too.
My process starts with a detailed history, from birth until now, that identifies all of the contributing factors to your eczema and what potential root causes need to be investigated.
Next we order the appropriate tests to identify your specific and individual underlying causes.
From there, I design a comprehensive program based on your results and history that addresses all of your root causes in a systematic way. We don?t throw the kitchen sink at you all at once and hope it works. Instead, the plan is outlined in a step-by-step manner that makes it easy for you to follow and allows your body to heal.
If you?re tired of living in the eczema cycle of remissions and flare ups, or have an active, raging outbreak that itches so bad and looks so horrible it?s affecting every aspect of your life and you don?t think it will ever end, I invite you to work with me and my team to heal your eczema for good.
We?ll work together to put the pieces of your health puzzle in place. We?ll guide you at every step with a plan of action to get your body healing and skin happy again.
If you?d like 1-on-1 support troubleshooting which root causes are contributing to your Eczema, and get a specific plan to reverse it, the first step is to book a 1-hour ?Eczema Root Cause Troubleshooting Session?.